April 16, 2025 • 34 mins
Get answers to some of the most common women's health questions, answered by Marissa Walker, a registered nurse from the Cleveland Clinic's Center for Specialized Women's Health. Together, Host Dr. Holly Thacker and Nurse Marissa uncover the critical differences between a GYN annual exam and a pap smear, and discuss the essential role of maintaining personal health records.
They explore the world of women's health screenings and the truth behind common misconceptions. Dr. Thacker and Nurse Marissa guide you through the importance of regular HPV checks and mammograms, shedding light on Ohio's new mammogram reporting laws and what they mean for you. The conversation doesn't stop there—find out why annual GYN exams remain crucial even post-hysterectomy, as we emphasize comprehensive health monitoring.
Join them as they tackle hormone therapy and the complexities of managing prescriptions. They delve into why continuous monitoring of hormone levels is vital, especially for women with specific health backgrounds. Plus, they address the anxiety surrounding test results and the importance of medical guidance over online misinformation. This episode is packed with invaluable advice to empower you to take charge of your health with confidence.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am glad to be back in the
Sunflower House for a newepisode.
For a new episode.
(00:28):
Joining me on this new Speakingof Women's Health podcast
episode is one of our favoriteCenter for Specialized Women's
Health nurses, marissa Walker,and, I think, somewhere in the
background, beth, you want topop up?
Beth is my daily nurse thatworks with me with patients.
Where are you hiding Beth?
There she is.
I love these ladies.
They're so great.
So a little bit about Marissa.
(00:50):
She has her bachelor's ofscience in nursing and she is a
registered nurse and she is anurse in the Center for
Specialized Women's Health atCleveland Clinic in our OBGYN
and Women's Health Institute.
Marissa is a mother of two boys.
She's a boy mom, like I am, andher boys are so cute.
(01:12):
You just want to pinch them.
They've had fun meeting mygranddaughters and Marissa and I
kind of share a guilty pleasurewith nails, right?
Oh, yes.
Speaker 2 (01:24):
Yes.
Speaker 1 (01:24):
And sometimes we'll post both of our hands together
on our Speaking of Women'sHealth social media.
If you don't follow us onpodcast or if you don't follow
Speaking of Women's Health onour Facebook or X, formerly
known as Twitter, or Pinterestor LinkedIn, we're also on
YouTube and Rumble channels.
(01:45):
So if you're listening to thispodcast and you want to see
Marissa and her pretty eyelashes, you're a girly girl.
I see Beth sneaking out,probably to get some patients
ready for clinic.
Anyway, welcome, Marissa.
We're so excited to have you asa guest on the Speaking of
Women's Health podcast to talkabout a lot of the common
(02:07):
questions that you field everyday.
You work as a facilitator withDr Batour's virtual shared
medical visits.
You work in triage, so tell usabout some of the work that you
do in our center and some ofyour areas of expertise of the
work that you do in our centerand some of your areas of
expertise.
Speaker 2 (02:28):
Oh yeah, so background, I do have experience
in emergency medicine, laborand delivery, and I've been in
gynecology women's healthmenopause for the last three
years, now Coming up on threeyears.
Speaker 1 (02:48):
You're a very smart cookie and you also have
expertise in helping a lot ofour patients who get bone
infusions and you do nursevisits as well.
Yes, yes, so we're going to goover some of the common
questions that I think you fieldmost every day.
So tell our listeners what'sthe difference between getting a
GYN annual exam and getting apap smear?
Speaker 2 (03:11):
Oh yes, now this question is so common because I
know back like not even aboutmaybe five or six years ago.
We used to get our paps in ourannual exams, like at the same
time every year.
Because medicine is changing,these guidelines are changing,
we have to change things up fromtime to time.
(03:32):
Common misconception is thatyou have to get a pap smear
every year.
They found that you don't haveto get it that often.
A pap smear is a gynecologicaltest that will screen for
cervical cancer and we tend todo it typically every three to
(03:52):
five years.
Now an annual GYN exam that'sgoing to consist of your breast
exam and your pelvic exam andthat will be done annually,
hence the annual yearly everyyear.
So a pap smear is justsomething that may occur in one
of those years, but notnecessarily every year, unless
(04:14):
there is something that needs tobe followed up on.
Speaker 1 (04:17):
And that is such an important point and I find a lot
of my patients think they had apap smear simply because they
saw a woman's health clinicianor a gynecologist and had a
speculum put in the vagina tolook at their vagina and cervix.
