Season 4 Episode 8 – Women’s Wellness Exams

Dr. Mironda Williams:

Welcome to Take Good Care podcast.

Dr. Deanna Guthrie:

An endeavor that grew out of our love for obstetrics and gynecology.

Dr. Karen Greene:

Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.

Dr. Mironda Williams:

I am Dr. Mironda Williams.

Dr. Deanna Guthrie:

I am Dr. Deanna Guthrie.

Dr. Karen Greene:

I am Dr. Karen Greene.

Dr. Mironda Williams:

Welcome to our show.

Dr. Deanna Guthrie:

Welcome to our show.

Dr. Karen Greene:

Welcome to our show.

Dr. Mironda Williams:

Welcome to another episode of Take Good Care podcast. I’m Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

I’m Dr. Karen Greene.

Dr. Mironda Williams:

Dr. Guthrie is going to let us all know what we’ll be talking about today as we get started.

Dr. Deanna Guthrie:

Okay. On this episode of Take Good Care, we’re going to delve into the bread and butter of our GYN practice, which is the woman’s wellness exam. This is what we do every day. This is what usually brings our patients in to see us. The well-woman exam is so important. If you think of your body as a vehicle, your vehicle needs regular maintenance. If you only wait until something is wrong, then you’re always dealing with problems or a problem that may has gone too far to where it would be a simple fix or a simple answer. Today, like I said, we’re going to be talking about the well-woman exam. What is in a well-woman exam? Why is it so important to have a well-woman exam? Dr. Williams is going to start out by telling us what’s so important about a woman’s wellness exam and how that benefits us.

Dr. Mironda Williams:

It’s interesting because recently we were all just chatting in the office, and as it so turns out, a couple of us are a little overdue for our wellness examinations, so Dr. Greene was gently prodding the two of us who were overdue to get our exams done. We understand, like everyone else, even doctors don’t want to go to the doctor. It’s not that we want to do this. We understand the apprehension that a lot of people have about going to see a doctor, but coming in and getting these wellness examinations is important as we have to also keep up with our own health. Why are women’s wellness exam’s so important? For those of you who may follow us on our many social media platforms, you may have seen a recent article that we posted, a blog post that talked about why women’s wellness exams are so important. These checkups will help you and your healthcare team members look for early signs of disease or other conditions. Then we can act on them proactively.

This allows us to provide better preventative wellness, which is really the goal. We don’t want to have to wait until there’s an issue or a sickness that then have to treat it though we will. We really want to set up a routine and a regimen so that all of us, ourselves included, can be wellness minded so that we can stay in the preventative mode before we have to worry about dealing with actual sickness or disease. This is a great opportunity to set up a baseline when you’re feeling healthy and normal so that if something does start to change, it’s a little easier to identify because you’ve set up what is normal for you. In addition to seeing your gynecologist, we always encourage our patients to have a relationship with a primary care physician. While we will take care of many of the feminine or woman issues that occur with the gynecology exam, your primary care provider is going to do those general other screening tests that I’m sure Dr. Greene will go into as well, because again, we remind people that the number one killer for women in this country is heart disease.

Dr. Karen Greene:

But, Dr. Williams, you’re my only doctor. I don’t see anybody else.

Dr. Mironda Williams:

Well, I appreciate that, and I can do some screening blood tests, but I don’t treat heart disease, and I don’t treat hypertension. Even though I would say all of us have probably had the occasion where a patient comes in and their blood pressures are elevated in our office, and we ask them, “Do you have a primary care provider? Or have you seen your primary care provider?”

Dr. Karen Greene:

Nope, just you.

Dr. Mironda Williams:

Right. Then we tell them, “Well, you need to go see them, and this is why. Because this blood pressure is elevated and even though you don’t feel bad, even though you’re not having signs and symptoms, that is the time to get in to get it taken care of.” Because as we’ve talked about on other episodes, by the time you start to feel bad with heart disease and hypertension, you’re already well down the road of that disease process, and that’s harder to reverse some of those changes. While we love that you come and see us and we want you to come and see us, we’re still going to encourage you, especially, if we pick up some things that are abnormal on your vital signs or with any of your laboratory examinations to go and see a specialist or your primary care provider who can better coordinate that care. Again, heart disease is the leading cause of death for women. There are certain vaccinations, colon screenings, a number of different things, and I’m sure Dr. Greene will hit on that. If not, we’ll all talk about it once we wrap up with the general introductions.

