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Health&Wellness August Special Section


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Health Wellness

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August 2013

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Five Myths about Concussion: And the Facts from the Concussion Institute at Gwinnett Medical CenterDuluth. For parents, it’s gut-wrenching to see your child crash on the soccer field or get elbowed in the temple while charging the plate in baseball. Although contact sports, such as football, have been in the news regarding concussion risk, this injury can also result from collision with another child, the ground, a wall, a goalpost or a ball—even a fall from a bicycle or skateboard can result in concussion. Here are some of the most common myths about concussion…and the facts that will help you identify and treat this serious injury: Myth: No KO, no concussion. Fact: With most concussions the person is not knocked out or unconscious. In fact, a concussion where the person is not “KO” can, in some instances, lead to worse symptoms. Myth: “Shake it off” worked in my day. Fact: A concussion is a mild traumatic brain injury. While the injury is immediate, symptoms vary widely, may

not show up until hours or days later, and they range from subtle to obvious, including: • Headache • Nausea or vomiting • Dizziness or balance problems • Double or blurry vision • Sensitivity to light and/or noise • Feeling dazed or stunned • Trouble concentrating or remembering • Confused or forgetful about recent events • Slow to answer questions • Changes in mood – irritable, sad, emotional, nervous • Drowsiness • Sleeping more or less than usual Myth: Take the weekend off. Get back to practice on Monday. Fact: Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to fully recover. To help the brain heal, the student-athlete should avoid participating in sports, driving or working, and minimize demanding cognitive tasks. Ask your child’s school

to work with you to make suitable arrangements. Myth: The student-athlete will know when he or she is ready to return to play. Fact: Your child may feel better and want to return to play before their brain has completely recovered. It is important not return to play until the doctor says it is okay, and then to implement a progressive, individualized plan for safely returning to play. One objective measurement tool is the Immediate Post-concussion Assessment and Cognitive Testing program (ImPACT), which provides information that can take the guesswork out of safe return-to-play decisions. ImPACT provides neurocognitive computer testing in the preseason to establish a baseline. Then if a concussion is suspected, follow-up tests can confirm the injury, determine severity and track recovery. Myth: In sports, there’s no way to prevent concussions. Fact: Not all concussions can be prevented, but wearing helmets for riding activities or collision sports and learning

Although concussion in football has been in the news, other sports -- and even leisure activities like bicycling – also carry a risk of concussion. safe playing techniques can be helpful. Most importantly, every athlete, parent and coach needs to know never to ignore a head injury, no matter how minor.  The Concussion Institute is the newest addition to the Sports Medicine Program at GMC-Duluth. Since 2005 this program has provided comprehensive care including ImPACT testing, educational events and providing certified athletic trainers for professional teams, recreational leagues and high schools. To learn more about the new Concussion Institute and ImPACT testing, visit gwinnettsportsmed.com/concussion or call 678-312-7880.

ADHD – not just in children anymore Adult ADHD is associated with multiple comorbidities such as anxiety, depression, bipolar disorder and other personality disorders. Adult ADHD is a valid psychiatric disorder of adulthood distinct from these other conditions. Adult attention deficit disorder differs from the childhood variant because the hyperactivity in adults may be replaced by other symptoms such as anxiety, impulsivity and inattentiveness. In fact, prior to 2002 there were no diagnostic guidelines, but there have been great advances since. Some of the symptoms that characterize Adult ADHD are:

ADHD is a relatively common psychiatric disorder among adults. The prevalence is thought to be 3.5%-5.3%, which accounts for more than 11 million cases in the United States alone. With increased public awareness, adult ADHD became a topic of great interest so clinicians should be able to diagnose, treat, and manage patients with this disorder. Etiology is still uncertain. Genetics however is believed to play a prominent role, followed in importance by acquired injuries to the brain. ADHD was widely thought to be strictly a disorder of childhood. Now there are numerous scientific papers and clinical trials that acknowledge the existence of an adult version of this disorder, which can be traced back to the younger years. Before this time ADHD in adults was known as Minimal Brain Damage or Dysfunction (MBD).

