Download Enclosed you will find information on the practice and a list of

 Enclosed you will find information on the practice and a list of policies and services offered, as well as other frequently asked questions. Page 1: Table on Contents Page 2: Welcome to Our Practice Page 3: Office Visits/Child Policy Page 4: Office Visits/Policies cont. Page 5: Billing Information Page 6: Patient Rights and Responsibilities Page 7: Useful Web Links Page 8: Services Offered Page 9: Essure Page 10: Nexplanon Page 11: IUDs Page 12: IUDs cont. Page 13: LEEP Procedure Page 14: LEEP cont. Page 15: Da Vinci Surgery: Hysterectomy Page 16: Da Vinci Surgery: Endometriosis Page 17: Endometriosis cont. Page 18: Da Vinci Surgery: Uterine Fibroids Page 19: Uterine Fibroids cont. Page 20: Novasure Page 21: Novasure cont. 1 Dear Valued Patient: Thank you for choosing Clarksville OB-­‐GYN Associates! Our goal is to provide you with the best quality of medical care and service as a patient with us for your gynecologic needs. Clarksville OB-­‐GYN Associates has four obstetricians/gynecologists and two nurse practitioners. You have chosen or been assigned to one doctor who will follow your care, answer your questions, examine you and order tests. You can take comfort in knowing that your doctor will come to know you very well, because he or she will be seeing you for most of your visits. However, in the event that your doctor is not available at your requested date and time, we will schedule you with one of our great nurse practitioners that assist in your care. Gynecology refers to the surgical specialty dealing with the health of the female reproductive system (uterus, vagina and ovaries). Literally, outside medicine, it means “the science of women”. We encourage you to ask questions, share your concerns (and your joys) and take comfort in knowing that you will receive compassionate, high-­‐quality care from our doctors and staff. If you have routine questions, please call us during normal business hours and a medical assistant will be happy to assist you. Our regular office hours are Monday-­‐Thursday 7:30-­‐7:30 and Friday, 7:30-­‐5:00. Welcome to Clarksville OB/GYN Associates – The Physicians and Staff 2 Out of necessity, our doctors must work by appointment. This gives them the opportunity to allocate their time and proves to be more convenient for the patient. Appointments are made during business hours, Monday through Thursday 7:30 AM-­‐ 7:30 PM and Friday 7:30 AM-­‐5:00 PM. We suggest you make your appointments at least one month in advance. Your family members are welcome to come with you to your visits, however no more than two visitors can be accommodated in the exam room. A sincere attempt is made to adhere to the schedule, though emergencies can happen at any time. Should a situation arise where immediate treatment is necessary, please call our office. Every effort will be made to have you seen at the earliest possible time. If you experience a wait longer than 15 minutes while in the office, please feel free to check in with us. We try our best to keep your wait times at bay, but every patient’s needs are different and this could result in a longer appointment time. We ask that if you are unable to keep an appointment, please call to cancel/reschedule. Someone else will be able to use the time we had reserved for you. If you cannot keep an appointment, we require a 24-­‐hour advance notice. If a patient does not cancel and does not show for her appointment, there will be a $25.00 fee. To reschedule an appointment in the evening clinic, select option 4 when calling after 5:00PM. This courtesy on your part makes it possible for other patients to be seen. If we need to reschedule your appointment due to an unexpected medical emergency, you will be contacted as soon as possible. We practice together for your benefit. While it is impossible for one physician to be available 24 hours a day, seven days a week, it is possible for us, in a joint practice, to give you this type of coverage. We feel we can assure you that one of us will always be available to assist you. Child Policy It is office policy that children under the age of 12 are not brought to the office due to possible infectious illnesses. This is the recommendation of The Center for Disease Control (CDC) and the American Congress of OB-­‐GYN (ACOG). It is for the protection of our pregnant mothers and their unborn children. Many children exposed to communicable diseases do not show any symptoms for up to two weeks after exposure, and their exposure to our pregnant mothers could be a health threat to them and/or their unborn child. For this reason, we appreciate your cooperation in the policy. If this presents a problem or hardship on your scheduled appointment day, we ask that you reschedule your appointment at a more convenient time when child care is available. 