Maggie McKay (Host): Women's health. There's so much to know from childbirth to menopause and everything in between. So today, OBGYN and Director of OBGYN Services at Symphony Medical Group, Dr. Janusz Rudnicki is here to discuss it all. Welcome to Riverside Radio HealthCast, a podcast from St. John's Riverside Hospital. I'm your host, Maggie McKay. Thank you so much for joining us today.

Janusz Rudnicki, MD: Thank you for having me.

Host: Absolutely. Let's just get right into it. What kind of screenings should a woman expect to get at her yearly checkup?

Janusz Rudnicki, MD: Yearly checkup, which women often refer to as going for a PAP smear, entails much more than that. It's basic blood pressure and vital signs, BMI, which is a metabolic index, which shows where are you with your weight vis a vis your height and age, which is a very important subject because it's part of a problem that is common to the whole country, and that is weight gain.

So you have your blood pressure checked, you have your BMI assessed, and you have a history taken by your doctor. And examination entails check the thyroid, general examination, hard lungs, but breast examination, abdominal examination, and pelvic, which may or may not include, may or may not include PAP smear.

In the younger group under 30, we do routinely, at least in New York State, we routinely do chlamydia and gonorrhea testing. The older group, I used to do rectal examination to check for occult blood, but that's sort of by a wayside because, because the colon screening became so common and so well established that it's probably not necessary and it's not very accurate anyway.

Host: So is there any current research or technological breakthroughs that you're excited about?

Janusz Rudnicki, MD: Well, I've been a robotic surgeon since 2012. We currently operate using a DaVinci XI machine. This is a fourth generation of robot. Right now in the works is DV5, DaVinci 5, next, version of this incredible machine. DV5 using AI technology. It is absolutely amazing. It's not yet used the hospital, it's not yet available for purchase, but I was in Atlanta in the headquarter of Intuitive, the company that makes it, and this thing is absolutely amazing.

Suffice to say that, it has about 10,000 more computer power than a currently used DaVinci XI, which practically means that one new machine has more computer power than all the other robots all over the country because there's less than 10,000 of them. So it's pretty amazing how it traces every movement.

You can look back and check any procedure you ever done to see how effective and efficient you were, and computer remembers it and helps you correct your surgical technique.

Host: That is amazing. What conditions is it used for and who benefits the most from these types of surgeries?

Janusz Rudnicki, MD: There are three specialties that use it commonly; general surgery, urology, and gynecology. Gynecology probably was the first specialty that had an interest in it because we used to do laparoscopic surgery with a direct, narrow and with a straight stick, as we call it, for a few decades. Robot is a further development of laparoscopic surgery, allowing more precision, better viewing, and generally allowing us to do the surgery that we couldn't do laparoscopically. And we do it better than with the open surgery. So there, there are different types of the, the most common gynecological procedure, of course, among the major procedure is hysterectomy.

It could be done open through the incision, which is, still, most of them are done that way, could be done transvaginally, could be done laparoscopically, and of course could be done robotically. The last two are in many ways superior because it allows the patient to suffer less pain, go home, less incision, less healing. It's generally highly beneficial to patients.

Host: What does PCO stand for and how common is it?

Janusz Rudnicki, MD: PCO stands for polycystic ovary or PCOS, polycystic ovary syndrome. It is very common. It's a common cause of menstrual problems, of lack of periods, and of infertility. It is a whole syndrome that goes back to 19th century Stein Leventhal syndrome that evolved into the polycystic ovary syndrome. It is endocrinopathy.

It is a failure of the ovaries to get to the full ovulation with the cycle, which creates increased amount of androgen, produces a male hormone, produced in the body, it creates multiple follicles from incomplete ovulation in the ovaries, and it is a whole spectrum. There are women who have very minor changes, but it may affect their ability to conceive.

There are other women who have extremely advanced stages with extra hair growth, the male pattern balding, lowering of the voice, and all other deleterious effect of testosterone like hormones on a female body.

Host: You mentioned not being able to conceive possibly. Let's, talk about high risk pregnancy because you have a lot of experience in that. What are some of the ways women can be proactive before they get pregnant to have the best possible outcome and try to avoid complications?

