Content on this website is for The Women’s Clinic patients’ general information only. It should never replace consulting Dr. Boo, Dr. Graber, Dr. Merle, or any of our staff if you have any questions or concerns about your healthcare.

PREGNANCY
GYNECOLOGY
PHENTERMINE DIET PLAN

Harmonic WAVE is a new way to perform surgery which enables Dr. Boo or Dr. Graber to simultaneously cut and coagulate the tissue, using ultrasonic vibration. There is much less damage to tissue with WAVE than with traditional methods of cauterizing tissue to stop bleeding. Dr. Boo uses WAVE during a variety of surgeries and would be happy to discuss it with you. Studies have shown that by limiting damage to tissue caused during surgery and by limiting the number of surgical instruments used during a procedure, complications are reduced -- and so is pain.

PREGNANCY
I think I’m pregnant -- what should I do?
Congratulations! Take a deep breath and get ready for an exciting time.

First of all, if you think you might be pregnant -- or if you are trying to get pregnant -- you should stop doing anything that can hurt the baby, like smoking, drinking alcohol, or using any of the substances listed below. Discuss any prescription medication that you are taking with Dr. Boo, Dr. Graber, Beth, or Marcia as soon as possible.

If you are more than a week late for your period, please contact the office to schedule a urine or blood test. We can help you find out quickly whether or not you are pregnant. The doctors like to see new obstetrical patients within the first eight weeks of pregnancy -- or about three weeks after your missed period.

What drugs are safe for me to use during pregnancy and nursing?
It’s very important during your pregnancy not to take medications that might harm your baby. The most obvious solution is not to take any drugs. However, from a practical standpoint, that would be impossible. Risk factors have been assigned to many drugs, based on the level of risk the drug poses for your baby. Do not ever use previously prescribed medication without checking with us first. We have assembled a list of non-prescription drugs that you can use sparingly for minor problems.

Please consult Dr. Boo, Dr. Graber, Beth, Marcia, or Kim before using any drug not listed below:

• Pain relief: acetaminophen (Tylenol, Extra-Strength Tylenol)
  cough suppressant (Robitussin, Robitussin DM)
• Runny/stuffy nose: Sudafed, Benadryl, Actifed, Tylenol Cold
• Diarrhea: Kaopectate, Immodium
• Constipation: stool softeners (Colace, Dialose, Metamucil), laxatives (Peri-Colace, Dialose Plus, Milk of Magnesia, Metamucil)
• Antacids: Riopan, Riopan Plus, Mylanta, Maalox, Tums
• Sore throat: Chloraseptic, Cepacol gargle, Cepastat lozenges
• Nausea: Emetrol -- other anti-nausea medications are used only in extreme cases and must be discussed with Dr. Boo or Dr. Graber individually
• Hemorrhoids: ice packs are probably the most helpful, but you can also use hydrocortisone ointment, Tuck’s Pads, or Preparation H (all available without prescription)

The following drugs carry unacceptable risks to both mother and baby and should not be used during pregnancy:

• Aspirin
• Alcohol
• Tobacco
• Pepto-Bismal
• Ex-Lax
• Certain antibiotics (do not use old prescription medication)
• Illegal substances (i.e. marijuana, methamphetamines, crack, etc.)

When should I call?
If you have any questions, it’s generally best to call the office during regular hours. You can get a much quicker and thorough response than by postponing your call until the evening or weekend. And if we need to see you in the office or call in a prescription for you, there won’t be any delay or unnecessary trips to the emergency room. Many prescriptions cannot be filled without checking your chart first. Don’t postpone your call until it is more convenient or until it gets worse!

In case of bleeding Many pregnancies are accompanied by some spotting, usually following sex. However, if you start to bleed heavily (more than a maxi-pad every hour) or if your bleeding is accompanied by strong cramping, you should contact us immediately.

In case the baby hasn’t moved In general, after 24 weeks you should feel the baby move at least 10 times a day. If you notice that your baby has not moved, it is important for you to do the following: get something to drink that contains sugar (Sprite, 7Up); go to a quiet place with no distractions (TV or people); and lay down for 30 minutes. If the baby has not moved 3 times during that time, contact us immediately.

