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be involved in your health JANUARY/FEBRUARY 2017 A Publication of the

January/February 2017 ~ living well January/February 2017 ~ living well

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living well ~ January/February 2017


A publication of the

missoulian.com

People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well suited to more than 30,000 readers monthly who want health tips on fitness, nutrition, family, financial advice, wellness, therapy and beauty.

publisher Mark Heintzelman graphic design Tyler Wilson

advertising sales Mindy Glenna 406-523-5211 contributors Kay Jennings Keila Szpaller

the opinions, beliefs and viewpoints expressed by the various authors and forum participants in this publication do not necessarily reflect the opinions, beliefs and viewpoints of the missoulian or lee enterprises. the author of each article published in this publication owns his or her own words. no part of the publication may be reprinted without permission. ©2017 lee enterprises, all rights reserved. printed in the usa.

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JANUARY/FEBRUARY 2017 VOL. 39

IN THIS ISSUE BE INVOLVED IN YOUR HEALTH

LONG LIFE

pick up a tennis racket

Page 5

ALSO IN THIS ISSUE

TESTING

for breast cancer gene

Page 6

3 TIPS

to beat burnout

Page 10

NEW YEAR’S RESOLUTION

5 pillars of health

Page 12

AVOID JOINT PAIN page 14 RISE IN DEMAND FOR IUDS page 18

Make Life E x t r a o r d i n a r y Choose We s t e r n Montana Clinic 15 Specialties 406.721.5600 60 Providers we s t e r n m o n ta n a c l in ic . c o m

Facebook: @westernmontanaclinic 4

living well ~ January/February 2017


Steve Lopez/Los Angeles Times/TNS

For a long life, consider picking up a tennis racket Story by Karen Kaplan, Los Angeles Times You probably know that exercise is good for you, but do you know whether you’re better off riding a bike or swimming laps in the pool? Actually, if you want to get the biggest bang for your exercise buck, you should pick up a racket, new research reveals. An analysis of more than 80,000 adults who were tracked for nearly a decade finds that those who played tennis, badminton or squash had the lowest risk of dying during the course of the study. Compared with people who didn’t play racket sports, those who did were 47 percent less likely to die of any cause and 56 percent less likely to die as a result of cardiovascular disease. If these kinds of sports aren’t your racket, you could don a swimsuit and goggles. In the study, swimmers were 28 percent less likely to die for any reason and 41 percent less likely to die of cardiovascular disease than were people who stayed out of the water. Another good alternative is to join an aerobics, Zumba or other type of active fitness class. Those who did were 27 percent less likely to die of any cause and 36 percent less likely to die of cardiovascular disease during the study period than those who didn’t. The results, published Tuesday in the British Journal of Sports Medicine, are based on data from 43,705 women and 36,601 men who participated in the Health Survey for England or the Scottish Health Survey. These volunteers, whose average age was 52, told interviewers how often they exercised, what type of exercise they did and how intense their workouts were. Swimming was the most popular type of exercise, claimed by 13.4 percent of study volunteers. Cycling was second, with 9.9 percent of volunteers saying they rode a bike either outside or in an indoor exercise class. Aerobics-

type classes were third (6.4 percent of people took them), followed by running or jogging (5 percent), racket sports (3.6 percent) and football or rugby (3.1 percent). Overall, 44.3 percent of people met minimum recommendations for some kind of physical activity. The study authors checked to see how many of the volunteers died in subsequent years, tracking them for an average of 9.2 years. Overall, 8,790 of the study participants died, including 1,909 who succumbed to cardiovascular disease. The risk of death was not spread equally, the researchers found. Compared with people who didn’t get enough exercise, those who met the minimum standards were 27 percent less likely to die of any reason and 28 percent less likely to die of cardiovascular disease during the course of the study. Cyclists had a 15 percent lower risk of death from any cause than noncyclists, but cycling didn’t have a significant effect on the risk of cardiovascular death. Runners and joggers were no less likely than their counterparts to die of cardiovascular disease or anything else during the study period. Ditto for those who played football or rugby. All of the calculations were adjusted to account for each person’s age, level of education, body mass index, underlying physical and psychological health, smoking status and drinking habits. For all six types of exercise, the median age of death from any cause was “considerably lower” for participants than for nonparticipants. (The age gap ranged from 3.6 years for aerobics to 23 years for football and rugby.) The study authors said this pattern was due to the fact that for every sport, the median age of participants was lower than the median age for nonparticipants. It should not be taken as a sign that exercise “leads to earlier death,” they wrote. January/February 2017 ~ living well

