Dr Warner Huh (Host): Hello everyone, it's Dr. Warner Huh again, the Chair of the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham, and I'd like to welcome you to this monthly episode with Women's Health with Dr. Huh. Wishing you all a very happy holiday, and that we're recording this after Thanksgiving, and hope you all had a great Thanksgiving holiday.

So today, I'm really excited that we're going to talk about an important element of the care that we

Host: provide

Dr Warner Huh (Host): in the Department of OB-GYN, and that topic is on pediatric and adolescent gynecology. And with me today is Dr. Blair Lacy, who's an Assistant Professor in the Division of Women's Reproductive Health, and in the section of Pediatric and Adolescent Gynecology. She's actually one of four faculty in the Department of OB-GYN that practices pediatric and adolescent gynecology. She practices her expertise both here at UAB Medicine in the Women and Infant Center, as well as the Children's of Alabama Hospital. And she also has an interest in quality care and medicine. So, welcome to the podcast, Dr. Lacy.

Dr Blair Lacy: Thank you so much for having me, Dr. Huh. I'm happy to be here.

Host: So, many of our listeners are probably not fully aware that there's a separate discipline of pediatric and adolescent gynecology under OB-GYN. Can you kind of share with our listeners what are some of the more common medical issues that you evaluate, treat, and manage?

Dr Blair Lacy: Sure, happy to do that. And it's not uncommon for people to express surprise that there's this discipline of pediatric and adolescent gynecology. We see young women in the office from ages of 0 to age 18 years old and deal with just about everything that would fall within that time frame, primarily issues of pubertal development, either delayed, precocious or early onset puberty. We also address menstrual concerns, whether that is abnormal menstrual bleeding, heavy menstrual bleeding, painful menstrual bleeding, again, the whole gamut of menses and what that entails. We see a number of more anatomical concerns, obstructive anatomical concerns, ovarian pathology. We see it all.

Host: You all do incredible work in your section. And in fact, it goes without saying for our listeners that the group that Dr. Lacy is involved with is like really the only group of its kind in the Southeast region. And so if I'm not mistaken, your referrals not only come from the Birmingham metro area, but all over the state in the southeast. Is that correct?

Dr Blair Lacy: Absolutely. No, that's correct. We are here in Birmingham, the four pediatric and adolescent gynecologists. We are the only four in the state. We see young girls from across the state, across state lines, all over the Southeast. We receive referrals from pediatricians all over the Southeast, as well as self-referrals for those who are interested in seeking pediatric gynecology care.

Host: So, that was the question I was going to ask you. So, the majority of referrals come from pediatricians, is that correct?

Dr Blair Lacy: Yes. Pediatricians, oftentimes, when they get to a point within, they feel they've exhausted their management options, or they no longer feel comfortable managing certain conditions, they reach out to us. Oftentimes, we'll discuss some things over the phone, but most often they will send patients on in to see us in person. And so, we do receive large amount of referrals from pediatricians.

Host: Well, it's one of the many reasons why I love working for this department, because we have members that work through the entire spectrum of a woman's health from obviously the pediatric side all the way to menopause. But anyway, it's fascinating to learn more from you.

So, can you just share with us, how is your training in this discipline different than like a traditional OB-GYN? I think our listeners would probably be interested in knowing what your training and skill set is, how that differs from a traditional obstetrician and gynecologist.

Dr Blair Lacy: So initially, pediatric and adolescent gynecologists start out on the same trajectory as generalist OB-GYNs. So, we complete a four-year OB-GYNs residency and then continue on to do a two-year fellowship, so subspecialist training. There are about 10 to 12 fellowship opportunities each year in the United States. And UAB has one such fellowship. So, we are very fortunate to have that. And within those two years, we manage patients from a clinical standpoint, surgical standpoint. There is a lot of endocrinology, so overlap of other pediatric subspecialties, urology, hematology, endocrinology, like I said. So, we see a lot within those other subspecialties and in fellowship as well.

Host: So, I think it goes without saying, and I know this first hand having co-managed many patients with your partners and you, is that the work that you do is incredibly challenging. I mean, challenging not just from a medical complexity perspective. Who would ever know that taking care of the pediatric and adolescent population could be so complex, whether it's structural abnormalities, hormonal abnormalities, like you talk about, but also that there are difficult social situations as well that you deal with every day.

