Post Operative Instructions for Ablation, D&C

You have just had a procedure called a Hysteroscopy, D&C, or Endometrial Ablation with or without biopsy or removal of tissue from the uterus. Now that your procedure is over, you may eat or drink anything you like. Take it easy for the next 48 hours. Most women find it best to avoid strenuous activities; be guided by how you feel. It is important that you read over these instructions and follow them to the letter. Do not hesitate to call us if you are having a problem.

PRECAUTIONS AND WHAT TO EXPECT

1. Use sanitary pads only — NO TAMPONS– for one week.
2. Do not have intercourse or douche for one week.
3. Take showers only. No tub baths for one week.
4. You will likely experience cramps for which you can take Advil, 2 pills every 4 hours as needed or a pain prescription that was given to you.
5. Bleeding is unpredictable after these procedures. Small clots and bits of tissue are normal. Brown discharge is normal as is bleeding off and on for several days or even weeks. Some women will not bleed at all which is normal.
6. After an ablation, you may expect discharge for 3-4 weeks.
7. It is important that a follow up visit be scheduled for 2 weeks after your procedure. Please call our office as soon possible to schedule this appointment. Any tissue removed during your surgical procedure will be sent to pathology for analysis. These results will be discussed with you at your 2 week post operative appointment.

BE SURE TO REPORT THE FOLLOWING

1. Your bleeding is very heavy, i.e. heavier than the heaviest day of your menses.

2. Your temperature is 100 degrees for two days in a row or greater than 100.4 at any time.

3. You have a foul smelling discharge.

4. You have severe pain, unlike menstrual cramps.

Post Operative Instructions for Laparoscopy

You have just had a procedure called laparoscopy. This is usually performed for sterilization, diagnostic purposes, treatment of endometriosis, treatment of adhesions, treatment of ectopic pregnancy, treatment of ovarian cysts, and many other conditions as well. What was done to you, how many incisions you have and how fast you will recover, depends on what exactly was done inside your body. Sterilization procedures usually will heal quite a bit faster than other procedures. You should limit your activities for the next 48 hours. Do no strenuous activities for the next 10 days.

PRECAUTIONS AND WHAT TO EXPECT

1. You will have one or more incisions. Keep the dressings clean and dry. You may change them as often as you like. You may keep your incisions uncovered after 24 hours.

2. SHOWERS ONLY. No baths or soaking the incision for the next 2 weeks. If your incision gets wet in the shower, pat them dry when you get out.

3. You may have vaginal bleeding. This is normal.

4. You will likely have some abdominal pain for which a pain prescription has been given to you.

5. Neck and shoulder pain is common after laparoscopy. In some patients, this is worse than their abdominal pain. This is normal and is best treated with Advil, 3 pills every 6 hours. If you are unable to take Advil medications, take your pain pills. This will usually go away in 24 hours or so, with or without treatment.

6. You may eat and drink as you please.

7. Take your usual medications that have been prescribed (such as blood pressure pills, etc).

8. No intercourse for one week.

9. Sanitary pads only, no tampons for one week.

10. Do not drive for at least 24 hours. You should not drive until you are off narcotic pain medications and you feel well enough to safely operate your vehicle.

11. IT IS IMPORTANT THAT A TWO WEEK FOLLOW UP APPOINTMENT IS MADE AND KEPT. Please call our office to schedule this appointment as soon as possible.