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testing for the breast cancer gene

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Mayo Clinic News Network

Dear Mayo Clinic: At my last mammogram, I asked my doctor if I could be tested for the breast cancer gene. She didn’t think it was necessary even though I have an aunt who had breast cancer. How do doctors decide who should be tested? Why shouldn’t all women be tested? A: Genetic testing for the gene mutations associated with breast cancer, called BRCA1 and BRCA2, is offered to people who are likely to have inherited one of the mutations, based on their personal and family medical history. There are oth6

living well ~ January/February 2017

er newer genetic tests that may be available, too, depending on a person’s family cancer history. BRCA gene mutations are uncommon. Affecting only about one percent of the population, they are responsible


for approximately 5 to 10 percent of breast cancers. Because of their rarity, testing everyone for them isn’t necessary or recommended. If you’re concerned you might have one of these mutations, ask your doctor to help you assess your overall risk. The first step in determining the possibility of a BRCA mutation is gathering a comprehensive family history. Your doctor would want to know if anyone in your family has had breast cancer or other types of cancer. If you have a first-degree relative with the disease – a parent, sibling or child – that has more of an impact on your risk than other relatives who have breast cancer, such as aunts or cousins. If you have a male relative with breast cancer, that could raise your risk more significantly, too. The age a relative was diagnosed with cancer also makes a difference. People who have a BRCA gene mutation tend to develop breast cancer at a younger age than people who do not. If someone in your family had breast cancer before 50, that may increase the possibility a genetic mutation could be involved. Typically, a family with BRCA will show a pattern of breast cancer that affects multiple family members over several generations diagnosed with breast cancer at young ages. But other cancer diagnoses should be reviewed, too. Ovarian, pancreatic or prostate cancer at a young age also could point to a hereditary predisposition to breast cancer. If your family history suggests the possibility of a BRCA gene mutation, consider meeting with a genetic counselor

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before you make any decisions about testing. A genetic counselor can use your family history to calculate the family’s risk of hereditary breast cancer more specifically. He or she can help you fully understand the pros and cons of genetic testing. A genetic counselor also can offer guidance on the ideal individuals in the family to be tested first. If genetic testing is recommended for you, you decide to have it done, and you learn that you do have a BRCA gene mutation, your risk for breast cancer would be much higher than normal. In women without BRCA, the odds of getting breast cancer are 1 in 8. For people with a BRCA mutation, lifetime risk for breast cancer ranges from 50 to 80 percent. With that in mind, women who carry the mutation should be referred to a breast health specialist or breast center to determine how often they should be screened for breast cancer and review possible medical and surgical treatment options that are available to them, based on their individual circumstances. Keep in mind that, for most people, the likelihood of having a BRCA gene mutation is low – even when a family member has had breast cancer. The vast majority of breast cancers are not inherited. It is important, however, for all women to be screened for breast cancer regularly. How often you need breast cancer screening tests should be based on your personal medical history, family history and preferences. Talk to your doctor about the schedule that best fits your needs.

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living well ~ January/February 2017


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tips to keep burnout at bay Mayo Clinic News Network The pace of life today is crazy. Many people juggle multiple responsibilities – work, home life, caregiving and relationships. How many times have you felt like the demands, expectations and time pressure are exhausting and relentless? Humans aren’t programmed to go through life without rest, solitude or downtime. With everything going on, it’s easy to get blindsided by stress and burnout. So experts explain it’s important to beware of symptoms and acknowledge when your responsibilities start to become too much to handle. “The symptoms of stress can include head and muscle aches, upset stomach, fatigue, anxiety, irritability, lack of focus, overor undereating, angry outbursts and social withdrawal,” says Dr. Tiffany Casper, a Mayo Clinic Health System family physician. “No one is superhuman. You need to recognize and then respect your limits.” Casper shares three tips for keeping burnout at bay:

Ask yourself, ‘What’s important now?’

If you’re driving, pay attention to the road. If you’re having dinner with a friend, be engaged and present. Don’t play around with your phone. It’s not only distracting; it’s disrespectful.

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Quantify the commitment.

