My Doctor Online The Permanente Medical Group

Barrier Methods

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Barrier methods of birth control keep you from getting pregnant by placing a physical barrier between the sperm and the egg. There are several types of barrier birth control: condom, female condom, diaphragm, and spermicide.

Unlike other methods of birth control, barrier methods are used only when you have sex. There are certain advantages to this: You don't have to remember to take a pill every day or change a patch every week. But, on the other hand, thinking about birth control before and during sex can be a disadvantage as well. Some people feel like stopping to put on a condom or insert a diaphragm is an interruption when they’re in the mood.

The condom and the female condom are the only types of barrier birth control that can protect against sexually transmitted diseases (STDs), including HIV/AIDS. This is very important, as STDs can be passed on to others and cause serious or even life-threatening diseases.

Some barrier methods are very easy to get: condoms, female condoms, and spermicides are available at your local drugstore or in our pharmacies. To begin using a diaphragm, you should make an appointment to see us and be fitted for the correct size. Some people are allergic to latex so they cannot use regular condoms. The substitutes, like polyurethane, don't give as much sensation, and the animal skin condoms don't protect against STDs.

Hormonal Methods

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Birth control pills, patches, and rings are methods that use hormones to prevent pregnancy. Hormonal birth control methods are highly effective. They work by stopping your ovaries from producing an egg once a month. The hormones can also thicken the mucus made by your cervix (the narrow lower end of the uterus), making it harder for sperm to reach the egg.

Some hormonal methods require that you use them every day; others only need to be used on a weekly or monthly basis. Hormonal methods include the pill, the patch, and the ring. Some methods can be used continuously. Let us know if you are interested in scheduling your periods or decreasing the number of periods you have.

Most birth control pills contain 2 hormones: estrogen and progesterone. There is one kind of hormonal birth control that uses 1 hormone instead of 2: The progesterone-only "mini-pill" has no estrogen in it.

Depo-Provera, sometimes called "the shot," is an injection that contains the hormone progestin.

Are hormones right for you?

Most women can use hormonal birth control safely, but some women should not. We should discuss your options if:

• You are over 35 and smoke.
• You have had blood clots or a stroke.
• You have high blood pressure or diabetes.

Long-term Methods

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Long-term birth control methods are very effective at preventing pregnancy. They are also convenient and easy to use. There are several types of long-term birth control, including a birth control implant and intrauterine device (IUD).

Long-term birth control is best for people who want to prevent pregnancy for a long period of time. With these birth control methods:

• You do not have to think about birth control every day or every time you have sex.
• You might see changes in your menstrual cycle. This could mean unpredictable bleeding patterns, having lighter periods, or not having periods at all.

Here are some helpful questions to ask yourself, to decide if long-term birth control is right for you.

How long do I want to postpone becoming pregnant?

If you are sure that you want to prevent pregnancy for a year or longer, long-term contraceptives might be a good choice for you.

Will it be hard for me to remember to take a pill every day or use birth control every time I have sex?

Long-term contraceptives might be a good option for women who prefer not to think about birth control every day or every time they have sex.

Is it important to me that I have a period every month?

Some long-term contraceptives change the way you have your period every month or even stop you from having it altogether.

How do I feel about taking hormones?

Hormones can be a good choice for many women, but some would rather not use hormones at all. Some long-term birth control methods use hormones and some do not, so the way you feel about hormones can help you choose which method of long-term birth control is best.

There are many things to consider when choosing a method of long-term birth control. We are happy to talk with you about your options.

Permanent Methods

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Surgical, permanent birth control methods might be an option for you if you know for sure that you do not want to have any more (or any) children. This process is sometimes called sterilization.

In all these methods of birth control, pregnancy is permanently prevented by closing off the fallopian tubes, so sperm and eggs can never meet. Until recently, that meant "getting your tubes tied." Now there are new, safe, and effective ways of doing this, including:

• Hysteroscopic sterilization (Essure)
• Laparoscopic tubal ligation
• Tubal ligation with cesarean section
• Mini-laparotomy sterilization

In addition, a vasectomy is a method of permanent birth control that may be an option for a male partner. It's important to know that vasectomy is a simple and safe office procedure.

Surgical sterilization for women is safe and effective, but it's a big decision to make. It's a good choice only for women who are sure that they will not ever want to become pregnant. Please talk to a trusted friend or family member, a professional counselor, or to us before making a decision about permanently ending your ability to become pregnant.

Emergency Birth Control

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If you have sex without using any protection, emergency birth control can prevent you from becoming pregnant. You should consider emergency birth control if:

• You had sex without using birth control.
• You had a problem with your birth control (the condom broke or slipped off, or your diaphragm slipped out of place).
• You missed several birth control pills, you were late for your contraceptive shot, or you forgot to insert your ring or apply your patch.
• You were forced to have sex.
• You have a partner who will not use or let you use birth control.

