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HomeMy WebLinkAbout5.3 Amdmt to Massage OrdncCITY OF DUBLIN AGENDA STATEMENT CITY COUNCIL MEETING DATE: July 22, 1991 SUBJECT: PA 91 -049 A Touch of Health - Veronica Krell Initiation of Amendment to Massage Ordinance REPORT PREPARED BY: Carol R. Cirelli, Associate Planner EXHIBITS ATTACHED: Exhibit A: Letter with attachments from Veronica Krell dated July 2, 1991 RECOMMENDATION: Provide Staff direction concerning the Applicant's request FINANCIAL STATEMENT: Applicant pays for the Ordinance amendment DESCRIPTION: The Applicant, Ms. Veronica Krell, is requesting the City Council to initiate an amendment to the Dublin Municipal Code, Chapter 4.20 Massage Establishments and Massage Services, Section 4.20.020 Exemptions. The Applicant, a massage therapist certified by the National Holistic Institute and a licensed cosmetician, owns and operates A Touch of Health located at 6995 Dublin Boulevard. A cosmetician is licensed in the State of California to massage the face, neck, arms, bust, or the upper part of the human body, and a cosmetologist is licensed to massage in addition to these body parts, the hands, feet and scalp. The State does not issue any other license that regulates massages other than what is allowed under the State cosmetician or cosmetologist license. The Applicant indicates that as a massage therapist, she is certified to massage the entire body, including legs and lower back. Staff does not know who certifies such massage and would need to research that certification. The Applicant's massage and cosmetology business is located in a C -2, General Commercial District zone. A massage parlor /establishment is not an allowed use within this zone. A massage parlor/ establishment is permitted in a C -1, Retail Business District zone subject to the approval of a Conditional Use Permit. Under the Massage Ordinance, the massage therapist use is considered a massage establishment. According to the Applicant, the Dublin Planning Department and Police Department gave the Applicant verbal approval of the massace establishment use and massage permit in the Fall of 1988. The City has no written documentation that this approval was granted. The massage establishment needs to comply with all current and applicable zoning requirements. ITEM NO. COPIES TO: General /Agenda File Applicant /Owner Project Planner PA Address File _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ �ry � ITEM NO. _�� 'f COPIES TO: The Applicant is requesting that certified massage therapists be exempt from the provisions of the Massage Ordinance if they: 1. hold a valid, unrevoked certificate of massage therapy from an accredited institution, 2. have completed a minimum of 500 hours of massage therapy instruction, 3. are members of the American Massage Therapy Association, and 4. hold a valid, unrevoked cosmetician's license of registration by the State of California Board of Cosmetology. If massage therapists with these qualifications are exempt from the provisions of the Massage Ordinance, the massage therapy business would not be considered a massage parlor /establishment as specified in the Zoning Ordinance. Staff informed the Applicant of options to resolve the massage establishment's inconsistency with the Zoning Ordinance. The Applicant's request was one of the options presented by Staff. The following are other options available: 1. With an approved Conditional Use Permit, the Applicant can relocate her massage establishment in a C -1, Retail Business District. 2. The Applicant can request an amendment to the Zoning Ordinance to allow massage establishments in a C -2, General Commercial District with Conditional Use Permit approval. 