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Dr Weis (Host): All right, well, welcome to another edition of the Get Wise with Weiss Podcast. It Is my great pleasure today. I have Dr. Taryn McGilvery. who's one of our primary care physicians. And Dr. McGilvery helps serve our friends and family down in the Canyon area. Dr. Do you wanna just talk a little bit about your background and what services you offer at the clinic there?

Dr Taryn McGilvery: Well, thanks for having me, Dr. Weiss. it's nice to be here. We do all kinds of preventative care. We see you for things that you need, maybe sprained di ankles, sometimes broken arms. If you need vaccines. Definitely women's health. Well child checks, all that stuff, and if you're over 65, I'm also happy to see you as often as you need me to. Okay.

Dr Weis (Host): Fantastic. Well, we had a podcast a little while back looking at men's health and we talked about that the number one chief complaint for a man comes to the clinic is my wife made me come here. But I think women tend to be a little more self-motivated when it comes to maintaining their health. And you mentioned women's health, Talk a little bit, the more standard screening, procedures that we do for women in terms of maintaining their health.

Dr Taryn McGilvery: Well I guess I would've to say it obviously varies by age as you know, the biggest things are just annual visits, usually with routine pap smears. And then we talk about things like mammograms, regular testing, things like that, regular vaccinations. .

Dr Weis (Host): I know a lot of things have changed recently in terms of recommendations and guidelines. I mean, used to be believed that women had to have a pap smear every year and had to have a mammogram every year. Has that changed? Are we seeing differences in those recommendations?

Dr Taryn McGilvery: Well, that's a good question. the way I explain it to patients is your insurance will probably still pay for this once a year. I don't know if they've changed that part. But yeah, generally now we say, if you've had a normal pap smear, there's not anything concerning in the past as far as that you can repeat it every three to five years, just depending. And so that's usually the role that I go with with my patients, unless there's a concern, or if you need exams for other reasons, not just the pap smear, you know, because the pap sear, I explain to patients all the time is just the screening of cervical cancer. So looking at cervical tissue.

Dr Weis (Host): how about mammograms? I know there's quite a bit of controversy as to when do you start doing mammograms of women any recommendations there?

Dr Taryn McGilvery: So this is the way I explain it to patients. I just say, depending on what society you're on, sometimes they'll say every one year, every two years, obviously if people are higher risk or they have family history, I tell them every year is what they need. But usually that starts at the age of 40, unless you have family history of somebody, a first degree family member or someone on your maternal side.

Dr Weis (Host): You mentioned cervical cancer, the pap smear screening for that. Now, we've learned that cervical cancer is caused by a virus and now we have a vaccine for that. Tell us a little bit about, do you recommend the, the Gardasil vaccine in particular who should get it and, what are we trying to prevent?

Dr Taryn McGilvery: I Definitely do, and I have this conversation a lot, so I'm glad you brought it up. Dr. Weis. Good job. We usually like to start it really early, obviously before any exposure to HPV becomes a concern because it is something that is still sexually transmitted, but it's usually something that if people have it, they don't know that they have it.

So we usually start targeting our teenage audience. So usually I think we can do it as early as nine now, but usually recommendation is like 11 to 12 for the first dose. So parents ask me all the time. if I have a boy and he doesn't have a cervix, why does he need this vaccine? And that's when I go into the conversation. Well, one day he potentially could be sexually active with a female partner. and that's how HPV has transmitted.

And so, we do know it can cause some problems in men too. Like I think there is some very low risk of penile cancer.. It's not as high as the risk of cervical cancer, but those higher risk strains of HPV that human Papiloma virus that we're covering for. Those higher risk strain are just more likely to cause tissue changes that can lead to cancer. So that's why I tell parents all the time boy or girl, you need this vaccine.

