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Robin Kish (Host):  Women are often so busy taking care of their families, they delay devoting time caring for themselves. What it means for women to stay healthy at every stage and every age on this edition of Here for Your Health. Welcome to the Healthcare District of Palm Beach County’s Podcast Here for Your Health. I’m your host, Robin Kish. The Health Care District of Palm Beach County is a unique healthcare system located in south Florida. This public healthcare system provides county residents access to primary care, skilled nursing and hospital care, registered nurses in nearly all of the county’s public schools and plays a key role in the county’s trauma system, including operating the country’s two life saving Trauma Hawk Air Ambulances. Through all of these programs, the Health Care District serves as the healthcare safety net for Palm Beach County. On this edition of Here for Your Health, we take a closer look at the importance of women’s health from your 20s through pregnancy, motherhood and into your senior years, we’ll discuss how taking good care of yourself and following your doctor’s guidance, are key to living a long, healthy life and keeping your family well and strong. Our guest today, is Dr. Jennifer Dorce-Medard, Associate Chief Medical Officer at Lakeside Medical Center, the Health Care District’s rural acute care teaching hospital in Belle Glade, Florida. Welcome Dr. Medard.

Jennifer Dorce-Medard, DO (Guest):  Thanks Robin. It’s great to be here.

Host:  Dr. Medard, why is women’s health such a priority in the medical field?

Dr. Medard:  Robin, we know that healthy families starts with healthy women and that’s not a luxury, it’s a necessity. So, it’s really important to keep women healthy throughout all of the stages of their lives, especially now during the COVID-19 pandemic. So, at Lakeside Medical Center, in Belle Glade, Florida, we offer optimal quality care to women of all ages and really, also in our clinics throughout the county. Women’s Health is a vital service that has grown over time at Lakeside Medical Center and we now offer Women’s Health Services at every stage including prenatal care, annual checkups, diagnostic services, family planning, and gynecology services. I can go on and on, but our goal is to empower women to make them have informed decision about their healthcare and the options available to them as well as their mothers, sisters, daughters, aunts, nieces, cousins, grandmothers.

We encourage women to go to visit their PCPs for wellness plan and that may include for them to have additional exams done by their OB-GYN and get well-women checkups, have their mammogram screening, their bone density depending on their age and then to detect things like osteoporosis which is a thinning or weakening of the bones, osteopenia could be detected which is just a decrease in the bone mass. So, these are the conditions that can be treated as soon as possible to prevent bone fractures.

I also recommend and we recommend that women stay active, eat healthy, pay attention to their mental health; that’s very important. Stress management is particularly at this time, and to get enough sleep is so important. I have to remind myself that every day.

Host:  So do I. You mentioned PCP which stands for Primary Care Physician, something you know very well about because you yourself provide Primary Care at our CL Brumback Primary Care Clinics in addition to your work at Lakeside Medical Center. Let’s talk a little bit about maternity care. Why is it so important for women who are planning their pregnancies or who are expecting to see an OB-GYN on a regular basis?

Dr. Medard:  So, being the mother of a 17 month old myself, I know how important it is to have a healthy pregnancy. It promotes a healthy birth. So, getting early and regular pregnancy and prenatal care improves that chances of healthy pregnancy and helps prevent complications. So, that takes the stress of you as a mother, as much as you have appointments. I felt like that calmed me to know I’m doing what I need to do. Maternity care is defined as a health services provided to women, their baby, their family throughout the pregnancy, during labor and birth and after birth for up to six weeks. Prenatal visits to a healthcare provider usually includes a physical exam, weight checks and providing urine samples. Depending on the stage of pregnancy, healthcare providers may also do blood tests, imaging such as an ultrasound exam. These visits also include discussions about the mother’s health, the fetuses health, a discussion about the family’s health history of both parents and any questions about the pregnancy.

Maternity care is typically provided by obstetricians, midwives, but can be also done by family physicians who are trained in that area. Some women also see other healthcare professionals and community workers throughout their pregnancy. These other health professionals might include endocrinologists, social workers, psychologists, dieticians, just to name a few. And we all, in the field just work together to support the women’s health during the pregnancy and during their birth. Maternity care includes monitoring health and the wellbeing of the mother and the baby. Health education, assisting during labor and birth. In addition, supporting after birth too. We can’t forget about that time to ensure the mother and the baby continue to be in health and are well and also part of the overall maternity care. It includes guidance on breastfeeding, and I honestly have a wonderful podcast with my friend Dr. Anna Ferwerda, who works for our clinics as well.