The sooner you take emergency contraceptive pills (ECPs), the more effective they are in preventing pregnancy. ECPs alone are not a good form of birth control. If you find yourself using them often, now is the time to plan a regular, more effective method of birth control.

Women with Medical Conditions

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Deciding which method of birth control is best for you is always a personal decision. However, if you have special needs that might influence your choice, we can talk and make sure you're choosing the best birth control for you. Preventing a surprise pregnancy is especially important for women with medical conditions because some conditions can complicate a pregnancy and put your health or the health of the baby at risk.

Contact us to discuss your birth control options if you have a long-term medical condition that requires medication, such as:

• Migraines
• High blood pressure 
• Diabetes
• Seizures
• A history of blood clots
• Kidney or liver disease
• If you smoke and are older than 35 

While there are many good options, some kinds of birth control may not be right for you.

Your Care with Me

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If you aren’t sure which type of birth control is best for you, you and I can discuss your options and make a birth control plan.

If you’d like to start using a new method of birth control, your next steps depend on which type of birth control you’re interested in using.

• Condoms, female condoms, and spermicides are available in our pharmacies and at your neighborhood pharmacy. They are inexpensive, and you don’t need a prescription to buy them.
• If you’d like to start using a diaphragm, please make an appointment to see me. During a visit, we can talk more about the diaphragm, how to use it correctly, and I can recommend a size of diaphragm that I think would be best for you.
• Let me know if you’re interested in starting hormonal methods (like the birth control pill, patch, ring, or Depo-Provera) or long-term methods (like a birth control implant or an IUD).  Some of these should be discussed during a visit with me while others can be discussed by e-mail or by phone.
• Please talk to me if you’re considering permanent sterilization. If you’re interested, we can talk about which of the sterilization procedures might be a good choice for you.

If you need emergency birth control:

• Members of any age can call to get a prescription. Then you can pick up your pills at our pharmacy.
• If you are over 18, you can also buy emergency birth control from our pharmacies without a prescription.

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Contacting Me and Protecting Your Privacy

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

If your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for you.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Protecting your privacy

Teens 13 and older can get help from any medical professional without parental permission for these confidential services. 

Make an appointment to talk with me privately if you:

• Think you might be pregnant.
• Need birth control.
• Think you have a sexually transmitted disease (STD).
• Need information about alcohol or other drug use.
• Want to talk about personal, school, or family issues.

You can make your own appointments for confidential services by calling our Appointment and Advice Line, 24 hours a day, seven days a week.

What we talk about is private. In most cases, I cannot tell your parents or guardians anything about your visit for any of the confidential services listed.

One important exception: I do need to tell them if you are in danger or if you are thinking about hurting yourself or someone else.

We will protect your privacy. We also encourage you to talk with your parents or another trusted adult, if possible, for advice and support.

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For Parents of Teens

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How teen care is different

In partnership with you as a parent, we want to teach our young adolescent patients to begin to take charge of their personal health care as they transition from childhood to adulthood.

We sometimes request confidential time with teens to ask about sensitive issues. Time alone allows us to address important health and safety issues. It also gives your teen a chance to confidentially ask questions or voice concerns about topics that may be embarrassing. Many teens (and adults) find it difficult to talk about sensitive issues and prefer to see their doctor privately.

As your teen’s doctor, I also want to talk with you about your questions or concerns. At your teen’s appointment, please let the medical assistant or nurse know if you have any specific concerns that you wish to  discuss. I will make sure to set aside time during the appointment to talk with you about any concerns or questions you may have.

Contacting me

For nonurgent concerns or questions, you can e-mail me using this site, once you have set up access to manage your teen’s health. Use the Manage Your Family’s Health links to get started.

If your concerns or questions are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your teen.

How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed.
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your height, weight, or vital signs.   

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many teens like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you.

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed.

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

If refills are needed in the future, you can:

Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.

• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department.

When the results are ready, we will contact you with the results by phone. We may ask you for a phone number where you can receive your results confidentially.  If you do not have a cell phone, we may ask you to call us for the results instead, to ensure that we protect your privacy.  

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
 

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Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your care at any time that is most convenient for you. From my home page you can sign up for kp.org and:

Stay on top of your health

• Manage your prescriptions and refills.
• Schedule well visit and non-urgent appointments.
• View your preventive health reminders to see whether you are due for any immunizations or well visits.
• View and send secure e-mail messages*

*Secure means e-mail communication between you, me, and other members of your health care team is behind our firewall and password protected.  Anyone who can act on your behalf (for example, your parents) will have access to this e-mail box.  If you want to talk confidentially, l encourage you to call me or make an appointment to see me in person, instead of sending a secure message online.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition. 
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• Check to see if you are due for a well teen visit or need any immunizations.
  

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