Gina Schnathorst (Host): Welcome to the Iowa Specialty Hospitals and Clinics ISH DISH podcast. Practical health advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life. With us in the studio today, we have Dr. Selena Losee. Thank you so much for agreeing to be on today.

Selena Losee, DO: Yes, thank you.

Host: So I'm curious, you haven't been here with the ISH family for very long, so tell us where you came from, how it is you came about, and what it is that you do for us.

Selena Losee, DO: Yeah, absolutely. So I grew up in Hanlontown, Iowa, graduated from Manly High School, and then I did my undergrad at University of Northern Iowa. I then worked in health care for a few years before going on to medical school at Des Moines University, and then I finished my psychiatric residency out in Sioux Falls, South Dakota, and I finished that about two years ago now. So after that, I knew that I wanted to come back to Iowa and kind of to the general vicinity of where I grew up. And so that's what brought me here. And, I now see patients age 15 and up, and on an outpatient basis, so, in the clinic.

Host: Okay. And do you get referrals?

Selena Losee, DO: Basically, any sort of physician or provider can refer to me, but also patients themselves can just decide that they want to come see a psychiatrist and they don't have to have a referral from someone else. We have Abby Zeman. She's our Mental Health Coordinator and she is the one that coordinates that getting it set up and we just have a form that we have them fill out to get some background information beforehand and then once we have that we can get you on the schedule.

Host: There's a lot of talk lately and we just had a meeting today and this topic comes up quite a bit about the absolute overwhelming need for mental health in the state of Iowa. I'm sure it's national, but when we're just talking locally. Can you talk a little bit about the difference between, when would somebody need to see a mental health counselor versus taking it another level and seeing a psychiatrist or psychologist? Because I think the differences are a little bit muddied.

Selena Losee, DO: Absolutely, yeah, not many people do know those differences and it can be tricky to know, so I would say that a therapist in general could be for anybody. I mean, I'm all about therapy and think that people should go all the time, so whether you are just starting a new job or in a different stage of life, those common stressors that might come about and just need someone to kind of talk through, problem solve, things like that, that is definitely appropriate for a basic counselor or therapist.

In terms of the psychiatrist versus the psychologist side of things, the psychologist does mostly provide therapy as well, or counseling, you may hear it called. And they do have a Doctorate degree. But they, yes, mostly do focus on that therapy side of things. Now it can kind of be a preference.

Some people prefer to go to a PhD versus maybe a Master's level counselor. But the biggest thing with therapy is who you feel like you connect with. And so that's one of the biggest things. The other things with psychologists is that they sometimes do some testing, and that can help kind of clarify diagnoses.

And that's one thing that we may at times refer to a PhD level. So the PhD then versus the psychiatry, what I do is I have a Medical Degree, so I can prescribe medications. And that's one of the biggest differences there. Now in residency, I did also learn some therapy techniques, but I'm definitely not as skilled as a PhD psychologist would be in the different types of therapy that are out there and all the different ways to work with patients. So, my biggest part is the medication management side of things. And then we do, a little bit of therapy amongst those appointments as well.

But that's kind of the biggest difference. If you know, that you're going to want to just do therapy or may want to consider medications, I usually recommend both for many of my patients.

Host: Okay, I do have a list here of things that you had given me that you commonly may be diagnosed and treat. I'm gonna list those. Maybe we can talk about a couple of them a little bit further, and then I want to talk about how you are involved in pregnancy. So the diagnosis and treatments that you had listed out include anxiety, depression, ADHD, bipolar disorders, schizophrenia, OCD, PTSD, substance use disorders, and personality disorders. That is a long list.

Selena Losee, DO: It certainly is. Yes.

Host: But I hear a lot of those, just being in social media even, all all the time you see people that suffer from PTSD or they have OCD, or, you know, I just saw a gal that I follow on Instagram today that just got diagnosed with ADHD. So talk a little bit about what you see across that spectrum.

Selena Losee, DO: So I guess I would definitely say my most frequent patients and that's because it's the most frequent diagnoses are anxiety and depression, but you're right with social media lately diagnosing ADHD in adults has been a big thing that people are talking about lately. A lot of patients that I have coming in wanting to know, is this something I have?

And so it's tricky, figuring out all the differences because there's a lot of overlap in symptoms between, anxiety, ADHD, a lot of different diagnoses. But, those are my most common, but I have experience with a lot of them. And so, really my goal when I see you for the first time is having a pretty good handle on what it is we think we are treating and then if it's something that needs more specialized care, we can always refer on.