1. Often fails to give close attention to details or makes careless mistakes in school-work, work or other activities. 2. Often has difficulty sustaining attention in tasks or play activities. 3. Often does not seem to listen when spoke to directly. 4. Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand directions) 5. Often has difficulty organizing tasks and activities. 6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)Often loses things necessary for tasks and activities (eg. School assignments, pencils, keys) 7. Is often easily distracted by extraneous stimuli. PAID ADVERTORIAL

8. Is often forgetful in daily activities.

Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, keep a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD. These adults may have a history of failure at school, problems at work, failed relationships and traffic accidents. Like teens, adults with ADHD may seem restless and may try to complete several tasks as once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards. Treatment is very rewarding. The first medications to be approved by the FDA belonged to a non-stimulant group of medications: Atomoxetine. The FDA later approved stimulants such as methylphenidate and mixed amphetamine salts. Group delivered cognitive behavioral therapy is recommended in some cases as a supportive treatment. If you or someone you know may have Adult ADHD, call Johns Creek Family Medicine at 770-771-6591 and schedule an appointment with Dr. Zack Charkawi.


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NEED

A team of concussion experts.

WANT

Doctors who cared how much sports meant to her.

While Gwinnett Medical Center has long specialized in a variety of sports injuries, improving the standard of care for athletes who suffer concussions is one of our top priorities. Our team of sports medicine experts utilizes the latest technologies, like our Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) program. Our goal is to begin treating concussions as soon as possible and to reduce the chance of follow-up concussions, especially among students. This is one of the reasons why the Sports Medicine Program at Gwinnett Medical Center–Duluth has placed certified athletic trainers in numerous high schools across the area. This unique approach is one more reason we’re the only hospital system in the region committed to Transforming Healthcare.

See Rachel’s story and others at gwinnettmedicalcenter.org/stories.

Transforming Healthcare


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3D Mammography — A major advance in the fight against breast cancer By Lynn D. Baxter, MD, Director of Breast Imaging, Northside Radiology Associates, Northside Hospital Breast cancer is the most commonly occurring cancer in women, aside from some non-aggressive forms of skin cancer. One in eight American women will develop the disease at some point in her lifetime. Early detection is the key to improved survival and less invasive treatments. Mammography is the only test of any kind scientifically proven to decrease the death rate from breast cancer. In fact, the death rate from breast cancer has decreased by 30% since mammography screening programs were introduced. Because of this, the American Cancer Society and many other organizations recommend annual mammograms for almost all women beginning at age 40. Some high risk women should begin screening even earlier. Mammograms have consistently been shown to reduce the death rate from breast cancer in many studies in many countries, even through using film/screen technology from the 1970’s. However, standard 2 dimensional (2D) mammography has some limitations. Because this

technology creates a 2D image of a 3 dimensional (3D)part of the body, tissues from one part of the breast can overlap with tissues from another part, creating a false impression of a mass on the image, or allowing normal tissues to mask a cancer. Breast tomosynthesis, also known as 3D mammography, is a new advance in breast imaging technology that goes a long way toward overcoming these limitations. In 3D mammography, images are obtained from multiple angles around the breast and synthesized by a computer into a series of images 1 mm thick. The radiologist can view them together like a “movie” where they view the inner structures of the breast, moving from one side to the other. This helps to eliminate the problem of overlapping tissues. Studies so far have shown a 27 – 30% increase in cancer detection with 3D mammography and a 30 -40% decrease in the rate of recalls for additional imaging. Benefits have been proven for women with all breast densities. Still, 3D mammography is not perfect, and it cannot find all cancers or prevent all recalls. It is currently only approved by the FDA for use

as a combination exam with standard 2D mammography. As a result, the radiation dose from the combination exam is higher than that of a 2D mammogram alone ( but still within FDA limits, and actually lower than some old film mammograms). All that being said, 3D technology shows tremendous promise towards overcoming some of the most common limitations of mammogram screening, and will continually improve breast cancer screening and diagnostic capabilities. Northside Hospital Breast Cancer Center Northside Hospital is one of the leading providers of breast cancer services in the nation, diagnosing and treating more cases of breast cancer than anyone else in the Southeast. Northside Hospital was the first facility to make 3D mammography clinically available in Atlanta, and has continued to expand its availability, now providing 3D services at the hospital’s Forsyth, Alpharetta and Atlanta locations. For more information about Northside Hospital’s premier breast cancer screening technology go to www.northside.com/cancerinstitute, or call 404-851-6577 to schedule an exam.