In case of contractions

Before 36 weeks: Lie down with your feet slightly higher than your head, making yourself as comfortable as possible. You may lie on your side (left side is preferable). Drink two glasses of water (dehydration is a common factor in experiencing premature contractions). Time the contractions and if they get closer than 7 minutes apart and are getting stronger despite laying down and drinking water, please contact us or go to Labor and Delivery at Salina Regional Health Center. Going to Labor and Delivery to be checked is always good option.

After 36 weeks: Lie down and sip on water as instructed above. You may wait to go to Labor and Delivery until the contractions are coming regularly every five minutes and lasting45 seconds or if the pain from the contractions worsens.

When should I go to Labor and Delivery?
Please go to Labor and Delivery at SRHC immediately if:

• Your contractions are coming regularly as listed above.
• Your pain becomes severe.
• You start bleeding or have leakage of fluid. When your membranes rupture, the water will usually soak through your underwear and your clothing.
• Your membranes break.

What kinds of tests are done during my pregnancy?

Glucose tolerance test A glucose tolerance test (GTT) is done at 28 weeks to check for diabetes of pregnancy. It’s very important that you follow the instructions so that the test result is accurate!

• Nothing to eat or drink after 8:30 PM the night before your appointment. You may have sips of water.
• Arrive promptly at your appointment time to drink the glucose. One hour after you drink the glucose, your blood will be drawn. Do not eat or drink anything during this hour, including gum.
• Bring a snack with you to eat after your blood is drawn, like peanut butter and cheese crackers. Due to the fasting required for this test, sometimes the glucose drink will make you nauseous or light-headed. Make sure that you allow yourself time to recover!

Alpha fetal protein
An AFP blood test is done at 18 weeks to check for spina bifida, and Down syndrome.

Sonograms Dr. Boo and Dr. Graber recommend that you have two sonograms at 18 and 28 weeks. We offer BabyView 3-D sonograms, utilizing the latest in fetal imaging, so that you can get an early glimpse of your baby. Please make sure that you visit with Karen or Jennifer to confirm that your insurance will pay for the sonograms (if they are for routine screening purposes, some insurance companies will not).

Are BabyView 3-D sonograms available to the general public?
Yes. We welcome you to visit us for a relaxed, personalized session. Beautiful 3-D prints and a live 2-D recording will preserve this magical moment for a lifetime. Best results can be seen between 24 and 28 weeks. Call us for scheduling and pricing information. After hours and weekend scheduling is available.

How do I make sure that my insurance will cover the pregnancy?
We encourage all expecting patients to visit with Karen or Jennifer, who handle all insurance claims and billing. They can help alert you to potential financial concerns, as well as help you to set up payment options.

What should I pack for the hospital?
You will be in the hospital a very short time -- usually 48 hours following a vaginal delivery and three days following a cesarean section. Here are some things you might want to remember:

• Personal care items (lip balm for dry lips, toothbrush and toothpaste, lotion, shampoo and hair care products, make-up)
• Focal point
• Lollipops or hard candy
• Nutritious snacks for coach
• Tennis ball or other back massage equipment
• Lotion or powder for massage
• Robe, gown, warm socks or slippers
• Bras/nursing bras and breast pads
• Camera and batteries
• Video recorder, media, batteries
• Loose-fitting clothes for mom
• Going home outfit for baby
• Blanket
• List of phone numbers, pencil, and paper

What should I expect following my vaginal delivery?
Expect your energy level to be low the first few weeks after the baby’s birth. Listen to your body and pace yourself. Don’t hesitate to nap when necessary. Gradually increase your activity and exercise over time. During the first week, you may ride in a car and take walks, but rest as much as possible and avoid heavy lifting. In the second week after your delivery, you may begin exercises with activities like leg lifts, mild hip rolls, and very gentle sit ups. After three weeks, you may resume normal activities at home -- but allow yourself rest periods in the morning and afternoon.

You may take a shallow tub bath or shower daily, but do not use douches or tampons until your follow up visit with Dr. Boo or Dr. Graber at five to six weeks. Please resume eating a regular, well-balanced diet unless you had diet restrictions before your delivery. Continue taking your prenatal vitamins until they are gone. If you are breastfeeding, continue taking prenatal vitamins while you are nursing. Drink at least two quarts of fluid daily and if you are breastfeeding, drink one extra quart.

Pain medicine may be prescribed for you. Please follow the directions on the label. Or you may take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as the label indicates for pain.

It is not unusual for you to have mood changes after delivery. While your family can help support you through these changes, if your emotions become overwhelming or not resolve, please call our office, Dr. Boo, or Dr. Graber.