3 Office Visits/Policies continued-­‐ Fees The responsibility for payment of fees is a direct obligation of the patient. Please make payment at the time of service, unless you are insured with a company for which we are a Participating Provider. In this case, we will file with your insurance for the visit. If surgery is needed you will need to make financial arrangements prior to the surgery with a billing representative. She will help with the pre-­‐certification for your surgery and answer your questions. Any fee for surgery quoted by our office is an estimate and it should be understood that the fee could increase if complications occur. Insurance We will make every effort to work with you and your insurer to maximize your health care benefits. Please notify us immediately of any changes in your insurance coverage or carrier. To avoid problems and expedite the services, please be aware that you are responsible for knowing your benefits, including co-­‐payment, co-­‐insurance levels, requirement for specialist referrals and any benefit exclusions. Patients are responsible for co-­‐payments at the time of service. Your insurance company’s Customer Service Department can help answer any additional coverage questions. The phone number is typically located on the back of your insurance card. *Please bring your insurance card with you for each visit. If your insurance company requires specialist referrals, please have a valid referral for your visit to our office. If you do not have a valid referral at the time of your appointment, you may contact your primary care physician to arrange for the referral. Telephone Availability We try to be available to you at all times, but request that you call during our normal business hours unless it is an emergency. During business hours, the medical assistants will return your calls as soon as possible. If you call after hours, choose option 7 and you will be able to leave a message for the night nurse in case of emergency. Choose option 7 when calling after hours to reach the night nurse. We are prompt about returing after hours calls, however, if you do not get a call within 30 minutes, please call again. In the rare event of an answering service equipment failure, call Gateway Medical Center’s Labor and Delivery unit at 931-­‐502-­‐3200. They will be able to reach the doctor on call. As always, in case of a medical emergency, call 911 Tennova Healthcare – Clarksville (formerly known as Gateway Medical Center) 651 Dunlop Lane Clarksville, TN 37040 Telephone: 931-­‐502-­‐1000/931-­‐502-­‐3200 (Labor & Delivery) 4 You may also be referred by your physician to one of the following: Quest Labs AEL Labs 751 Chesapeake Lane 781 Weatherly Drive #B Suite 103 Clarksville, TN 37043 Clarksville, TN 37040 Lab Corp 311 Landrum Place Suite 300A Clarksville, TN 37043 It is our intention to provide and fully explain all financial policies and arrangements. Clarksville OB-­‐GYN Associates accepts most insurance plans and will bill all insurance companies with whom we participate. If you have questions about your coverage, referrals, co-­‐pays, etc., please contact our billing department. If your insurance provider has a special form for deliveries, you will need to provide us with the completed form as soon as possible. Your insurance will be billed at the time of your delivery. If you do not have insurance, you may be eligible for Tennessee’s state program, TNCARE. The Health Department will be able to assist you in processing that application. Hospital care, anesthesia, ultrasounds and lab charges will be billed separately by those providers. To inquire about insurance coverage or cost for these services, contact your insurance provider or Tennova Healthcare – Clarksville (formerly known as Gateway Medical Center) billing office (931-­‐502-­‐1000). Costs will vary depending on the type of delivery you have.