But as your gynecologist, we want you to come in for your annual visit. Most women only associate their annual GYN examination with a Pap smear. Dr. Guthrie’s going to talk about the nuances as it relates to when to get a Pap smear and how often to get a Pap smear. But a Pap smear is only a portion of the pelvic examination. Your pelvic examination allows us to look at the entire area of the woman’s genitalia. We are looking at the outside to make sure there’s nothing unusual in terms of any lesions or something that may occur. Some of you may have heard about something called melanoma, which is a certain type of cancer. It’s a rare cancer, but you can sometimes see moles that are changing or different things that are occurring on the outside of the woman’s vulva. Then if we note that, we can evaluate that. The same thing in the vaginal area. We’re looking to see are there evidence of infection or some other abnormal lesions. We’re looking and examining the entire genital tract.

If there is the time and the need for the Pap smear, then the Pap smear will be collected as a part of that pelvic examination. Then we usually do an examination with our hands so that we’re trying to get an assessment of your anatomy. For women who still have their uterus, their tubes, and their ovaries, we’re trying to feel to see what is there and if it feels normal or abnormal. We have patients all the time who say, “Well, I don’t know how you can feel all that. I got all this down here.” I promise you that all of us have been in practice for a few decades now, so we’ve had a little practice.

I think we’re very good at being able to determine if something does not feel normal if there’s an enlargement, and then we usually can follow up with a pelvic ultrasound that we’re able to do here in our office to further evaluate that. There’s a pelvic examination, and then we can talk about a woman’s birth control needs if there is a need for that, and can begin to explain different things as it relates to irregularities with your menstrual cycle or pain that you may have with your period.

Again, depending on the age of the patient, preparing for or managing menopause, prevention of sexually transmitted diseases, there are a number of different things that we can do as a part of the routine examination by the gynecologist. Again, for our young patients, those who are 18, finishing high school, starting college, another reason why we really, really like to have those young ladies come in to establish care with us is because it’s good to have a relationship that has already been established with your gynecologist so that if something starts to occur while they’re away at school or for any other things, they can feel comfortable either messaging us through our electronic medical record patient portal or coming in for a visit so that we can address those things.

Routine check-ins are important. Again, because we want to be in a prevention mindset. We want to help you establish those healthy routines that will ensure a healthy reproductive cycle and prepare as we all start to transition toward menopause. Physicians are now increasingly looking at patient-reported outcomes. This is some information that Dr. Guthrie provided with one of the resources we used from a Northwestern Medicine study that was published in JAMA. Again, what we are beginning to understand as physicians, and I think we’ve always understood that, which is the patients know their body, they know if something’s not right, they may not be able to articulate it. I tell patients all the time, “I don’t need you to come in with a diagnosis, tell me what you’re feeling or tell me what you’re seeing, or let’s have a conversation about it.” Then it’s my job along with the patient to try to figure out what that could be. These patient-reported problems or extremely, extremely useful for us as we’re doing your history and your physical because that’s what a history and a physical does.

I know when we trained, coming through our residency program, most of our attending physicians would tell us, “You pretty much know what’s going on with your patient if you can take a good history and do a good physical.” The laboratory examinations, the imaging studies that we’re doing more often confirm what we may be thinking as opposed to giving us the answer. A lot of times it may give us an answer if we don’t have something specific, but we need a good history and a patient-reported problem can be very helpful to helping us to go down the right path in terms of determining what kinds of things could be going on. Again, in your early 20s and 30s, we’re really in that preventative mindset. We want to make sure you’re having safe sexual practices, that your reproductive health, menstrual cycles, all of those things are going as they should be going, and that you’re not having any issues.

As we get older, in our 40s, again, women begin to have changes in their menstrual cycle, most likely associated with menopausal or hormonal changes. Again, because you’ve had this established relationship where you’re used to coming in to evaluate these things, we can help you manage them with treatment options if treatment is necessary or other lifestyle changes, supplements, herbal regimens, different things that can also happen. Also, again, as you go into your 60s and beyond, you still need to have these normal screening examinations. We have a lot of patients like, “Haven’t I gotten over this? Am I at the age where I can stop all this yet?” Not quite yet. Again, it’s not about the Pap test. It’s not just about your Pap smear. At age 65, as Dr. Guthrie will tell you, there are some instances where you may no longer need to get a Pap smear done, but that doesn’t mean you still don’t come in to get that annual GYN pelvic examination as well as breast examination.

That’s one of the things that we do as a part of our annual checkups with our patients. We’re going to do a pelvic examination, an abdominal examination, and then we also do the breast examination because the clinical breast exam is extremely important. Doing yourself breast examinations monthly is important, but coming in for that clinical breast examination with your provider is extremely important. Even in your 60s and beyond, we want you to come in and have your annual GYN examination so that we can evaluate what’s going on. We don’t need you to decide if you need that pelvic exam or not. Dr. Guthrie.

