Transcription:
The Importance of Well Woman Exams

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Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.

Melanie Cole (Host): Welcome To say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss well-woman exams, the importance of these types of exams. So, women, we can be our own best health advocate. Joining me is Lila Brooks Fritz. She's a Certified Nurse Midwife and Certified Lactation Counselor at Memorial Hospital.

Lila, I'm so glad to have you with us today. Why don't you start by telling the listeners, what are well-woman exams and why are they so important?

Lila Brooks Fritz, CNM, CLC (Guest): Well-woman exams are basically coming in, reviewing your medications, reviewing your past medical history, reviewing your concerns, and then a lot of setting up for preventive procedures, such as mammograms, pap smears, cervical cancer testing, SDI testing, colonoscopies, getting lab works done. So, I'm kind of the gatekeeper to get people tested and refer them onto appropriate other pathways.

Host: Okay. So, tell us a little bit about that service of what you do to help women navigate this, because these are a bunch of different appointments and some are certainly combined, I mean, seeing a gynecologist and we get our pap smear and then going somewhere for the mammogram, that sort of thing. Tell us a little bit about how you work with patients as far as navigating this. Cause it can be confusing for patients.

Lila: That's where it comes in very helpful because I know how to navigate the patient. So, the patient comes in, her vital signs are checked. We review her medications and then we go over her concerns. But then we also talk about the preventive exams that are necessary for good health. Typically I do her pap smear. I do a breast exam. I do a pretty much a top to bottom full physical exam with her along with also giving her information on what the latest testing is, what kind of lab work should we get ordered for her, and then we set them up for everything from the colonoscopy to their mental health concerns.

So, of course I obtain the pap smear and the STI testing when she is in the office. But we also even set her up for a primary care provider, things that I don't do, that she needs to have available for her. We get her into a gastroenterologist or a surgeon for colonoscopy. And then we schedule the mammograms right here in our office.

Host: So, how often do we schedule one of these well-woman exams and as we get older? I'm 57 Lila, so do we get these more often? Are there certain recommendations you'd like to point to as far as some of these, I mean, you've mentioned colonoscopy. We're going to get into that a little bit, but why don't you start with something like mammograms or pap smears and how often we're supposed to be getting these.

Lila: Well, we schedule the annual exam yearly. And for those other questions, those are the things that I'm going to tell the patient because they're fluctuating with different people. So, usually colonoscopies are every 10 years, unless you have a family history or they found polyps. Pap smears are usually at the age of 21 we start. And then basically we do them every three years. Once they're 30, we do an expanded test. If that's negative, we do that every five years. The labs are typically yearly unless there is a health concern. The sexually transmitted disease testing, any new partner, you get tested. And I think it's hard for people to remember exactly when they should be tested, what age they should be tested. And that's where the annual exam is so important because I know all those answers and I'm going to remind them on a yearly basis. And if they haven't got their exams done, when I see them back the next year, I'm going to remind them again. But yearly exams, pretty much when you get to be 13,14 years old, even if you don't need birth control, you don't need an STI test. You're not even getting the other tests that we talk about the preventative screening, but it's talking about your health. You need to be on a multi-vitamin. You need to have vitamin D. What are your periods are like? What kind of problems are you having? Are you having concerns? And I'm going address all those things at the annual exam. then it's my job to remind you when the tests are due. It's my job is to refer you to another provider that will do things that I am not a specialist at.

Host: Well, I'm so glad that you brought that up because the fact is that midwives such as yourself are really our practitioners throughout the life course. You're not only delivering babies, but you're helping women well into their seventies, eighties, and hopefully beyond. Right? So, what do you want women to bring with them or to talk to you about? What issues? If we were to write down a list before we come in for our well-woman exam, what do you want us to think about to remember, to say to you? You know, I am really having a tough time with this COVID thing or my mental health has been suffering a lot or I'm getting bullied at school and I'm not sure what to do about it, any of these things. What do you want us to write down and bring in?

Lila: Well, I'm glad you brought up Melanie about a lot of people don't realize that nurse midwives do women's care from, we're with women for a lifetime is our motto and they think I just deliver babies. And I did deliver babies for 18 years. I do prenatal care, but not the delivery as I've gotten older, but I've always expanded and loved women's health care from the young teen to my older favorite patient also. So, they need to bring in any concerns they have. I am kind of a specialist and I am fortunate enough that most of my annual exam spots are like an hour. We usually pretty much take up every bit of it. So, I want the patient to have a list of questions. What are her concerns? Providers kind of dissuade people from having lists. I love lists. And I usually say to the patient now, did we hit everything on your list? What else do we need to talk about? But the patient does bring in any concerns they have, and if they don't have a big list, I'm going to tell them and ask them questions.