5 v The patient has the right to a reasonable response to her requests and needs for treatment of service within the healthcare providers capacity, stated mission and applicable regulations. v The patient has the right to considerate, compassionate and respectful care that recognizes her personal values and belief systems. v The patient has the right in collaboration with her healthcare provider to make decisions involving her healthcare, including the right to accept medical cre, or refuse treatment and to be informed of the medical consequences of such refusal. v The patient has the right to information necessary to enable her to make treatment decisions that reflect her wishes and participate in the consideration of ethitcal decisions that arise in her care. v The patient has the right to be informed of any human experimentation or other research/educational projects affecting her care or treatment. v The patient has the right to personal privacy and confidentiality of information. v The patient is entitled to have privacy during examination, to have visitors excused and to be informed why any observer is presant and to grant or refuse another person’s presence. v The patient’s guardian, next of kin or legally authorized responsible person, has the right to exercise certain rights on the behalf of the patient. v The patient has the right to expect explanation of any portion of the bill. Where appropriate, the billing office staff will assist the patient in making arrangements for payment of the bill through a payment schedule or assistance program. v The patient has the responsibility to provide a complete and accurate medical history to the best of her knowledge. v The patient has the responsibility to ask questions and seek clarification about her diagnosis and treatment and participate in decisions involving her care. v The patient has the responsibility to make it known whether a proposed course of treatment is understood, and whether she is willing and able to comply. v The patient has the responsibility to provide information about complications or symptoms. v The patient has the responsibility to be considerate of the rights of other patients and clinical personnell, and to treat them with respect. v The patient has the responsibility to follow the office policies set in place by Clarksville OB-­‐GYN to ensure the best possible care for herself and the other patients of the practice. 6 American Academy of Pediatrics http://www.aap.org/topics.html American College of Obstetrics and Gynecology (ACOG) patient information http://www.acog.org/publications/patient_education ACOG Exercise During Pregnancy http://www.acog.org/publications/patient_education/bp119.cfm Babycenter.com – products and services for expectant and new mothers http://www.babycenter.com Babynamer.com – will help you find the perfect names http://babynamer.com Breastfeeding.com – Information and support http://www.breastfeeding.com Centers for Disease Control and Prevention – Prenancy Information http://www.cdc.gov/ncbddd/pregnancy_gateway Child Safety Seats – National Highway Transportation Safety Administration http://www.nhtsa.gov/portal/site/nhtsa H1N1 Flu (Swine Fle): Resources for Pregnant Women http: http://www.cdc.gov/h1n1flu/pregnancy Diapers.com – free shipping and coupons on baby items http://www.diapers.com Mayo Clinic – Pregnancy Week by Week http://www.mayoclinic.com/health/pregnancy-­‐week-­‐by-­‐week/MY00331 Morning Sickness http://www.femalepatient.com/pdf/pat_0309.pdf Pregnancy Information Library http://www.femalepatient.com Womenshealth.gov – The federal government surce for Women’s Health Information (Spanish) http://www.womenshealth.gov/pregnancy http://womenshealth.gov/espanol/elembarazo Ethicon Women’s Health & Urology – http://www.smarterpatient.com/patients/health-­‐topics/womens-­‐
health?utm_source=redirects&utm_medium=pelvichealthsolutions.com&utm_campaign=301_redirects HOSPITAL Tennova Healthcare – Clarksville (formerly known as Gateway Medical Center) http://www.tennovamiddle.com/ If you need help obtaining healthy food and health care for you and your child, contact: U.S. Department of Agriculture Food Stamps Program http://www.fns.usda.gov/fsp Women, Infants and Children Program (WIC) http://www.fns.usda.gov/wic 7 v Infertility-­‐ Primarily refers to the biological inability to contribute to conception. Infertility may v