Dr. Deanna Guthrie:

Everything that Dr. Williams said, agreed wholeheartedly. We as women, we put everybody else first. You’re thinking, “Well, I feel good. I don’t feel anything is wrong. I don’t have any discharge or itching. You know what I’ll just put off that wellness visit until next year.” But again, as Dr. Williams just said, it is so important to keep up that regular maintenance. When women do come in, it’s so funny that they’ll come in and they’ll say, “Well, do I have to get undressed?”

Dr. Mironda Williams:

Magic wand.

Dr. Deanna Guthrie:

I was like, “Well, most of the time, yes.” There are a few visits where, yes, it will be just a conversation if you have a particular issue. But, yes, as Dr. Williams just said, we are going to do a complete exam. That is our job to do. That’s how we take a survey. We don’t necessarily treat every area of what we’re examining, but if we do find something, we are then going to get you referred to whoever you need to see to resolve that issue of further evaluate what’s going on. We do listen to your heart, we listen to your lungs, we look at your skin, all those things we do in a complete examination.

Also, we want you to come in prepared. Before your wellness exam, sit down and think, take stock of you, and see how you’re feeling if you have any questions. Now there’s certain routine questions that we will ask you when you come in for your visit. We’re going to check in with certain bodily functions. But if anything is going on, write down a list of questions. We don’t mind if you bring in a list of questions. As time allows, we will certainly address as many as we can and if we can’t at that particular time, another visit can always be scheduled to then further answer your questions or address your concerns.

So bring it. We don’t mind questions. If we don’t ask, it doesn’t mean that we don’t think it’s important. It is important for you, like I said, to ask questions and get the answers that you need. Going back to the pelvic exam. There’s the pelvic exam and the Pap smear. People often confuse the two as the same. I’ll have a patient who will come in and I’ll say, “When was your last Pap smear?” “I went to the urgent care for an infection last week, so they did a Pap smear.” I’m like, “No, they didn’t.” You may have had a pelvic exam to address whatever your issue was at the moment. But a Pap smear is a very specific test that checks for cervical cancer.

Now Pap smear has been equated with the GYN visit, but that is not the only thing that we do. It is one of the tests, one of the evaluations that we do to evaluate your female health. The Pap smear, as I said, is to pick up cervical cancer. Prior to having Pap smears, the people weren’t doing regular pelvic exams. In the late 1800s, early 1900s if a woman was developing cervical cancer, there was really no way to tell.

By the time she started having issues because of cancer, the cancer had spread significantly. In 1928, a doctor named Papanicolaou, that’s where the Pap comes from in Pap smear, he found out that if he just scraped the surface of the cervix and looked at the cells, he could tell if the cells looked normal or not. This was a way of showing that it was starting to develop into an abnormality. Now the one good thing about cervical cancer is that you don’t start out having an abnormal cell today, and then two weeks later you have full-blown cancer. It takes a significant amount of time, but at least we’re catching things very, very early. Once we started doing Pap smears, we saw that the women who were dying of cervical cancer dropped significantly. In the early days of Pap smears, it was true that you did get a Pap smear every single year. Well, about, I want to say 25 years ago, they found that this virus called the human papillomavirus was actually what was causing the majority of the cervical cancers, not all of the cervical cancers.

They started doing testing for this, and where a woman was getting a Pap smear every year where they were just looking at the cells alone when we started adding this HPV test with the Pap smear, we were getting more accurate predictions of women who were then going to go on to possibly form cancer.

Dr. Mironda Williams:

Dr. Guthrie, real quickly because I know patients, they get confused sometimes with HSV versus HPV, so just distinguish that.

Dr. Deanna Guthrie:

Yeah. There’s HSV, which is herpes simplex virus, and that’s what people typically call herpes. You do get that through sexual contact. It is a virus that once you get it, you will always have it, but it can be, what we call, recurrent. It will go away for significant periods of time. Some people may only get one outbreak and never have another one, and some people will have recurrent outbreak. That’s HSV. HPV is human papillomavirus. This virus has several strains and they number them 1, 2, 3, 30, 40, whatever the number is. With all the research that has been done, they now know which ones are more likely to cause pre-cancer cells.

Right now they focus on nine of them. There is now a vaccine that we give to… It started out with younger patients. It’s starting out as early as nine. First, it started out from 9 until 26, but now you can get the vaccine up until age 45. The idea behind a vaccine, as we’ve all learned in recent years with COVID, is that vaccines help to prevent you from getting whatever the virus is to then have to suffer from the effects of it. When you get the vaccine early before any exposure, it mitigates you getting any problems from the virus.

Dr. Mironda Williams:

From those severe strains.

