Transcription:
Women's Health at Every Stage of Life

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 join us as we discuss women's health at every stage of life. 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. And you've been with us before. You're such an awesome guest. So, let's start with kind of the younger ladies, our ladies in their teens, twenties, thirties. Are annual wellness exams important at those stages of our life, because at those stages we kind of feel immortal.

Lila Brooks Fritz, CNM, CLC (Guest): Well, that, that's a great question, Melanie. So yes, it is important. And I start seeing young women as early as 12 and 13. Now they're often not sexually active. But we do kind of talk about that a little bit, but a lot of it is, are you on a multivitamin? Are you taking vitamin D and then they usually need sports physicals. So, my sports, my yearly exam, it counts as a sports physical, but it's a lot more thorough than that. And then we're still looking at their family history. We're looking at their weight. You know, we've got a lot of young people who are a little overweight even as early as 12, 13, 14 years old. So, we look at that real early, we're looking at what medicines they are on, what supplements would be helpful.

And then do they need birth control? Do they need period control? Like, there's no reason young people should be miserable with periods when we've got a lot of safe options. And then I kind of joke with them a little bit here. If you're not secually active, you don't have any lumps in your privates, you're not having itching or discharge, you can leave your pants on. So, we're mostly talking and I do an exam, but they can still have their clothes on because sometimes they're very modest. As far as immunizations go, we always talked about Gardasil, which can prevent cervical cancer. But now we're talking about flu shots. We're talking about COVID immunization when they're, you know, 12, 13, 14 years old. So, that kind of gets them into a right track of healthy lifestyles.

Host: So, important. And I love that you say, you know, you can keep your pants on for this one. That was what my gynecologist said to my daughter when she went to her first appointment, she's like, you know, you don't have to do this. Whatever you're most comfortable with. As we get a little bit older, we start screening for diseases, but this group doesn't really get screened for much, right? You spoke a little bit about vaccinations, HPV. So, when does cervical cancer screening start for women in these age groups? And does HPV status come into play with that?

Lila: Well, that's a great question. So, we do not do Paps until they're 21. In fact, it is bad care to do a Pap before 21, but pretty much anybody that has a glimmer that they're sexually active is going to be a gonorrhea, chlamydia. And we have a new version where we don't have to really talk a lot about their sexual activity. We can just automatically screen them unless they say no. And so that way, if they don't want to tell me they are having sex, I'm still going to protect their fertility. So, the Pap wouldn't be till 21. Even if they have HPV, 80% of people who are sexually active in their teens and twenties have been exposed to HPV, but we only worry about if it's going on for a period of time.

So, by 21, we do start looking for that. And what we know before that, not a big deal. Now, when you talk about screening, though, sometimes we do screen even for lipids, which is your cholesterol. I have a young gal, she's 16. She is overweight. She's got some family history. I did her lipids and she was twice average risk for heart disease at 16 years old.

So, you know, we don't screen everybody for lipids, but sometimes if they're struggling with their weight, we might check a thyroid. If they're obviously obese, we might want to check their lipids along with the family history. But the biggest thing is the gonorrhea and chlamydia. And then sometimes herpes testing. You know, if they've got lumps, bumps in their privates, they're having itching, they might possibly have a yeast infection or bacterial vaginosis, which is an overgrowth of normal bacteria. They may have that without even being sexually active. So, I would be looking for those, if they had symptoms.

Host: I remember those days. And you know, when we had to worry about those kinds of things. Now as they get just a little bit older, and you mentioned lipids and cholesterol really isn't checked, we don't do blood work in our teens. And, but as we get into our twenties and thirties, and certainly with the obesity epidemic that we're seeing, do you screen for things like diabetes, because we are seeing more and more of it with this obesity epidemic that we're in. Tell us a little bit about diabetes and obesity and how you screen for the risk of those things.

Lila: Well, if I see, you know, their body mass index, which is their weight and height combination, if I see those are high, I am going to probably do the lipid test. Now, the lipids, not only do they look at cholesterol, your good cholesterol, your bad cholesterol, but they look at your triglycerides. So, triglycerides will show up years before a diabetic is even diagnosed. So, if I start seeing high triglycerides, I'm going to start with diet and exercise. Get the weight down. But if that's not responding, I'm going to think about getting them to their Primary Care Doctor. Most people are familiar with the A1C that shows what your sugar was for three months. If there's a strong family history, there's a lot of obesity.