If your breasts become full and painful and you are not breastfeeding, you can apply a tight binder or sports bra and ice packs. Do not express milk from breasts!

You may notice a change in your bowel habits. If you become constipated, try some dietary changes like increasing the amount of fluid you drink and the amount of fiber in your diet (bran flakes, prune juice, Metamucil, or Senakot). If you continue to have constipation, you may try some over-the-counter medications such as Colace or Milk of Magnesia -- but please follow the directions on the label. Avoid consuming a lot of milk and cheese, as they can cause you to become more constipated. If hemorrhoids are swollen and painful, use a tub bath, Corticaine ointment (available over the counter), Anusol suppositories (by prescription) and/or witch hazel pads (over the counter). Should your episiotomy stitches become uncomfortable, taking a sitz bath three times a day can be very soothing.

The amount of bleeding that each patient has following a vaginal delivery is quite variable. The important thing is that it should not ever become extremely heavy -- heavier than the heaviest day of your period or soaking more than a pad every hour. You may bleed off and on or have some discharge for six to eight weeks after your delivery. External cleansing of the vaginal area is all that is necessary. Do not douche, use tampons, or have intercourse until after your follow-up visit with Dr. Boo or Dr. Graber.

Even if you are breastfeeding, it is possible that you can get pregnant. Talk with Dr. Boo or Dr. Graber at your follow up appointment about contraception options.

Call our office immediately if any of the following occur:

• A temperature above 100.4 degrees
• Unusual pain that does not respond to pain medication
• Excessive vaginal bleeding (any amount that is heavier than the heaviest day of your period or soaking more than one pad per hour)
• Signs of a urinary tract infection like pain, burning, blood in your urine, or needing to go frequently
• Foul-smelling vaginal discharge
• Symptoms of mastitis (a very painful area of the breast that can also be red and hot to the touch and which may be accompanied by a temperature of 100.4 degrees or above)
• Feelings of depression

What should I expect following my cesarean delivery?
Expect your energy level to be low the first few weeks after the baby’s birth. Listen to your body and pace yourself. Don’t hesitate to nap when necessary. Gradually increase your activity and exercise over time. During the first week, you may ride in a car and take walks, but rest as much as possible and avoid heavy lifting. You may climb stairs. In the second week after your delivery, gradually increase your activity. If you are not on pain medication and it doesn’t hurt when you push the car brakes, you may drive. Do not lift more than 30 pounds (yes, that includes children). After three weeks, you may continue to increase your activities as you feel like it, but no exercises until your first post-operative check up. Make sure to continue to allow yourself rest periods in the morning and afternoon.

Showers are preferred for the first ten days to two weeks. If a shower is not available, a very shallow tub bath may be taken. Please resume eating a regular, well-balanced diet unless you had diet restrictions before your delivery. Continue taking your prenatal vitamins until they are gone. If you are breastfeeding, continue taking prenatal vitamins while you are nursing. Drink at least two quarts of fluid daily and if you are breastfeeding, drink one extra quart.

Pain medicine may be prescribed for you. Please follow the directions on the label. Or you may take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as the label indicates for pain.

It is not unusual for you to have mood changes after delivery. While your family can help support you through these changes, if your emotions become overwhelming or not resolve, please call our office, Dr. Boo, or Dr. Graber.

If your breasts become full and painful and you are not breastfeeding, you can apply a tight binder or sports bra and ice packs. Do not express milk from breasts!

You may notice a change in your bowel habits. If you become constipated, try some dietary changes like increasing the amount of fluid you drink and the amount of fiber in your diet (bran flakes, prune juice, Metamucil, or Senakot). If you continue to have constipation, you may try some over-the-counter medications such as Colace or Milk of Magnesia -- but please follow the directions on the label. Avoid consuming a lot of milk and cheese, as they can cause you to become more constipated. If hemorrhoids are swollen and painful, use a tub bath, Corticaine ointment (available over the counter), Anusol suppositories (by prescription) and/or witch hazel pads (over the counter).

The amount of bleeding that each patient has following delivery is quite variable. The important thing is that it should not ever become extremely heavy -- heavier than the heaviest day of your period or soaking more than a pad every hour. You may bleed off and on or have some discharge for six to eight weeks after your delivery. External cleansing of the vaginal area is all that is necessary. Do not douche, use tampons, or have intercourse until after your follow-up visit with Dr. Boo or Dr. Graber.