Dr. Deanna Guthrie:

From those nine strains. Like I said, there’s a strain now. Also, when it first came out, they thought, since it had to do with Pap smears and cervical cancer, “Oh, we’re only going to give the vaccine to young girls.” Well, where are the young girls getting the virus from? We are getting [inaudible 00:18:01]. Well, there are two. It takes two people. Also, they found out there are a lot of other cancers now being caused by this human papillomavirus, HPV, which include rectal cancers, they’re now finding oral cancers, throat cancers, things like that. It has to do with sexual practices.

This vaccine does help both girls and boys, men and women. That’s the breakdown between HPV and HSV. But going back to the Pap smear, HPV, when the testing is done combined with a Pap smear, also increases the accuracy of prediction of cervical disease. As Dr. Williams stated before, there is the pelvic exam where there’s an external look. Women say, “Do I still have to get these exams once I get past a certain age?”

Well, actually, some of the things that we look at and the outside are more likely to occur the older you get, so the vulvar cancers, things like that. The older you get, the more likely you are to have those things. I hear a lot of people say, “Well, my doctor told me I don’t have to have Pap smears anymore,” which may be true, but that does not mean the pelvic exam. We also deal with other issues with your bladder. A lot of people may have prolapse, leaking of urine, things like that. We also use an examination to see the extent of that prolapse. There’s also a complete exam includes, like I said, an external examination.

It also includes an internal examination, looking at the vaginal walls, looking at your cervix if you still have one. If not, we just look at the top of your vagina if you’ve had a hysterectomy. Then we do what’s called a bi-manual exam where we use two hands to do an exam, and we’re feeling if you still have your uterus, the size of your uterus. If you have things like fibroids, your uterus may be larger than the normal woman.

We’re feeling for cyst, we may feel a mass on either side of the uterus. We use our hands to tell those type of things. Then for a complete pelvic exam, especially as you get older, a rectal exam is part of that. I have a lot of women that go, “Oh, my God, what are you doing?” Well, we explained that in order for us to feel completely behind the uterus, that’s one of the ways that we do it. We do a rectal exam to feel behind the uterus so that if you had a fibroid or a mass that was sitting behind your uterus, us just examining the top part of your abdomen would not tell us that. But feeling behind the uterus, we’re able to feel those things. Also, with colon cancer screening too, that used to have a part with that where you could check stool before if you saw any blood and things like that.

A complete exam, just to go over it again, is an external view, an internal view of your vagina, a two-handed examination of your abdomen. Depending on your age, it included rectal exam. Now the Pap smear. How we do Pap smears has changed significantly recently. It used to be a Pap smear every single year. Woman knew she was coming in every year and getting a Pap smear. If she saw her doctor last year, she goes, “I had a Pap smear last year.” I go, “Well, no, not necessarily because of the way we do Pap smears now.” With that HPV test, like I said, it’s more accurate at predicting if you have cervical disease.

Also, we know how HPV behaves. Like I said, it’s not pre-cancer today and full-blown cancer three weeks later. We know it takes years to develop. If you have a negative Pap smear, meaning no abnormal cell seen, and a negative HPV test, because of how we know cervical cancer typically behaves, we are reassured that when a certain period of time, the likelihood of then developing pre-cancer cells or cancer is very unlikely. That’s how they decide how often we do the testing. Right now, recommendations are if you get a Pap smear alone, you repeat that every three years.

Dr. Mironda Williams:

If normal.

Dr. Deanna Guthrie:

If normal. If you do a Pap smear with an HPV test, that’s now repeated every five years. Women who-

Dr. Mironda Williams:

Say that again because I know we have patients who come in and would be, “What do you mean I didn’t get a Pap smear? I thought I was supposed to get a Pap smear.” Then we…

Dr. Deanna Guthrie:

Right. It’s also based on your age too because cervical cancer behaves differently or cervical abnormalities and HPV behave differently depending on how old you are when they’ve done research.

Dr. Mironda Williams:

One quick thing too, I wanted to bring up, Dr. Guthrie. Again, we’re giving you information. There are a lot of specifics. Dr. Guthrie’s doing a great job at explaining why things are being done. But this is not for you to decide, “I don’t need to get a Pap smear because my…” No, we want you to come in every year because it is our job. We’re giving you general categories, but every patient is different. You may have risk factors associated with other parts of your history that may alter how we do the Pap follow-up in terms of the how often you’re getting a Pap smear done.

She’s doing a great job at explaining why we can look at the Paps at intervals now as opposed to doing it every year. But that is not for you to make the decision about that. That’s for your healthcare provider. Again, before we go on, as we always say, we’re providing information so that patients can be informed and engaged in their care. We are not substituting the care that you get with your provider and your provider’s recommendations because everyone’s individual history has to come into play. Just keep that in mind as she continues to give you this great information.