We talk a lot about PCOS, which is polycystic ovarian syndrome. Those people are a lot more likely to be diabetic. So, I might see somebody who has a high weight, do her lipids and they look fine. I might see somebody who doesn't have as high a weight, and they do have some PCOS going on and their lipids are really high. Their triglycerides are high, so they could be headed towards diabetes. You know, sometimes how you, put your fat on is differently on different people. There's like fat, you can put on your butt and your thigh that's okay. But if you put fat on your belly, it's not okay.

Host: That's a really good point that you just made. And along those same lines, as we're talking about obesity and watching our weight and certainly women in their teens and twenties and thirties, this is a big thought that we're thinking about is weight. We're always thinking about that. But so bone health, isn't something we think about till we're much older, however, as we're exercising and trying to control that weight in our twenties and thirties, and even into our forties, that bone health comes in. When you recommend exercise, whether it's to lose weight or to build strong muscles and bones, what is it you recommend Lila for people as they start kind of getting into the childbearing years and all of that?

Lila: Well, that's another great question, Melanie. And like with the bone health issues, I start real early with that too. So, I'm talking to my teenager, going to do their sports physical, maybe talk about birth control. I want to talk about, are you having calcium foods? Now I've got people who say, no, I don't drink milk. I'm lactose intolerant. But what about cheeses? That counts as dairy and it shouldn't be an oral supplement. It should be real foods. So, I'm going to talk about your vitamin D level, 70% of young people are low in vitamin D and we need to get that from a supplement. That's another lab test that's very important.

So, I'm going to talk about her dairy and then as far as exercise, I usually ask now what to do, because I could tell you what I like to do, but maybe you're not a cross country skier. Maybe you're not, you know, into walking. Maybe you like to do YouTube videos. So, what is going to be best for you? And we even talk about exercise snacks. So, if you do 10 minutes, six times a day, that's still going to account for your hour of day. And you know, if they are actively involved in sports, they're probably going to get their exercise. So, then you might throw in how about a little bit of weight bearing like hand weights. You're waiting for your supper in the microwave. You could have some hand weights and do some crunches and some lifts with those. And of course, then that actually gets into the older population also, for the bone density and the bone health, because not only does it keep the calcium in the bones, but when you have good muscles, you grab yourself, so, you don't fall because fall becomes a big factor with the older population.

But you know, even my women of childbearing age, if they don't have good calcium levels, the baby's going to steal from them just like they steal their iron levels. And their vitamin D levels is the babies are little parasites and they're going to steal from the mom. Now, fortunately we have figured out when women breastfeed, they actually have bone protection from breastfeeding. So, those women don't get low in the bone health, but a lot of times I, you know, that can be really proactive and I'll say, you know what, you're going to be 65, 70 years old, and you have bad bones, we don't have the best bone medicines out there right now.

A lot of things we use have fallen out of favor. So, we don't really want you to get to that point. Let's start years and years and early, you know, the pop thing is a huge factor with the young people and old people. There's nothing good about pop and it steals calcium from the bones. So, we got to like talk about those issues with the old people and the young people.

Host: For those listening she means soda, you're from Illinois, we say pop. So, yes, that is awesome. Now, another thing that we're seeing right now is this mental health crisis, our kids in their teens, but twenties, thirties, I mean, in these COVID times, everybody's got something and we're all so stressed out. What would you like to tell people about mental health screening for depression? All of these kinds of stress related things that we're all going through and how you help people with that.

Lila: Well, that's a great question. And it's a great observation that it is really tough with young people who are going through and what you, middle people and older people, all walks of life. I have a hundred year old relative in the nursing home, and this has been really hard on her dementia.

I've not seen people, the young people they're not getting with their friends. They're not doing the athletics. So, we actually at Memorial, have a great system for mental health. And I refer to one of my colleagues, Shelly Wier, she's probably gonna do podcasts with you, but she is awesome and she is an awesome counselor.

So, I was just talking to my patient before this podcast and she's getting great benefits of seeing her and just as compassionate as I am and passionate about health screenings and preventing disease, my colleague Shelly, is that for mental illness. So, we do have wonderful resources. I see there's some online resources that people could even be using during the pandemic, but it is super important to have that mental health. That's another reason why the vitamin D is so important because it helps make serotonin, which is your happy chemicals. So, we do need to address that more than ever right now.

Host: We certainly do. Wow. You're just such a wealth of knowledge and information. What a great educator you are Lila. So, now we're talking more in our age group. We're talking 45s, fifties and up. There's so much to talk about. So, at what age do we start mammograms, colonoscopies, annual wellness exams. What's involved. Come on, tell us about all of that. Cause there's a lot to talk about.