North Atlanta Medical & Digestive Care

Jeff H Ye, MD, Ph.D.

• Trained at Yale University affiliated hospitals. • Internal Medicine Board Certified. • Expert diagnosis and treatment of difficult, complicated diseases. • Advanced medical care: diabetes/needle-free treatment, obesity/effective weight loss program, fibromyalgia, sexual dysfunction, hypertension, coronary artery disease, COPD. • Successful treatment of digestive disorders: abdominal pain, diarrhea, constipation, GERD, Crohn’s disease, liver cirrhosis, hepatitis C, pancreatitis.

Testimonials: “Excellent! Most careful! Takes time with me. Helped me avoid taking insulin for diabetes.” Ed E. “Dr. Ye makes you feel very comfortable during your visit. He is very good at explaining what he has found wrong with you. The options you have on getting help with pain and sickness. He is also good at working with you about getting the best medication that works for you.” Bryan S. “Most doctors I’ve been to haven’t talked to me a lot of the time or care to find the real problem causing all of my symptoms, but Dr. Ye cares for me and doesn’t stop until he finds the root cause of the problems or issues. He then takes great care at treating the entire body. I appreciate all he has done for me.” Angela H.

Accept Medicare, Medicaid, most commercial Evening/Weekend Appointment Available 4020 Old Milton Pkwy, Alpharetta, GA 30005 770-346-0900 Walk-in Welcome Mon-Fri 9am-5pm, Wed 11am-7pm, Sat 9am -1pm

GENERAL AND SPECIALTY DENTISTRY

Dr. Randy Muccioli Prosthodontist

Dr. Randy Muccioli is a dental specialist who focuses on the restoration and replacement of teeth, cosmetic and implant dentistry.

Dr. Lydia Muccioli General Dentist

Dr. Lydia Muccioli provides comprehensive dental services for the entire family including children.

CLEANINGS AND EXAMS FULL MOUTH REHABILITATION COSMETIC DENTISTRY FILLINGS • CROWNS • VENEERS BRIDGES • ROOT CANALS IMPLANTS 6300 HOSPITAL PARKWAY, SUITE 275 • JOHNS CREEK Conveniently located across from Emory Johns Creek Hospital

www.MDentalSmiles.com • 678-389-9955


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Start living a happy, healthy life today Everyone wishes to live a happy healthy life. If you were to look at your health as a chain, you would see a connected series of links. Your brain, heart, lungs, eyes, and other organs are links which must all work together to keep the body functioning. Each link plays a vital role in the strength and performance of the chain and your overall good health. But, what happens if one of the links, such as the ability to hear, fails to work properly? Dr. Deborah Woodward is a Doctor of Audiology and is committed to be “your link to better hearing”. Correcting a hearing impairment requires detailed knowledge of how ears respond to sound and familiarity with the latest technologies and hearing devices. Patients appreciate the “personal touch” Dr. Woodward gives. “It is important to establish a patient relationship based on professionalism and trust while focusing on

their individual needs and lifestyle”, states Woodward. “Forget about what you know about hearing devices up to now. You’ll WOODWARD be amazed at how smart, how helpful, and how transforming better hearing can now be.” The value of a strong hearing link is immeasurable. With Dr. Woodward’s expertise in providing solutions to hearing loss, patients regain their confidence in business and social situations and are not embarrassed by inappropriate responses in conversations. In many cases, family harmony is restored, and a patient’s self-esteem is regained with their ability to hear and understand speech. For the past twenty years, Dr. Deborah Woodward has been serving the hearing healthcare needs of the

residents in the Johns Creek and surrounding areas and is now in private practice at the Johns Creek Audiology & Hearing Aid Center. Audiology services at Johns Creek Audiology & Hearing Aid Center include hearing evaluations for both adults and children; testing for middle ear function; fitting of the latest hearing aid technology with a 45-day trial period for all hearing aids dispensed; hearing aid service and supplies; custom ear molds for swimming, noise protection for hunters