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also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention. Cervical Dysplasia Treatment-­‐ Treatment of a medical condition of the cervix in which cells on the surface of the cervix undergo a potentially premalignant transformation. This abnormal growth (dysplasia) may lead to the development of cervical cancer if left untreated. Colposcopy-­‐ A “colpo” is a way for your doctor to use a special magnifying device to look at your vulva, vagina and cervix. If a problem is seen during this time, a small sample of tissue (biopsy) may be taken from the cervix or from inside the opening of the cervix. LEEP (Loop Electrosurgical Excision Procedure) -­‐ The LEEP procedure is an effective and simple way to treat dysplasia. LEEP uses a thin wire loop that acts like a scalpel, and an electric current is passed through the loop, which cuts away a thin layer of the surface cells. Endometrial Ablation-­‐ NovaSure-­‐A medical procedure that is used to remove (ablate) or destroy the endometrial lining of a woman’s uterus. NovaSure Endometrial Ablation is the simple, one-­‐time, five-­‐minute procedure that removes the uterine lining, while preserving the uterus to reduce or eliminate bleeding. NovaSure is for premenopausal women with heavy periods due to benign causes who are finished child bearing. Ultrasound-­‐ Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. The most well-­‐known application of this technique is its use in sonography to produce pictures of fetuses in the human womb. Essure-­‐ Essure is a permanent sterilization procedure for women. An Essure procedure involves inserting tiny micro-­‐insert coils into the fallopian tubes which cause natural tissue in-­‐growth that block the tubes permanently. IUDs-­‐ We offer a variety of IUDs or Intra-­‐Uterine Devices as an effective form of birth control. These include the Mirena (up to 5 years protection), the Skyla (up to 3 years protection) and the Paragard (up to 10 years protection). Nexplanon-­‐ The Nexplanon is a hormone-­‐releasing birth control implant that is placed under the skin in your inner, upper arm. Da Vinci Robot Surgeons-­‐ The Da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including high-­‐definition 3D vision and a magnified view. The Da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. The Da Vinci system has been used successfully worldwide in hundreds of thousands of procedures to date. It can be used for hysterectomies, treating endometriosis and treatment of uterine fibroids. 8 Surgery-­‐free, hormone-­‐free and worry-­‐free, the Essure is for women who are ready for a permanent form of birth control, without the costs in time and in money of a typical sterilization procedure. The Essure is a simple procedure performed in your doctor’s office in less than 10 minutes. It’s hormone free, making it a more natural birth control method. There’s no slowing down to recover, since there’s no use of anesthesia and most women return to normal activities in less than a day. What makes Essure the most effective? The shape: The small, soft Essure inserts are designed to slide easily into each fallopian tube. The material: The Essure inserts are made from the same trusted, silicone-­‐free material used in heart stents. The material is flexible, so it conforms to the shape of your fallopian tubes. The Essure is placed in three simple steps: Step 1: The Procedure-­‐ An Essure-­‐certified doctor places a soft, flexible insert into each of your fallopian tubes through the natural pathways of your vagina and cervix. There is no incision necessary. The tip of each insert remains visible to your doctor, so proper placement can be confirmed. Step 2: The Barrier-­‐ Over the next three months, your body works with the Essure inserts to form a natural barrier against pregnancy. This barrier prevents sperm from reaching your eggs, so pregnancy cannot occur. You must continue to use another form of birth control during this three-­‐month period. Step 3: The Confirmation-­‐ After three months you’ll have an Essure Confirmation Test. A special dye is introduced into your uterus and viewed on an x-­‐ray so your doctor can confirm that the inserts are in place and your fallopian tubes are fully blocked. Once you receive verification from your doctor, you can start relying on Essure for birth control. Can I trust the Essure procedure? Yes! Essure is 99.8% effective based on four years of clinical data. That’s higher than any other permanent birth control. Is the procedure painful? Generally, no. Some women report mild discomfort or cramping during or after the procedure, similar to what they feel during their normal monthly cycle. Will I still have a period? Yes. Some women report slightly lighter or heavier bleeding than usual, but these changes might be in the result of discontinuing hormone-­‐based birth control and returning to your normal cycle. Is Essure easily reversible? No. Like all permanent birth control, Essure should not be considered reversible. Before choosing Essure, you should be sure your family is complete. 