Scott Webb (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.

I'm Scott Webb, and today we're going to discuss Women's Health, recommended screenings, hormone therapy, and more, with Dr. Twyla Ostercamp. She's a family physician who sees patient's from womb to tomb.

Doctor, it's so nice to have you here today. We're going to talk about women's health issues and family medicine practice and everything in between. So let's start there. What are some of the most common women's health issues encountered in family medicine practice, and how have their management strategies evolved in recent years?

Twyla Ostercamp, DO: Well, that's an interesting question in that I wouldn't say there's anything that's most common in women's health, honestly. Because we see everything,. I treat everything. When a woman comes in, we treat everything. But I would say some of the more debating topics are hormone replacement therapy, and that's because the management has changed over the past several years and how we understand hormone replacement.

So when a, a woman either surgically has her ovaries removed or she goes through natural menopause, hormone levels decrease and women can have symptoms such as hot flashes, inability to sleep, might get some depression and anxiety. So it's extremely important for us to address those issues because they do compromise quality of life.

Host: Yeah.

Twyla Ostercamp, DO: And if you've ever been around someone who's in menopause, they will actually tell you, oh, it's just my menopause. I'm grouchy because of my menopause. So there is some understanding of that. However, we have in the past 10 to 20 years, there's been huge evolution of how we treat it. Hormone replacement has been used.

It was felt to reduce risk of osteoporosis or bone loss and reduce the risk of coronary artery disease. However, nowadays, I think most of us just understand that we are going to treat symptoms with hormone replacement. We're not going to cure their heart disease or prevent it, and we're not going to prevent osteoporosis.

So we are using hormone replacement more selectively, however, we still need to use it. And we balance risk versus benefit by talking with the patient and talking about some of the risks, which can be increased risk of stroke or blood clot or even some heart attacks. So we do discuss that with them one-on-one.

And, you know, if their symptoms are terrible and they're not able to sleep and we need to use it, we use it. There's no defined, you know, length of time to use it. We used to say just five years, but we know that hot flashes go on longer than that.

Host: Right. There's no, uh, one-size-fits-all.

Twyla Ostercamp, DO: There isn't, and but it does involve a conversation and it needs to be a pretty in depth conversation. But we do involve the patient in our decision-making.

Host: Yeah. Yeah, there's a reason, doctor, you can't see me, but there's a reason I'm so bundled up in my house right now because my wife is going through menopause and it's freezing. It's freezing in my house. So I'm quite bundled up for someone who's indoors. So, uh, yeah, I was kind of nodding my head as you were going through the symptoms there.

Twyla Ostercamp, DO: Yes. Yeah. And anybody who's lived with somebody going through it knows.

Host: Yeah. Yeah, we do. If you know, you know, that's the, that's for sure. So, doctor, how do family medicine or family physicians tailor preventative health screenings for women across the different life stages from, you know, adolescents to post menopause?

Twyla Ostercamp, DO: Well, the huge advantage of being in family practice is we see people from what I like to say is womb to tomb. So we're seeing newborns and we're seeing women in the elder stages of life.

Host: Right.

Twyla Ostercamp, DO: So this really does help us to understand that evolution of their life, very, very well. And I enjoy seeing people throughout their lifespans. So if I see somebody as an adolescent and into their adulthood, that's a huge benefit because I can maintain a relationship with these women, and I think that helps a lot with tailoring the preventive services we offer, because I know what their background is, I know usually what their family is, I know where they have come from.

So it's a lot easier for me to discuss these preventive screenings, such as HPV vaccine to an adolescent, and a mammogram to a woman in their forties. I may have not seen her as an adolescent, but maybe I see her children. So, it is all interconnected. And so that preventive screening is much easier to discuss when you know your patients better.

Host: Yeah, I, I was thinking about, uh, I don't know if you guys have t-shirts or not, but the womb to tomb, it has a nice ring to it. I love that.

So, so let's talk about lifestyle factors. I know that you know some things, you know, genetics, family history, we can't outrun those things, but lifestyle behavior within our control somewhat.

So what are some of the factors that have the greatest impact on women's long-term cardiovascular health, and how do family physicians address these in the preventative care discussions you have?

Twyla Ostercamp, DO: Well, again, that's something that we have the benefit of being family docs because we can discuss it longitudinally. So over a great, you know, time span.

Host: Hmm.

Twyla Ostercamp, DO: So I'm going to talk to young people who haven't started smoking yet about not starting.

Host: Yeah.

Twyla Ostercamp, DO: And I talk to women about quitting smoking. It's the number one modifiable health factor that we have. And for heart disease in particular, it's smoking and being overweight or obese. Yes, you can't change your genetics. But those are definitely two things we can help women modify both of them. You know, it's very difficult to quit smoking, and I realize that. I've never done it, but everybody I talk to, it's a very, very difficult thing to do. So, it isn't just one and done, it's not one office visit. It's supporting this woman through that whole journey to make sure that, okay, yeah, I'm not smoking at all. I'm doing great. Or oh, I'm still smoking here and there, you know, so we can continue to discuss that throughout through time.