Before you agree to sit on a committee or host a dinner party, recognize that it means giving up time that can’t be replaced. Anticipate that the time commitment probably will be longer than your initial estimate. Factor that into decisions about what’s worth your time. Be willing to say “no.”

Make yourself unavailable.

It’s OK and important to set aside time for yourself. Schedule it on your calendar, and don’t let other responsibilities encroach on that time. This may mean saying “no” to some requests.” In addition to these tips, it’s also important to maintain healthy habits in order to prevent burnout,” says Casper. “Making sure you’re getting enough sleep at night, eating healthy meals during the day and exercising regularly will help give you the energy to take on life’s myriad of responsibilities.”

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A better New Year’s resolution: Optimized living using the 5 pillars of health Story by Kay Jennings BSN, MSHSA, MSN, APRN-PMH Have you ever tried to diet and exercise and turn over a new leaf as the new year begins? You might get some results initially but they never seem to last. Do you wonder why, despite your best efforts, you just can’t seem to achieve your goals? If you have never heard of or practiced the five pillars of health, you may want to pay close attention. Applied in the proper order, these five pillars (detoxification, nutrition, fitness, nervous system and hormones) are the basis of optimized living.

Detox your food and your environment

Detoxification is often thought of as a nasty event that consists of taking a boat load of pills and ending up in the bathroom half the day. This is not the type of detox that I 12

living well ~ January/February 2017

am referring to. Toxins are found in our environment, our food, our medicines, cosmetics, fibers and our air, to name a few. Elimination of the top eight foods that can contribute to sensitivity is a good place to start. These foods can be temporarily eliminated over a matter of weeks with surprising results. They consist of corn, eggs, shellfish, soy, tomato, peanuts, dairy and gluten. Try to eat organic, locally grown foods that avoid herbicides and GMOs. Go to ewg.org to see the Environmental Working Group’s “Dirty Dozen plus Clean Fifteen” list of foods to focus on. One of the biggest concerns for people who switch to a clean and nutrient-dense diet is cost, so consider buying in bulk. There are many local ranches and growers who sell in bulk, and the order can be shared with friends. Frozen vegetables are another great choice. Removing toxins in your home is also important


to ultimate health. Look up those cosmetics, shampoo, deodorants, detergents and lotions that you are using on ewg.org and you might be surprised. Choosing less toxic products is a good start. Water sourced from a good filter, not plastic bottles, also is important. Speaking of water, you should drink your weight divided by two in ounces of water each day. So, for example, a 200 pound man should drink 100 ounces of water per day.

Easy and affordable changes to improve nutrition

Nutrition is the next obstacle most of us face. We are used to the Standard American Diet (SAD) which is contributing to the greatest obesity epidemic that the United States has ever seen. Just by adding more protein, vegetables, fruit and good fats and eliminating refined processed foods and sugar, tremendous gains can be made in health and losses in weight. Paleo diets or a version of the Mediterranean diet are an excellent starting point. In my practice, I have found that most people with weight issues are actually eating less protein than recommended and not enough good fats. Some are even eating too few calories. If weight is an issue, work with a functionally trained practitioner to help overcome this condition that leads to chronic health conditions.

of main hormones can affect optimal health. Making sure that your adrenal glands, thyroid and sex hormones are functioning well is an important step in achieving optimal health. Make your next New Year’s resolution one that will have a healthy, positive and lasting change in your life and your lifestyle. Find a functionally trained practitioner to help you navigate your way to optimal wellness. Go to The Institute for Functional Medicine (functionalmedicine.org) for a list of trained practitioners in your area. Kay Jennings, BSN, MSHSA, MSN, APRN-PMH, owns and operates Aleph p.c. and New Health in Missoula. She has post graduate training in integrative functional medicine, obesity medicine and psychiatry and specializes in insomnia, mood, weight loss, fatigue and life style medicine. Jennings has compounded an all-natural sleep formula “New Sleep” that is now available for retail sale through wellnessmt.com, and is at work compounding an oxidative stress formula (to be released for retail sale in the near future). She is also a Certified HeartMath Practitioner. To learn more, call 406-721-2537.

Increased activity – simplified

Fitness is another pillar of health that needs to be addressed by anyone desiring optimal health. Recommendations now are for High Intensity Interval Training (HIIT) three times per week and daily walking or activity for brain and heart health. HIIT can be effective no matter what age or condition you are currently in. However, you should consult with a trained professional if you are unsure of how to do this. Getting outdoors snowshoeing, skiing, walking, running, gardening and hiking are all great for the brain and for the heart. Do it with a friend and you will improve your mental health as well.