Dr. Karen Greene:

Dr. Williams, I can’t Google it and make a decision on what I’m supposed to do.

Dr. Mironda Williams:

You can Google it. I Google.

Dr. Karen Greene:

Make a decision on what I’m supposed to do now.

Dr. Mironda Williams:

I’m not going to disparage Googling because I Google. I don’t mind you Googling. But when it comes to decisions on timing, you should have the conversation with your healthcare provider. Bring your Google information if you choose, that’s okay, but we need to have a conversation about it and not for you to make a decision on your own based on your outside research.

Dr. Deanna Guthrie:

Going back to the Pap smears, we don’t start Pap smears until age 21. That’s the PAP test. Now, as a young woman, as Dr. Williams said, we’re concerned about your sexual health, your reproductive health. We’re there to help you make decisions on your choice of birth control. You can usually start coming in. Most women start coming in when they start college, at the end of high school. You can come in every year, have a conversation with a doctor, check in. Doesn’t necessarily mean that we’re doing any testing on you or anything like that, but it’s just a way to establish a relationship with your GYN doctor. Once you do get to age 21, from age 21 to age 29, you’ll start getting Pap smears. But they only need to be repeated every three years. We don’t need to do the HPV test because usually, in this age category, this is when most people, not all become sexually active. So we know that at times you may get that HPV, but because you’re younger and your immune system is better at working, you usually can, what we call, clear the HPV.

Even if we did a test and it came back positive for HPV, there is no treatment that is actually needed at this time because we know how HPV behaves in younger patients. Age 21 to 29 Pap smears every three years. When you get to age 30, you have three options. Again, it’s your doctor to decide based on your history, past Paps, things like that. But the three main ways are either you get a Pap smear alone every three years or an HPV test alone every five years. Or what most people are doing is the Pap smear with the HPV test every five years. That’s age 30 to age 65.

Dr. Williams mentioned before, as you get older, there’s certain tests that because we know again how the disease behaves, the likelihood of getting HPV at age 65 to then have time for it to then develop into a cervical cancer is highly unlikely. If you’ve had a history all of your life of having normal Pap smears, once you get to age 65, that routine screening is not necessary. Now, of course, if anything changes, if we see anything, then we can always, a Pap smear can always be done. But in general, if you’ve had a negative history your entire life at age 65, Pap smears aren’t indicated anymore.

Dr. Mironda Williams:

I know we all have older patients who just want that Pap smear done. [inaudible 00:27:22]. It gives them a sense of comfort because this is what they’ve known because they came up in the era of needing to get that Pap every year. We understand that. We’re sensitive to that, but we want to try to inform our patients as to why it’s not needed. It’s not because government doesn’t want to pay for Pap smears. This is not a cost issue. Now there are some things in the healthcare system that are cost-related. This particular issue is not about cost. It’s not about insurance not wanting to pay for a Pap smear. It’s because the science has told us that the chances that you’re going to be exposed to one of the more virulent strains of HPV to then cause you to have changes in the cervix or the vaginal area. If your cervix is gone, that could lead to cancerous changes is extremely low. But again, that doesn’t mean that you don’t come in to get a pelvic examination. We’re just not doing the Pap smear.

Dr. Deanna Guthrie:

Then the only other one, like that was mentioned just a while ago, is if you’ve had a hysterectomy and you no longer have a cervix, as long as your hysterectomy was done for any reason other than having pre-cancer cells on your cervix and then severe pre-cancer cells, then at that point you no longer need Pap smears because you don’t have a cervix anymore. But if your hysterectomy was done because of pre-cancer of the cervix, then, yes, for a while after your hysterectomy, yes, you will continue to have Pap smears. Again, there’s the pelvic exam, which is a complete… Think of that as the complete evaluation of your female health, your female physical health. Then the Pap smears, just one of the tests that we use to evaluate you. But there are other things that we do evaluate and speak with you about.

Dr. Mironda Williams:

It’s like getting a car wash or a car wash with wax.

Dr. Deanna Guthrie:

There you go. Or the total detail. You should get at least detailed once a year. Then if you have problems throughout the year, you come in for a little touch-up.

Dr. Mironda Williams:

That’s it.

Dr. Deanna Guthrie:

Now Dr. Greene is going to talk about other things that we do in our complete examination to help screen for other problems that you may see other providers for.