9 The Nexplanon gives you up to 3 years of continuous pregnancy prevention* It is a hormone-­‐releasing, estrogen-­‐free birth control implant that is placed under the skin in your inner, upper arm. When the Nexplanon implant is placed correctly, your chance of getting pregnant is very low (less than 1 pregnancy per 100 women who use Nexplanon for 1 year). Nexplanon is placed in just one simple step: Step 1: The procedure-­‐ The Nexplanon is placed in your arm by a trained health care provider. During the process, your skin is numbed in that area. The applicator guides Nexplanon under the skin of your arm. This minor surgical procedure is done in office. Once the implant is placed, you and your health care provider should check that it is in your arm by feeling for it. You’ll need to keep track of the date of the implant so you are aware when it needs to be removed. The Nexplanon can be removed anytime during its 3 year period. Removal of Nexplanon: Removal of Nexplanon involves a minor surgical procedure in which your health care provider makes a small incision in your arm when it is located. What risks are possible with insertions and removal? The most common problems noted with insertion and/or removal includes; pain at the insertion site, irritation, swelling or bruising. Scarring, including a thick scar called a keloid around the insertion site have also been noted. In some cases, the implant may need to be removed surgically if the implant is not where it is supposed to be. How effective is the Essure? Nexplanon is 99% effective and works just as well as the pill. Is the procedure painful? You should not feel any pain during the procedure, as the area is numbed. You may experience some pain or swelling after the numbness has worn off. Will I still have a period? You may have longer or shorter bleeding during your period, no bleeding at all during the time of your period, spotting between your periods or varied amounts of time between your periods. What if I change my mind about birth control and want to stop using Nexplanon? Your health care provider can remove the implant at any time. You may become pregnant as early as the first week after removal of the implant. If you do not want to get pregnant after the removal of the Nexplanon, you should start another birth control method right away. *Nexplanon must be removed by the end of the third year and may be replaced by a new Nexplanon at the time of removal, if continued contraceptive protection is desired. 10 The Mirena and the Skyla are a hormone-­‐releasing IUD (intrauterine device), while the Paragard is 100% hormone free. The IUDs are placed in your uterus to prevent pregnancy for as long as you want for up to 10 years (depending on your IUD choice). IUDs are also used to treat heavy periods in women who choose intrauterine contraception. What makes an IUD effective? IUDs are FDA-­‐approved. The Mirena and the Skyla are made of soft, flexible plastic, while the Paragard is copper. Getting an IUD is nonsurgical and placement typically takes just a few minutes during a routine office visit. Why should you consider an IUD? IUDs are: v Highly effective – one of the most effective birth control methods on the market. v Convenient – No daily pills and no monthly refills. It lasts for as long as you want it to, for up to 3 (Skyla), 5 (Mirena) or 10 (Paragard) years. The timeframe is up to you. v Reversible – You can have the IUD removed by your healthcare provider at any time, and try to become pregnant right away. v Approved to treat heavy periods – The Mirena is the first and only birth control that’s FDA-­‐
approved to treat heavy periods in women who choose the IUD method. Placing an IUD is simple and is done in a just a few short steps. -­‐The Mirena, Skyla or Paragard are placed in the uterus, not the vagina, so neither you nor your partner should be able to feel it during intercourse. Sometimes your partner may feel the threads. If this occurs, your healthcare provider may be able to help. -­‐Once the IUD is placed, you should do a monthly self-­‐check to ensure your IUD is in place. Your healthcare provider can show you how to do this. How does the IUD work to prevent pregnancy? This diagram helpfully explains the processes the IUDs use to prevent pregnancy. Mirena/Skyla/Paragard Two thin threads attached to the stem of the IUD are the only part you should be able to feel. Inhibits sperm from reaching/fertilizing egg, thins uterine lining and thickens cervical mucus to prevent sperm from entering u terus. 11 Will I still have a period? With an IUD, your periods may change. For the first 3 to 6 months, your monthly period may increase. You may also experience frequent spotting or light bleeding especially in the first 3 to 6 months. A few women report heavy bleeding during this time. After your body adjusts, the number of bleeding and spotting days is likely to decrease, but may remain irregular, and you may even find that with the Mirena and Skyla, that your periods stop altogether for as long as your IUD is in place. This may occur because the hormone in the Mirena & Skyla reduces the monthly thickening of your uterine lining, which can mean lighter or no periods. Typically, after one year of Mirena use, 20% of users report no period at all and 6% of Skyla users report no period after one year of use. What are some common side effects with getting an IUD? Some women may experience cramping or pain, bleeding and/or dizziness during and after the IUD is placed. To help minimize the cramps, ask your healthcare provider about over-­‐the-­‐