Lakeside Medical Center offers prenatal and maternity care, obstetricians and family physicians like me, along with other health professionals work together to support women’s pregnancy and birth. We provide quality pediatric services also at the hospital as well. I’m just going to sneak that in.

Host:  I’m glad you did because it is a whole continuum of care. Tell me a little bit about mammograms. I know I’m due for my annual mammogram. What is a mammogram and who should get one?

Dr. Medard:  So, a mammogram is just like an x-ray that can help reduce the number of deaths from breast cancer amongst women, particularly in the age group of 40 to 70 who are not in the high risk group but again, that’s something I want our listeners to know to discuss with their primary care physician to develop a wellness plan. This is not the time you are going in with the knee pain or something of concern. You’re specifically going to the office for your annual physical and discussing with your doctor what are my screenings for my age group and a detailed family history and what your symptoms are; you will develop what is your wellness plan.

And because other than skin cancer, breast cancer is one of the most common cancers among American women. And just so we don’t forget, also that men can develop breast cancer as well. So, this could be something you’re discussing with your PCP during your wellness plan. Mammograms are the best way to detect breast cancer early. And early is important. It’s easier to treat before it’s big enough to feel and cause symptoms. So, oftentimes, I get patients who say oh, but I do self-exams and that’s great, but we want to catch it as soon as possible and the mammogram is going to be the tool that gets us to be able to detect it early. And age and as I said family history are factors in terms of your risk of getting breast cancer. Women who are at higher than average risk are recommended to start mammograms by the age of 40 if not earlier. Again, you would discuss it with your PCP. Sometimes it can take up to three years before you feel or notice a growth in your own breast.

At Lakeside Medical Center, we offer mammograms and staff are specially trained including a radiologist who looks at the images specifically to note any abnormalities in that imaging. Thanks to a grant from the Common South Florida, Lakeside Center has been able to provide free mammograms to those who are eligible. In fact, this year, I went for my very own first mammogram at Lakeside and it was easy. The tech made me feel comfortable. You do have to be in a robe that opens in the front with no undergarments so it can be a little delicate exam. You can have a chaperone with you in the room. But she really set me at ease by describing to me each step of the process. What I can tell my patients is now I don’t only talk the talk, but I also walk the walk and I had my own very mammogram this year.

Host:  So, you can check that off the list. But it’s not the only time that we need to get a mammogram, right. There will be a need to do it again. How often should we expect to have a mammogram done?

Dr. Medard:  Again, I’m going to give you guys different academies and what they recommend. But again, each patient should discuss with their primary care in detail to determine their risk factors and what is recommended for them. But according to the American College of Obstetricians and Gynecology ACOG and the American Cancer Society, women ages 40 to 49 with average risk should have mammograms every year. For women ages 50 to 74, with average risk, ACOG recommends annual screenings, however, ACS which is the American Cancer Society, recommends women ages 50 to 54 to continue with annual screening with women who are 55 and older, switching to mammograms to every two years.

Host:  So, really follow your primary care physician’s and your OBGYN’s guidance on that because every woman is different. And for those who have not had a mammogram, you mentioned a little bit about what you experienced but what else should they expect?

Dr. Medard:  So, this is always a conversation that I have with my patients before they even go get their mammogram because I think it’s important to prepare you and for you to understand what you may get as a call or in the mail from your provider. So, will be told not to use any lotion or perfumes or deodorant so that’s because you are going to be on the machine, it gets in your axilla or your armpit area, so that’s the reason for that instruction. When you get to the testing location, you’ll be asked to wear a special robe and like I said, it opens up in the front and can’t have any garments under there. The technologist will place your breast on a plastic plate and then another plate will firmly press the breast down from above. The plates flatten the breast holding it still while the x-ray is taken. The steps are repeated so that the radiologist can see different views of the breast. The other breast is x-rayed in the same way. While the test can be uncomfortable for some, the whole process is pretty quick and for me, it went very smoothly. I was relaxed and like I said, the technician really made me feel comfortable.

Once the x-ray was completed, they are sent to the radiologist who reads the mammogram. He or she will look at the x-rays for early signs of breast cancer, other problems in the tissue can also be reported. Usually you will get results from your physician within a week or two. And the technologists, just so you know and so you are aware, will not be able to give you the results because that’s not what they’re trained to do. And then, each mammogram may look a little different because our breast are different density and sizes.

Host:  And what are the types of results you can receive after you complete your screening and get the information back?