Dr. Karen Greene:

Thank you, Dr. Guthrie and Dr. Williams. I just want to piggyback on one of the things that we have said repeatedly that the wellness exam, the GYN exam is really about communication with your doctor. I think that because we have been practicing for a minute, we’ve actually seen the changes. We’re used to doing a Pap every year, and that was our comfort level. But because of the science, things changed. I actually had a patient who had a Pap smear before the age of 21 because at the time Pap smears were done when you became sexually active. She became sexually active, she had a Pap, and sadly, her Pap was abnormal.

What that meant for her is that suddenly when she got to 20, the rules changed. Now all of a sudden, we weren’t doing a Pap smear. Back to the comfort level of, “Is it really, okay? Can I not have a Pap this year?” We had to have a discussion. That discussion had to go a lot into the science of what was being done and why we were following things and why it was okay to wait until she was 21. Even though we had done one when she was 17.

Because things change. As we learn things, as we see things scientifically, we want to communicate that to our patients so that when they come in, they understand why the exams being done, the full tune-up versus the detail, and why certain things are not being done on certain years. As we’ve also said, a lot of times our patients, they come to us because we’re the only doctor they see, and that’s okay. We encourage them to see other physicians, we encourage them to get other screening tests, but oftentimes there are definitely things we will pick up on because they are coming to see us, and they feel comfortable talking to us about different problems they might be having and we can give them referrals to go see other doctors. There are definitely other screening tests as gynecologists that we do on a fairly routine basis. When a patient comes in looking at their blood count if it’s appropriate. If a patient comes in and tells us a symptom that may affect their blood count, the most common being bleeding or heavy bleeding, then we will check a blood count.

If it looks like that their blood count is normal, then we may evaluate the heavy bleeding in other ways. When they go to see their primary doctor for the same problem, the primary doctor will get the laboratory work, but then when they come in to see us, we’re going to expound on that and say, “Well, they’re having heavy bleeding. They’re also anemic. Their blood count is low, so maybe it has to do with some female organ.” Because 9 times out of 10, the primary doctor won’t be thinking about that. When a patient comes in to see us, we’re targeted in on, “Okay, if their blood count is low, it’s probably due to their cycles. It may not be due to the gastrointestinal organs, it’s probably due to something GYN.” Coming to see your gynecologist when you’ve been referred from your primary doctor makes a lot of sense. For us, specifically, because we don’t always do that type of screening test, we don’t always do a blood count unless it’s indicated.

The other thing we look at on a routine basis, especially as our patients get older and we’re trying again to be preventative is their bone health. Osteoporosis is something that you may have heard of in terms of thinning up the bones, not to be confused with osteoarthritis, which is more of painful joints and wear and tear on your joints. Osteoporosis has more to do with as we get older, our bones can become thinner. Women are living longer. As we will tell patients it is important to keep those bones strong because as we get older, we don’t want to break something. The screening for osteoporosis is not something that you can feel, but it is something what we recommend. The recommendation is usually about age 65. So somewhere between 60 and 65, a women can be sent for a special X-ray test to look at their bones. Osteoporosis is when those bones become thinner and they use certain numbers to measure what that thinness is.

You can range anywhere from very, very thin bones, which is osteoporosis to thinning of the bones, which is osteopenia. You may hear us talk about, “Well, your bones are not what they used to be, but they’re a little bit thinner. They’re osteopenic.” What can be done about them, doctor, is what we’re usually asked. The things that we would recommend are dietary changes, lifestyle changes, and sometimes medication.

The dietary changes would be adding calcium to the diet, lifestyle changes would be exercise, and medication would be if the symptoms progress, so it’s not just a little thin, but at risk for breakage, which is the osteoporosis, medications to prevent that. Then if we’re sending them for these specialized tests, how often do you have to have them done? When we send a patient out, we give them the order, go have the screening test, they come back and say, “Well, I didn’t have it because A, B, C.” We’ll tell them again, “This is why it needs to be done. We don’t want you to break something.” They have the test, they come back to us to go over those results and determine what the next step will be.

If it’s medication, if it’s lifestyle changes, and we can push them in the right direction to get those additional testing if they need to be done, put them on medication if that needs to be done, and then repeat it in about every two to three years. The main thing that women come to our office specifically further than the Pap smear and wellness exam, of course, is the mammogram. One in eight women, we have talked before, will develop breast cancer. In the past, there was no real screening test for higher-risk women in terms of whether or not they’re more prone to develop breast cancer other than those particular statistics.

When women come into the office for their routine exam, it is important for them to understand it is the breast exam that we do, the breast exams that they do on a monthly basis, as Dr. Williams has alluded to. Then the compression exam to actually take a closer look at their breast tissue. Some women will come in and say, “I’m afraid I don’t want to have that done because it’s going to hurt.” Or for women that may have artificial implants in their breast tissue, “It’s going to pop one of my implants.”