Build a healthy nervous system

A healthy nervous system is critical to an optimal life. To have a healthy nervous system, one must have a healthy gut that is able to process vitamins and minerals and transport necessary nutrients to the cell. All of our neurotransmitters need either macro or micronutrients to thrive. So eating a colorful, rich diet helps the brain. Stress impacts the brain and must be attended to by various ways. Yoga, meditation, prayer, intimacy and social connectedness all help to reduce stress.

Test, don’t guess, for hormone balance

Finally, hormones must be balanced. Test, don’t guess, how your hormones are working if you have a health concern. Too much or too little of any of the hundreds January/February 2017 ~ living well

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Want to avoid surgery for joint pain? Pro athletes, others try PRP and stem cell injections KAREN GARLOCH Charlotte Observer CHARLOTTE, N.C. – It’s been 18 years since Bernie Zeledon injured his knee while playing soccer with his kids. His doctor recommended surgery, but Zeledon didn’t want to risk infection or face a long recovery. So, he put up with the pain, took ibuprofen several times a week, and walked around “like a little old man.” But in July, Zeledon, now 60, read about a new clinic in Charlotte, iOrthoBiologix. It offers non-surgical therapies for joint pain, including injections of platelet-rich plasma, derived from a person’s own blood to promote healing of tendon and muscle injuries and arthritis. Zeledon knew the treatment was popular with professional athletes, such as Tiger Woods, Kobe Bryant and Peyton Manning. So, he called for a free consultation. Two days later, Dr. Jason Tucker treated both his knees on the same day. And two weeks later, the swelling around Zeledon’s knees was down, he walked steadily with braces, and felt no pain. Platelet-rich plasma therapy, known as PRP, first gained widespread attention in 2009 when players for the Pittsburgh Steelers – Hines Ward with a sprained knee ligament and Troy Polamalu with a strained calf – had the injections, recovered quickly and went on to play in the Super Bowl. That news led to demand from weekend warriors. And sports medicine doctors obliged, even though research to support the therapy was still thin. In Charlotte, a few orthopedic practitioners, who offered PRP even before that Steelers moment, have been low-key about it, careful not to over-promise on results. But in the past year and a half, PRP — and a newer injection therapy using stem cells – have taken on a higher profile in Charlotte. New providers are marketing “regenerative” or “bio-restorative” medicine as an alternative to joint replacement surgery. Flexogenix opened a SouthPark clinic, one of three clinics in North Carolina, in January/February 2017 ~ living well

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August 2015. Its full-page ad in the Observer says “regenerative therapy can stimulate new cell growth, regenerate new cartilage and accelerate the body’s natural process to rebuild tissue and heal itself.” iOrthoBiologix, which opened this summer in Ballantyne, was featured in a recent Men’s Health magazine about the benefits of stem cell therapy: “The idea is that you’re giving your own body more healing potential by using your own restorative stem cells and growth factors.” Atlas Integrated Healthcare, a chiropractic clinic in Matthews, touts owner Michael Schmitt’s “miraculous recovery” from knee pain after stem cell injections. Its full-page ad says the procedure “can literally repair and regenerate tissue in the body that has been damaged by age, disease or degeneration.” As hopeful as this sounds, these therapies remain controversial in the medical community. They are also expensive – maybe several thousand dollars per injection – and insurance does not cover them. Dr. Pat Connor, an OrthoCarolina surgeon and team physician for the Carolina Panthers, the Charlotte Knights and Joe Gibbs Racing, offers PRP to some patients. But he warns, “It’s important to balance hope versus hype.” Research in the United States and Europe has produced contradictory results. Some show symptom improvement; others show the treatment is no better than placebo. Even doctors who believe PRP and stem cell injections relieve pain disagree whether it can regenerate tissue. “The marketing gets ahead of the science,” said Dr. Scott Rodeo, an orthopedic surgeon at the Hospital for Special Surgery in New York City. “There is great potential there. But we need more data. … I’ve seen a number of disappointed patients who’ve spent a lot of money. … It may help, and it may not help.” Dr. Sean Whalen, a Flexogenix cofounder who used to work in Gastonia, North Carolina, said there is “plenty of research that supports the effectiveness of PRP alone or in combination” with other therapies. Much of the skepticism comes from “old guard” orthopedic surgeons, he said, who are threatened by change that would reduce demand for surgery. “Go back to (the introduction of) laparoscopic surgery,” Whalen said. “It was called the ‘snake oil of surgery’ at the time. Now, of course, it’s widely accepted, and it’s even the standard of care.” Tucker, the founder of iOrthoBiologix, also disputes the doubters. He’s seen positive responses in patients, and cites a long list of studies, including his own, to support the benefits of PRP and stem cell injections. “People that say there is no evidence for this,” Tucker said, “are categorically wrong.”