and musicians; and Cochlear implant and BAHA evaluations with mapping and programming. Woodward believes in giving back to the local community. As a breast cancer survivor, Deborah is active in raising funds for the benefit of the Susan B. Komen charity. Dr. Woodward performs hearing screenings at health fairs, churches, and for several corporations. Elementary school children learn from Dr. Woodward how the ear works at Career Day events and staff members of

assisted living facilities are educated on the use and care of hearing aids for their residents. The next Open House and Seminar events are September 24th and 26th. Space is limited and it is highly recommended to secure a slot by contacting the office at 770-814-1260. At Johns Creek Audiology & Hearing Aid Center, you can expect a warm welcome and a caring Doctor of Audiology who is sincerely interested in helping to keep your link to better hearing strong and healthy!


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Goodbye to Insulin Jeff Ye, MD, Ph.D. I have many patients who have successfully graduated from an insulin program. They are grateful that they don’t have to stick their body with insulin several times a day. Many have been on high doses of insulin for years with significant weight gain and poor sugar control; now they are taking oral medications and only need to check their blood sugar on special occasions. The mechanism for type 2 diabetes includes impaired normal biological response to insulin, defects in the glucagon regulation, and decreased beta

Live in the now At Johns Creek Audiology and Hearing Aid Center, we are ready to help if you’re not ready to let hearing loss get in the way of enjoying your favorite activities. With more than twenty years of experience in bringing the best possible hearing care to this area, Dr. Woodward will work with you to find the hearing solution that best fits your individual needs and budget. Be free to enjoy all that life has to offer.

Dr. Deborah Woodward Audiologist

For appointments or to register for the September 24th and 26th Open House and Seminars, please call

770-814-1260.

4045 Johns Creek Parkway, Suite B Suwanee, GA 30024

www.johnscreekaudiology.com We accept CareCredit®

cell mass. Risk factors include uncontrolled hyperglycemia, dyslipidemia, hypertension and obesity; all contribute to the worsening of type 2 diabetes. Patients may ultimately depend on insulin, but efforts should be made to reserve their beta cell mass and delay the process. New oral medications are available to reserve the beta cell mass along with the benefit of weight loss. We should exhaust all medication therapies before turning to insulin. Some diabetic patients have transient loss of beta cell function and increased resistance

to insulin; They are put on insulin in the hospital and kept on insulin afterwards. Most of them can be successfully treated with replacement oral antidiabetic medications in a couple of weeks. If you have any questions, please contact Dr. Jeff Ye, North Atlanta Medical & Digestive Care at 770-346-0900.


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Thomas Eye Group Reminds Parents to Catch Vision Problems Early with Back to School Eye Exams As kids head back for a new school year, parents are making checklists of items they’ll need for their academic and after-school activities. But high on the list should also be preparation for kids’ health and well being. August is Children’s Eye Health and Safety Month, so now is the perfect time to schedule an eye exam at Thomas Eye Group to ensure good eye health and learn the signs and symptoms of declining vision and other eye maladies that can affect classroom performance. 80 percent of a child’s learning during their first 12 years of life is obtained through their vision, so an eye exam is essential to make sure your child is getting the most of his or her education. Some common signs of

vision problems include headache and fatigue, holding reading material closer than normal, turning or tilting the head to use one eye only or consistently performing below potential. But vision changes can occur without you or your child noticing them and a school or pediatrician’s vision screening is not a substitute for a thorough eye examination. An eye examination at Thomas Eye Group will include an examination of the health of the eyes, including the front and back and a check to see if a prescription is needed for glasses. It also includes a check to make sure eyes focus well together ruling out a “lazy” or wandering eye that can hinder depth perception. If necessary, your doctor can prescribe treatment

including eyeglasses, contact lenses or other depending on your child’s needs. Visit www.thomaseye.com or call 770-809-3366 for more eye care information and to schedule a visit with the pediatric specialists at our Suwanee location. Make sure your kids get off to a good start this year by making vision a priority.