Like, you know, are things that you normally make you happy, still make you happy, you know, have you had a new boyfriend change? What are your periods like? We need to talk about birth control. So even if they don't bring up, I'm probably going to bring it up, but I love lists. I say any concern, the patient has, bring that list with you and we will get a chance to address those.

Host: I'm a list-maker too. So, I am glad to do that at my doctor's appointments. I go in with these lists and, and try and check them all off. So, I love that you do that because it really is a more comprehensive exam, and it gives you a chance to hear from the woman, some of these things that are specific to her.

So, let's start some of these things. So what about blood work? When a woman is having a well-woman exam, an annual physical, what are the most important components of that blood that we get to taken?

Lila: Well, it kind of depends on their age and their health. So, if they're a young, healthy person and they're not obese and there's not a strong family history, she might not actually start getting cholesteral labs until she's late twenties, early thirties. Now, if a patient is obese, I will do their labs a lot sooner because some people are clogging their arteries at a very young age. And we want to know that ahead of time. So, if they are obese, there is a possibility that she could also have high cholesterol and not even realize it. So, labs are a little bit variable, but usually at age 30, we're usually testing those yearly. What I usually talk to people too, is you have to know your insurance benefits because I love getting the information, but I don't want to create a big bill for them. So, we actually can do things at our hospital, but we also have the option to do them at our local health department. And it's a lot cheaper for patients. Because I am very concerned that I don't want to scare people away and get a bad bill with a lot of financial burden when I need to get this information, but I don't need to incur a big bill for her. So, I have a lot of resources for patients too, on even labwork testing. Now, things like sexually transmitted disease infection, pretty much any new partner you get tested. Like I said earlier, the paps don't start till ,21. Used to be, we pap people earlier and now the recommendations are sometimes, what we don't know is okay in the pap world. So, a lot of times that's like my job to keep current on that. But lab work, I do like it. Now, if a person has obesity, they've got a family history, I might want to check their thyroid. Might not necessarily be interested in their cholesterol as much as doing a thyroid test.

If they've got a history of anemia, they have fatigue, they're having heavy periods. I might want to know like a blood count to see what's going on with that. And of course, pregnancy, we have a lot of lab testing that's required. And as I said earlier, I do the prenatal care up to 36 weeks. We do a birth plan. I talk about options that they can do. And then they transfer to my collaborative physician, who's an OB GYN who is going to deliver them.

Host: In the last minute of this segment, Lila, can you just reassure women that by being this good of an advocate and with the help of you as a navigator, the importance of these types of exams, to know our numbers, to know our blood pressure, and as you said, cholesterol, to talk about diabetes screening. We're going to talk a little bit more about that too, but just in the last minute here, just give us your best advice in summary of why this is so important.

Lila: Well, one of the things that I wanted to mention, I think is one of the most important key factors is that the annual exam is going to be free for anyone in the United States. And we're blessed with that. So, if they have public aid assistance, annual exams are paid for, if they have private insurance, they're mandated to pay for annual exams.

Now, if they don't have those, Medicare has to pay for annual exams, but if they don't have those resources, we have a federal program throughout the United States that pays for paps, breasts, annual exams. And if there is a problem with a mammogram or a pap smear, they also have resources to pay for that.

So every woman in America has access to a free annual exam. So, we really need to make certain that people are coming in for their exams and then they can let me help guide them, what other practices you need to do? What other procedures, what other health benefits you could have, what is your exercise and diet options? I have a lot of resources and other specialists I can refer to if I can't do those services myself, but everybody should be screened. I've had probably eight picked up during the pandemic, and I'm not a general practitioner, I'm a midwife that's doing annual exams. I'm not just taking care of old people. I take care of young people. Two of my women that I've picked up on breast cancer, they were in their forties. So, I think that's the big key. Come in. Let me give guidance on your health practices and what resources are available.

Host: That's excellent. That's a message that we all need to hear and some women are afraid and they don't make those appointments because of the financial constraints or because they're worried what they might find out. You mentioned earlier, vitamin D and we were talking a little bit about blood work. We're in Illinois, so we're not outside a lot in the winter time. And can you tell us a little bit about vitamin D, and some of the other important numbers that you feel it's important that we know about?