BE SURE TO REPORT IF:

1. Your temperature is greater than 100.4 degrees.

2. Your pain is severe and not controlled with pain pills.

3. Your incisions are bleeding excessively. Note that bruising and light drainage is normal.

Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to fracture. Usually the bone loses density, which measures the amount of calcium and minerals in the bone. Causes, incidence, and risk factors Osteoporosis is the most common type of bone disease. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bone of the spine) during their lifetime. Bone is living tissue. Existing bone is constantly being replaced by new bone. Osteoporosis occurs when the body fails to form enough new bone, when too much existing bone is reabsorbed by the body, or both. Calcium is one of the important minerals needed for bones to form. If you do not get enough calcium and vitamin D, or your body does not absorb enough calcium from your diet, your bones may become brittle and more likely to fracture. Sometimes bone loss occurs without any cause. White women are more likely to have bone loss. Sometimes the tendency to have bone loss and thin bones is passed down through families. A drop in estrogen in women at the time of menopause and a drop in testosterone in men is a leading cause of bone loss. Other causes of bone loss include:

Being confined to a bed

Certain medical conditions

Taking certain medications

Other risk factors include:

Absence of menstrual periods (amenorrhea) for long periods of time •A family history of osteoporosis

Drinking a large amount of alcohol

Low body weight

Smoking Symptoms

There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning that they have the disease. Pain almost anywhere in the spine can be caused by fractures of the bones of the spine. These are called compression fractures. They often occur without an injury. The pain may occur suddenly or slowly over time. There may be a loss of height (as much as 6 inches) over time. A stooped posture or kyphosis (also called a “dowager’s hump”) may develop. Signs and tests Bone mineral density testing (most often with a DEXA scan) measures your bone mineral density. Your health care provider uses this test to:

Diagnose bone loss and osteoporosis

Predict your risk of future bone fractures

See how well osteoporosis medicine is working A spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis. You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Treatment for osteoporosis may involve:

Lifestyle changes, such as diet and exercise

Taking calcium and vitamin

​Using medications Medications are used to strengthen bones when:

Osteoporosis has been diagnosed by a bone density study, whether or not you have a fracture.

A bone fracture has occurred and a bone density test shows that you have thin bones, but not osteoporosis.

Medicines used to treat osteoporosis include:

Bisphosphonates (the main drugs used to prevent and treat osteoporosis in postmenopausal women)

Estrogens, teriparatide, raloxifene, and calcitonin Exercise plays a key role in preserving bone density in older adults.

Some of the exercises recommended to reduce your chance of a fracture include:

Weight-bearing exercises — walking, jogging, playing tennis, dancing

Free weights, weight machines, stretch bands

Balance exercises — tai chi, yoga

Rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures in older adults.

Your body needs calcium and vitamin D to keep your bones strong. Vitamin D helps your body absorb calcium.

Adults under age 50 should have 1,000 mg of caclium and 400 – 800 IU of vitamin D daily.

Women ages 51 to 70 should have 1,200 mg of calcium and 400 – 800 IU of vitamin D a day; men ages 51 to 70 need 1,000 mg of calcium and 400 – 800 IU of vitamin D a day.

Adults over age 70 should get 1,200 mg of calcium and 800 IU of vitamin D daily.

Your doctor may recommend a calcium supplement.

Follow a diet that provides the proper amount of calcium and vitamin D. Stop unhealthy habits:

Quit smoking, if you smoke.

Limit your alcohol intake. Too much alcohol can damage your bones, and put you at risk for falling and breaking a bone. It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good.

Other ways to prevent falling include:

Avoid walking alone on icy days

Leave lights on at night so you can see better when walking around your house

Remove slippery rugs from your house

Use bars in the bathtub, when needed

Wear well-fitting shoes

Osteopenia

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop BMD that is very low compared to normal, known as osteoporosis.

What causes osteopenia?

Bones naturally become thinner as people grow older because, beginning in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker and increasing their risk of breaking. All people begin losing bone mass after they reach peak BMD at about 30 years of age. The thicker your bones are at about age 30, the longer it takes to develop osteopenia or osteoporosis.