Even if you are breastfeeding, it is possible that you can get pregnant. Talk with Dr. Boo or Dr. Graber at your follow up appointment about contraception options.

Call our office immediately if any of the following occur:

• A temperature above 100.4 degrees
• Unusual pain that does not respond to pain medication
• Excessive vaginal bleeding (any amount that is heavier than the heaviest day of your period or soaking more than one pad per hour)
• Signs of a urinary tract infection like pain, burning, blood in your urine, or needing to go frequently
• Foul-smelling vaginal discharge
• Redness or drainage around the wound
• Severe vomiting, diarrhea, or constipation
• Severe chest discomfort or cough
• Symptoms of mastitis (a very painful area of the breast that can also be red and hot to the touch and which may be accompanied by a temperature of 100.4 degrees or above)
• Feelings of depression

GYNECOLOGY

When should I start seeing a gynecologist?
That’s a common question. If you are having regular periods (defined as bleeding for no more than seven days out of every twenty-eight and not using more than ten pads per day) and are not sexually active, a pelvic exam and Pap smear can wait until you are 18.

If you are bleeding excessively (more than seven days out of every twenty-eight or using more than ten pads per day), are bleeding irregularly, or are sexually active, you should schedule an initial consultation. We can visit about what to do next.

How often should I have a Pap smear?
You should have a Pap smear yearly once you are sexually active. Do not assume it’s safe to skip a few years without talking to Dr. Boo or Dr. Graber about your risk factors.

If you have had a total hysterectomy (removal of uterus, ovaries, and cervix), you will need a Pap smear once every five years. But don’t neglect regular physicals.

What happens if I have an abnormal Pap smear?
Don’t panic. While it doesn’t automatically mean you have cervical cancer, it means that you may have some pre-cancerous changes and/or a condition that will require monitoring and possibly treatment. You may be scheduled for a colposcopy that will be done after your next period. A colposcopy is an office procedure where we look at the cervix under a high-powered miscroscope. It is basically an in-depth, five- to ten-minute Pap smear that can give us some important information about why your test results were not normal and what action that we may need to take.

How often should I have a mammogram?
Generally, your first mammogram should be done at age 35 and then every two to three years from age 40 to 50 (depending on your family history and risk factors); and yearly after age fifty. Please discuss specific guidelines with Dr. Boo or Dr. Graber based on your risk factors.

What should I expect following a dilation and curettage (D&C)?
A dilation and curettage or D&C is a surgical procedure used to diagnose or treat abnormal bleeding from the uterus, and is sometimes used following pregnancy or miscarriage. In this outpatient surgery -- performed at Salina Regional Health Center -- the lining of the uterus is removed and the tissue is sent to a lab for examination.

A D&C is usually free of problems and the recovery period is short. After the procedure, you will probably be able to go home within a few hours. Anesthesia and prescription pain medication may slow your reflexes and memory for24 hours, so do not drive, drink alcohol, operate heavy machinery, or sign legal papers. Following surgery, you will need someone to take you home, your throat may be sore from the tube inserted during anesthesia, and you may have mild cramping and spotting or light bleeding. You should be able to resume most of your regular activities in a day or two, however do not put anything in the vagina (tampons, douching, or sex), until you’ve checked with Dr. Boo, Dr. Graber, or one of the nurses.

If you plan on starting birth control pills, count the day of surgery as day one. Start the pills on day five.

While complications like infection or perforation of the uterus are extremely rare, contact us immediately if your vaginal bleeding is heavier than your normal period, if you have a fever of 101 degrees or higher, if you have severe abdominal pain, or a foul-smelling discharge from the vagina.

What should I expect following a laparoscopy?
Laparoscopy is often used to diagnose causes of abdominal pain or masses; to evaluate infertility; and to perform certain procedures like tubal sterilization. The advantages to a laparoscopy over traditional surgery is that the recovery time is often much shorter. During this outpatient surgical procedure, performed at Salina Regional Health Center, a small incision is made in or near the pubic hair line and navel and then gas (like carbon dioxide) is pumped into the abdomen and swells the abdomen so that the pelvic area can be seen more clearly.