It's one of the few things we have to protect against cervical cancer, which still kills, lots of young women in their thirties and forties these days. And another thing that I liked, I usually cover with some of my older patients. I say older, but mostly people in my age group, so like mid thirties, late thirties, this vaccine, I forgot exactly what year it was when it came out, but it was at the time recommended for patients only below the age of 26.

Because I remember I was 25 when this became a thing. And I remember asking my doctor about it. So now I think they've extended that to you. I think it's 45.

Dr Weis (Host): I believe so. Mid 40s

Dr Taryn McGilvery: Yeah, I think that's indication now. So even if you've ever been told you have HPV, it's still a good idea for you to get the Gardasil vaccine. I think if you're older, it's a three dose series, but if you start it, when you're younger, it's two doses. So, and there's a new vaccine. I think there's one aside from Gardasil, but I don't, I don't use that one.

Dr Weis (Host): Yeah. See I preferentially use Gardasil. Okay. So, you know, it's interesting to say, I think a lot of people associate, so HPV is that virus that many people associate with genital warts. And so the vaccine has had that, kind of connection between that and sexual activity when really, the connection needs to be vaccine to prevention of cancer.

Because again, we know that this virus is the cause of cancer. And made a great point, which is. Men can get this vaccine too. And it is protective in men, even more in men, HPV can cause oral cancer. And that there too, that's a preventive there. So it's a fantastic vaccine. And as you pointed out, now they've extended the age for it. Even if you have had genital warts from HPV, You still need to get the vaccine.

Because the strains of the virus that caused the war are not the strains that cause cancer. So you can still protect yourself from cancer. I think it's a huge breakthrough over in the last number of years. And I thank you for really encouraging that. Cause I think it's good for both boys and girls. Back in the sixties, we had fifties and sixties, we had Masters in Johnson, Masters in Johnsons were the ones that first studied sex.

You know, and we learned a lot from their studies as to, human sexuality, but we continue to learn more. And, I think a lot of women, we are recognizing that there's a lot of issues with sexual dysfunction in women. Pain, things like that with intercourse. Is that something you talk about in your clinic or do patients bring that to your awareness or ask questions?

Dr Taryn McGilvery: Yeah. I mean, it's not something I regularly bring up unless it becomes a topic of conversation. So yes, a lot of my female patients do bring it up. and it's usually more, Recently post-menopausal female patients. Sometimes that's not always just natural menopause, sometimes that can be post-surgical menopause. So if you had early menopause, if for some reason someone took out your ovaries with a hysterectomy early.

But yes, we do talk about that there and We try supportive things as much as we can. Sometimes we talk about hormone therapy in this context. Sometimes we'll talk about just lubricants and, using whatever you can just to help as far as conservative treatments. And then there is actually something that we've discussed before. There is something that's pelvic floor, physical therapy, something they offer through Northwest.

That's a very good service. I don't have a lot of patients who have branched out to try it yet. I have had a few who've had very good results and have been very happy with it. I think it's easier these days to just think there's a medicine for everything, but this is one of those things. It takes a lot of time and training and just practice, sort of like physical therapy for any other part of your body. But that's a good option to have. I do have a few patients. Who've been very happy with their outcomes there.

Dr Weis (Host): I've had the same experience. I've actually sent men for pelvic floor physical therapy and, there's a number of good practitioners. Amarillo. Obviously you see is one. We have a Pelvic for physical therapists at, Northwest. And there's also several others in the community that do a fantastic job, but, I never thought of it and it makes sense, but the pelvis is a structure that is full of complex muscles and nerves.

And just like you can have, a leg or an arm have problems that require physical therapy. The pelvis is no different. And boy, it's amazing what these therapists can do in terms of improving pain and dysfunction of the pelvis. So, yeah, that's been a huge development in town here over the last number of years to have these physical therapists.

Do you ever find that there's a psychological element to sexual dysfunction and, is it better a person to go for cognitive behavioral therapy or, some form of counseling in that sense?