Some people who have osteopenia may not have bone loss. They may just naturally have a lower bone density. Osteopenia may also be the result of a wide variety of other conditions, disease processes, or treatments. Women are far more likely to develop osteopenia and osteoporosis than men. This is because women have a lower peak BMD and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause. In both men and women, the following things can contribute to osteopenia:

Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
Chemotherapy, or medicines such as steroids used to treat a number of conditions, including asthma
Exposure to radiation
Having a family history of osteoporosis, being thin, being white or Asian, getting limited physical activity, smoking, regularly drinking cola drinks, and drinking excessive amounts of alcohol also increase the risk of osteopenia and, eventually, osteoporosis.

Osteopenia is treated by taking steps to keep it from progressing to osteoporosis and, for a few people, by taking medicine. Lifestyle changes can help reduce the bone loss that leads to osteopenia and osteoporosis.

What you eat is very important to bone development. Calcium is the most critical mineral for bone mass. Your best sources of calcium are milk and other dairy products, green vegetables, and calcium-enriched products.

Your doctor may also want you to take a calcium supplement, often combined with vitamin D. Vitamin D helps your body absorb calcium and other minerals. It is found in eggs, salmon, sardines, swordfish, and some fish oils. It is added to milk and can be taken in calcium and vitamin supplements. In addition to what you take in from food, your body makes vitamin D in response to sunlight.

Exercise is important for having strong bones, because bone forms in response to stress. Weight-bearing exercises such as walking, hiking, and dancing are all good choices. Adding exercise with light weights or elastic bands can help the bones in the upper body. Talk to your doctor or a physical therapist about starting an exercise program.

In addition to diet and exercise, quitting smoking and avoiding excessive use of alcohol and cola will also reduce your risk of bone loss.

There are medicines for treating bone thinning. But these are more commonly used if you have progressed past osteopenia to the more serious condition of osteoporosis. Medicines that may be used for osteopenia include bisphosphonates, raloxifene, and hormone replacement. For more information on these medicines, see the topic Osteoporosis.

How can osteopenia be prevented?

Whether you will tend to develop osteopenia is, in part, already determined. Things like whether you have any family members who have had osteoporosis or osteopenia, whether you have chronic asthma that requires you to take steroids, and how much calcium and vitamin D you got while you were growing up are beyond your control now. But if you are a young adult or if you are raising children, there are things you can do to help develop strong bones and help slow down osteopenia and prevent osteoporosis.

Your bones don’t reach their greatest density until you are about 30 years old, so for children and people younger than 30, anything that helps increase bone density will have long-term benefits. To maximize bone density, make sure you get plenty of calcium and vitamin D through your diet and by spending a little time in the sun, get weight-bearing exercise on a regular basis, don’t smoke, and avoid cola and excessive alcohol. If you have children, teach them to eat healthy, get regular exercise, and avoid smoking and alcohol. Also, get them to play a little in the sunshine to help their bodies make more vitamin D. Talk with your doctor about how much and what sources of vitamin D are right for your child.

If you’re older than 30, it’s still not too late to make these lifestyle changes. A balanced diet and regular exercise will help slow the loss of bone density, delay osteopenia, and delay or prevent osteoporosis.

Laboratory, Radiology and Hospital Charges

Due to the requirements of some insurance companies or the nature of certain laboratory studies, your lab tests may be sent from our office to a reference laboratory. Reference laboratories are independent of our practice and will bill separately for their services. For all laboratory, radiology and hospital charges, it is the patient’s responsibility to determine if these providers are covered by your individual plan. Most will bill your insurance directly. If you have questions about bills and cannot resolve them with insurance company or other provider directly, please talk to a member of our billing staff.

Insurance Plans Accepted

We are a participating provider with the following insurance companies. If you have questions regarding billing, please call the office during normal business hours for referral to the billing department.