It’s up to us to reassure them that we can actually see around the implant. We can detect different changes early on so that if there is something abnormal, a diagnostic studies can be done, biopsies can be done if it need be done, and more importantly, catch it before it turns into a problem. That is the bottom line, as we’ve talked about on other episodes, on the podcast, and on our social media pages, that screening for breast cancer is one of the things that we encourage. We have it in our office so that we can do it when the patient is here so that she’s not sent out and forgets to do it because of the million other things she has to take care of.

We want to get that screening test in. We want to do them on a yearly basis. As I’ve said, women live longer. Our older patients will come in and think, “Well, do I need to still have that exam? Do I need to still have a mammogram?” That’s based on their own personal history as also based on their lifestyle, meaning that if they’re a healthy 70 and 80-year-old woman that doesn’t have any other medical issues, it does make sense to do a preventative test on someone that if something were detected, if surgery were needed for something early on, they would want to have it because they don’t want to not know.

I think that one of the reasons that women as well as men do not go to the doctor has a lot to do… For women, they have other things that they’re doing and they just put it off or they’re afraid they might find something.

Dr. Mironda Williams:

Exactly.

Dr. Karen Greene:

We had that population of patients that will wait and wait and wait either because they’re putting it off and then when they finally come in, there’s nothing going on because they were worried that there was something going on or they’re afraid to find out something. We would much rather you come in on a regular basis to be seen so that you can get those routine screening tests so that you can come in and be seen when you’re healthy so that you can come in and be seen and be informed, “That number one, this is normal, this is not normal, or we’ve caught it early enough so that we can treat it.” There are options as opposed to I’m just going to not do anything and not worry about it. Then if it happens, it happens. We would rather you come in and communicate with us so you know that there are things that can be done.

Dr. Mironda Williams:

Right. The one thing I wanted to say about that fear of finding out, what I try to help patients understand is whether you come in for an early test for something to be detected early or not, doesn’t stop it from happening.

Dr. Deanna Guthrie:

Exactly.

Dr. Mironda Williams:

At least if you come in for regular routine examinations so that things can be caught early, it gives you the options of early treatments that could prevent any detrimental effects to your quality of life or the shortening of your life because things were detected in their later stages. Not wanting to know doesn’t mean it’s not going to happen if there’s something there that is taking place. It’s just better to come in, let us evaluate you, see what’s going on because there are so many new treatment regimens and things that are available that are so advanced from what you may have been remembering from early years when people would have to go through so much trouble, they felt like the treatment was worse than the disease. That’s no longer the case. Many of these different problems and diseases that we find, they’ve made tremendous advancements in treatment options and protocols so that your quality of life is maintained.

Dr. Karen Greene:

I think that in terms of the other screening tests because patients often don’t have a primary doctor or don’t go to see a primary doctor, they will often request of us, “Well, can you test for this? Can you test for that?” For the most part, we don’t have a problem checking for it because we understand that if you’re in our office and we can get the blood for it, we don’t have a problem checking for it. If it’s a fasting cholesterol or if it’s a fasting thyroid testing, or if it’s any type of fasting blood work that you want to have done, we can do understanding that we’re probably not going to treat it.

We’re probably not going to put you on the medications for it, but at least you know because as we’ve said many times, you can’t feel when your blood pressure’s up, you can’t feel when something’s off with your thyroid. But if we find out that something is off or something is abnormal, we can at least make the appropriate referrals. I had a patient years ago that came in, was probably half my size, and was having some weight changes and thirst and just an odd constellation of symptoms in terms of her appetite.

She was a new patient. She comes in, and I thought, “Well, I’m not really sure what this is, but let’s just do a complete metabolic panel,” not really thinking I would find anything because it was an odd constellation of symptoms. As we’ve discussed that when a patient comes in, they know something’s wrong. So we try to take a good history, we try to get the information, and then put all the pieces together. As it turns out, her sugar level was extremely elevated to the point that we had to call her the next day to get her to see her primary doctor immediately, immediately. She was diagnosed with diabetes. She probably weighed about 120 pounds at the time, and it wasn’t something that I expected to diagnose, but when I saw her recently, she was very appreciative of that, the fact that I took the time to sit down and listen. We encourage patients to talk to their doctor if something is wrong to, as Dr. Guthrie and Dr. Williams has said, write that list out of questions so that we can actually address them if we can.

Dr. Mironda Williams:

Or send you to where somebody-

Dr. Karen Greene:

Exactly. If we can’t address them, send you to the appropriate [inaudible 00:41:53] at least you feel like that someone sees you and someone has listened to you so that you can get the appropriate treatment in the appropriate amount of time so that something can be done.