Dr. Medard:  Oh yeah. So, this is also important to discuss with your primary care before you go through that process. You can receive results that say your mammogram is normal. You would need to continue to get the mammograms according to the time intervals your doctors recommend. Mammograms work best when they can be compared with previous ones. This allows the radiologist to compare them to look for changes in your breasts. So, we recommend the same facility or keeping records so they can compare. That’s in your best interest.

A mammogram can sometimes be abnormal. Now abnormal does not mean you have cancer you know, and I get patients who are very concerned. But these are the reasons why you can get a mammogram that they report to you as abnormal. It can indicate a need for additional mammogram testing or exam. The doctor can tell you with more certainty that they are not concerned about any areas of the breast that they are analyzing. You may be also referred to a breast specialist or a surgeon. Again, this does not necessarily mean you have cancer. We, in the medical field, want to be thorough and want to know that whatever we’re seeing, we’re sure and if there is a doubt that we take the extra steps. These doctors are experts, and they are used to diagnostic issues in the breast and they will do follow up tests with you and to determine if there’s no cancer.

I have patients who actually one recently, who went through the whole process and it was rather stressful for her. However, at the end of the day, even going through all the way to the step of a biopsy, everything was okay, and she was really set at ease. So, another thing I want to stress is, it’s so important for you to take the step for you to know your history so you can pass this on to your children and then how important it is for you to know your family history. This is all part of what we’re trying to educate and get out there so we can help save lives.

Host:  Dr. Medard, earlier in the podcast, you mentioned bone density testing. When do women or men need that type of test and what does it detect?

Dr. Medard:  Sure. So another important part of your wellness plan that should be done with your primary care. So, our bone density test is mainly conducted to detect osteoporosis as I said, the thinning or weakening of the bones or osteopenia which is just a decrease in the bone mass so that these conditions can be treated as soon as possible. Those at risk include postmenopausal women who are not taking estrogen, women over 65 and men over 70. Anyone who smokes or drinks too much alcohol, people of certain ethnic backgrounds, and those with family history of hip fractures or osteoporosis are included in the increased risks. Early treatment helps to prevent bone fractures.

Early identification and treatments are important since complications of broken bones related to osteoporosis often are severe in the elderly. The earlier the osteoporosis can be diagnosed, the sooner the treatment can be started to improve the condition or prevent it from getting worse. Again, the key here is just prevention, early detection is key.

A bone density test is used to measure bone mineral contents and density and can be used to determine the patient’s risk of a bone fracture. This can be done as an outpatient as part of your hospital stay depending on your situation. During the test, you would lie flat on your back again, an x-ray would be done just like when you are taking an x-ray on a table. It’s used in combination with proton generators to measure the bone minerals and density in the patient’s bone. The entire procedure will take likely around 30 minutes. And just like a mammogram, there is no injection, nothing to drink. It’s just you lay there as they do the exam.

Host:  Now this fall, Lakeside Medical Center celebrated Women’s Health and Breast Cancer Awareness month with the Trunk or Treat drive through outside the hospital. How did that go?

Dr. Medard:  It was awesome Robin. I had such a great time. It was a lot of fun to speak with the families as they drove through the hospital. We kind of had challenges because of COVID on trying to do something safe but we still wanted to get the word out there and explain how important it is to be aware of breast cancer. So, the cars stopped at our various tables and to meet the doctors in our facility, to learn about all Lake’s health services and receive some Halloween treats, free children face masks and other goodies. There was such cute little costumes. My favorite was one that was a little black panther. He was dressed up all with his bag to collect his goodies. We provided educational information on breast cancer, mammograms, OB, and our other health services. Those who came out had a chance to win some prizes and actually we’ve already given away not all, I think most of them by now which included two children’s bicycles and some gift cards.

It's important to get the word out to our rural close knit communities that we are here to be a resource and provide access to quality healthcare services for our families. We enjoy getting to know the residents and to serve at every age and every stage in our community.

Host:  Dr. Medard, in your prior role, you served as the Director of Lakeside Medical Center’s Family Medical Residency Program. As these fifteen residents train at the hospital and at the CL Brumback Primary Care Clinics, what impact do they have on the patients there and the community that you just described?