Following surgery, anesthesia and prescription pain medication may slow your reflexes and memory for24 hours, so do not drive, drink alcohol, operate heavy machinery, or sign legal papers. You will need someone to take you home. Common complaints following surgery include nausea (from the anesthetic or from pain medication), sore throat from the tube inserted during anesthesia, abdominal cramps, a discharge (like your period) that lasts a few days, a swollen abdomen, tenderness at the incision site, or shoulder or neck pain from the air that was placed in your abdomen during surgery. Excessive use of prescription pain medication can cause nausea and constipation. Take acetaminophen (Tylenol) or ibuprofen (Advil) as the label directs for mild pain and increase your intake of water, juice, fruit, and fiber. Resume normal activity as your comfort permits.

You may shower or bathe after24 hours. Remove the band-aid or wound dressing when you shower. Gently wash the wound with soap and water and pat dry. Apply a clean band-aid if desired. If you have dissolvable stitches, they will begin dissolving in a few days.

Your menstrual cycle should not change. If you had a tubal sterilization and are currently taking birth control pills, finish your current package prior to discontinuing the pills.

Although problems seldom occur with laparoscopy, there can be some complications like injury to blood vessels, or other organs like the lower abdomen, the bowel, or the urinary tract. Contact us immediately if your vaginal bleeding is heavier than your period; if you have a fever of 101 degrees or higher; if you have severe abdominal pain; or if you have nausea or vomiting and are unable to keep fluids down for24 hours.

What is the Essure procedure?
The Essure procedure is a new way of doing a tubal ligation -- without an incision. It’s a simple, outpatient procedure for permanent birth control. In fact, Essure is the first non-incisional permanent birth control procedure approved by the FDA. It has a 99.80% effectiveness rate at preventing pregnancy, based on four years of data. Essure is covered by most insurance plans.

How does it work?
During the Essure procedure, soft, flexible coils called “micro-inserts” are passed through the body’s natural pathways (vagina, cervix, and uterus). They are then placed into each fallopian tube. The micro-inserts are made with materials that have been used in medical devices for many years. They do not contain or release hormones.

During the first three months following the Essure, your body and the micro-inserts work together to form a tissue barrier (like scar tissue) so that sperm cannot reach the egg -- and preventing pregnancy. You will need to use another form of birth control during this three-month period, until an x-ray test called an HSG confirms that your tubes are completely blocked.

Is Essure reversible?
No. You should not have the Essure procedure unless you are sure that you are done having children.

Does Essure have any affect on my periods?
You may experience a temporary change in your period (either lighter or heavier). Only a few women experience permanent changes in their periods.

What should I expect following the Essure procedure?
Because there’s no incision involved, it takes about 35 minutes to place the micro-inserts and confirm that they are in place. Most patients are ready to leave the hospital less than an hour after having the procedure. You should be able to return to normal activity the following day.

Remember, you will need to use another form of birth control during this three-month period, until an x-ray test called an HSG confirms that your tubes are completely blocked. Occasionally, it will take up to six months for the barrier to form. You must have an positive HSG before you stop using another form of birth control.

As with any procedure, there are risks associated with Essure. Please consult Dr. Boo, Dr. Graber, Beth, Kim, or Marsha and take advantage of our materials. Essure does not protect against HIV or other sexually transmitted diseases. If at any time you think you are pregnant, call our office immediately to rule out the possibility that you have an ectopic pregnancy.

What is HSG?
The HSG (hysterosalpingogram) is a an x-ray test used to diagnose problems with fallopian tubes and uterus, including infertility. When done after the Essure procedure, an HSG confirms that the micro-inserts are in the right place and that both your fallopian tubes are completely blocked.

What should I expect during the HSG?
Much like a Pap test, you lie on an exam table with your knees bent and a speculum is inserted in the vagina to hold it open. A thin tube called a catheter is guided through the cervix and into the uterus. The radiologist positions the x-ray machine over your abdomen and contrast fluid is then inserted through the catheter. As the fluid flows through the uterus, x-rays are taken and displayed on a monitor.

What should I expect after the HSG?
HSG tests cause minimal discomfort and generally take less than thirty minutes. You may go back to your normal routine right away. You will likely have a thick discharge as some of the dye drains. Use pads, not tampons, until the discharge is gone. It's usually recommended to take two Aleve 30 minutes prior to the procedure to minimize cramping, but you may have minor cramping for a few hours and can take over-the-counter pain medication. Dr. Boo or Dr. Graber may tell you not to have sex or douche for a day or two. Call the office, Dr. Boo, or Dr. Graber if you have severe or increasing pelvic pain; heavy vaginal bleeding (more than a pad an hour for over two hours); a fever over 101; or foul-smelling or unusual discharge.