Lila: Well, that's a great question you brought up Melanie and I am very passionate about vitamin D and I am very thorough about screening people for vitamin D. And if they don't have resources through our local hospital or insurance coverage, I know that I can get a cheaper test at our Hancock County Health Department also, But I'm amazed how many people are vitamin D deficient. So, you don't want to get it from the sun or you get skin cancer and wrinkles. And when we wear sunblock, we stop the vitamin D absorption. So, there is a great lab test. Everybody kind of needs a different amount of vitamin D. Vitamin D also needs to be certified. And I actually know some of the resources in the area that carry the certified brand because it's over the counter.

You might have a good brand. You might have a bad brand. So, the best thing of vitamin D is not only to be on a supplement, but to get a lab test, to know that we're at a good level. You actually can get too much vitamin D and it could negatively impact your kidneys. So, some day vitamin D might not be over the counter and only as a prescription, but I constantly am seeing vitamin D deficiencies and, you know, the literature says 70% of Americans are deficient in vitamin D. And I definitely see that in my practice.

Host: Well, I'm glad you brought that up because that leads us very well into some of the other things that we should be considering screenings. I mean, in my age group, bone health is something that's really important and getting that bone density checked, taking our vitamin D, making sure we're getting calcium and certainly weight bearing exercise is important. So, do you discuss bone health, especially with these older women?

Lila: I discuss bone health with everybody. So, what I tell my young people, I don't want to wait until you're 65 years old, we do your first DEXA scan and find out you have bad bones because the bone health medications are limited. So, I'm talking to my young 16 year old, cutting out the pop, getting your exercise, get your vitamin D checked, take your supplement. Do a multivitamin. Again, weight bearing exercises are awesome. So, I start really early and I'm pretty much addressing it to all women. And I do focus a lot, on my older women about fall prevention, making sure your vitamin D is at a good level. I love DEXA scans cause I think it is a very valuable screening and DEXA scans are paid by Medicare when you're 65 years old.

So, and if they do have a problem with their bones, I also have resources for that too. We've got some great medications now available to women that research has shown to be working better. But I think bone health is important for everybody.

Host: It is. ANnd you and I could really chat about this for a much longer time, but I want to hit to some of these other important ones that women don't always think about such as stress. And sleep. And right now these two things are kind of combined because we're all in this weird time. And we have so much stress in our lives right now. And especially women, because we're the caregivers to the world. Really. What do you talk to women about controlling their stress levels and getting enough sleep? We're on our phones all the time and the white lights and the noise. What do you tell them?

Lila: Well, I like to tell people, that's one of the questions I ask at their annual exam, are you sleeping well? And if not, why? And then we start talking about sleep hygiene. Now, you know, young people they've got phone access, they can Google anything. And I used to give out handouts and then my newer generation, I say, just Google sleep hygiene. Is that, that will give you all the information you need and you have to follow through with that.

If we're not sleeping, that means we're more likely to have obesity and struggle with it. There's actually a book out there, Sleep the Pounds Away. So, we know that everything is evolved with sleep. And I often tell my people set your alarm, what time to go to bed. So, you get at least 7 hours of sleep, not what time the alarm needs to come off in the morning, because I think as women, we try to do a couple last minute jobs and next thing we know it's getting late and we do have to have that 30 minutes away from the monitor where I say, read a boring book, have low lighting on board, you know, make a list of the things you need to do tomorrow. So, you're not waking up at three o'clock in the morning, saying I've got to remember to do this. I even tell people to have a little pad by your bedside. If you wake up at three o'clock, write it down. So, your brain can relax and you can go back to sleep and you know, there are medications that can help with sleep, but you really want to do the sleep hygiene before you start medications. And if you do start medications, you want to have the sleep hygiene on board also.

Host: I like warm milk. It's really helped me a lot lately.

Lila: Absolutely.

Host: I've been sleeping hard. I have this great glass of almost hot milk before I go to bed. And I can tell you, it knocks me the heck out and I stay asleep all night, but, you know, hey, that's just what works for me. Now, another thing that I think people don't often, you know, discuss as we get older, is vaccinations. When we're little kids, of course, there's this schedule that everybody follows that we get, you know, whether it's MMR and chickenpox and whatever. What about vaccinations as we get older, do you discuss this with women? As far as shingles, pneumonia, all of those kinds of things as well.