Dr Taryn McGilvery: I do talk about this with some of my patients, I would say, it's a select group. It's usually patients who've had more maybe sexual trauma or just some traumatic things happen to them during their life. But yes, things like that can be really helpful for some of them. I haven't gotten to, follow up completely with the ones that I've started on that path because I haven't been there that long, but yes, that's definitely something else we talk about. So it's kind of a complex picture, it's not just maybe just the physical part of it, but also the mental part.

Dr Weis (Host): Absolutely. I think we're recognizing more and more people who maybe in childhood or early years did undergo some form of trauma. Event, that starts 'em off on the wrong foot in that sense. And all these therapies are really now coming to fruition in terms of helping these people get past this.

Dr Taryn McGilvery: Yeah. And speaking of this, Dr. Weiss, I do, I do have quite a few patients who come to see me and they, for some reason or another, would've been avoiding a pelvic exam or pap smear for, 10 or 20 years. And it's usually related to some history of that. So I try to tell all my patients, if you have any concerns about this or doing a pelvic exam, I still think it's important, but I like to very carefully tell patients what we're doing and what to expect. And I will walk you and talk you through it if we need to do that. But I understand there's a reason a lot of people do avoid that.

Dr Weis (Host): Fantastic. Excellent point. So, years ago when I was a young doctor, we used to believe that estrogen was the cure for everything, and we were told that Esher prevented heart disease and obvious osteo, protected bones and made women feel better. It was a panacea. I think we've kinda learned some things from now, how do you manage estrogen, your patients? Do you give it to everyone who's post-menopause? I mean, what's the role for estrogen therapy with women?

Dr Taryn McGilvery: I definitely talk about it with a lot of my patients. So don't know if a lot of our listeners are aware, but the, practice where I am in Canyon, it was previously run by a doctor who was double board certified in gynecology and family medicine. So, I inherited a very large population of patients that are maintained on estrogen. And I had to really get up to speed on the guidelines and everything very quickly.

So I've had to branch out and learn more about that I think, than I did when I started. but always tell my patients, I'm about shared decision making and coming up with a plan together. Definitely not every patient is appropriate for hormone therapy. There are people who've had a history of breast cancer or in multiple first degree, family relatives with breast cancers.

It just really probably shouldn't be on it, people who've had a stroke or very high risk for stroke. So we do have to follow a decision making process and make sure patients are a candidate, but if they are, and it's something they want to try. And other things I think we've failed sometimes, we'll start with also some types of mood medicines that I'll use just to help with some of the symptoms associated with menopausal things.

Sometimes if that completely fails and patients are noticing big changes in their quality of life or their sexual health, then sometimes it's worth a conversation worth having. And if they're somebody who meets criteria for it, then yes, we definitely talk about doing it. and I tell my patients all the time, if I'm planning to start you on estrogen, I think we all know this, but we don't talk about it.

If a patient still has their uterus intact and they want to be started on estrogen therapy and are good candidate for it, they also have to have dual therapy with progesterone just to prevent endometrial overgrowth from cancer. So I think that's a big, important point to make. If you wanna be started on one hormone, you may get just more than one. And then there's a lot these days about testosterone therapy.

Dr Weis (Host): Very valid points. And the other thing we know is a lot of the advantages we used to believe in estrogen were really not real. And we also know there's some downsides to estrogen. as you mentioned, just in terms of when You're going to do hormone therapy, it is critical that you talk to the patient and the patient talk to the doctor about this.

Cause one thing we know is, is particularly estrogen can put women at increased risk for blood clots. And particularly if that woman does smoke, and that can be a very dangerous combination. So it is, it has to be a very purposeful decision, make sure that whether it be symptom control for menopause, whether it be bone density, that there'd be a very purposeful reason why that hormone's being started.

Dr Taryn McGilvery: Yes. And I also remind all my estrogen patients, if you do not want to get your mammograms, you don't get this estrogen . So that's kind of a, do not Pasco issue for me. Sort of the same thing, you know, as men who are probably on testosterone therapy, getting prostate exams. So very similar.

