The Physicians at NEWS....and you the patient....have together decided on the use of Percutaneous Gels in the management of your hormonal changes.  In order for this therapy to be successful, you need to follow the below directions.  If after reading through these directions you still have questions, call the office, 706.769.0720.
     Please remember gels are not a "panacea for what ails 'ya"....most women and men, when using these therapies, find that they begin to feel "better" within the first week of therapy; however, most people need to give their bodies 4 to 6 weeks to adjust to the gels and experience the full benefits.  If after this amount of time, you still don't feel as well as you think you should, be sure to keep your six week appointment so we can adjust your therapy. 
     Percutaneous gels for Hormone Replacement Therapy (HRT) can be applied to the skin once a day.  However if you shower or bathe twice a day use half (1/2) of your dose after each cleaning. Studies show plasma values remain constant throughout the day with daily application. Percutaneous gels use the natural reservoir effect of the skin to deliver a continuous flow of hormones into the body between applications.    
     All HRT needs to be individualized for optimal effect. If adequacy of the dose is of concern, it can be checked with a single saliva sample.  Variances in individual plasma levels due to differences in skin absorption can easily be corrected by simply adjusting the volume or strength of the gel used by the patient for the most physiologic effect. 
     The gels dry completely within 1 - 3 minutes of application leaving no visible trace or smell. 
     Bathing or swimming may be done 1 hour after application.
     Combinations of 2 or more hormones can be combined into a single dose. 
     Unlike transdermal patches, skin irritation is unlikely, even in warm or humid climates.

Directions:
Adapt-a-cap:

1. Remove the child proof cap.
2. Screw the blue adapt-a-cap onto the bottle.
3. Shake bottle well with blue cap closed and in place.
4. Fit the tip of the syringe into the adapt-a-cap orifice and invert the assembly.
5. Shake the gel in the inverted bottle to remove any air trapped in the neck of the bottle.
6. Draw the prescribed dose into the syringe using the markings on the syringe to read the volume desired. (1 cc = 1 ml) If you have been prescribed more than 1 cc (1 ml) you may have to refill the syringe. For example, if you have been prescribed 1.5 cc of gel, you will have to fill the syringe 1 full syringe then refill the syringe to the .5 marking in order to get the desired amount. If you have problems with this call the office at 706.769.0720 and one of the office staff will be able to help you.

Application of Gel:

1. With your hand, spread the prescribed amount to your arms, forearms, shoulders, lower back or inner thighs and leave it to dry for approximately 3 minutes.
2. Do not massage or rub the gel.
3. Should the skin remain tacky after 3 minutes, this means that the area of application was insufficient.
4. Remember, spread the gel over a larger area next time.
5. Do not apply to the breast or outer vaginal area.
6. DO NOT EXCEED THE PRESCRIBED DOSE!I
7. f you have been using the gel for at least 6 weeks and you have not felt adequate relief from your symptoms, be sure to keep your six week appointment with you physician.