But just figuring that out in that first visit is one of the biggest goals.

Host: Do you feel like we're seeing more diagnosis of ADHD in adults, or is it just the disorder of the month?

Selena Losee, DO: It's tricky because there is some overdiagnosis of it, but there's also sometimes that it's getting missed. So part of it is if you have ADHD, you've had it your whole life. It's not something that just comes about in adulthood.

It's just that we are now just kind of learning how to find it and identify it in adults that weren't diagnosed as kids. And like I mentioned, there's so much overlap there that people think, oh, if I can't concentrate, it must mean that I have ADHD. But you can see how, if you're anxious or you're just really sad, that makes it hard for you to concentrate too.

So that's a good question because yes, it's definitely being diagnosed more now, but I think it's really important that you go to somebody who really understands, nuances of that diagnosis because there's definitely different ways to treat it based on if it truly is ADHD that you've had your whole life and just was missed or if it's something else.

Host: So let me get your professional opinion on this. Do you feel that social media has spiked anxiety and depression?

Selena Losee, DO: Yeah, and I think there's, if I remember correctly, there's evidence for that, at least in adolescents and children, that it does worsen some of those psychiatric symptoms. It's tricky because, it's kind of like anything else in life, in moderation is key, if you're using it to be more social and chat with people that you wouldn't get to otherwise, it can be great, but it definitely, I see that a lot as a cause of worsening anxiety, suicidal thoughts, things like that, in, in teenagers in particular.

Host: Yeah. So sad. Just put your phone down.

Selena Losee, DO: Right? For sure. Absolutely. That can only help.

Host: Let's pivot a little bit because you did say you also have a special interest in treating patients through pregnancy and postpartum. I'm really curious on how these two things relate.

Selena Losee, DO: Yeah, absolutely. So I kind of found my love for that in residency and I just had my first baby. She just turned a year old now. So I realized the stressors that come with being pregnant, but one thing I'm very passionate about is that kind of in the past, it tended to be a thing that it was like, okay, you're pregnant. We got to stop all your meds. And that's definitely not the case now. And I, find patients still at times being told that, or kind of having that idea in mind and, so, I love to chat with patients about, the risks, the benefits, because it's not just the thought that we usually have about, what are the risks to baby if we are on medications. We also have to remember the risks to baby and mom if you don't treat depression and anxiety. And there's definitely evidence that there's worse outcomes if we're not treating that anxiety and depression. So I love to have that conversation, provide that education to patients that don't feel like, you know, you may not have to just straight up stop your medication.

A lot of them we are able to continue. So it's something that I really encourage people to talk with their doctors about.

Host: So how we're really relating this back is if you've already had a diagnosis for one of these disorders and you are taking meds and you become pregnant, that really you need to have another conversation about how to manage that.

Selena Losee, DO: Absolutely. And then addition to that, if you've never been diagnosed before, cause like I said, it's a stressful new time in life. And, talking with someone too, if you feel like you are more anxious than you should be, you are more down than you should be in that period. It doesn't mean that just because you're pregnant that we can't start a medication.

So definitely, you know, reaching out and being willing to talk to somebody about that.

Host: Then what is pharmacogenic? Is that right? Testing? Yeah. I know you sent me that word and I thought I'm going to have to practice this one.

Selena Losee, DO: Yes, absolutely. Yeah. So pharmacogenetic testing is another thing that I like to talk to my patients about because it's something you may hear about, on social media or on the news or whatever. And it sounds very exciting, but I like to make sure that people actually understand what we get when we do that.

So pharmacogenetic testing, usually it works by, we just take a swab of your cheek and then there's some companies out there that we send that to and they're able to send back some genetic data that we can then use in order to help decide which medications may be most beneficial for you. I think what the companies really try to push is like oh this is going to help us know which med is going to work for you and which one will be perfect And I wish that were the case, but it's not.

And so that's what I like to make sure that I teach my patients about, that it can be a tool. So what actually happens when we order that testing, is we are able to then understand which type of enzymes you have in your body that break down different medications. So we've been able to identify, especially for psychiatric medications, which enzymes your body uses, once you take that medication to break it down.

And that then plays a role in if you have side effects, if it's effective, things like that. So you may have just a normal version of the enzyme and then we can kind of say, all right, you'll probably break it down similarly to most people would, but it doesn't mean it will for sure work for you.

It just means that it's going to be similar to how other people may respond. The other thing we may find from that info is that you have some mutation in those enzymes. And one way that can turn out then is that you may break down the medication faster than other people do, which means that it's probably not going to stay in your body as long.