3. The Applicant can discontinue her operation as a massage therapist in the C -2, General Commercial District, but may continue to perform massages as a cosmetician holding a valid, unrevoked license of registration from the State Board of Cosmetology. If the City Council initiates the ordinance amendment study, Staff will consider other options such as amending the Zoning Ordinance definition section to include a definition of massage parlor and massage therapist. Staff may also consider variations on the Applicant's request. Staff will research membership qualifications for the American Massage Therapy Association and the requirements for approving a massage therapy school pursuant to Section 29007.5 of the Education Code of the State of California. Staff will also verify whether the National Holistic Institute is accredited by the State, whether the school certifies massage therapists and what schools, agencies or organizations issue certificates of massage therapy. The draft amendments will be reviewed by the City Police Department and the City Attorney and all applicable comments will be incorporated into the amendments. Staff recommends that the City Council provide Staff direction concerning the Applicant's request. -2- july 1991 .fear City COWICIL Plombzrs: „' L 6995 Dilhlin My name :is L•''aroni,_a B, Krell. I de business as fl 7cuCh Of H',11 ­:1 �t and State E1.v,4 in the Hairihlai1 Emporium, i am a Certified i'lassaga Ther•spi I have been doing business at ,h o is Dublin location fr Licensed Cosmetician, the last three: years. I was told by former Cit;: of D�.L'oiin officials il,1983 Chief n -,' Police Shores and Associate Planner- Laura HO"fneister in April, 1983 that T was apRroved tc perform facials, massage and body wa::inq at this location. 'tll all O.1' tlla Ci 1iy Ii rd J. nallce5 that I have gone tc great lengths to ccinpiy w_ oiorra�;:ed snd fing'arprinC�ad was made a:.aare of st that time, irlC1Lldill❑ being Pal n n., by the F'c1.iC2 Department in 1:a8 and attain in ove:Jber. I Lev_ r�, L. been �.,, J-ed ;,y the i1. �, rlclrlrtl I += w c 'cl a zoning w:sh tc cont 11UQ `r locate n ot,:r:c.1 it C __ is iOcAtcd in �i_CI ..C� cation, iy bu =_fines ., ` ercial district _c•n'ed for --_,vice. raas acm ^,o' pe-ri;IJ ttcd Cs2 within tht. C -2 Aril a ('. i; i �nan�e, _ _ ' a It r 4J i r . h 1�'- J. .. _r u rr +l > i a n ;, Cj- Under n: ,' t ^` -- Cc r ticisn li �:. I t znnlrq w;u'.d fc Le C1,� u hi,r, b a c am L..Ii r. 1:•e orl, ad•d,.t Lin .� i r� p'r I ur,:_fl.d 1 Fie to prc';eese an a1n1n'andment to hlassag2 G•di 1,111C'2 i•io. °7 cd:der Sr -coon the F_XC , c O111= tO lliCliide the fOiio' :J T C' i „ 1 al (I i -� �..__ .iiO1 �'iCl of l" &. 11 I -r ;;. C •., -..., .... .,,, ,.._ �. 1.. 1 L i it I , tIt, Ill tl l ,al ll ltif ?Il 1 a .,7„ a ,1, o,- w- =.'•_ ' tor. , ":11 i - 17 l, v c =- - _ a(U :v C.. fly 1':° 'd. ?. - -1- ,�, r -_ - Lf. , - :' =.a' wli CF 1' lG 4' -.i L .... � r 1 Or 13 i ' .. rr bl F T L 1. L l.t lc' J4 a *, ,�_. �1_ - - -n t., J.L. u,l. -.1 a1.;: f,Jal' -:�t .Jl.tlfa 1 r for i ;i .in r7 tl:e ..f III --kd2. RECEIVEb EMIT A PA 91 -0 y� DUBLIN PLANTING / J� A Touch of Health of furs a full service beau W and Thu Hair/Hail Emporium and the health and beauty W: health complex to their clients enaKinq them to manaas their ha nols and skin and to their jcvais of stress. i have inve&- , amount of time, mon?V old lyfor t ove- As last thpoe y2sr5 Q: "d a consWarabla hwayt- and build up a SLUM, -, e"Oya of--� to contribute tu this WOO sod Drozils 600 oy massacs QwurEnn and urad:ztjd frcm tha HatLonal • And AKFA an'rWit2d srhoul. 1 aW:; Holistic institute which is a ScAn apiraw"A frQm the Calwornia 3ho-, yd mv Etate Licaps2 as a ,,aduajej - A d va rious seminars to vurinor my education and Cosmetician. I naW attened in the massal , ,d ..... jLdids, 1 was arvnip'.' WOW current knowledne and "n buy n tilausand dollars in student inans to fina0c! my ejucah"un several ,bj, to moko my monthij payments the lant W13 "arl :!? In " sua""; of 0' small husins3s. 1 have five more 1?3rs Of Owymj" to OQ' P II.NliNING L A BA May 15, 1991 City of Dublin Planning Commission Civic Center Dublin Boulevard Dublin, CA 94568 Subject: Use Permit A Touch of Health - Located at 6995 Dublin Boulevard Veronica Krell, Licensed Esthetician /Massage Therapist Dear Planning Commission: to the problem Veronica Krell has encountered concerning I am writing in response above - referenced location. I am a client and I am very her use permit for the concerned that the City is not treating this business in it marine lSebusiness special circumstances involved. This is a now provided ablf very p rofits and would cut into the p clientelle and not allowing the service to establish over the years. Mrs. Krell has worked I understand that you do not permit this particular service in this location. this business has built its clientelle based on the fact that she did receive a do business at this location and since the time the business was approved by of Police the law has changed. Since she has changed nothing but the changed I would respectfully request that you allow a conditional use permit for the current service to remain at the same location. This would not be precedent because this is not a new application. application but I believe it is very unreasonable to conduct the service she has been doing (with However, permit to the Chief law has in order setting a I could understand denial of a new tell her that she can no longer permission) in previous years. Thank you for consideration of this matter. Sincerely, Darleen Good 11369 Dillon Way Dublin, CA 94568 iP. / ?