Education References

LAB DRAW INFORMATION

FASTING LAB TESTS:

CHOLESTEROL   (LIPIDS, NMR)                                                                                            DIABETES  (fasting sugar, insulin)                                                                                                   8-12 hour fast.  Water or Black coffee are okay to drink.                                                You should drink 2-3, 8 oz of water before you get your                                                         labs drawn so your not dehydrated.                                                                                      

Thyroid Lab Testing:

NO FASTING REQUIRED                                                                                                             It is okay to take your thyroid medication on the same day as your blood Draw.       Anytime there is a change in your Thyroid  medication, levels should be                 re-checked 8-12 weeks after you start the new dose.

Hormone Lab Testing: 

  • NO FASTING REQUIRED

  • Progesterone, Testosterone, Estradiol, Prolactin, DHEA

  • If your are still having periods it is best to check between days 19-22 of your cycle ( Day 1 is the 1st day of your period)

  • If no periods, Hysterectomy or IUD can be checked at anytime.

  • If taking hormones of any kind should be checked 8-12 hours after last dose but no more than 24 hours.

Cardiac Information

What is an NMR??

The NMR (Nuclear Magnetic Resonance) Lipoprofile is a cholesterol test which provides more information than a standard Lipid Panel. This test includes measurements for Total Cholesterol, LDL, HDL, Triglycerides, Insulin Markers, Lipoprotein Particle Number and Size, and Lipoprotein Sub fractions.                                                   ***  FASTING 8 hrs REQUIRED                                                                                         

Here is a good reference for more information about: Smart Cars vs Buses                                NMR Lipo Profile

Cardiac CT Calcium Score

Mountain Medical 5323 So. Woodrow Street, Ste. 100 Murray, Utah 84107 (801) 713-0600

***NO ORDER IS NEEDED JUST CALL TO SCHEDULE AN APPOINTMENT

CardioRisk Laboratories

9677 South 700 East, Suite A                Sandy, Utah  84070                                       (801) 855-6775                                                                                                                                                                                           CardioRisk website  has some great information on what a CarotidArtery Scan is.                                                http://www.cardiorisk.us/cimt/                                                                                                                                                                                                                                        

THYROID THERAPY

Conditions Associated with Hypothyroidism:                                                                                       - Hypertension                                                                                                                                         - Angina (chest pain), Atherosclerosis                                                                                             - Elevated Cholesterol levels                                                                                                               - Irregular menstrual cycles. Infertility                                                                                             - PMS, fibrocystic breast disease                                                                                                       - Hypoglycemia                                                                                                                                       - Psoriasis, Urticaria                                                                                                                               - Allergies, Asthma, Rhinitis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

Signs & Symptoms Associated with Hypothyroidism:                                                                          - Fatigue (morning)                                                                                                                                - Weakness                                                                                                                                                - Constipation                                                                                                                                          - Weight gain                                                                                                                                             - Cold Extremities, Intolerance to cold                                                                                           - Edema around ankles or below eyes                                                                                           - Muscle aches, headaches                                                                                                                 - Depression                                                                                                                                             -Poor concentration, Memory loss                                                                                                   - Hoarseness                                                                                                                                             - Dry, rough skin, Follicular Hyperkeratosis                                                                                   - Orange tint to palms and soles, pallor                                                                                         - Dry, thinning hair                                                                                                                                 - Axillary Basel Body Temperature < 97.5                                                                                                                                                                                                                                                                         -TSH  >3.0      (1.0-2.5 optimal)

The human thyroid gland makes a combination of T4, T3, and T2. Levothyroxine (T4)  is converted to the more active form of thyroid, T3 in the peripheral tissues as the body needs it. However, some people lack an enzyme (deiodinase) and are unable to adequately convert T4 to T3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Levothyroxine  (Synthroid) consist solely of T4. USP thyroid (Armour) contains approximately 80% T4 and 20% T3. Most people who are treated with thyroid                 hormone  do fine on either Levothyroxine  (T4 alone) or USP Thyroid (T4, T3 and T2) . Some Patients feel worse on the combination.  Because T3 is more active, it can cause symptoms of  to much thyroid like a rapid heart beat or anxiety. Measuring levels of free T4 and free T3 may help to guide therapy. T3 is approximately four more times more potent then T4.    