Insurance And Office Payment

Our practice participates in many insurance plans. An updated list is available on this web site or by contacting our office. Since each plan has different requirements and coverage limitations and exclusions, it is the responsibility of the patient to understand and meet the requirements of their individual plan. Most patients will have a “co-pay” (a portion of their charges which is not covered by insurance). Those covered by Medicare and some other insurance plans may have “deductibles” as well. Many insurance plans and Medicare do not consider “routine” check-ups (those performed without regard to a specific medical problem) or “screening” laboratory studies to be covered services. Co-pays, co-insurance, deductibles and non-covered charges are payable at the time services are rendered. Our billing staff is available to assist you with questions you may have about coverage conditions and payment arrangements. We accept payment by cash, personal check, Visa, MasterCard, Discover and American Express.

In Case of Emergency

In the event of a life-threatening emergency, please go directly to the nearest emergency room, (by ambulance if appropriate), and advise the staff that you are our patient. If you are having a medical problem after hours or on Weekendss and Holidays, please call the regular office number. The doctor on call will be contacted through the answering service.

Health Tips Young Adult

Your Prescription for Health

Eat Right – 5 a day of fresh fruits and vegetables, lots of fiber, lean meats, chicken, turkey and fish. No junk food, no fast food (salads are a great substitute for French fries). If you do not feel well, chances are you are not eating well!! Do not underestimate the power of healthy eating, or the ability of eating the wrong thing to make you feel badly!! Please visit Healthy Approach Market for nutritional counseling with Bryan Bradford CN (817-399-9100)

Drink lots of water – it should be your main beverage of the day. Limit caffeine to one a day if you must. Avoid artificial sweeteners, they are thought to increase PMS as well as other health problems

Weight loss – If you are doing the top 3 you WILL lose weight. In a nutshell, eat protein at EVERY meal, moderate carbohydrates and fats, and fruits, veggies and water at EVERY meal. If you can do this, you will lose weight.

Exercise – 30 minutes of cardio a day to maintain weight, 1 hour a day to lose weight. Pilates and Yoga are great for sculpting and toning. Exercise On Demand with cable and satellite – lots of great options for quick workouts.

Safety – wear your seatbelt, drive the speed limit, wear sunscreen, pick good friends, no drinking and driving, no smoking, don’t walk alone at night

Safer Sex – abstinence is best, but use condoms every single time if sexually active. Remember, you are with every partner your partner has been with, and every partner they have been with and so on. ….That’s a lot of exposure to warts, herpes, chlamydia, HPVand don’t forget HIV!!

HPV – Human Papilloma Virus. It is sexually transmitted. Over 100 strains of the virus. A few strains cause abnormal pap smears, a few strains cause genital warts. Guys pass it to you not knowing they have it. A vaccine for the four main strains of the virus is available for women ages 9-26. It takes 3 injections over 6 months total. It provides 99% protection in preventing pre-cancer and cancer of the cervix and 100% protection against genital warts.

Pap smears – every year once sexually active or age 18 whichever comes first. Papsure it optional, it allows us to see your cervix with a special light and microscope. It can pick up things a pap can miss. Probably worth the money.

Birth Control Options – The pill, patch, ring and shot can be used for birth control or to help control heavy or painful periods, or acne. This is a personal as well as medical decision. Side effects also can include weight gain, breast tenderness and headaches. The weight gain is caused from increased eating, so if you eat right, you won’t necessarily gain weight. If you are on Depo Provera you must take Calcium every day to prevent bone loss.

Vitamins – a good multivitamin, calcium 1000mg a day total (diet and supplements in divided doses), Fruits & Veggies if not obtained from diet (Juice Plus, Nature’s Way). B Complex for energy, essential fatty acids (fish oils) for helping with brain function, Vitamin C 1000mg a day for anti-oxidant.