$ F P' 9/- 0 DUBLIN PLAN:MMG �/ /� Seth Yarx D.C. 51+6 Weldon Ave Oakland, Ca 94610 (415) 834 -1557 To Whom it nay concern; I are a Chiropractor practicing holistic health and natural healinx in Oakland, Ca. Veronica Krell is.on ry referral list for patients in need of therapeutic FSssaxe and I consider her work to be outstanding and her services invaluable. Therefore, it is imperative that she be able to continue to offer her services. If yott have any further questions please contact me. sincerely; Seth Na x D.C. U /25/91 RECriV=D 9/-0 �U�LIN rLANNIN Kaiser I mente Medical Center Public Affairs Department 115o veterans Boule.ard Redwood City , Califomia 94063 -2087 (415) 7W2452 IVAISGR PCRMANCNTC City of Dublin City Planning Department Civic Center Dublin Boulevard Dublin, CA 94568 To Whom It May Concern May 21, 1991 RE: A Touch of Health 6995 Dublin Boulevard Dublin, CA 94568 A Touch of Health is owned and operated by Mrs. Veronica Krell a Licensed Esthetician and Massage Therapist. Mrs. Krell has been notified that her use permit will not be renewed at her present location. I am urging the City Planning Department to please reconsider the judgement made to not reissue the use permit for A Touch of Health at the present location on Dublin Boulevard. The original use permit was issued two years ago by the Chief of Police and since that time the law has changed. It would seem in a case such as this, where the law changed but the business did not, that an existing business would be grandfathered and would be allowed to remain in the present location. A new business coming into the location would then be subject to the new law. A Touch of Health is a professional and responsible service and an asset to the City of Dublin. Because of Mrs. Krell's expertise in massage therapy I am not at the mercy of a stress related illness. My job as a public affairs professional is stressful and intense; it was at a friend's urging that I contacted Mrs. Krell at A Touch of Health, and received my first session with her. It was as though someone provided a light at the end of the tunnel for me. She is in a very accessible location and it would be a shame to move her services to another area. Thank you for your time and your consideration regarding this particular use permit. Sincerely, _/ tricia �n RE E C E l V E _ 5343 Blackbird Drive _. 1991 Pleasanton, CA 94566 PA 9 / -Ovq DUBLIN PLAT G ALAN _ ..r MAN CHARLES, M. D. A MEOICAL CORPORATION 1414 MARIA LANE WALNUT CREEK. CALIFORNIA 94396 TELEPHONE (415) 937.3331 April 23, 1991 To Whom It May Concern, I am a physician in Walnut Creek, practicing preventive medicine for the treatemnt of pain disorders. This letter is to affirm that Veronica Krell is practicing massage for the past three years. Her qualifications are exceptional and she is on our list for referrals for massage therapists. If you have any questions re- garding Veronica Krell please contact me. Sincerely,,, p Alan S. Charles, M.D. ASC /cl RtCEIYEU c, <) 1 Iv• DUBLIN PLANNING Tiz Ono u lz 0� ct pc� u 0 U u r-4 ct r4 Q 4M4 vJ s r1 ON M-1 R E -C I- I V E P!AOil pa C//- a K \ , NiNP O —z— E-4 l.I 7:3 C) u 4-J QJ I- C,!- + cf) j cz CJ cn zs wL. I- C,!- + I- C,!- qtr N Y N J L' c 6 L H G c C v. M v 1 1 i � U � G y � � G a 7; < O n O L � G N U L U Q n U V ^ 7 v r, b•- � c �' cj 4 \may) G •- V U i CC G � U I J J r � U r T i1 E J l ➢_A CJ/— 0 V9 :n _ N Y N J L' c 6 L H G c C v. M v 1 1 i + "K r c. IDO rr 1:Z 17� LU JI Aj-,,1Y- M3.1; iO cy oz ca o 1 ct Aj-,,1Y- M3.1; iO -- v -,► 'W \ t ljL1 n � o \fir D' i v.v l U � U O CD O � A C.