Lila: Absolutely. Now, one of the things that's been very helpful with our current computer system is they have, what's called a health maintenance section. Basically that's going to show me, right off the bat very easily. My nurse has been trained to look at that also to kind of help me out a little bit, but it's going to show what vaccines are encouraged and available.

I'm a big fan of Gardasil that someday we may get rid of cervical cancer because our young generation has gotten Gardasil. So, any person, basically they're 13, 14 years old. When I start with them, I'm going to talk about Gardasil before they're even thinking about becoming sexually active. And then of course, you know, the recent you know, pandemic that we've got going on, I'm big fan of COVID vaccines.

Now, you know, people can always say no to me, but I feel like it's my responsibility to tell them the health benefits and include the health risk. But vaccinations has been one of the biffest bangs for the buck that the United States has ever had to keep our children. Like in the past, people had big families because half the kids were dead by the age of two, and now we have vaccines available and very smart people have invented these vaccines and these vaccines are very safe.

But it is a challenge sometimes to get that information through people, and you get the accurate information to people. So, vaccines are very important. I'm a big fan of flu shots. I've had a flu shot every year for the last 40 years, and I very rarely get the flu. In fact, I can't even remember when I got the flu last and I never have a problem with the vaccine. You know myself, I follow my own rules. I just got my second pneumonia shot. Now my arm was sorer by far, than when I got my COVID vaccine, but it's okay because I don't want to get pneumonia and I follow the vaccine recommendation by my provider.

Host: I do the same and I got my booster COVID, but I also got my shingles and my flu shot. And so in my age group, shingles is something that we want to, you know, really think about because boy, I'm just knowing it's going to try and come and get me one day. Before we get ready to wrap up here, there are lifestyle behaviors we haven't really discussed, exercise, staying active, good nutrition, smoking cessation, alcohol consumption, because Lord knows right now it has been something that we've seen on the increase. In just in a few minutes, Lila, can you give us your well-rounded best advice for those lifestyle behaviors that we should really pay a little extra attention to right now?

Lila: Well, in a short summation, I could say basically four words, move more, eat less. So, it is important and those are all questions that we're asking at the annual exam. We have a section the nurse fills out before they even see me. And I'm always looking at that. I'm looking at, are they a smoker, is an alcoholic, says, what are the exercise we have, what's called a body mass index that shows if they're overweight or not. And I talk to those people and I say, it's not about what you look like. It's about being healthy. Cause nobody really wants to be unhealthy. It's a burden to our society. It's a burden to the family. And those are just really important things that we talk about. And I do try to set a good example myself, that I do keep a normal weight.

I do exercise on a regular basis and I've done that since I was a chubby teenager. I kind of had to learn early about being healthy. And of course, during pregnancy it's very important and it's important the woman doesn't gain too much weight, that she gets her weight under control before she gets pregnant, because there's really nothing good about obesity and pregnancy.

I tell people, I love you how you are. I don't want to be embarrassing or condemning to you, but I don't want you to be sick. I kind jokingly say, if you get too sick for me as a midwife, I don't get to take care of you. I don't get to take care of diabetes and cancer and things that are related to obesity. So I want you to be super healthy so you can stay in my care and not necessarily have to go to the specialist.

Host: What a great message that is. got any final thoughts you'd like to leave women with about scheduling an appointment with you?

Lila: Come in and see me. And if you have the resources or insurance help, it's a wonderful program through the Illinois Breast, Cervical Program. I just had a patient who came in on Tuesday and she didn't have insurance, she was young, she was healthy, but she's over the age of 35. And so I said to her I said you know, let's just cancel your appointment and let you get through the program. Because when I get done with you and do all the testing I want to do and catch you up, it's going to be probably a thousand dollars. And that could be all paid through the Illinois PAP Breast Program.

Host: What great information. This was such an informative episode and show today. Thank you Lila for coming on and sharing your passion, your voice, and your expertise for women so that they can be their own best health advocate. You know, it's a little bit ironic. Now we say, put on your mask before you put on the masks of your loved ones. That is certainly true for women really all over the world. Thank you so much again. And to schedule a well-woman exam with Lila, please call 217-357-2173. For more health tips, visit our website at mhtlc.org to get connected with one of our providers as well. That wraps up today's episode of Say Yes to Good Health with Memorial Hospital.

I'd like to thank our audience and invite you to download subscribe, rate, and review this podcast on Apple podcast, Spotify, and Google podcast. And if you found it informative, please share it with your friends and family on your social channels, because we're learning from the experts at Memorial Hospital together. I'm Melanie Cole.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.