Janusz Rudnicki, MD: There's multiple factors, but you know, being smart and proactive always helps. It's a healthy lifestyle. It's not smoking. It's not getting obese. It's eating the right diet, proper nutrients, maybe supplementing, especially when you are close to trying to get pregnant with prenatal vitamins, folic acid, sometimes extra vitamin D, which everybody has a very low level, and almost everybody. There is a trend in this country and the whole western world that women delay their childbearing as well as they do when they're pregnant. The fertility rate is at its peak in the late teens, early 20s. It seems to be declining. Some women can get pregnant 42, 43, have successful pregnancy, healthy babies, but the chance for the conception, for getting pregnant, having a baby decreases with time.

 This not a very beneficial trend in the, in this country.

Host: I remember when I was pregnant, they called me a senior mom and I was 35 and I was like, what? Is that still the case? 35 is pretty old to have a baby your first?

Janusz Rudnicki, MD: It is the line in the sand that we do serentesin 35. And yes, it's called AMA, which is advanced maternal age.

Host: Better than senior.

Janusz Rudnicki, MD: I remember, you know, a few decades ago when I was a brand new OB and, and one of my colleagues was in labor and the labor was slow and hard and I feeling very bad and very sorry about it. And my boss said to me, what do you want? She's an elderly primigravida. She's an old woman. She was 28. Okay. At least, at least we don't call them that young, but.

Host: Yeah, exactly. Oh my goodness. That's hilarious. Well, we have to talk briefly about menopause because, that's part of being a woman. What about postmenopausal health? Because I've heard people say, oh, I'm in postmenopausal health so I don't have to worry as much about, going to my OBGYN or whatever every year. Is that true?

Janusz Rudnicki, MD: No, I don't think so. Menopause happens around 50. This is average age. And the perimenopause, the few years prior to menopause could be trying, could be trying with irregular periods, with some hot flashes or insomnia, changes in the body. They definitely get more pronounced after the menopause.

Now, If you think as a, as 50, as old, you are wrong. This is halfway through average woman's life, at least in the generations that come. Women's life expectancy is up in the 80s, but it includes all the accidents and tragic death and young children and so forth. So I think it's reasonable to expect that young, healthy women who are now 50 may have another 50 years ahead of them.

Host: Wow.

Janusz Rudnicki, MD: if you call it old and start abandoning some healthy practices, it's not going to serve them well. So I think they should maintain their schedule as they used to. You have to look at several things. You have to see your general health. You have to look at the sexuality that seems to wane after menopause.

You have to consider the issue of estrogen replacement or hormone replacement therapy. There was a study that came out some 15 years ago, WHI, that really frightened everybody. The study was, the idea that estrogens give you cancer is incorrect. They are a risk to everything, but they're tremendous beneficial if you use them right.

And that improves the bone health, improves sleep, improves sexuality. So this is something that needs to be at least discussed. What I'm saying is don't dismiss it right off the bat without even looking at it. Have the meaningful discussion with your gynecologist about estrogen or estrogen progesterone, whether it would benefit you or whether it's something you can do without.

Another issue is you need to do your mammographies. I know the recommendation is one to two years. In my opinion, mammography should be done every year, often with the sonogram, and sometimes even with MRI for high risk patients. Colonoscopy. The age of colonoscopy moved down to 45 from 50, and it's a test that can prevent, actually, colon cancer if some polyps or some early malignant changes or pre malignant can picked up early enough. It's a huge thing and it should be considered.

Host: Right. We have to use all the resources we have and stay on top of it. Like, like you said, every year for sure. The mammograms and like you said, colon cancer is so preventable if you stay on top of it. Well, in closing, is there anything else you'd like to add you'd like women to know that we did not cover?

Janusz Rudnicki, MD: The interesting thing is that for many women, a gynecologist is her primary, if not the only doctor. I think that they should also utilize our internal medicine colleagues because, there's not everything could be included in the, in the short annual GYN visit. But we do a lot for our patients.

We often have to venture into areas of internal medicine and if you have questions, if you have problems, talk to us. Nothing is off the table when it comes to talking to your doctor. Even the very sensitive subjects like sexuality, problems with lovemaking and so forth.

Host: Right. Don't be shy for sure, because you guys have heard it all.

Janusz Rudnicki, MD: Absolutely, nothing will shock us. Well, occasionally, but most of the time, nothing will.

Host: Well, thank you so much for sharing your expertise. This has been so informative. We so appreciate your time.

Janusz Rudnicki, MD: Oh, thank you very much for having me.

Host: Absolutely. Again, that's Dr. Janusz Rudnicki, and if you'd like more information, you can call St. John's Physician Referral Service at 914-964-4DOC, D-O-C, or email findadoc@ RiversideHealth. org.

And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Riverside Radio HealthCast from St. John's Riverside Hospital.