> ,%4-4 C� a XP C U ^ W tn � A U U � M+ U O. v a v L 'q ^�JI -- v -,► 'W \ t ljL1 n � o \fir D' i v.v l LICENSE NO. Z 9397 RECEIPT NO. 06900970 THIS PERMIT DUES NOT AVTHORIZE THE HOLOEN TO ENGAGE l All OVSiN ESs cOflraRr To LAws PEG VLA TING THAT VSIHESS OII TO P O S s E 5 S O R OPERATE. All IL- LEGAL DEVICE, CALIFORNIA STATE BOARD OF EQUALIZATION SELLER'S PERMIT ACCOUr4T NUMBER FT/89 SR CHB 21- 831189 6995 Dublin Blvd., Dublin Veronica B. Krell & Craig E.S. Krell 1569 Greenridge Dr. Pittsburg, CA 94565 L_ IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LA's/ TO ENGAGE IN THE BUSINESS OF SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE LOCATION STATE BOARD OF EQUALIZATION THIS PERMIT IS VALID UNTIL REVOKED OR CANCELLED BUT IS NOT TRANSFFP.ABLE Not valid at any other address BT -642 -R Rev. 9(1 -83) DISPLAY CONSPICUOUSLY AT THE PLACE OF BUSINESS FOR WHICH ISSUED ee n257 VERONICA 8 KRELL �I C 6995 DUBLIN BLVD DUBLINI /CA 94568 BOARD OF COSMETOLOGY 1020 N STREET, ROOM 426 SACRAMENTO, CA 9E314 (9 16) 445 -7061 VALID UNTIL APRIL 30, 1992 In accordance with the provisions of Section 7373 of the BUSINESS .A_ND PROFESSIO \S CODE, the individual named hereon is issued a Cosmetician renewal license, and is subject to the rules and regulations of the California State Board of Cosmetology. SIGNATURE MCA- ----- .PpSZ I0 'PZITLIC tJIEZ.h ----- (ousz- SE IDIS•PLA`JS'D AC, •PRIL DA•R L) U (D:R K S�AZ Ic?1? BY NICK ba LLV rr � . . - • -- THE BENEFITS OF MASSAGE gncient relief for today's stresses My body feels like one big knot," groans Laurie Brown, 39, her mus- cles tense and aching after a stress -filled morning. Draped by a sheet, she Lies facedown on a massage table and stretches out beneath the soothing hand of Meta Chessin- Yudin. As the Seat- tle massage practitioner rubs out the kinks in her muscles, Brown grows more relaxed. An hour later, she is smiling and buoyant. "After a mas- sage, I feel like a weight has been lifted from me," she says. "All my tension floats away." Brown is not the only one being rubbed the right way. In the last decade, massage has enjoyed a boom in popularity. Once thought of as a luxury for the pampered, it has become a hands -on favorite of stressed -out office workers, recreational athletes, and wellness enthusiasts. Massage has transcended its image as a euphemism for shady adult entertainment. It has come out of the shadows to present its legitimate side, popping up in health clinics, shopping malls, and even corporate suites. An ancient art. Faddish as it sounds, massage is an ancient healing art, mentioned in Chinese literature as early as 3000 B.C. Centuries ago, Greek and Roman physicians used it to treat their rulers. "Massage has its root in earliest medicine," says Richard van Why, president of the Texas - based Bodywork Research Institute. "It's been an integral part of the health systems of most cultures." But massage is no panacea. "It won't cure your arthritis," says Rita Corell, a massage therapist in Omaha. By law, therapists can't diagnose, prescribe, or claim to treat or cure specific illnesses. But massage can be part of an overall strategy for good health and well- being, says Corell. For most people, the practice is safe. However, experts warn anyone with a history of blood clots or diabetes, a recent fracture or sprain, or a high fever to avoid massage. Doctors recommend caution to those with circulatory, skin, or cardiac problems. If you have a chronic health problem, consult your doctor for advice. Benefits. Massage stimulates the circulation of blood Massage: a much - "kneaded" break in a ras. -pace ­ off r l >>c 1 RFrrER'NOMES AN GARDENS, AV0.11 1991 ANN" G and lymph fluids, fueling the muscles with fresh oxygen and nutrients while flushing away metabolic waste prod- ucts. By stretching and loos- ening muscles, it also releases physical tension and soothes the nerves. The result is a blend of energy and relaxation. Like a tune -up designed to pro- duce smoothness, a massage is likely to leave you feeling refreshed, but not revved uD. Massage often helps people reduce stress and think more clearly, says Patricia Benis- min, Director of Education for the American Massage Therapy Association (AV1TA). "It can have an effect similar to meditation," she says. "It calms the mind through calming the body." Increasingly, medical doctors find massage useful. Regu- lar rubdowns may help with relief, breaking the cycle of spasm and pain. Tension headaches, sore backs, and neck cricks may benefit. "Massage has helped