Health TIps Over 50’s

Your Prescription for Health Over Fifties

Eat Right -5 a day of fresh fruits and vegetables, lots of fiber, lean meats, chicken, turkey and fish. No junk food, no fast food . If you do not feel well, chances are you are not eating well!! Do not underestimate the power of healthy eating, or the ability of eating the wrong thing to make you feel badly!! Please visit Healthy Approach Market for nutritional counseling with Bryan Bradford CN (817-399-9100). Read the Eat Clean Diet book. It is awesome at explaining nutrition and helping with weight loss. (www.eatcleandiet.com)

Drink lots of water – it should be your main beverage of the day. Limit caffeine to one a day if you must. Avoid artificial sweeteners, they are thought to increase PMS as well as other health problems

Exercise – For weight loss you need 45-60 minutes a day, 5 times a week. To maintain weight and bone health, 30 minutes a day 5 times a week. Yoga and Pilates are great, I like Leslie Sansone walking for weight loss; fun and easy to fit in a busy schedule. Exercise On Demand with cable and satellite – lots of great options for quick workouts.

Weight loss – If you are doing the top 3 you WILL lose weight. In a nutshell, eat protein at EVERY meal, moderate carbohydrates and fats, and fruits, veggies and water at EVERY meal. If you can do this, you will lose weight.

Menopause – the absence of a period for one year is menopause, peri-menopause are the 5-10 years prior to that. In the female body, balance of hormones is key. Women need a balance of estrogen, progesterone, testosterone, thyroid hormones and cortisol. When this balance is not in place, women can feel symptoms such as hot flashes, night sweats, forgetfulness, foggy thinking, unwanted weight gain, declining interest in sex, PMS, sleep disturbance…. the list is endless.

Do you have any of these symptoms? Lab tests are not very sensitive for detecting these hormone levels because hormones are protein bound and not free floating in your plasma, therefore we recommend saliva testing for detecting hormone imbalances.

This testing includes estrogen, progesterone, testosterone, DHEA and cortisol. Saliva testing can accurately measure your free and available hormone levels, eliminating the guessing from your treatment. If we discover a deficiency or imbalance we can monitor your hormone levels after starting bio-identical hormone treatment, which allows us to individualize your hormone therapy.

Blood testing can evaluate your thyroid hormone, fasting sugar, insulin and cholesterol.

There are 2 options for treatment, non-hormonal relief such as soy, black cohosh and other herbs, or estrogen and progesterone. You can use synthetic hormones, or bio identical hormones compounded at the pharmacy. These are personal as well as medical decisions, and the facts keep changing as studies are being conducted. Hormones won’t give you cancer, but if you have one, it will cause it to grow and sometimes aid in earlier detection. If you decide on hormone therapy, there are a lot of options, pills, patch, ring, creams, which we can discuss and try. We work with several compounding pharmacies that can make your hormone preparation based on your individual needs.

Pap smears, mammograms and fasting lab work every year. Have a good family doctor or internist follow your high cholesterol, high blood pressure or diabetes. They are more familiar with changes in research and medication options. • Bone Density every 1-2 years. If you have normal bones, continue your weight bearing exercise and calcium 1500 mg a day. If you are on Fosamax or Actonel, we probably don’t need to check your bones every year, as changes of improvement are very subtle. • Colonoscopy – begin at 50 unless family history dictates earlier, and repeat every 3-10 years. Your GI will tell you when to return. • Vitamins – a good multivitamin, calcium 1500mg a day total (diet and supplements) in divided doses, Fruits & Veggies if not obtained from diet (Juice Plus, Nature’s Way). B Complex good for energy and cholesterol, essential fatty acids (fish oil), baby aspirin if appropriate. Vitamin C 1000mg a day for anti-oxidant. • Recommended Reading: You, The Owner’s Manual by Dr Michael Roizen & Dr Mehmet Oz is a must read. It really hits the high points on every body system, how it works, and what to do to help your body feel great. Also Dr. John Lee’s Hormone Balance Made Simple is an easy read and makes sense of complicated hormone explanations. The Eat Clean Diet by Tosca Reno is a must read. Also, CW Randolph’s From Belly Flat to Belly Fat is a great, easy read and hits on vitamins, eating right, thyroid balance and hormone balance for weight loss and feeling great. The 30 day diet plan in this book is a guarantee to lose weight.

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