Dr Weis (Host): Very good point. Cause we do, we know a lot of breast cancers in essence are essentially fed by estrogen. Just like a lot of prostate cancers are essentially fed by testosterone. So yes, very important points. We talked about HPV human papillomavirus, are there other infections that we need to worry about or screen for in both men and women, who go to see their primary care physicians?

Dr Taryn McGilvery: Yes, at my routine while woman visits, I'll just start with a woman. I usually always recommend screening for gonorrhea and chlamydia, if we're doing any sort of pelvic exam, because usually you want to take a cervical tissue swab, because it's usually the most accurate. And then sometimes trichomonas, which is another thing. And then it's also recommended that in higher risk populations, everybody gets screened.

At least annually or I guess, depending on their risk for, HIV and syphilis. So I tell all my college age students, if you've never had a blood test, you've never had this checked, we should do it at least once. And you're gonna come back and see me and we'll reassess your risks next year.

Dr Weis (Host): Being an HIV provider myself, I can't tell you how many older individuals I've encountered that presented in full blown aids because they never knew they had the virus. And who knows when that encounter was or how they contacted, but they never suspected it, and by that time it's now advanced. And the recommendations now are that everyone be tested for HIV at least once in their life, because it's a virus which if we know you have it, we can control it incredibly well.

And it's amazing to know that nowadays the life expectancy of someone with HIV is essentially normal, who are being appropriately treated, okay. But left to its own devices. It still can cause devastating illness in a person. And then you mentioned syphilis, which is another affection. That's just a bacteria. Syphilis, you may know is actually the oldest known or described infection in human history. Which is incredible, but it's seen a real Renaissance over the last number of years.

Mostly because of its, commingling with HIV, unfortunately, but syphilis like HIV or even more is very treatable and curable when found. But if left with its own devices over many years can cause devastating effects. So I'm big believer just screen people for those and make sure that if we catch them, we take care of them.

Dr Taryn McGilvery: Yeah. This is sort of a lude joke, but one of the ways I talk patients to letting me sometimes check them for HIV and syphilis is, you know, I tell them if you asked any doctor what STD probably you would like to have most, it would probably be syphilis because it's easily treated. So I just tell them, it's important. Let's just check. We can give you a medicine and clear it up.

Dr Weis (Host): That's a Great point. We treat syphilis with penicillin. Syphilis is just as sensitive to penicillin from the day penicillin was invented to today. So it's never developed any resistance, like I said, very easily treatable, but you have to detect it first to treat it. So excellent points you let's talk about, I know one, issue, a lot of women encounter are urinary tract infections or UTIs. Talk about what is a UTI, how does women know they have it? And then what do we do about it?

Dr Taryn McGilvery: Well, UTI. So we usually classify it kind of as like a lower UTI or like an ascending or complicated UTI. So just a urinary tract infection. Sometimes it'll start in just the urethra and kind of get into the bladder in females. just say females, because they're usually higher risk for that to happen. And then if it starts ascending at all and going into your kidneys or turning into Pylo arthritis or something, we treat it kind of more as a complicated urinary tract infection.

I tell my female patients that have this problem more often, E coli, it's just something that's found in your GI tract. It's just closer proximity in females to your urethral structure. So you're just more likely to get some contamination there. I think one of the more common things that causes it, but there's all kinds of things, as you know.

And sometimes weird things that aren't typical bacteria that we're looking for. I don't know what the urology guidelines hardcore say, but for me, you know, if I have an older female patient, for sure, an older male patient with specific symptoms and we do a quick test on their urine, then we call it just a urine dipstick just to look for bacterial byproducts, just to tell us if there is a sign of infection.

And if that ends up being positive, I will usually empirically treat my patients. And depending on their age or risk factors or symptoms, sometimes it's longer duration or a certain type of antibiotic based on their history. But usually just with antibiotics. So sometimes you can get a shot there's oral medicines. We don't have any of those shots in our clinic.