patients of mire with cervical strains, where the neck muscles have gone into a chronic cramp because of an auto accident," says David Yonker, M.D., a Washington State family practitioner. The physical benefits of massage have value for athletes, claims Ralph Stephens, a sports - massage therapist in Iowa Citv, Iowa. Properly administered massage helps prt%ent injury, aids recovery time for injured muscles, and improves 'athletic performance, he says. Healing touch. For many, massage answers an ernoc;cn- al need for touch. Doctors and psychologists have long known of the benefits of physical contact. A Universi;c et Miami study reports that premature infants gained weight quicker and were able to leave the hospital earlier aver regular massage. Similarly, people who are lonely er cs- abled may be touch - starved. "Massage is sometimes mscn- derstood as being sexual," says Corell. "Done in a save, nonsexual setting, it can be nourishing and therapeutic." Bottom line. Promising as the benefits of massage so=d, not everyone agrees that all have been well documented by scientific studies. Many people believe massage has t:-e po- tential to deliver both physical and emotional benefis. but conrirhued on Pc;, :6 55 RECEIVED n; I - 1991 MASSAGE PA 91-OVNI wU3l dGB� ✓�' continued from page SS �7 much of the evidence is anecdotal. Skeptics also suggest that the positive effects of massage tend to be short - lived. On the other hand, these effects probably are cumulative. From one session to the next, a person is able to relax more and release tension easier. Over the course of time, massage sessions teach people where they store tension and how to watch out for it in their day -to -day lives. "The beauty of massage is that you learn from it," says Corell. "You be- come more sensitive to your own patterns of ae..: stress." MASSAGE BUYER'S GUIDE" Derived from the French word for kneading, mas- sage is a general term for manipulating muscles and soft tissue. Over the centu- ries, a wide variety of ap- proaches has evolved, each with its own goals and techniques. The most commonly encountered methods of massage are: Swedish, or Western - style, massage. The most prev- alent form of massage found in the U.S., Swedish is an all - purpose method to get the blood moving and promote general well- being. Featuring long, gliding strokes followed by kneading and rubbing motions, it usually is relaxing and enjoyable. Clients lie under a drape, either totally or partial- ly undressed so that oil can be applied for smooth stroke'-.. If you are too embarrassed or uncomfortable to take your clothes off for a massage, don't give up, says Benjamin. Take off only as much clothing as you want to, she advises. Keep on your underwear or wear a swimsuit. "You can't DO- IT-YOURSELF MASSAGE with a little special care and at- temlon, you can give your spouse or a friend a relaxing, enjoyable massage. Follow these tips from Meta Chessln- Yudin, a massage practitioner and Loban movement analyst with New Seattle Massage In Seattle. Begin in a warm, quiet space, softly lighted, with gentle music, If you like. Find a good, firm surface. (A couch or had Is likely to be too soh and too few.) Pour a little oil on your hands and rub them to- gether so that the oil feels warm. Coconut oil Is good, but even vege- table oil will do. Have your partner take deep, comfortable breaths. use a smooth, gentle approach and a light teach. Make a long, continuous stroke the entire length relax if you don't feel comfortable," she says. shiatsu. Used widely in Japan for more than 1,000 years, this form of acupressure is derived from traditional Chinese medicine, which postulates that chi, or life energy, flows along invisible body pathways called meridians. Illness oc- curs when energy becomes blocked at specific pressure points. During shiatsu sessions, therapists press on these points with their fingers or feet, even with their knees, to release energy trapped within the body and restore health. While Swedish massage is oriented to physiology —blood flow and contracted muscles --- oriental massage has a spiri- tual goal to get mind and body in harmony. It is done without oil, sometimes When considering a through loose clothing on a mat rather than a table. massage practitioner, Shiatsu, like Swedish - style massage, can involve look for a licensed some