Dr. Medard:  You just keep hitting all my favorite topics Robin. But this is a great topic of mine. I’m a little biased but I love to let everyone know that family medicine is a great field. We love to say that we take care of our patients from the cradle to the rocking chair. So, we really are wide ranged. And our physicians here, our resident physicians, they go above and beyond to provide care and a range of quality services to our patients, many of whom have complex medical conditions and limited resources. It’s one of the many benefits of having them especially during this pandemic. So, if we have time, I will share a little story about one of our resident physicians who has just recently graduated had a patient of ours who has been to five specialists over a period of time and was really frustrated with the process, was on a lot of medications and a diagnosis was not being made. And because the residents are in the books looking at all the things that they could possibly have; he made a suggestion and a recommendation. She did follow it and ended up going to a neighboring hospital for that type of specialist and she was able to be diagnosed with something that was rare. So, that’s just a little example to let you know of how it is to just have residents in a teaching facility and how that helps enhance to have those extra eyes looking at your case.

In the rural underserved communities, of the Glades, the residents diagnose and treat a wide range of conditions that are not seen in urban settings. So, it’s also an advantage to our facility.

Host:  Yeah, I know that I’ve had the opportunity to meet a number of the residents and they seem so pleased with not only the training that they receive but also the warmth and compassion that they receive from the patients who they serve. Dr. Medard, before we wrap up, so much focus is on the COVID-19 pandemic these days as it should be, right and the importance of staying away from crowds, wearing a mask, socially distancing and washing hands. As a bilingual physician, I know you speak Creole which is wonderful in serving our Haitian community. What are you telling your patients of various backgrounds and cultures to protect themselves and their families from COVID-19?

Dr. Medard:  Well first things first. Wearing the masks and the importance of this so my Haitian patients mete mask new, okay? So as we see a number of the positive COVID cases again starting to increase in Florida, unfortunately we are experiencing some prevention fatigue unfortunately. But we cannot let our guard down. We need to do all of the things you’ve mentioned. Wearing a mask in public, socially distancing, washing hands and staying in well ventilated places or outside. In other words, we must continue to be vigilant and remember to avoid the three C’s, crowded places, close contact, and confined spaces. I’m also advising parents to have their children six months of age or older to get their flu shot. My daughter go her’s at 12 months and it’s available at no or low cost and It’s more important than ever during the 2020-2021 year to protect yourself and the people around you from the flu. It also helps to reduce the strain on healthcare systems responding to the COVID-19 pandemic.

So, at our CL Brumback clinics, throughout the county, we offer the option of Telehealth visits through video chat for our patients on a Smart Device or phone. These are the steps we’re trying to take to make sure the community stays safe. The Brumback clinics are following the CDC screenings and the CDC infection control guidelines for healthcare settings to provide safe in-person medical appointments and pharmacy services. To maintain physical distancing, patients who do schedule in-person appointments, they can check in virtually through an easy to use phone app or an office iPad that we have. The patients remain safely outside in the clinic parking lot, waiting room or in their cars until the phone app alerts them to enter the clinic. Patients can call our number at 561-642-1000 to schedule an appointment for Telemedicine visits, in-patient visits or COVID-19 testing.

Host:  Well Dr. Medard, thank you so much for joining us today and providing such important information. Women are the backbone of a family and anything that we can do to raise awareness about the importance of staying healthy at every age; we really value that guidance that you shared.

Dr. Medard:  Thank you so many Robin, it was great to be here and I want to thank everyone in the community for supporting us providers out here during the pandemic, all the messages you guys leave and put in your windows during testing. We greatly appreciate it.

Host:  All right well, you deserve it. You’re healthcare heroes and we’re very appreciative of all you do. And we want to thank all of our listeners. If you find this podcast helpful, share it on your social channel and check out our full podcast library for topics of interest to you at www.healthcaredistrictpodcasts.org. Let us know what you think. Your review helps us reach more people just like you and if you have a suggestion about a future podcast topic, have questions or some feedback, you can call 561-804-4111 and leave us a message. Please check out our other Health Care District podcasts on health topics you won’t want to miss again, at www.healthcaredistrictpodcasts.org. Today’s podcast is brought to you by the Healthcare District of Palm Beach County’s Acute Care Teaching Hospital Lakeside Medical Center in Belle Glade, Florida. For more information on women’s health services, please contact Lakeside Medical Center at 561-996-6571 or visit www.lakesidemedical.org. This podcast is also brought to you by the CL Brumback Primary Care Clinics which offer women’s health services, medication assisted treatment for patients with substance use disorders as well as primary care, dental services, behavioral health and pharmacy services for adults and children. Call 561-642-1000 to make an appointment or visit www.brumbackclinics.org.