August 2013 7


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What is a Prosthodontist? Getting that Lean Beach Muccioli Dental is proud to be one of a handful of dental practices in Johns Creek and all of the Atlanta area that has a Prosthodontist on staff. Dr. Randy Muc­cioli is specially trained to provide complex restorative, esthetic and cosmetic dental services. A Prosthodontist trains three years longer than a general dentist and is skilled in the replacement of missing teeth and the restoration of natural teeth. Their training consists of rigorous clinical and didactic preparation in the basic sciences, head and neck anatomy, biomedical sciences, biomaterial sciences, function of occlu­sion (bite), TMJ, and treatment planning and experience treating full-mouth recon­struction cases, and esthetics. There are only 3,200 prosthodontists in comparison to 170,000 general dentists in the United States. Another feature our office has that is very different is an on-site dental laboratory. This allows direct communication with our laboratory technicians and gives our doc­tors the ability to be hands-on during the fabrication process of our restorations. This unique facet of our practice helps us ensure the highest quality standards and cus-

tomized appearance of our dental restorations. Our dentists and staff work hard to provide a tranquil and caring environment that is relaxing and comfortable MUCCIOLI for our patients. Our amenities include a beverage bar, warm scented towels, headphones for music or TV viewing; free Wi-Fi, and soothing hand treatments. We offer our patients a state-ofthe-art office with low radiation x-rays and only utilize the best rated materials for your treatment. Muccioli Dental proudly serves the residents of Johns Creek and the surrounding areas with comprehensive dental services ranging from dental cleanings and exams to full mouth rehabilitation. Whether you are in need of general dental services or complex restorative care, we want to be the dental practice you trust to care for the dental needs of your entire family! Conveniently located across from Emory Johns Creek Hospital; 6300 Hospital Parkway, Suite 275, Johns Creek, 678-389-9955, www.MDentalSmiles.com

Body through Sleep From Caroline Sparks FNP-BC, RN, MSN EVP Clinical Operations at AgeWell Men’s Institute Ever think you could sleep your way to a perfect body? Sleep plays a vital role in lean muscle mass production and overall health. Muscle makes us look good, makes us stronger and provides other benefits such as bone density, fat loss and helps us stay alive longer.  A recent study showed that insufficient sleep curtailed the efforts of human subjects to lose body weight and retain lean mass. Compared to the control group, the bad sleep group saw their lean body mass losses increase by 60% and their fat mass losses decrease by 55% suggesting that lean muscle mass was being broken down into amino acids for energy.  We do not know exactly how many hours of sleep one needs per night and it differs on an individual basis, but most scientists agree that 8 hours is optimal.  Aim for 10 hours, an unrealistic goal for most but a worthy one.   Never skip exercise as it may ben counterproductive and work out a

Experience The World’s First Visible/Infrared LED Therapy and Massaging Ultrasonic Toothbrush The Pro-Medic Professional Toothbrush provides the total solution to dental oral care in regular daily brushing. • Effectively removes bacterial plaque from teeth and gums • Deeper tooth whitening without chemicals • Reduces or eliminates gum bleeding and gingivitis • Reduces sensitivity while promoting regeneration of tooth nerves • Two replacement heads, charger, travel case and manual Call Sunny at 404.890.5157 included

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reasonable am amount of time that promotes better sleep.  1 hour per day is a great goal to set. As training volume increases so must sleep.  In the event of a negative night of sleeping, there are 3 things you can do to counter balance: 1- Meditate, 2- Drink Coffee and 3-take Creatine.  Creatine has been shown to reduce the negative effects of a poor night’s sleep in performance as well as Caffeine.  Sweet Dreams... Caroline Sparks is the

EVP of Clinical Operations at AgeWell Men’s Institute in Milton. A board certified family nurse practitioner for 15 years, Caroline has developed patient-centric wellness and complex disease management programs for national companies. See their ad for more information or visit their website at www.agewellmensinstitute.com.

New toothbrush with cutting-edge technology Most people would be surprised to learn that tooth brushing was not a widely-accepted practice until the beginning of the 19th Century. These days, consumers have a myriad of products to choose from to address their oral health, but a new toothbrush that employs multiple cutting-edge technologies is now available that could provide a simple solution for individuals concerned about maintaining/improving their oral health and appearance.  “Dental disease, from bleeding gums to gingivitis to even tooth loss, is largely avoidable with good preventive care,” said Dr. Henry Malak, Ph. D., President of Technology of ULMC- Pro-Medic and an inventor of the Pro-Medic technology. “This is why we are very excited to have successfully combined revolutionary technologies in one toothbrush and to make it accessible and affordable for all individuals seeking solutions to address their oral health needs and those of their family members.”  I decided to get involved with Dr. Malak’s extraordinary work. I did so by building a website and introducing one of my favorite products on the planet.