But it might still be the med that works for you, we just may need a higher dose than other people may. Versus maybe you have a mutation that means that you break down that medication more slowly than other people, then it's going to be in your body longer and you may be a bit more prone to side effects.

So maybe we need to start at a lower dose than we would for other people. Again, it doesn't necessarily mean like, it will or won't work. It just may give us a bit of a different starting point in terms of dosing. So I think it's important that people know what the data is that you're getting back from it.

Host: Yeah. This is incredibly fascinating and just makes me think, wow, how far have we come?

Selena Losee, DO: Yes, absolutely.

Host: It's crazy.

Selena Losee, DO: It is exciting. And, they like to, call it precision or individualized medicine. And that we are getting there. We're not at the point yet where I like to tell patients that I wish I could just draw your blood and say, this is what you have and this is what we should use.

We're not quite there yet. Yes, we are absolutely way further ahead in psychiatry than we were, 20, especially 50 years ago, which is exciting for what we have to come.

Host: Yeah, it takes guesswork out.

Selena Losee, DO: Yes. And there is still some of that, which can be frustrating to patients, but, that's why this can, provide a little bit of extra data that we may be able to use.

Host: Okay, very good. Just curious, how did you decide to pursue this career?

Selena Losee, DO: I never would have thought that I would do this. I thought I wanted to do ER, because I used to work as tech in the ER, but I found once I did my ER rotation, that I wasn't doing the same things as a med student as I had been as a tech. It was in and out and on to the next patient.

The thing I liked at the tech was reassuring the patient and telling them what was coming next and in their most stressful days that they may have had. You know, you're in the ER. It's not good. So then I found that it's really the talking with patients that I like. And so then I did my psych rotation and loved it.

It was hard for me to decide that that's what I was going to do. I started to feel like I'm not going to be a real doctor anymore, right? But once I decided I love my job and I would never change for a different specialty.

Host: We are so lucky to have you. Just want to back up a little bit too, and then since we're talking about you as the person, tell me about your family a little bit and what you like to do when you're not doing your real job?

Selena Losee, DO: Yeah, absolutely. So like I mentioned, I just had my first daughter, so she just turned one a few weeks ago. So, I live with her and my husband in Clear Lake. We have what we like to call a zoo because we have two dogs and three cats there. So we stay plenty busy there. We've got an acreage, so we also spend a lot of time upkeeping that.

We like to get on the boat in the summer. I like to read. I like to shop and just have stayed plenty busy with my daughter these days.

Host: We have something on your profile about dancing.

Selena Losee, DO: So I grew up in dance my whole life. And then actually after undergrad, before med school, I got the opportunity to teach the Garner dance program for a few years as, the head instructor and loved that. So then once I got back into medicine and stuff, I kind of missed that side of things. So now I do teach dance at Nicole's Dance Studio in Garner one night a week, which is really fun to get to continue that part of my life.

Host: That's really cool. I love that. So if somebody wants to set up an appointment, they need to reach out to our mental health coordinator, Abby, is that at the Garner clinic?

Selena Losee, DO: She actually is in the Belmont Clinic most days, but you can reach her, I'd have to look up her phone number

Host: We advertise the 641-444-3223, the Belmont Clinic and anybody can help then from that point. Is there anything else you would like to let people know about your services? What you do?

Selena Losee, DO: I would just say don't be afraid to reach out. I have the benefit of having more time in my appointments than a lot of other doctors do. And so that's what I really enjoy doing is just spending time talking with you, getting to know you, and educating you on what the best options are to help you feel better.

And so even if it's just a one time thing to talk about, what are some of the options, I'm glad to see you. And I am able to get people in relatively quickly still right now, so anyone age 15 and up, I would be glad to see ya.

Host: Perfect. Okay. Well, you heard it. Don't be afraid to make that call because I feel like that's what really hampers people is just the stigma of seeing a therapist or a counselor or a psychiatrist. So great work.

Selena Losee, DO: Thank you.

Host: So if you wanna make an appointment, reach out to the mental health coordinator, Abby, at our Belmont Clinic. That number again is 641-444-3223. Or if you can't remember that through the podcast, just call the Belmont Clinic and we will get you to the right people. So again, thank you Dr. Losee.

Selena Losee, DO: Thank you so much.

Host: Thank you for listening to Iowa Specialty Hospitals and Clinics ISH DISH Podcast. For more information on the topic we discussed today, visit us on the web at iowaspecialtyhospital.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer. For the ISH DISH Podcast, I'm Gina. Thanks for tuning in.