counter pain medications. If these symptoms do not stop within 30 minutes, contact your healthcare provider. Will I feel the IUD inside me? No. Unlike many other forms of birth control, an IUD doesn’t interfere with sexual spontaneity. You should not be able to feel your IUD once it’s placed and your partner shouldn’t feel it during intercourse. 12 Cells on the cervix grow and shed continuously. Sometimes these cells change and become abnormal. This may be an early warning that cancer may occur. When tests show that you have abnormal cells on your cervix, your doctor may suggest the loop electrosurgical excision procedure (LEEP). LEEP is used to remove the abnormal cells from your cervix. The Cervix The cervix is covered by a thin layer of tissue like your skin. The cells that make up this tissue grow all the time. During this growth, the cells at the bottom layer slowly move to the surface of the cervix. When these cells reach the surface, they are shed as a normal process. When this normal process is changed in some way, cells become abnormal. This condition is known as dysplasia. In mild forms, this condition may go away on its own. It if is severe or does not go away, it may lead to cancer of the cervix. Other factors such as smoking and being exposed to STIs also increase the risk of cancer. A simple pap test can detect changes in the cervix. Treating Dysplasia-­‐ Abnormal cells can be removed with LEEP. This allows new healthy cells to grow. LEEP is just one way to treat dysplasia. Dysplasia can also be treated with other procedures such as cryosurgery, electrocautery, laser or cone biopsy. The decision of which method to use depends on how much cervical tissue needs to be removed and where on the cervix the abnormal cells are located. When normal cervical cells become abnormal, it is known as dysplasia. When dysplasia is severe, it may lead to cancer. 13 How is the LEEP done? LEEP uses a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the surface cells. The procedure should be done when you’re not having your menstrual period. This allows a better view of the cervix. In most cases, LEEP is done in a doctor’s office on an outpatient basis and should only take a few minutes. You may be given pain relief before the doctor begins. A solution is applied to your cervix to show the abnormal cells. Colposcopy will be used to magnify the cervix during the surgery. Your cervix will be numbed with a local anesthesia that is given through a needle attached to a syringe. You may feel a dull ache or cramp during the procedure. The loop is then inserted through the vagina to the cervix. There are different sizes and shapes of loops that can be used. After the procedure, a special paste may be applied to your cervix to stop any bleeding. The tissue that is removed will be sent to pathology to confirm the diagnosis. What is the recovery time? It may take a few weeks for your cervix to heal. While your cervix heals, you may have: v Vaginal bleeding (less than a normal menstrual flow) v Mild cramping v A brownish-­‐black discharge (from the paste used) For a few weeks after the procedure, you should not have sex or use tampons or douches. If you have any discomfort, your doctor may prescribe pain relief. After the procedure, you will need to see your doctor for follow-­‐up visits during the year. At these visits, your doctor will check the health of your cervix. After 1 year of normal results, you may return to having exams once a year. If you have another abnormal Pap test, you may need more treatment. 14 If your doctor recommends hysterectomy, you may be a candidate for minimally invasive da Vinci Hysterectomy. Using a state-­‐of-­‐the-­‐art technology, da Vinci Hysterectomy requires only a few tiny incisions so you can get back to your life. Da Vinci enables surgeons to perform this delicate operation with enhanced vision, precision, dexterity and control. Common benign (non-­‐cancerous) gynecologic conditions like fibroids (growths in and/or around the uterus), endometriosis (uterine lining growing outside the uterus), adenomyosis (uterine lining grows into the wall of the uterus) or pelvic prolapse (slipping of the uterus, vagina and/or bladder) can cause pain, heavy bleeding and other mild to severe symptoms. Women who experience severe symptoms are often treated with hysterectomy – the surgical removal of the uterus. The da Vinci surgery is a highly effective, minimally invasive surgical procedure. If your doctor recommends a hysterectomy, you may be a candidate for use of this technology. Da Vinci Hysterectomy offers women many potential benefits over traditional open surgery and traditional laparoscopy including: v