What else should I know about the HSG?
The HSG is a very safe test, but it does carry very small risks of infection and an allergic reaction to the dye used. Make sure that you tell Dr. Boo if you are allergic to shellfish, iodine, or contrast fluid.

What should I expect following a hysterectomy?
Hysterectomy is the surgical removal of the uterus. Reasons for performing a hysterectomy include uterine fibroids, endometriosis, pelvic support problems (like uterine prolapse), abnormal bleeding, cancer, and chronic pelvic pain. It is inpatient surgery that is performed at Salina Regional Health Center. A hysterectomy may be performed through the vagina, through an abdominal incision, or by the da Vinci Surgical System, depending on your diagnosis and your body.

Expect to stay in the hospital from two to four days, depending on the type of hysterectomy that you had. You will be encouraged to walk around as soon as possible following surgery. Walking keeps your blood moving and helps prevent blood clots in your legs. You can expect some pain following surgery, but it will be controlled with medication.

Once you return home, showers are preferred for ten days to two weeks. If a shower is not available, a shallow tub bath may be taken. Pain medicine may be prescribed. Follow the directions on the label and know that excessive use of prescription pain medication can cause nausea and constipation. If that happens, switch to acetaminophen (Tylenol) or ibuprofen (Advil) as the label directs and increase your intake of water, juice, fruit, and fiber. A mild laxative can be taken as the label directs.

During the first week following surgery, you may ride in a car, take walks, and do light housework as long as it does not involve straining or lifting. You may climb stairs, but only as needed. You can eat what you ate before surgery. Get plenty of rest and keep up your fluids. During the second week, you may drive if you are not on pain medication and it does not hurt when you push the car brakes. You may gradually increase your activities as you feel like it, but do not lift more than 30 pounds. During the third week, continue to increase your activities as you feel like it -- but do not exercise until your check up with Dr. Boo or Dr. Graber. If your ovaries are removed, discuss hormone replacement therapy with Dr. Boo or Dr. Graber to avoid symptoms and complications from menopause.

The risk of problems related to hysterectomy is among the lowest for any major surgery. As with any surgery, though, problems -- even death --can occur and include blood clots in the lungs or legs, infection, bleeding during or following surgery, injury to the bowel or bladder, and complications from anesthesia. While some discharge -- even tinged with a little blood -- is normal, the amount should not be excessive, even though it may continue until you see Dr. Boo or Dr. Graber three or four weeks after surgery.

Call our office, Dr. Boo, or Dr. Graber immediately if you have a temperature above 100.4 degrees, heavy bleeding, severe pain, redness or streaks around the wound, signs of a urinary tract infection (pain, burning, frequent urination, or blood in the urine), severe vomiting, diarrhea, or constipation, or severe chest discomfort or cough.

PHENTERMINE DIET PLAN
Phentermine works by suppressing your appetite and increasing your metabolism. Side effects -- which include shakes, nerves or jitters, dry mouth, constipation, insomnia, and headaches -- usually lessen as time goes on. Dry mouth may continue while you take Phentermine.

In our experience, best results are achieved by taking the Phentermine in mid-morning on an empty stomach. You may have to adjust the time that you take the medication, depending on how it reacts with you. If you notice that you are starving in the evening, then you may want to take the Phentermine closer to noon. If you are unable to sleep at night, then you might want to take it earlier in the day.

It is important to drink at least eight to ten glasses of water daily. We recommend that you accompany the phentermine with a 1500-calorie diet with 20-25 grams of fat per day. We have American Diabetes Association diets to help you plan your meals -- or you may prefer to use Weight Watchers or NutriSystem meals.

A food diary is also provided for you to keep track of what you are eating, when you are eating, and how many calories you are consuming. Exercise is an important part of the diet regimen. Start with a low impact exercise like walking 20-30 minutes three times a week. Then increase your activity level and intensity so that we can build on that to increase your metabolism.

Please call to schedule your monthly diet appointment at least four or five days prior to running out of phentermine. Each month, one of our staff nurses will evaluate your weight and blood pressure. You may be on the medication for up to six consecutive months -- then you will need to take a month off. At that time we will discuss the progress that you’ve made, as well as your future weight-loss goals.

If you ever have any questions or concerns, do not hesitate to call the office. We are here to help you!