Melanie Cole, MS (Host): Welcome to Valley Vitals, the pulse of healthy living in our community. Brought to you by Carson Valley Health, we're going beyond the checkup to bring you real conversations with the experts you trust. I'm your host, Melanie Cole. And today, we're highlighting primary care, preventive screening, and well-woman care.

Joining me is Heather Wetmore. She's a family medicine primary care provider at Carson Valley Health. Heather, thank you so much for joining us today. So, let's start with kind of how our health concerns change. As we get older, as women get older, our health concerns change a little bit. When you see women from young to old, what do you see as we go through those stages of life?

Heather Wetmore, PA-C: Yes, definitely. When women age, there's definitely different patterns. And one thing that I see often is that women tend to take care of the people around them in their life and don't always put themselves first. And that's such a loving, compassionate thing to do, but it's also very important for women to come in and make sure that their health is taken care of, being monitored.

Sometimes people feel it's not necessary to come in for an appointment because they don't feel unwell. But this important information that we take when we see patients from their lab work, from their blood pressure, their vitals, from their preventive screenings can help us monitor and trend their overall health as they age through life.

Especially when we hit our early 40s, things like perimenopause come into play, cervical cancer screening around age 21, osteoporosis starts coming into play around late 50s or the menopausal range. So, there's quite a few things as women age that we need to keep our eyes on.

Melanie Cole, MS: Well, you said it so perfectly, and thank you for that answer. Really, we are the caregivers to society, right? So, if we don't take care of ourselves, we can't take care of the ones that we love. So, tell us a little bit about primary care, and how does that help us to stay just a little bit healthier?

Heather Wetmore, PA-C: Primary care is the foundation for our health, and I think the relationship between the patient and the provider is very important so that we see each other and see what normal is for that particular patient or how their lifestyle is changing throughout their years. Primary care is just very important so that the patient can continue to stay up on those screenings or be aware of different changes that may be occurring as we age. Especially as women, sometimes we are more complex with all our hormones and different cycles that we go through. So, that's definitely a big concern.

Melanie Cole, MS: Well, that's so true. So for women who haven't been to the doctor in a while, what are some of the biggest reasons to schedule a primary care or well-woman visit rather than waiting until we feel something's off or something's wrong?

Heather Wetmore, PA-C: Yeah. One of the big reasons we should schedule before we feel like something is wrong is, one, our medicine has just advanced so much than what it used to be. So with our cervical cancer screenings and our mammograms, bone density, all of these things are preventive, meaning usually you won't experience any symptoms of anything going on, but we have the ability to detect when something is abnormal much earlier.

So for cervical cancer screenings, we're taking a look and seeing if there's any changes to the cells of the cervix, then also for any presence of HPV. For mammograms, oftentimes mammograms can detect early signs of breast cancer many years potentially in some cases before a mass is detected or palpated on an exam even by a provider.

Same with the bone density screenings like osteoporosis. You usually do not feel that your bones are getting weaker or anything like that, and it's important to keep an eye on the bone density, especially when we face that drop of estrogen through the menopausal years.

Melanie Cole, MS: So Heather, if we get these well-woman exams and we get the screenings that we're supposed to be getting, if a Pap smear or a mammogram comes back abnormal, what are usually the next steps?

Heather Wetmore, PA-C: Yes. I always tell women, "Do not be alarmed if there's an abnormal result." It is a screening test. It's not a diagnostic test. So often, this means that we need further testing. It is not a cancer diagnosis if something is abnormal. We need to just look further.

So in the case of cervical cancer screening, oftentimes that could just mean that there's some cells that are abnormal, may be pre-cancerous, could potentially be cancer. But usually, we just need to repeat tests in a year or do a procedure called a colposcopy where we magnify the cervix or look at the cervix under magnification and identify if there's any abnormal changes, pre-cancerous cells, and potentially take a small biopsy or a collection of the cells, to determine that.

HPV is also very common. A lot of times, our bodies can clear it, but there are some high-risk strains that over time can turn cancerous. And so, that's the reason we need to monitor and screen for that. For mammograms, if something comes back abnormal, usually, that requires additional testing as well. So instead of a screening mammogram, we would get a different kind of mammogram called a diagnostic mammogram. We may also usually get an ultrasound along with it to further assess and examine the area and determine what may be required.

Melanie Cole, MS: Heather, are there any mental health conditions that you can treat in primary care?

Heather Wetmore, PA-C: Yes, of course. Mental health is definitely a big concern of mine. And any patient, I would hope, would feel comfortable talking with their primary care provider about their mental health, especially just to reduce that stigma. We often see anxiety or depression in our patients, those can definitely be handled in the primary care setting.

We often have medication management or therapy that can be used. And I think it's important to remember that it doesn't have to be this lifelong diagnosis of depression or anxiety or a lifelong medication use. Medication can be used as a tool in the time being if needed to kind of help that person in that particular time and use their skills in coping in their therapy appointments to help them, hopefully pull out of that state if possible.

Melanie Cole, MS: Yeah, there's so many things. I mean, stress management is so important. We're learning more, Heather, about sleep and its association with diabetes and obesity and heart disease and all of the way these things tie together. And certainly, we women, as we get older, are looking at all of these things. Certainly sleep is a big one too, because we're really not getting the restorative sleep that we need. Give us your best advice for preventive care, whether it's sleep, obesity, stress management, all of the things that go into being a woman as we age

Heather Wetmore, PA-C: I think the number one thing is building blocks to health are our diet and our exercise, our sleep. So, prioritizing those things so that we can be as healthy as possible. Sleep can be quite challenging. And there definitely are some disturbances, especially when you start experiencing perimenopause as a woman.

So if you're starting to be in the mid-40s, late 40s, somewhere around there, and you're starting to not feel like yourself, definitely consider some of the symptoms that may be ongoing and talk with your practitioner about ways that we could combat that. For sleep hygiene, I just recommend waking up at the same time and going to sleep at the same time every day. Exposure to sunlight is great. trying to exercise at some point throughout the day will help tire you out so you can have better rest. And some of those things, keeping the room cool at night also helps promote a good sleep environment.

Melanie Cole, MS: Wow, that was great advice. As we wrap up, tell us about primary care at Carson Valley Health and what you want women to know about scheduling that appointment now before they have something else that they want to get ahead of.

Heather Wetmore, PA-C: Yes. I think it's very important to schedule with your primary care provider. As I mentioned before, that relationship is just very important, that you know who your healthcare provider is, that you talk with them on a day-to-day basis before anything goes wrong so that they have an understanding of who you are as a person, what kind of life you live, family history, things like that, so we can get all of your health history down and understand what you're at increased risk for or lower risk for, and what kind of decisions you like to make as a patient about your health and making that shared decision about what would be best for you overall.

I think that having that information, having that relationship, the rapport, will help over time monitor your health levels and be able to give you the best care possible.

Melanie Cole, MS: Great advice, Heather. Thank you so much for joining us today and really sharing your expertise and letting women know how important it is that we take care of ourselves. Thank you again for joining us. And to learn more, visit carsonvalleyhealth.org.

And as we wrap up another episode of Valley Vitals, make sure to subscribe to our podcast, share and connect with us on social media, and stay tuned for more engaging discussions. This is Melanie Cole signing off from Valley Vitals. Let's move mountains.