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Less blood loss Fewer complications Shorter hospital stay Minimal scarring Lower conversion rate to open surgery Less need for a pain narcotic Note: As with any surgery, these benefits cannot be Open S urgery Da V
inci H ysterectomy guaranteed since surgery is unique to each patient and incision Incisions procedure. The enabling Technology: da Vinci Surgical System The da Vinci surgical system is designed to provide surgeons with enhanced capabilities, including high-­‐
definition 3D vision and a magnified view. Though it is often called a “robot”, da Vinci cannot act on its own. The surgery is performed entirely by your doctor. He or she controls the da Vinci system, which translates all hand movements into smaller, more precise movements of tiny instruments inside your body. Together, da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. As a result, you can get back to your life without the usual recovery following major surgery. The da Vinci system has been used successfully worldwide in hundreds of thousands of procedures to date. 15 Endometriosis is a condition in which the tissue that lines the uterus – the endometrium – also grows outside the uterus. This tissue, called implants or lesions, is found most often in the pelvic area, but it rare cases, develops in other parts of the body. Normally, the endometrium sheds each month during a woman’s period, but implants stay in place. Endometriosis is usually diagnosed between ages 25 to 35 but can occur anytime during a woman’s reproductive years – menstruation through menopause. Endometriosis is very common, affecting five percent of the female population of reproductive age. Family history plays an important role; a woman who has a mother or sister with endometriosis is six times more likely to develop the condition. Many women have no symptoms, but for others, endometrial implants can cause irregular bleeding, infertility and pain. Mild to severe pain is the most common symptom, which may include pain during periods, intercourse and bowel movements, and in pain in the lower back or abdomen. The treatment: Endometriosis Resection: Depending on how severe the symptoms are, treatment options for endometriosis may include lifestyle changes, medication to control pain, medication to control endometriosis growth or surgery. For women suffering from severe symptoms, there are two surgical options to treat endometriosis. Endometriosis resection involves removing all visible implants while leaving the uterus and other organs in place. Endometriosis resection is usually recommended for women who are not planning a future pregnancy. Resection can be performed using traditional open surgery or laparoscopy. Fortunately, there is a minimally invasive treatment for endometriosis that requires just a few tiny incisions, designed to overcome the limits of both open and tradtional laparoscopic surgery. Open surgery incision Da Vinci Endometriosis Resection Incisions 16 If your doctor recommends surgery to treat endometriosis and its symptoms, you may be a candidate for minimally invasive da Vinci Endometriosis Resection. The enhanced vision, precision, dexterity and control of the da Vinci system allows your surgeon to perform a more thorough removal of deeply penetrated or widespread endometrial implants. Da Vinci offers patients many potential benefits over traditional laparoscopy, including: v
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Low blood loss Low conversation rate to open surgery Low rate of complications Short hospital stay Minimal scarring Note: Every surgery is unique to each patient and procedure, therefore results cannot be guaranteed. The Enabling Technology: da Vinci Surgical System The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including HD-­‐3D vision and a magnified view. Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. Though it is often called a “robot”, da Vinci cannot act on its own – the surgery is performed entirely by your doctor. Together, da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. As a result, you may be able to get back to life without the usual recovery following major surgery. The da Vinci system has been used successfully worldwide in hundreds of thousands of procedures to date. 17 A uterine fibroid is a common type of benign (non-­‐cancerous) tumor that can grow inside and also outside the uterus. Uterine fibroids are most common in women ages 30 to 40, but can occur at any age. An estimated 20 to 80% of women develop fibroids by age 50. Uterine fibroids are the most common reason a hysterectomy is performed. Uterine fibroids may grow as a single tumor or in clusters. They often increase in size and frequency with age, but may shrink after menopause. Not all women experience symptoms due to fibroids. When symptoms are present, they may include excessive menstrual bleeding, pelvic pain, frequent urination and difficulty getting