ALTERNATIVE TO SURGERY

Tucker’s interest in PRP stems from a high school football injury that led to three shoulder surgeries and derailed his dream of playing quarterback at Michigan State. Instead of an NFL career, he set his sights on becoming an

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orthopedic surgeon. In 2010, he learned about the emerging field of “biorestorative medicine,” which offered a less invasive, more natural alternative to surgery. Tucker switched his specialty to focus on PRP and, more recently, stem cell injection therapy. In his new Ballantyne offices, Tucker proudly shows off his lab and its central feature, the centrifuge. He draws blood or bone marrow from a patient, spins it down in the centrifuge to produce stem cells or platelet-rich plasma, full of growth factors and anti-inflammatory substances, and then injects the concentrated substance into the patient’s joint and surrounding tissues. With the centrifuge, he said, “We take out the bad and keep in the good.” Tucker said he never offers a guarantee of improvement. And even if the therapy doesn’t work, he said, the option of knee replacement surgery is still available. “You haven’t burned any bridges,” he said. At Flexogenix, Whalen said doctors offer an array of non-surgical alternatives, including traditional injections of cortisone or hyaluronic acid as well as the “more exotic” PRP and stem cell injections. Whalen said he doesn’t advise using PRP alone for osteoarthritis, commonly known as “wear-and-tear arthritis.” But he said PRP could be used in conjunction with hyaluronic acid, a substance that occurs naturally in the body and helps lubricate the joint. Combining PRP with stem cell injections is also beneficial for tendonopathy, such as tennis elbow, or partial tears of tendons, ligaments and cartilage, Whalen said. In this scenario, he likened stem cells to “grass seed” that won’t grow in the wrong environment. Adding PRP, he said, is like “adding fertilizer, sunlight and water” to help the grass grow.

CONTRADICTORY RESULTS

Elsewhere in Charlotte, OrthoCarolina, one of the nation’s largest orthopedic groups, offers PRP injections as an option for patients with joint pain – but without the marketing push of the newer clinics in the city. “I have had anecdotal success with it, but I’ve also had anecdotal failure,” said Connor, the Panthers team doctor. “I use it sparingly. … We don’t think it would hurt.” Connor said many small studies have been done on PRP for various injuries, and results are contradictory. For example, he said, one study of patients with hamstring injuries found PRP was better than physical therapy alone. Another found “absolutely no difference.” Earlier this year, researchers in the United Kingdom reviewed previous studies of patients with tennis elbow, a layman’s term for elbow pain caused by overuse of muscles. Connor said it showed “PRP had slightly better results than steroid injections, but was no better than placebo.” PRP therapy is difficult to study, Connor said, because of so many variables, such as the location of the injury in the


joint or muscle, whether the injury is acute or chronic and the quality of processing the blood and bone marrow. On the plus side, he said, PRP is safe, and “intuitively it makes a lot of sense” to use healing factors from a person’s own blood. Connor said he offers it to patients as an option, but makes sure they understand it’s in “the investigational phase of its evolution.”

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‘NEED FURTHER DATA’

Rodeo, the New York surgeon, praises the potential for PRP and uses it “on occasion,” but said he’s careful about claims of success because research data is mixed. Contrary to some claims, he said PRP injections don’t “regenerate cartilage and cure things.” He said there is little research about stem cell injections and “very little data that combining stem cells with PRP is more effective than one or the other.” Dr. Brian Halpern, a family and sports medicine physician at the Hospital for Special Surgery, said he’s withholding judgment on stem cell injections until there is more data. But he’s enthusiastic about PRP. He cited several studies showing PRP alone is helpful for osteoarthritis pain. Halpern said he got interested in PRP years ago, after becoming concerned about the long-term effects of cortisone injections. He read about veterinarians using PRP in horses and thought it made “physiologic sense.” He offered it to several patients, explaining clearly that “I don’t know if this is going work.” The first five patients were “completely cured,” he said. “That convinced me that there was something to this. “The beautiful part about this,” Halpern said, “is that your patient is healing themselves. You’re using their cells to heal them. You’re not putting a drug in there.”