Then we will send the sample off for culture in the lab and let it grow. So we know exactly what is there, so that way we can tailor treatment if we need to. So I tell my patients all the time, if I call you in two days and tell you to switch the antibiotic, it's because this one's not gonna work. So I have a lot of older females who have recurring UTIs and will have more problems having them more frequently.

I tell them all the time, your glandular tissue kind of changes when you start losing some of that hormonal stimulation and it just puts you at higher risk for getting those UTIs more frequently. So that's something else we watch out for and that we sometimes will treat with like topical or just a little bit of vaginal estrogen therapy, occasionally. Just to help kind of maintain things where they're supposed to be and help those glandular structures so that infection isn't recurring.

Dr Weis (Host): You made a very good point, which you see, you know, women tend to get urinary tract infections because the distance between the tip of the urethra and the bladder is much smaller than men. So men should not get urinary tract infections, if a man comes in with a UTI, there is a problem. Okay. That's usually due to some form of obstruction in the urinary system and that needs to be worked up. Whereas women, we treat it and it tends to go away and can recur. .

Dr Taryn McGilvery: That's a disclaimer for all my male patients that comes to me with UTI. I'm going to talk about your prostate and probably a urologist.

Dr Weis (Host): Absolutely. So yeah, men, if you get one, then you know there's an issue.. You mentioned, you take care of a lot of, older ladies. we think about osteoporosis and bone density and older ladies and falls, what should women look out for in that sense? And, is there a screening test that we should do to ask the question is there's a woman have thin bones?

Dr Taryn McGilvery: Yes, that is also something that we cover at our routine screening visits. And I feel like some of us are better at asking that question than others, just because it's a harder conversation to have with patients because the medicines we used to treat it, I think people are just still very apprehensive about using them kind of in general, more so than other medicines like penicillin, similar to hormone therapy.

It's just a big step when you decide to treat for osteoporosis because you're treating to ideally prevent something. But yeah, sometimes. That doesn't happen. And this just gets caught after somebody breaks their arm a couple times. Usually we'll screen for it. I believe it's 55 is usually when we start talking about it sometimes just after the age of menopause. And then for men also, sometimes we screen for it if they have a family history of osteoporosis or have had a pathalogic fracture.

So a fall with an injury that probably shouldn't have ended in a fracture having a fracture. I've had like one male patient with osteoporosis that we were treating. So we screened for it with a bone density scan. We call it a dexo scan. I think that's just funner to say, it's just a special type of x-ray where they look at, your wrist bones or your hip bones and your usually your lumbar spine, and just compare the density as of those and tell us about your risk for fracture.

So when they give us that report, it's really nice because they calculate what we call a FRAX score, which kind of tells us your risk of breaking a bone. And most of the patients that I'm getting into these conversations with, the reason that we do it is to give you better and longer quality of life. It doesn't always mean it's going to end your life if you fracture a bone, but it can definitely affect your quality of life.

And if you're extremely mobile 80 year old person living on your own, that has a big impact on things. So that's why I tell patients it's important to screen for it, important to treat for it. Usually if we end up treating for it, we use usually bisphosphate is now what we start with. But it is always important that we make sure patients like calcium and vitamin D levels are optimized because sometimes there are secondary reasons to have osteoporosis, like endocrine related reasons.

So something related to like parathyroid glands or kidney disease that can kind of contribute to that. Or even jus, loss of estrogen stimulation after a while.

Dr Weis (Host): Yeah, very good point. I think one of the thing is particularly vitamin D you mentioned. We know that that is essential for bone health. And 75% of my patients are deficient in vitamin D. Many of the ways we used to generate vitamin D was being out in the sun and we don't recommend more people be out in the sun long enough to generate vitamin D because you get other sun related problems.

But certainly a daily supplement of vitamin D is just a good idea for all of us. And, I typically recommend. Oh, 2000 upper of 4,000 international units of vitamin D3 a day. Cheapest you can buy at Walmart is good. And it helps also protect those bones.