And that's a huge benefit. And again, with weight loss, That is a huge struggle. We know that 50% of Americans are overweight or obese. So you know, working with everybody you know to say, Hey, what can we do to help you? How can we help you attain what your goal is? And by doing those things, we can reduce their risk of heart disease in the long run.

Host: Definitely, and I think doctor, you know, we all learned about telemedicine, maybe medical, you know, professionals knew about this before, but we all kind of, us lay people out here, we kinda learned about telemedicine during COVID and I'm wondering how it influenced access to women's health services in family practice, particularly in rural or underserved areas.

Twyla Ostercamp, DO: Well, this is a great thing to bring up. Telemedicine has been extremely important. You know, yes, you're right. In 2020 everybody became aware of it.

Host: Yeah, we sure did.

Twyla Ostercamp, DO: There were telehealth companies before that.

Host: Right.

Twyla Ostercamp, DO: That were working. And then it really exploded in 2020 for them. I just came off of working a year of just doing telehealth and it's interesting to me, the kind of patient's I saw, I saw everything.

I saw women who had severe agoraphobia and couldn't leave their homes because of severe anxiety. I saw women who worked full time and couldn't get time off to go to the doctor. So they'd run out to their car and do a telehealth visit with us. So we'd be able to manage their health concerns, their preventive health in a very, you know, easy thing for them to do.

Host: Yeah. Hey, you mentioned agoraphobia there, and it kind of leads into my next question, wondering like what evidence-based approaches are most effective for addressing mental health issues such as depression and anxiety in women that you're seeing in family practice? Be it through telemedicine or in-person?

Twyla Ostercamp, DO: Right, and you know, agoraphobia is a tough one. It's tough to do in-person because the patient usually is so anxious they're not absorbing what you're saying anyway. So it's kind of important actually for those folks to do telehealth at least until we can get them out of their homes. For depression and anxiety, evidence-based approaches have shown the best approach to be to tailor to the patient.

So, using talk therapy and medication or a combination of both is what we see to be most beneficial. The biggest thing is risk assessment. What is that risk of that patient trying to hurt themselves or trying to hurt someone else? And so doing risk assessments is very important, but evidence-based is still showing that talk therapy or medication therapy or combination is best.

Host: You know, we talked about hormone replacement earlier, but I wanted to circle back and just talk about the latest findings on the safety and effectiveness of hormone replacement. Like you and I were talking about the sort of the practical necessity for some women, especially for them and their partners and not having their house be freezing and all that good stuff.

But what are, when we think about the safety and effectiveness, let's talk about that. And also, you know, how do the findings inform the shared decision-making that it sounds like you do with patients?

Twyla Ostercamp, DO: Right. You know, effectiveness for menopausal symptoms is outstanding. It is extremely effective. We usually can use a very low-dose of medication to help these women. And that is what we want to do, is use the lowest effective dose, which helps then with the safety of the medication. The risks are blood clots is the main one that people talk about, which can cause heart attack, which can cause stroke, which can cause a blood clot in a leg or an arm. So those are the big side effects that we talk about. Definitely you get other ones such as nausea, vomiting, just not feeling well. Those can be side effects as well, but the most severe ones are the ones that can cause the most damage, which is heart attack and stroke.

Host: Right.

Twyla Ostercamp, DO: And to mitigate those, we do try to use the lowest, most effective dose. We also monitor the women and tell them that if they have any specific symptoms that they need to contact us immediately. You know, the most common one I've seen is blood clot with hormone replacement because estrogen does increase the risk of blood clots. That's the one I've seen most often. We use medication to dissolve the blood clot and we take them off of the estrogen, the hormone replacement, and unfortunately they cannot go back on it. So we have to look at alternative forms to control their symptoms, but it again, shared decision-making has to be done.

We have to discuss those. If they have a family history of blood clots or if they have a personal history, we avoid hormone replacement.

Host: Yeah, and I was thinking about social determinants. I wanted to get to that today because I think we're, most of us are a little bit more aware, a little bit more in tune about what social determinants are and you know, the, the influence they have on women's health outcomes. So I'm just wondering like what practical steps family docs take to mitigate the disparities?

Twyla Ostercamp, DO: That's a really good question and I'm, I'm glad we're talking about that. It's something that doesn't get much airplay.

Host: Hmm.

Twyla Ostercamp, DO: We see social media has exploded around the world. We can now talk to somebody in South Korea. We can view their videos with subtitles. And this has been a wonderful boon to learn about other cultures, but it's also been a bane.

And what I mean by that is sometimes people who have social media channels aren't the healthiest people and the biggest social determinants that I find that are detrimental to women is an image of one way or another. It's either extreme thinness. Which isn't good for people's health or it's the opposite, the, the super obese that are saying, no, this is okay.

I'm okay being this weight. And I think that we look at that and we try to fit ourself into a mold or we try to identify with those people. And of course we know that being underweight isn't good for our health and being severely overweight isn't good for our health. And I think those are two things that really have been pushed that I have actually seen on social media.

And some of the social media people I follow actually are other physicians and they have brought this up. A lot of times that you can't, you cannot compare yourself to other people. So when we sit down and talk with people in the exam room, we have to talk about, Hey, do you find, you know, social media beneficial to help you in your health journey?