discomfort. However, a massage shouldn't be therapist. Ask about painful, says Jocelyn training, credentials, Granger, a massage thera- pist in Ann Arbor, Michi- and experience. gan. "If it hurts, tell your therapist to stop." Reflexology. Practitioners of this method of massage believe that various reflex areas in the feet and hands corre- spond to parts of the body. Reflexologists apply pressure to these spots on the feet and hands to promote the health of the corresponding body part, organ, or gland. Independent of any medical value, foot massage also can be a very sooth- ing and relaxing process. Sports massage. Borrowing basic techniques from other traditions, therapists recently created a specialty massage for active people. Sports massage practitioners usually tar- get specific muscles rather than attempting to induce whole - body relaxation. continued on page 56 of a limb, following the contours of the muscle and bone. Lightly re- trace the area in the apposite direc- tion. Repeat the same gliding stroke many times, Increasing pres- sure as you do It, but always re- trace lightly when you return to your starting place. Generally, massage toward the heart. As you bath get comfortable, vary the stroke. Aker gliding strokes, try kneading the skin. Imaglns you are kneading dough, and create different shapes. Experiment with little side- to-side strokes. Try moving the muscle in little circles. Check often with your partner to see if the pressure Is comfortable.'io `.Inbh one - area, hold your hands lightly on it for about 10 seconds. Gently and slowly take your hands away. You can use the same kind of strokes for both sides of the arms, legs, and torso. When working on the head, cradle it for a little while, letting your partner enjoy the feel. Ing of support. Use gentle, smooth - Ing strokes on the face, as If you are trying to Iron out all the wor- ries and wrinkles. Outline the fore- head, eyebrows, and nose. You can apply a little more pressure to the cheekbones and taw. Try rubbing the ears. Give the scalp a vigorous rub, from the base of the skull to the very top, supporting the head with one hand while rubbing the other side. There Is no "one way" to do massage. Start with what you think would feel good and listen for feedback. Feel free to explore what works. BEM2 HOMES AND GAiDENS. A »IL 1101 56 MASSAGE continued from page 56 Rapid or rhythmic pummeling strokes often are used to warm up muscles before an event. Long, gliding movements after a strenuous workout aim to prevent muscle soreness and shorten recovery time. Choosing a therapist. While there are dozens of methods of massage and body work, most U.S. therapists are trained in one form of massage—I ally Swedish -style --and incorporate other methods to suit their interests. 58 Many practitioners offer a broad, eclectic range of techniques, but some have a narrow, specialized focus. It's important to match your need — whether it's basic relaxation or sports massage or deep - muscle work, for in- stance —with the right therapist. To find a good therapist: • Get referr.::s from friends, health professionals, or a reputable health club in your area. • Stick to licensed massage therapists if your state licenses practitioners. Or check with the 1 1,000 - member Amer- ican Massage Therapy Association for its Active Member list. The group, which sets industry standards and provides continuing education, has a referral service for its members. Call 312 /761 -AMTA. • When you shop around for a thera- pist, ask about experience and train- ing. If the therapist advertises as a specialist —a sports massage therapist or shiatsu practitioner, for example — ask about his or her credentials and training. • Expect to pay about S30 to 540 for an hour -long session, perhaps more in major metropolitan areas. If pre- scribed by a physician, massage some- times is covered by insurance. ED BETTER HOMES AND GARDENS, APRIL 1991 Please see an important message about osteoporosis prevention on the previous page. and BRIEF SU'AetARY(FOR FULL PRESCRIBING INFORMATION AND PATIENT INFORMATION. SEE PAG.rAGf Stu estrogen adverse reroacemem on site Choice of p!cysltin and may may It IncmtaranumnemuEg these chicl JEi) adverse. effects. REA)ARIN• Brand 0I conlupate0 esuU,k n REMARIHe Brand al coaIinto Ed aAlragents Vaginal Cream, In a nonllguOVing base I ESTRCGENS HAVE SEEN REPORTED TO INCREASE THE 81SK OF ENDCMEf HIAL CAHUtaumd, Close eLLCaI Surve,lance of all'nOmen taking estrogens is imperianl. Adequate dlarl if masuRi ia0l o s.9 endomeNldl Samotn'Qwhen indicalM- Should be undertaken to Nle Out maligaanry, m all e3se501 undiagnosed qe 'sisienl or tan-9 abnormal vaginal ble-aing. There is currently no evidence that - natural estrogens are mare a less hazardous than - synthetic estrogens At burstogenic doses. 