 Thyroid Treatment     

Levothryoxine (T4) or USP thyroid (T3, T4) may be prescribed if the TSH is elevated. A half dose is taken on an empty stomach for 4 days, followed by the whole  dose. Some patients are very sensitive to thyroid medication and may require lower doses of thyroid hormone. The dose mist be lowered  or discontinued  if the patient experiences the following side effects of too much thyroid hormone.                                                                                                                                                                                                   

  • Anxiety, nervousness, agitation, sweating

  • Insomnia, headaches

  • Rapid heart beat, palpitations, rapid pulse

  • Pain or tightness in chest

  • Fatigue

  • Hair Loss

If symptoms of thyroid deficiency have not been relieved on the initial dose, an increase in the dose may be considered after follow up blood levels are obtained. Thyroid hormone is the best absorbed on an empty stomach. Follow up thyroid blood levels are tested 2-3 months following the initiation of thyroid therapy or a change in dosage. 

FAQ:  Testosterone Hormone Implants for Women and Men

 

Data supports that Testosterone hormone replacement therapy with pellet implants is the most effective and the most bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.                                                                                                                                                                                                                                                                                                                                                                                                                             What are Pellets?  Pellets are made up of testosterone that is pressed or fused into very small solid cylinders. These pellets are slightly larger than a grain of rice. In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. There are also a commercially produced "FDA approved" 75 mg testosterone pellet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Why Pellets?  Pellets deliver consistent, healthy levels of hormones for 3-5 months in women and 4-6 months for men. They avoid the fluctuations, or ups and downs , of hormone levels seen with every other method of delivery. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             In studies,  when compared to conventional hormone replacement therapy, pellet have been shown to be superior for relief  of menopausal symptoms, maintenance of bone density, restoration of sleep patterns and improvement on sex drive, libido, sexual response and performance.

Testosterone delivered by a pellet implant, has been used to treat migraine, PMS, and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has shown to increase energy, relieve depression , increase sense of well being, relieve anxiety and improve memory and concentration. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for prevention of chronic illness like Alzheimer's and Parkinson's disease, which are associated with low testosterone levels.

Even patients who have failed other types of hormone therapy have a very high success rate with the pellets. There is no other method of hormone therapy that is as convenient for the patients as the implants.  Pellets have been used in both men and women since the late 1930's. There is more data to support the use of pellets than any other method of delivery of hormones.

How and where are the pellets implanted?  The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the upper buttocks through a small incision, which is then taped closed. The experience of the health care professional matters a great deal, not only in placing the pellet, but also in determining the correct dosage if hormones to be used.

Are there any  side effects or complications from the insertion of the pellets?  Complications from the insertion of the pellets include; minor bleeding or bruising, discoloration of the skin, infection, and  the possible extrusion of the pellet. Other the slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases he production of red blood cells.  A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implant or other methods, can cause an elevation in the red blood cells. 

After the insertion of the implants, vigorous physical activity is avoided for the 48 hours in women and 5-7 days in men. Early physical activity is caused of 'extrusion', which is a pellet working its way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a 'clean procedure' and antibiotics are  usually not needed.

Why haven't I heard about Pellets?   You may wonder why you haven't heard of pellets. Pellets are not patented and have not been marketed in United States. They are frequent used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from the 1940 through the late 70's when oral patented chemically altered estrogen's and testosterone's were marketed to the public. This is changing! Currently, some if the most exciting data on hormone implants a in breast cancer patients is out of the United States. Even in the United States, there are clinics that specialize in the use if the pellets for hormone therapy.

Do men need hormone therapy?  Testosterone levels begin to decline in men beginning in their early 30's. Most men maintain adequate levels of testosterone into  their mid 40's to mid 50's, some into their  late 70's to early 80's. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30's can be testosterone deficient and show sign of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested before 50 years of age. It is never to late to benefit from hormone therapy.

What if my primary care physician or my gynecologist says that there is "no data' to support the use of pellet implants? He or she is wrong. There is a big difference between 'no data' and not having read the data. It is much easier for busy practitioners to  dismiss the patient, than it is to question their beliefs and do the research. Patients need to make an informed choice.  After pellets are inserted, patients may notice that they have more energy,  sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increase in strength, co-ordination and physical performance. They may see an improvement in the skin tone and hair texture, Concentration and memory may improve as will overall physical and sexual health. There is data to support the 'long term' safety of hormones delivered by pellet implants.

Do pellets have the same danger of breast cancer as the other forms of hormone replacement therapy?   Testosterone pellets do not carry them in the increased risk of breast cancer as oral estrogen's. In fact, there is evidence that bio-identical testosterone pellets decrease the rate of breast cancer. Data supports that testosterone is the breast protective.

Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone balance estrogen and is breast protective. This is not true of oral, synthetic methyl-testosterone found in Estratest, which gets converted to a potent synthetic estrogen, which stimulates breast tissue.  In the past, testosterone implants have been used to treat  patients with advance breast cancer, In 1940, it was theorized that treating patients with testosterone implants earlier, at the time of diagnosis, would have an even greater  benefit, preventing recurrence. Androgen's have also been shown to enhance the effect of Tamoxifen therapy in breast cancer patients. (Reference supporting these statements can be found in the data section of the website www.hormonebalance.org in the 'Breast Cancer Folder'. A power point presentation 'Nov. 07" summarizing the full text references, may also be reviewed.)

Will hormone therapy with pellets help with hair loss?   Hormone deficiency is a common cause of hair loss and treatment  with testosterone implants can help to re-grow hair in many women. Hair often becomes thicker and less dry with pellet therapy.

How long until a patient feel better after pellets are inserted?   Some patients begin to 'feel better' within 24-48 hours while others may take several weeks or two  to notice the first changes. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness.            

http://www.myhormonetherapy.com

http://www.hormonebalance.org

Progesterone Challenge                          

 Progesterone capsule 200-400 mg take @ bedtime for TEN NIGHTS.   If your period STARTS while you are taking the Progesterone  STOP TAKING  IT  and call the office.      If you haven't had any bleeding by the 2 week after you have  taken the last dose  call the office.    (801) 619-0999                                                                         

Cyclic Progesterone

Regular Cycle:                                                                                                                                                                                                                                                                                                                                          Days 1-14:    Take 1/2 dose  of progesterone                                                                                                                                                                                                                                                                   Days 15-28:  Take full dose  of progesterone                                                                                                                                                                                                                                           

Irregular Cycle:     When you are instructed, use the dose of progesterone you were directed  for 14 Days.  Then the next directed dose of Progesterone for the next 14 days.                 Example:    1 pill of progesterone x 14 nights                                                                                                                                                                                                                                                                           2 pills of progesterone x 14 nights                                                                                                                                                                                                                                                                                             REPEAT                                                                                                                                                                                                                                             Your period should come when you are on the lower dose of progesterone. It may take 2 or 3 cycles to regulate.                                                                                                                               *  Progesterone should always be taken at night , they can cause you to be tired.                                                                                                                                                                       **  Creams and Troches can be taken either in the morning or at night, just be consistent.

Human Papillomavirus (HPV)

How do I know if I have HPV?     Because HPV may not  show any signs or symptoms, you probably wont know you have it. Most women are diagnosed with HPV as a result of an abnormal Pap test. A Pap test (also known as a pap smear) is a part  of a gynecological exam that helps detect abnormal cells in the lining of the cervix before they have a chance to become precancers or cervical cancer.               Many cervical precancers (change that could lead to cancer) are related  to HPV and can be treated successfully if detected early. That's why early detection is so important.

 What happens if i get HPV?    In most people, the body's defenses are enough to clear HPV.  If not cleared by the body, some HPV types cause genital warts.  Other types cause abnormal changes in the cells lining the cervix that can lead to precancers later in life.                                                                                                                         If you have the virus  on your Pap or your Pap test results are abnormal, then it's time to have colposcopy.  During a colposcopy,  your  practitioner uses a magnifying device to look at your cervix more closely. Your practitioner   will remove a small sample of tissue to analyze further in the lab. If any  precancerous cells are found, they can then be removed following the colposcopy.                                Depending on the pathology of the colposcopy, you may need follow-up pap testing every 3-6 months for 1 year. After achieving 1 year of benign results, you can resume yearly screenings. Your continued good health is our goal, so it is important that YOU follow thru with any additional screening needed.            

 

What is HPV?     HPV (human papillomavirus) is a common virus that affects both females and males. Most type of HPV are harmless, do not cause any symptoms, and go away on their own.                                                                                                                 About 30 types of HPV are known as genital HPV since they affect the genital area. Some types are high risk and can cause cervical cancer or abnormal cells in the lining of the cervix that sometimes turn into cancer. Others are low risk and can cause genital warts and changes in the cervix that are benign (abnormal but noncancerous)   

Who gets genital HPV?    Anyone who has any kind of sexual activity involving genital contact could get genital HPV. Because many people who have HPV may     not show signs or symptoms, they can transmit the virus without even knowing it. You can get HPV from being intimate with just one partner.