And if they're really watching something that is not beneficial to them, we have to bring that up and say, you know, that person may not be the best one for you to watch. Everybody has their own body type, we're all not going to weigh, you know, 90 pounds and we shouldn't all weigh 500 pounds.

Host: Right. Yeah. Somewhere in the middle. And it's probably good advice for most folks to just stay off Instagram because everybody is just, you know, prettier and thinner and tanner and more awesomer on Instagram. And I find myself doing it too. And I try to remind myself, this isn't real. You know, the.

Twyla Ostercamp, DO: Right, exactly.

Host: This is not how normal people, normal folks like us, look and act and eat and all that good stuff. Doctor, I'm guessing that a lot of women, and I don't know if I'm projecting here, but I feel like a lot of women probably have questions about immunization schedules, especially during pregnancy, reproductive years. So let's talk about the current recommendations and schedules that you know, address women's needs across the spectrum.

Twyla Ostercamp, DO: And that's very good. I just lightly touched on things like the HPV vaccine, which is human papillomavirus. Human papillomavirus is a virus that can cause cancer. So we encourage all adolescents to get it before they have sexual contact, but some don't. So I have to remind young women to get it because it can be extremely beneficial for their reproductive years, if they end up with a cervical cancer due to it, it could compromise their fertility. So that's something we discuss. For pregnant women in particular, we always want them to have a tetanus vaccine along with whooping cough or pertussis during pregnancy. So their infants do not get that after birth.

So we do have that as a routine during pregnancy, but we really try to stress those two in particular.

Host: For sure. You know, we've touched on a couple times here today about weight and obesity, but essentially what we're getting at is probably nutrition. So I wanted to get a sense from you the role that nutrition counseling plays in this comprehensive women's health management that you're doing and working with patients in primary care.

Twyla Ostercamp, DO: I think nutrition counseling actually is beneficial for everybody and whether you're, whether you're struggling with it or not, simply because people don't understand what the normal amounts are to eat. For Americans, we like to supersize everything, so our vision of what we're supposed to eat and what we see on our plates is much different than what we should be eating.

So I think just simple nutrition counseling on how much to eat, but also, what we eat to make sure that we're seeing a very colorful plate. So lots of fruits, lots of vegetables, a protein, and making sure that we're getting plenty of water. So we stay hydrated, which decreases hunger then.

So I think that nutrition counseling across all ages is extremely important and it's something I talk to my patient's about frequently, about, Hey, are you okay with what you're eating? Do you think you eat a healthy diet? It's something that I think that's get asked at, well, it gets asked at every wellness visit, but gets asked quite commonly just if you come in for routine visits in between.

Host: Yeah, and you know, maybe the answer is just don't go to fast food restaurants. But I feel like Doctor, sometimes I go and I, and I feel like I'm being shamed for not upsizing, for not, are you sure you don't want large? Yes, I'm sure. I don't want 32 ounces of soda with my food. So, good stuff today, doctor, I want to finish up and talk about emerging technologies or research areas, maybe such as personalized medicine or digital health tools, that are most likely to transform women's healthcare over the next decade or so.

Twyla Ostercamp, DO: That's a good question as well. I think that, of course, telehealth is going to continue to change the landscape of medicine. It just is. Technology is here. People want to use it. They're eager to use it. And so it is here to stay. But the other thing that people are not aware of, possibly, especially in rural areas, I'm in a very rural area and I would doubt patient's know about concierge service.

Host: Hmm. Okay.

Twyla Ostercamp, DO: Concierge service is something that, especially in large cities they're doing where you essentially pay a single fee for a doctor to be available for you 24/7.

Host: Hmm.

Twyla Ostercamp, DO: So that physician travels to you, and if you have an issue or you just need your wellness exam, they can order labs, they can order x-rays, they can order heart tests, they can order referrals. But concierge service is something that I think is going to become more of a factor in the future. I don't know about rural areas just because we are so spread out, but it is something that is becoming a larger and larger factor in cities. As insurance costs become out of control and people are having to pay more out of their pockets, a lot of them are saying, Hey, why don't I just you know, pay for a doctor to be available 24/7.

Host: Right.

Twyla Ostercamp, DO: And you know, the only complication is that, is if you have to go to the emergency room and you don't have insurance.

Host: Hmm.

Twyla Ostercamp, DO: That could be a factor in, you know, out of poket expenses and what you can afford. But otherwise, those are two things I think are going to play more of a factor in the future.

Host: Yeah, of course. Doctor back in the day, those of us who are old enough, and I'm not saying that you are, but uh, those of us who are old enough, we would probably have referred to those as house calls. Right. Does your doctor make house calls? Now? Of course it's fancy and we call it concierge. But I love that idea, bringing the medicine to the people, especially in rural areas where there isn't a hospital down the street on the corner.

So, really good stuff today. Comprehensive, appreciate your time, your expertise. Thanks so much.

Twyla Ostercamp, DO: Well, thank you very much, Scott, and have a great day.

Host: And 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@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 the services that we offer. For the ISH Dish Podcast, I'm Scott Webb. Thanks for tuning in.