I have met many people at networking events to spread the word about this product. I love this brush, I studied the product and company, and the rest is history. For more info please check out my website www.promedicshop.com, send me an email at sunny@promedicshop.com, or call at 404.890.5157


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Dr. Friedman has your back Russell A. Friedman, B.S.M.E., D.C., of AlternaHealth Solutions is an Upper Cervical specialist who focuses on the upper area of the spine which is closest to the head and the brain stem. Upper Cervical Chiropractic is measurable, predictable and uses an extremely light touch (no more pressure than is needed to take a pulse) without any twisting, popping, or cracking. Upper Cervical measures body misalignment using digital and laser posture diagnostics and 3D opposing x-ray views. The diagnostics allow for corrective results. Not only do you feel better after a correction, you can actually see the difference in the pre- and post- X-rays. In 2010, Dr. Friedman introduced Quantum Spinal Mechanics3 (QSM3), a progressive Upper Cervical Chiropractic protocol. QSM3 is changing the practice of chiropractics all over the country, attracting both the scienceminded allopath and the natural health practitioner. Chronic conditions such as TMJD, migraines, vertigo, fibromyalgia, sports injuries, and unsuccessful spinal surgeries respond to Upper Cervical procedures and have clinical significance as repeatable and success-

Dr. Friedman’s Success Plan uses the QSM3 protocol as a foundation in combination with other health essentials such as nutrition, hydration, exercise, muscle symmetry and emotional work. Today, Dr. Friedman’s in-depth and practical approach to correcting the spine and infusing health with the Success Plan has made him one of the most sought after chiropractors in the southeast.

MIGRAINES? VERTIGO? FIBROMYALGIA? TRIGEMINAL NEURALGIA? NUMBNESS? HYPERTENSION? FATIGUE? TIRED OF TAKING PILLS WITH NO END IN SIGHT? True health comes from Corrective Care – not covering symptoms with medications. This foundational approach has attracted patients to us from all over the country, referred by doctors locally, nationally, and from such prestigious institutions as The Mayo Clinic in Florida. Call AlternaHealth Solutions to access a new path to true health and pain-free living. Russell A. Friedman, DC

Alternatives to hysterectomy By LAURA TSAKIRIS MD Chattahoochee Gynecology

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August 2013 9

Picture this scenario. You are having issues with heavy bleeding at menstruation. You go to your gynecologist and are told you need a hysterectomy. This will require a major surgery, a prolonged recovery time and inability to get back to work and your daily life for quite a while. Is this the only solution? The answer is probably no. We now have many more alternatives to hysterectomy than ever before. In the category of medical alternatives to hysterectomy there is the possibility of oral contraceptives and hormonal Depo-Provera infections. These medications are traditionally used for contraception but are safe for women to use until menopause if no medical health issues exist. They can decrease monthly bleeding substantially and even be manipulated so that there are fewer menstrual cycles. Oral contraceptives can also decrease acne and perimenopausal side effects as well. Another new alternative to hysterectomy is the Mirena IUD.

This devise recently received FDA approval for use in managing heavy menses. It can easily be placed in an office visit without anesthesia. After the first few months most patients will have either no menses or very light menses. The device can be left in for 5 years and is very safe in all age groups. If you prefer not to use a medication or are reluctant to use an IUD another alternative would be an endometrial ablation. This is a procedure that in some cases can be done in an office setting or as an outpatient at the hospital. The lining of the uterine cavity is treated so there is either no menses or very light menses each month. The nice feature with this procedure is that recovery time is very quick. Most people are back to work within a 24-hour time period and the results last for years. So the next time your doctor days you need a hysterectomy, be sure to discuss these options. While the need for hysterectomy still exists in some cases there are more alternatives than ever before.


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August 2013 Health & Wellness