pregnant. Uterus is shown with five types of fibroids tumors. The tumors are named for their location relative to the uterine wall. The Treatment: Myomectomy Surgery Myomectomy is a common alternative to hysterectomy for treating fibroids. Myomectomy surgically removes fibroid tumors while leaving the uterus in place. Myomectomy is often recommended and considered the standard of care for women who want to become pregnant or keep their uterus for other reasons. Myomectomy is often performed using traditional open surgery, meaning a large incision is made in the lower abdomen. The da Vinci myomectomy is a highly effective, minimally invasive replacement surgery to the open surgery. If your doctor recommends surgery to treat uterine fibroids, you may a candidate for the da Vinci Myomectomy. 18 The da Vinci Myomectomy Surgery: Using state-­‐of-­‐the-­‐art technology, da Vinci Myomectomy requires only a few tiny incisions so you can get back to your life. Da Vinci enables surgeons to perform this delicate operation with superior vision precision, dexterity and control. Da Vinci Myomectomy offers many potential benefits over traditional open surgery, including: v
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Less blood loss Short hospital stay Less narcotic pain medicine required Small incisions for minimal scarring When compared to traditional laparoscopic surgery, da Vinci offers women the following potential benefits: v Greater likelihood your surgeon can remove heavier fibroids v Fewer complications during surgery The Enabling Technology: da Vinci Surgical System The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including high-­‐definition 3D vision and a magnified view. Though it is often called a “robot”, da Vinci cannot act on its own. The surgery is performed entirely by your doctor. He or she controls the da Vinci System, which translates all hand movements into smaller, more precise movements of tiny instruments inside your body. Together, da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. As a result, you may be able to get back to life without the usual recovery following major surgery. The da Vinci system has been used successfully worldwide in hundreds of thousands of procedures to date. 19 NovaSure Endometrial Ablation (EA) is the simple, one-­‐time, five-­‐minute procedure that has treated over one million women – without hormones, pills or hysterectomy. NovaSure is for premenopausal women with heavy periods due to benign causes who are finished childbearing. For 90% of women, menstrual bleeding is dramatically reduced or stopped. Pregnancy following NovaSure can be dangerous. NovaSure is not a sterilization procedure and not for women who may be pregnant. Do heavy periods affect your life? It is estimated that heavy menstrual bleeding affects 1 out of every 5 women – that’s about 10 million women. Many women begin to experience heavy and/or irregular bleeding in the 30s and 40s, as they begin to get closer to menopause. Heavy periods can take a physical, social, and emotional toll as well. Studies even show that heavy periods mean more than heavy bleeding. They can affect women in a number of ways: v
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Many feel tired and nauseated Many experience bad cramps Many have headaches More than 60% have had to miss social or athletic events About 80% report avoiding intercourse About 33% have been forced to miss work Around 77% have depression or moodiness 75% feel anxious 57% report a lack in confidence during their period If this sounds like you, NovaSure might be the right choice for you. How does NovaSure work? NovaSure works by permanently removing the endometrium, or the lining of the uterus (the part that causes the bleeding), with a quick delivery of radio frequency energy. 20 Are women satisfied with the NovaSure procedure? In a clinical study, twelve months after the NovaSure, 95% of patients were satisfied with the results and 97% said they would recommend NovaSure to a friend. What can I expect after the NovaSure procedure? Immediately after the NovaSure, some women report cramping, mild pain, nausea and/or vomiting. Most women feel back to themselves and can resume normal activities within a day or so. Most women who have had the NovaSure procedure have lighter periods or no periods afterwards. In a clinical study, 9 out of 10 women returned to normal or lighter periods and 4 out of 10 stopped bleeding altogether. Most women even report better moods, energy levels and a boost in self-­‐confidence. Many also had a significant reduction in painful periods and PMS symptoms like irritability. When will I know what my periods will be like after the NovaSure? Every woman is different, but plan to give your body about 3 months to fully heal on the inside and resume its normal cycle. Then, you and your doctor should be able to tell what your cycle and your periods will be like from that point on. 21