But aside from the challenges that you face with your work, it's obviously immensely rewarding. You otherwise wouldn't be doing it. So, I was wondering if you can just share with me and the listeners about what you enjoy most about this particular field of gynecology.

Dr Blair Lacy: At the very heart of it is clearly the patients, having these opportunities to connect with these patients. Let's be clear, no woman at any point in her life really wants to be in a gynecologist's office. It's not especially enjoyable time for many, and that is no different for our young women. So, to have these women in an office setting and to be able to put their minds at ease, to be able to offer them a safe, judgment-free space where they can ask questions, we can help debunk some myths surrounding reproductive health, is really an empowering moment, I hope, for these young women. And much of what we do is offer reassurance and education, and that, to me, is just in the way of giving these women some agency, in the way of making decisions surrounding their reproductive health, a really powerful aspect, I feel.

Host: Yeah. That's particularly meaningful coming from you. Because if I'm not mistaken, you spent a good chunk of your professional career taking care of adult women and then came here to do your fellowship training and now have largely dedicated your life to the pediatric and adolescent population.

Dr Blair Lacy: You're right. So, initially, the first iteration of my career was as a general OB-GYNs. And the majority of the patients I saw were postmenopausal in age. And after almost a decade of practicing in general practice, there was a a series of moments during which I really felt compelled to further subspecialize and narrow the scope of practice to seeing pediatric and adolescents. And so, that has just been truly a passion and something for which I feel so fortunate to be able to provide here at UAB.

Host: So, what stands out to you regarding the pediatric and adolescent Gynecology Program here at UAB Medicine and Children's of Alabama? I'm just curious. Anything that you're particularly proud of or excited about?

Dr Blair Lacy: The answer very simply is the reason why I am here and I feel so proud to be at UAB, which is the opportunities that we have to care for such a broad demographic and reach these young women across the state and across the Southeast. Additionally, we have an incredibly robust group of four pediatric and adolescent gynecologists, and we work very well and collaboratively with other multidisciplinary groups both here at UAB and at Children's. I think the opportunities that we have to provide this care are certainly among those that set us apart here at UAB.

In addition, as I mentioned, having the fellowship, which is truly a tremendous strength here at UAB to offer that additional subspecialty training to create the next leaders in the field is incredibly special. And I feel incredibly lucky to be here.

Host: Yeah. I want to second that because I think you're understating the importance of your group, not just to Birmingham and Alabama, but nationally. And you guys set the standards as it comes to training. And I couldn't be more proud of what you've all created and the type and quality of care that you deliver to our patients is truly second to none.  

Dr Blair Lacy: Well, thank you so much, Dr. Huh.

Host: Any other closing thoughts or comments that you would like to make to the listeners today?

Dr Blair Lacy: So earlier, I touched on how often we receive patient referrals from physicians in the area. I would encourage, you know, there's something called mom tuition, where moms or a caregiver just have a sense of needing to reach out or get some answers if they feel that there's a concern. And so, I would encourage those moms, those guardians, that if they feel that their issues are not adequately addressed or met from a pediatrician, that they can certainly reach out to us, self referrals, and we are happy to see them, and hopefully help their child navigate what can otherwise be a very challenging time.

Host: Well, again, I mean, you guys provide an exceptionally safe place because of the challenging conditions that you treat. And with like a lot of pediatric disciplines, the parents are very involved and they should be, right? And so, you guys thread that needle delicately and so expertly. But just for our listeners to recognize that there's always a safe place to seek that kind of care and advice.

So again, I'd like to thank Dr. Blair Lacy for giving us this awesome introduction into pediatric and adolescent gynecology. And as always, please rate this podcast and we welcome any comments that you might have, particularly on topics that you're all interested in learning more about.

And for more information on just general OB-GYNs care, including our awesome pediatric and adolescent gynecology program and other clinical services that UAB provides, please check out uabmedicine.org. And until next time, thank you and have a great day and wishing you all a very happy holiday and happy new year. Take care. Peace out.