2. ESTROGENS SHOULD NOT BE USED DURING PREGNANCY. Estrcgfn therapy during pregSwq is associaled with an increased risk of congenital detects in the leonoGUdlve organs of Ind mile and lemale fetus, an increased risk of vaginal apenosis. SOuamouacell assails, at Ire uterine cervb- and vaginal cancer in the female later in life. the 1985 DES Task Force ccnnuCea;bar women who usa OES during their pregnancies may subsurenUy "Offence an mCYac.J risk of lead cancer. HOw!vQ a causal relaliou ship is still unproven, and the obsHVed level 01 risk :S similar t0 that for a number a Other breast cancer risk fall Them is no indication tar estrogen therapy Strung pregnancy. Estrogens are ineffective for the rievenllon or Informed Of in ... test Or lout aborlion. DESCRIPTION: PREMARIN (cuj.'galed estrogens. OSP) contains A mixture 01 Csuugaln. UUI<ma :....•.•., from natural sources, blended u mfesenl the average composition of material derives Item pregqnant males mine. II contains estate. eCU84 and 17.4hydmeouilin, together with smaller amounts at Ira Official, ,currents. ALL 11a- mnyameouilmn as salts 01 [Pell Sulfate eimis Tablets are available in 0.3 at 0.625 10.9 mg, 125 r. g and 25 mg stFe4ts of conjugated estrogens. Cream i0 available as 0.625 mg conjugated emSens Pe gram. INDICATIONS AND USAGE: kbWale- lobnela vaeom01011ymploms associated will, the menopause. (There r5 no eCeCt! INI estrogens n NICCIiVe 101 net Oars SymOloms 01 deCIeSS :Cn vision miglll L<Gr dUnOg men0pauu Aral :hey'M uld'01 husea 10 real these Conditions I Ptevenbon after management at 0,fachroiis (aia0nr.a' bone mass). A is vaglNbS. Atrophic 'JI21111i1is. HyOcesticgenlsm due IC hypogcotosm. ...falter or J .mart Ovarian laden PRE :tAB:N (conjugated ecors) Vaginal Cream Is Indicates in the vealmenl of atrophic vm:rFF,S and fau053 ".vie. ,ii AS NOT BEEN SREWN TO BE EF °KTIVE FOR ANY PURPOSE CLAIMS PREGNANCY AND ITS USE MAY CAUSE SEVERE eAF1A TO THE FETUS ;SEE BOXED' WARNING). CONTRAINDICATIONS: ESltogm should not oe used'IA women (01 men) with any of Ihelallcwing cc. ^Clitoral' I Racwn ar msceaed oregnara.Y lsee Sexes Warning). 2. Bnewn or suSoecleri cancel 01 the bte..I !I :n aooloena!!ly selected part, 5 �+9 treated lot metastatic muse. 3. Nnown or SusdeC:M ¢Sfcgea- CLCafter' negOldS :d 4.'IdiagrosM Rossini genital Sleeting. 5. A.Ive hOm00phloaris Of Ihlom ce"i cilmCe6. 6. Esnc;n Retirement Irera]y has not been reported to IAVUSe the risk of Ihmmbook" iti5 land, inamocec.000 disease. Hcwes1 !here is insufficient mlorm0110n regarding women who nave had mev,eu5 ;monea-.:c:x disease. ests PREki ia0mis and V, use Cream sl,auld nor Se trsee In patients hyp¢6Cn51livC 10 melt IagmaiShi WARNINGS. Ems StuE r.2 "g bat a possiblt increased :ncdl Cf boost Cancer !n omen taking 111gn¢r cases LI IS Cron Is' oncron Fire ln; aFiOCS.Ire majority of studies have dal snOwn an aSSCdlan tlr I'll estrogen ¢% aliment acs^ -s. EraSCemal cancer risk among estrogen users was about 4 -Idd m great: Ivan In a0mu411 ac Appears cescear An treatment Cuta110n and cY.lOg¢n dose. In palleno On comb lea IsIlOgyen. o¢gul" C?Ody. this t6k RD,ox A be D,c,c,,e6 (So, PRECAUTIONS below ) Estmren?drops during peONAM is 35SCCamd win an inuee5¢d risk of teal "'I" dal "Ved'i "act enter's A 2 5 IYD increase in me list Of sul9ica11y confirmed gall starlet dis¢aie in women ¢cervtnq pOSlfnen_i us.l eslmg!ns has Idea sudden Large Costs 01 estrogen SuchaeSGSe used retreat postale and breast Cancer have been Sn0'xn IO IOcmase me 16k at son ralal myocamial hfan on, pulmonary embolism, and IhOmbrok ih3 m mom This Cannel nN- OSYlily : ??tanp0jaled to wmi However. to void IteatetrQl car RI risk ..USet by hgn estrogen cases, Ire ones for estligen n lament Ihelaay snCUjt n01 one N I<Camm¢OC¢d tCSe. Blood Gessure Should be mood with estrogen use, esdectally 111 doses are used Estrogens ,ray lead Io Se2re lyjacalcemla in pd119n1$ with breast cancel and bone