Lila: Well, first of all, the annual exam would be annually. And, you know, we've touched on just a minor bit of information. They're going to get that information when they're with me for an hour. So, anything they forgot about, they don't remember the screenings. That's my job. I'm the gatekeeper. And basically my job is to screen. Who do I need to refer you to, do you stay with me? What testing is on there? So, mammograms would start at 40 and I like them yearly. If I have a patient between 40 and 50, who's very low risk and they say, hey, I want to do them every two years. I would still be okay with that. Even the young people, I kinda missed that earlier, but I want to teach them how to do a self-breast exam.

So, my older women definitely doing their monthly exam, me doing a yearly exam, doing their mammograms. That's going to help with the breast health along with letting me know if anything is unusual between our yearly screens and being on vitamin D, which has been known to lower the risk for breast cancer. Making certain that my younger women of childbearing age that they're going to breastfeed, that's going to lower the risk of breast cancer later on.

So, mammograms are gonna start at 40. And then of course, the infamous colonoscopy typically for many years was at 50, they're now kind of backing that up to 45, especially if there's a family history. If I have a patient who's a little resistive, I kind of jokingly say, you think it's hard to sell a Pap and mammogram, try selling a colonoscopy.

If they're a little resistive, I will meet them half way. We'll do a Cologuard, Cologuards do work well. They are fairly predictive. Now it is a screening test. If it's positive, they have to go for the colonoscopy, but people don't argue with me once they see a positive Cologuard and the Cologuards are a nice tool for us.

So, they're going to start that between 45 and 50. And then DEXA scans for the patients over 65 or if there's a risk of a bone health issues, they could possibly start a little bit sooner. But Medicare does pay for a DEXA scan every two years, starting at 65. The Paps would be every three to five years, depending on the results. And if they do have an abnormal Pap, they get my full attention with that too, because they also, I do treat abnormal Paps along with my woman's health issues. So they don't have to all of the sudden go to a stranger because the Pap is abnormal.

Host: Women in our age group didn't get Gardasil. We didn't get the HPV vaccine. So, we're getting our Pap smears, how often? And do we have to still get them? Do we get checked for HPV and then don't need a Pap smear? How is all of that working now for people in our age group that weren't able to get the HPV vaccine?

Lila: Well, just to note, I have had several 40 year olds who broke up in their relationship, Paps were always normal previously. They're anticipating getting into a new relationship. They can still be a Gardasil candidate, but usually we start Paps at 21. We do those every three years until 30, but at 30 we do what's called a co-test. Co-test has meaning two that we do the Pap. We look at the cells and then we actually do an HPV, which is a DNA Test that's more accurate than the Pap test. Some people think someday we'll just be an HPV test because we now know HPV causes cervical cancer. But when you look at the researchers, they feel the combination of the two gives a better bang for the buck.

So, even if there was an ovarian cancer going on, even though the Pap isn't designed for that, there could be some cells that leaked onto that Pap and the pathologist could still see those. But it's just an extra test between, we don't want to get rid of the Pap smear. It has been around for a long time. It's saved a lot of people's lives.

So, then we throw in the HPV test, but you don't want to look for HPV unless the Pap is goofy before the age of 30. Because what sometimes what we don't know doesn't hurt anything. So, the Pap would be pretty much, most likely three to five years, depending on the abnormal history. And then at 65, most people would be done now saying that I had a 70 year old who remarried.

We did what was going to be her one last Pap and it was abnormal. And with her lower immune system at 70, it was getting worse. So, we did a treatment for her that was 85% predictive and she will probably get a couple more Paps because of the history. If a person's actually had a hysterectomy for cervical cancer, they get Paps for 20 years, every three years, a vaginal cuff Pap.

But a lot of times it's kind of hard to remember all those things. So, that's why they come see me. They come see me and then I can guide them through that because I've had many years of doing this.

Host: Well, you certainly have. And it's so confusing for so many people about that. Now, in this age group, you've mentioned vitamin D, we've talked about bone health. We've talked about all those kinds of things that people and women especially, really need to keep a track on. But another thing that this age group has is the mental health aspect. We're not sleeping. Or if we are sleeping it's a rough sleep. Maybe we have young kids or teenage kids. We also have older parents. In some cases we're the sandwich generation, and as a result, we are very stressed out. Women are, you know, have just had babies, maybe they're postpartum. There's just all of these things coming into play. And plus some of us work, there's a lot. What do you say to the women that come to you about depression screening, about mental health, stress, sleep? All of the things that go together to make us a happier, healthier woman.