Dr. Mironda Williams:

One of the other things I wanted to bring up, and we run into it a lot to patients who will come in, they only come in if they have a problem. Then when they come in for the problem, “While I’m here, can’t you just go ahead and do my Pap…” One of the things I wanted to bring up is that sick visits or problem visits do not allow for necessary routine screenings. We just can’t do it all in a “problem visit” or a sick visit.

Also, that’s the problem when patients use urgent cares or emergent care centers for their “healthcare.” As they said before, we’ll have patients who come in, having been seen in the emergency room, they say, “Oh, well, they did my Pap smear in emergency.” I say, “Oh, they probably did not do your Pap smears in emergency room because that’s not the setting for routine screenings.” We’ve talked about in other podcasts how we are aware of the barriers in terms of access to healthcare for a lot of populations and at-risk populations in particular, those Black and brown populations or people who are in geographic areas, more rural areas where routine medical care is not available to them, easily accessible.

So they go to their urgent care or go to emergency rooms because that’s the only thing that they have. But even in those circumstances, health departments, there are educational facilities, medical school programs, and things like that that have clinics where you can be seen for routine examinations. It’s so important to try to find a resource and we understand the barriers and we hope that with everything that’s been revealed over the last three years, that there will be some true intention in terms of policy and procedure to try to help break down some of these barriers. But nothing can substitute for regular routine visits with your doctor to make sure that you’re being wellness-minded, that we can prevent things before they happen or catch something in the early stages or even full-blown diabetes about to be into DKA. That can be a serious situation. You can get commas and other kinds of things if your blood sugar is extremely elevated.

We definitely want you to come in for those routine checkups. Come in with your questions, come in with your Google list. I don’t have a problem with it. Now I will tell you if that resource that you find on Google, I’m like, “I don’t know if that’s a reliable one [inaudible 00:44:37]. Let me give you some others that may be a little bit better.” But I don’t mind having an engaged patient. When you come in and because you’ve Googled everything, it’s because you’re engaged in your healthcare and you want to be informed and involved, we get it. But just understand everything on Google ain’t right. I’ll just put that out there.

Dr. Karen Greene:

But I’d rather have you ask the question [inaudible 00:45:00].

Dr. Mironda Williams:

[inaudible 00:45:01] and you’re involved. That’s good. But we are here to help you make your way through the weeds of things to know what’s reliable and what isn’t quite so reliable. This was a topic that Dr. Guthrie really had an interest in and making sure that we really took the time to talk about women’s wellness, Peachtree City Obstetrics and Gynecology, as well as this podcast, Take Good Care podcast. Our whole reason for being in business really, and to do this podcast is to be a resource of health and wellness for women and wellness examinations. Why we do Pap smears, when we do Pap smears, why you still need the pelvic examination, why you need the breast exam, the mammogram. Then to still get those other routine checkups with your primary care physician are important. Colon screenings, all the things we’ve talked about before. Ladies, do you have anything else you want to add before we get ready to sign off for this episode?

Dr. Deanna Guthrie:

Yeah, just to say that, like you said, use us. That’s why we’re here. Use us as a resource if you have any questions about anything. That’s why we’re here. If we can’t take care of the problem ourselves, we’re here to point you in the right direction.

Dr. Karen Greene:

I guess the only thing I would add is that for our younger patients who, and Dr. Guthrie alluded to, when they come in, it’s not necessarily an exam. When I have a younger patient that’s brought in by her mother, usually, I will say, “So why are you here? Because your mom brought you?” She’ll chuckle because that is usually the reason. It can be an uncomfortable exam for all ages. With social media and teens talking to their friends more than they talk to their parents about things such as sex and sexual health. I think it is important to educate them on that level so they enter that part of their life with at least a little knowledge so that they feel comfortable asking a question. As Dr. Williams says, so when they go off to school and have a problem, they can say, “Wait, I can send a MyChart message to Dr. Williams and ask her this and not listen to my friend because I’m not really sure she Googled the right source.”

That’s just so important that establishment of care and being comfortable with talking about things you may or may not understand. When we say use us, we look at the research, we look at the data, we do have experience with seeing these type of things. If you have a question, just ask.

Dr. Mironda Williams:

Yeah, absolutely. Thank you, everyone, for listening to this episode of Take Good Care podcast. We have really tried to expand what we do. We want to make sure that we’re talking to you in a way that you can understand and that you can relate to, and that encourages you to either seek us out or to be informed when you go to your healthcare provider about your healthcare needs. Please continue to listen to us, check us out on our website, ptcobgyn.com, and everywhere you get your pods, continue to tell all your friends and family about the show. Until we get together next time, I’m Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

I’m Dr. Karen Greene. Take Good Care.