m¢IaslJies. PRECAUTIONS: Rs ac d.lion ala:Ngeatm!at 7 or are aayi 01 a cycle at eilfogen ACmturranIhn RCO' :a :ry InxC6!R rocence LI enCalnenaloycaeeolaSla. Studies it enDOmelfran Suggest that 10 10 13 Flats of p tocir.I are Fee� a:;Owde maalmal rucca:r01 mall and elimnali0n Of hYdeplasbc CM1anges. AdIrolal risks, R E C E- ! t' r �. ,A d1,, ^UTKIN °LANNL!G rule medical ROD family history Should be :area ;nor to me Iniliafitn of any eKe to blood pllsSrue, brea512, aadOmen, era :'lure attain. Ala SAOi A general rule. estrogen Should not be aff or loner Iran One year card's at with nyaelcalcemla. the hallowing druglIttleactratory test interactions have been lepgnes, some Orly with eslmgeropmgestin combinations (oral contraceptives): 1. Increased prolhronst n and 111:015 VII, VIII, M. and X; decreased anfithromEin 3. Inceased no¢p :ne0hrl0e- inCUCed platelet aggreqabilily 2. Increased Ihymid binding globulin (TBG) leading to increased cio:ualms 10-31 thyroid hoopoe, is mneured by T, levels delummed by column or by radioimmunonssay, Free T? esa uptake is Decreased. tellecline the clevaled TBG: free T, ccncentralion is unaltered. e. Reduced response to melyraOCne test. 5. Reduced serum fatale cancithition, AIUTAGENESIS AND CARCINOGENESIS: Long term, conlinuaus administrLair of natural and synthetic estrogens uncertain animal sDi incressesthe frequency alcarrhadmasal the areas!, cervix, vagina. and liver PREGNANCY CATEGORY X: Estrogens Should cot be used during pregnancy See CONTRAINDICATIONS aca Boxed Warning, NURSING MOTHERS: AS a general pllnciale. be adminislralion of any drug to nuts no mothers should be done only when clearly necessary Node mans (Irugi are excreted in human milk. ADVERSE REACTIONS: The following take been redolt it with eSI1O§s is mefaa',II c-aages in vagma bleeding pattern aca abnormal withdrawal CCeing or flow, breakthrough bled^- -tag, Sit! !volatile In are Of uterine IF bnamyoka It vaginal carl change in amount at cervical S .loom XnC s ... largemen :I C¢asls' nau$u, vomiting, abdominal : :amps..feeling. cron,vat c aund-i hloasmd of _e'.s.a that Ray CessLA`len Lug i5 0isconhnuea, erylhema mW6lolme, effiti FOLOSU 1, resell ,'::Imm joss Of Scalp It 'r. tus'lism: steepening at corneal c: "Anne.intolerance !a ct lei hedaEC-?. - .Igraine, Ciro -SS, RRCIat Wmession. cirri Increase or decrease In weiBn! reduced cdm0.hyG010 lbuac:e, ay9ravation Of TCranytd. Stoma: changes In flood ACUTE OVERDOSAGE: May cause nausea and vomiting, DOSAGE AND ADMINISTRAT104: PREMARINt Brand of conjugated estrogens tablets, USP I.Given cyclically IOr socu-elm use only For ifoo d0j 01 moderale- :0- Severe vas- IOlOf symptoms Map" va9inilis, Or almph0 urelhrills a$$ce:alea with the menopause (11.3 and to 125 my cr,: ce carry). tie b'west case that will control sym0loms should Le chosen and armcailon SNOUL be ariccnl :neC as prOmolly as Lassiole. AMimSlralion Should be cyclic (N. B:ree weeis an and one 'odes oil). A!! ? ^::s to aiSC:nr',ree Or facer arefortion should be FORCE al le to S 'r:om. intervals. 2. Given cycncally Hypoeslmge "s OsleepOms :S _ Hypoesimgeli s0- due lo. Female hyporloi .5 mg to 75 mg oft tv Is c irci costs !or 20 Cars IcillMea b' ID day rest pence, It bli Joss all Frow by the end 01 ills set cc. :r? sell, O"Sage S,ri l 0 e;ea!e0 r. estate casuabon or pn• 2ryy ovauan talite—I 25 mg calls. rytllCalli ^'ust uOwarC OF c :hai according to response Of :he pallet! FOf .manleri adjust Casale m 'Most ' ere'.:, 31 will plavtce?Ileellve control. Osleopawsis -0.625 mg Carry Administration $'auto be cyclic (hl, cor' wed 31 and one week off PREN INS Brand of conjugated estrogens Vaginal Cream Given cyNlcally IOI sh0t1-rNm use ors For trutr Rtl 01 Armoric vaginihs or kr>.oafs vulvae, The lowest dose that will control Symplom5 Should Ce [Noses and medlCRi;.n 5 -Auld be disc :elated as prcmoily as possible. Attempts to 06crali0u< or facer medicalion should be made at 'he.. 10 six'mdnit Interval'. Usual dosage range: 2 g 10 4 g Carry mlravar rely, oepeadlQ an the severi!y 01 ;Ce conGjicn. Patients whin an i01aC1 uterus No are treated win either PR IAANIN Tablets 3 Y3^kinal Cream Should be mCndOrea lot signs 01 FanelliI cancer ono aopromiale nsafires:akea to rule ta'afignarc'y In the event of ption :eOI or returning aorro mal var'mal 01eeCi19 Revised August 21, 19ag rD SEC. Wyem-AyersLLabOANOies .fisemeney