Dr Taryn McGilvery: I agree. I blame the dermatologist occasionally when we're having this conversation. But yes, we know sunlight is good and the vitamin D is good, but too much is bad. So yes, I usually say the same 1000 to 2000 units of vitamin D a day. Yeah. And that's just for routine maintenance. Sometimes if we're replacing vitamin D we do like a once weekly higher dose for, a few months and then we'll plan to recheck it.

Dr Weis (Host): Yeah. Do the mega dose give catch up. And one thing I think you mentioned is elderly people who are otherwise mobile, independent, a broken hip is catastrophic. And a lot of times that could be the end of their freedom in that sense and their mobility. And we know that particularly in patients 75 and up their mortality, their chance of dying within two years is 50% after a hip fracture. So, preventing those is great.

And we also have all ways of making sure when you get into people's homes, you know, get rid of those, throw rugs, those slippery throw rugs, watch out for the pets. I can't tell you how many people I've admitted that broke a hip because they tripped over their dog or cat. So these are the kind of things that people have to be wary of to avoid that.

Dr Taryn McGilvery: For any of my Medicare patients that are listening, this is why we do those Medicare visits. And we have you fill out lots of forms because that fall risk is very important. Yeah. It tells us kind of how at risk you are, as far as things at home and maybe gives us ideas for things we need to work on to help prevent you from fracturing a hip for all those reasons.

Dr Weis (Host): We do those annual wellness visits and that is our chance to review those risks with our patients. And it can make a big difference, because that is a catastrophic development. Just one last thing There's obviously been a lot of talk about women's reproductive rights now, in a young woman who's interested in, maybe contraception, is that something they can talk to a primary care doctor about?

Dr Taryn McGilvery: Yes. I would say definitely these days more than ever. Please discuss that with your primary care doctor. That's something I talk about with all my patients. If you're young and childbearing age, I say, please, please talk to me and let me know if this needs to be a conversation we need to have. And I tell everybody also, if it's a sexually active female, you need to be on a prenatal vitamin. So it's probably a good time to mention that, unfortunately, because things can happen even if you're on birth control. But yes, I'm always happy to talk about that with my patients.

Dr Weis (Host): Great. Because yeah, nowadays there's all kinds of choices for women in terms of, birth control contraception. It's not just the pill anymore. There's all kinds of options.

Dr Taryn McGilvery: Yes. And I probably should mention, since I'm talking a lot about postmenopausal things or perimenopausal things, when we have a lot of more middle-aged females who haven't quite gone through that change yet, but they're still having some very irregular periods which can happen before menopause. We use a lot of those oral contraceptives birth control as we call it, just to help regulate periods. And sometimes we use all those methods to do that as well. So not just for contraception. But more for also controlling things.

Dr Weis (Host): Well, fantastic. And we have covered a lot of topics today related to women's health. I truly appreciate your insight into all of these. Anything else that you'd wanna bring up that I left out that you thought would be important for women in this community to know?

Dr Taryn McGilvery: I think for men and women, I was gonna mention it's not necessarily something that's sexually transmitted, but hepatitis C screening. I didn't talk about that. I think a lot of us forget to cover that, but that is usually something that's indicated more for middle-aged people as well, at least once.

Dr Weis (Host): Fantastic. No, thank you for bringing that up. You know, hepatitis C. At one point, there were about 250 million people in the world with hepatitis C. And that was a virus that was guaranteed to give you cirrhosis at some point. And we now have cures for it, which is just stunning. I thought I'd never see that in my life. So all the more reason why now screening for it detecting, it allows us to actually cure you from hepatitis C, excellent point.

Well, once again, we appreciate you being here today. I wish you continued success with your clinic in Canyon. I know you were serving that population very well, so for all our listeners, appreciate your listening and we'll see you next time on the Get Wise with Weiss Podcast. Thank you.