Lila: Well, that is a good question. One of the things we do at their annual exam is a health screening for mental health. So physical, mental, they're a combination, they go hand in hand. So, sometimes it's just as easy as a test is do things that normally make you happy still make them. If they say yes, we can move on to other things. When I'm talking about their review of systems, I'm going to say, are you sleeping well? And if they say, no, I used to give a handout. Now I say Google sleep hygiene. And we talk about limiting the Pad time, the same bedtime, you know, stuff that I just heard today on the Today Show before I came to work is that sometimes you need to set your alarm what time to go to bed, not what time to get up and you need a minimum of seven hours and you want to keep that sleep hygiene going. And, you know, there are things like, you know, a glass of warm milk, a hot bath, you know, for people who are sexually active, just having sex, and a nice body massage can be very helpful instead of being on your phone on FaceTime.

So, the sleep issue is a huge big thing. And a lot of times people are burning the candle on both ends and they just got to go to bed earlier.

Host: Absolutely. And sleep hygiene is a big field right now, and sleep disorders and things, and keeping the room a little cooler, a little darker. And like you say, really not using the bed except for certain things and for sleep. And that's so important. And I love that you said the warm milk, cause I do love my glass of warm milk at night. Now when we're thinking about these appointments and you're so comprehensive, do you discuss vaccinations for us older folks? Because we think of vaccinations as a kid thing. But as we get older, we look at shingles, pneumonia, COVID, flu, there's all these other things that come into play.

Lila: Absolutely. You know, I just got my second pneumonia shot. I had a lot more of a sore arm with my pneumonia shot than I did my COVID shot. So, in the, when we talked earlier about maybe women in their forties, maybe they are going to re-engage into the dating market. Maybe they would be a good candidate for Gardasil, you know, flu shots yearly.

I do a lot of talking about the COVID immunizations and sometimes I just kind of have to give it up a little bit because I sense that people do choose what they want to do. And they want to hear different things than what I have to say. But the flu shot is important. Your pneumonia shot your, you know, shingles is a horrible disease. And we now have Shingrix, which is 90% effective. And a lot of times insurance is paying for that. So, yeah, nobody wants to get these, these diseases when we've got shots available for them. And we have a nice thing in our office. It's a health maintenance, so they're going to show on there, what things they're behind on and that's going to include the immunizations. So, that's very helpful. My nurse can be addressing those before I even see them. That's a nice tool that we have with our computer system.

Host: Well, certainly, and the fact that, you know, we think about these things and I can tell listeners, shingles is nasty business. And so it's not something you want to get. So, look at those vaccinations and in last two minutes here, Lila. You, and I could talk about all of these things for a very long time, but what would you like women to know about being our own best health advocate at any age? The importance of motivation with health goals, following up with you and primary care for re-evaluation, modifications, knowing our numbers, following our prescriptions, if we're on blood pressure medication or we're on diabetes medication, taking these things as prescribed. Wrap it all up in a big nice beautiful package your best advice.

Lila: I think my best advice is the importance of your yearly exam. And the first podcast we talked about that pretty much every insurance has coverage for a yearly exam. We have extra programs we can do. Your private insurance, pays for them. Your public aide pays for them. Medicare pays for them.

And we have the Illinois Pap program, which is a national program. That will pay for women over the age of 35. So, pretty much everybody has access and they don't have to memorize when is your mammogram due? When is your Pap? When is your colonoscopy? Just come see your provider for your annual exam and they should be helping you with all those things.

And if they're not helping, the nurse is going to help, because it's going to flag on the computer, they're behind on these things. So, you don't want to be sick. You know, you could have all the money in the world, but if you don't have your health, it's not going to do you any good.

Host: Certainly true. Health is the great equalizer, isn't it? And what an awesome guest you are. Thank you so much Lila for coming on and sharing not only your great advice and your expertise, but your wisdom as well, because I can certainly tell your passion for your patients.

And I bet that just comes through in every single visit with every patient that you have. Thank you so much for joining us again today. And to schedule an appointment with Lila, you can call 217-357-2173. For more health tips, you can also visit our website at mhtlc.org. That concludes this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank our audience and invite you all to download and subscribe, rate and review on Apple podcast, Google podcast, Spotify, everywhere that podcasts are played. And if you found this podcast informative, please share on your social channels, because we are all learning from the experts at Memorial Hospital together. I'm Melanie Cole. Thanks so much for listening.

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.