‘IT FEELS GOOD’

At iOrthoBiologix in Charlotte, Zeledon returned to see Tucker two weeks after his knee injections. His joints were no longer swollen. And he no longer complained of discomfort. That met Tucker’s primary goal – “relieving pain and improving function. … With that, we frequently get tissue regeneration.” Zeledon had come to Tucker with several problems that caused his chronic pain – advanced osteoarthritis, a loose ACL and a torn meniscus. Instead of choosing between PRP and stem cell injections, Tucker did both, hoping for better results. For two days, Zeledon wasn’t allowed to put weight on his joints. Gradually, he could do more, using first crutches and then braces. Like most patients, he was back to full activity in six weeks. For the injections and two braces, Zeledon paid $6,400. None of it was covered by insurance. But he said: “It was just exactly what I was looking for.” Three months after treatment, he’s back at work in his construction business. “I have no pain,” Zeledon said. “I coached my son’s soccer game (recently). I haven’t done that in years. I ran up and down the field. It feels good.”

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Western Montana clinics see rise in demand for IUDs Story by Keila Szpaller, for Living Well Martha Stahl, president and CEO of Planned Parenthood Advocates of Montana, said the organization saw demand for IUDs, or intrauterine devices, double in December compared with the previous December. “It’s a huge increase,” Stahl said. “And even more IUCs (intrauterine contraceptives) than implants.” After the election, Planned Parenthood reported a 900 percent jump nationwide in appointments for birth control, including IUDs, compared to the previous month. In January 2017, the intrauterine devices remained a topic on Twitter, and women called for the birth control option in fear that it wouldn’t be available or affordable during President-elect Donald Trump’s administration. “Friendly reminder to get an IUD asap,” read one Tweet, from @jksharksteen. “TIME IS RUNNING OUT PEOPLE.” Most insurance plans must cover all methods of birth control, including IUDs, because of the Affordable Care Act, or Obamacare, according to Planned Parenthood. However, Trump, a Republican, isn’t a fan of the act, neither are others in his party, and early in January, lawmakers were wrangling over it in Washington, D.C. Stahl said patients fear their options will be limited, and as such, they are seeking new contraception and also replacing devices early so they have another five or 10 years of birth control. She said both men and women make smart choices about contraceptive health care, and preserving all options is important. “I think the fact that we’re seeing this increase really demonstrates how people are thinking about their reproductive choices and the fact that people really do think deeply about these things and make decisions based on where they are in their lives and what is going on in a bigger landscape,” Stahl said. 18

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At the Blue Mountain Clinic Family Practice in Missoula, executive director Annie Hansen said she’s seen an uptick in requests for IUDs and other “long acting reversible contraceptives” since the election, but not a big one since the trend has already been on the rise. “They’ve been gaining so much popularity in the last several years,” Hansen said. “So we’ve already seen high volumes of people wanting that.” She said people feel uncertain anytime a new president is about to take office, but it’s too soon to know how a new administration may affect contraception or how the Affordable Care Act might change. “Currently, a lot of insurance companies are covering birth control and wellness exams, which is wonderful,” Hansen said. At Women’s Choice of Missoula, Dr. Beverly Braak said she believes it will be difficult to do a wholesale repeal of Obamacare, but she also said she has concerns about the future. At this point, though, she agreed it’s too early to predict how coverage might change. “I think it’s just too soon after the election for us to have a whole lot of information about how this is going to affect our contraceptive practices,” said Braak. However, it’s important for people to understand their insurance coverage so they can plan, she said. Sometimes, her patients don’t know if their insurance covers birth control pills, and they might be surprised to learn it covers an IUD 100 percent. “We’re all kind of scrambling,” Braak said. “We don’t know what is going to happen. And sometimes, I think in situations like this, you don’t know what (you’ve) got until it’s gone. Once they start losing the privilege that they’ve got now, then they’ll start awakening.”


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Living Well Jan/Feb 2017