It doesn't mean that it wasscraped.
And for our listeners whohaven't heard, the interview I
did with Dr Sharon Sutherland,who is a gynecologist and she's
(04:38):
in charge of our cervical cancerprevention program and the head
of our gynecology ultrasound,which we may talk also about,
since we order lots of pelvicultrasounds that's a good
podcast to go back to listen to.
And the thing that I emphasizeto a lot of my patients and new
patients and I know that ourwhole team, like our
(04:59):
administrative assistant, julieStahl, who's been on our podcast
to talk about how to get anappointment at the Cleveland
Clinic, is she'll send outmessages on MyChart asking
people and women to bring intheir records and bring in their
actual pap smear results andkeep copies so that we have them
Because we can't see, even ifit's an electronic system, of
(05:19):
another system.
Do you want to talk a littlebit about MyChart and how
patients access and interactwith you on MyChart?
Speaker 2 (05:27):
Oh yeah, so from time to time we'll get a phone call
and that will be like throughour admins.
They'll leave us a message andwe'll get back to them, usually
within 24 hours.
And then if there's a questionnon-urgent or non-emergent, um a
medical question our patientswill type in that question in my
(05:47):
chart and we'll answer it now.
Sometimes it does take up toabout three days to get a
response, typically for that,because we have such a like
large patient flow, um but um,we get questions that have to do
with um menopause concerns,like symptoms that one may be
(06:08):
having, or questions about theirmedication, about refills,
trouble getting their medicationfrom a pharmacy, like pretty
much anything.
It's like a large range ofquestions that we get.
Speaker 1 (06:24):
Yeah, you get a whole wide variety and I know that
the other day, uh, when leadnurse Alexandra was there, she
was like there's not not anyonein triage right now and
everybody's box is overflowingand there's hundreds and
hundreds of questions, and soour nurses just really work so
hard and that's one reason whyI'm so grateful that we're able
(06:46):
to put out so much great contenton Speaking of Women's Health,
to empower women to be strong,be healthy and be in charge,
because a lot of these answers.
I bet people could go on ourspeakingofwomenshealthcom
website and just type in and getsome simple answers that they
need, as opposed to overlyrelying on the nurses.
And certainly for emergencysituations, people need to call
(07:10):
911 or go to the emergency roomfor heavy bleeding, you know,
chest pain, those kind of things.
I think it's very important forpeople to understand how to
utilize electronic securecommunications with their
healthcare team, how to utilizeelectronic secure communications
with their healthcare team, andI do believe that the clinic
has instituted sometimes chargesfor MyCharts.
(07:32):
Is that right?
Speaker 2 (07:35):
That is correct.
So if there is a MyChartmessage that requires more time
from the physician or from theadvanced practitioner, then
generally they will charge acertain amount to the patient's
insurance.
To answer that question,because it just kind of counts,
it'll be like equivocal, to likea telephone visit or a virtual
(07:59):
visit almost depending on howsensitive the question is.
Speaker 1 (08:02):
Yeah, yes, yes, and so that's why I think this
podcast is so important to goover a lot of questions that
maybe people can get answeredahead of time and not have to,
you know, go online and wait,you know, a few days to get an
answer.
So this other common questionis my doctor states that my pap
smear was normal, but on mychart it says yes for HPV reflex
(08:24):
.
What does HPV reflex mean,nurse Marissa, yes, Okay.
Speaker 2 (08:29):
So HPV is a STI or STD that we test for.
Generally when we do a PAP it'sautomatic for everyone after
the age of 30, as of right now.
So reflex just means in theevent that something is abnormal
, we will go and test for thisitem.
(08:50):
So when you get that messagethat says hey, yeah, your pap
smear was normal follow-up inthe year, you're fine to go.
It does and you see the reflex,yes, hpv.
It's just meaning that in theevent that you would have had an
abnormal pap smear, they wouldhave saw some atypical cells,
(09:10):
some cell irritation on thecervix or some low-grade cells
on the cervix, anything of thatnature.
They'll go ahead and test tosee is HPV the culprit of that?
We'll test for it, but itdoesn't necessarily mean that
you have it to indicate whetheryou have HPV.
Your actualV test you'll seewhere it will say detected or
not detected.
You will go by that.
Speaker 1 (09:32):
Excellent that is so excellent.
And most all women do getexposed to HPV, even if they
only have one sexual partner,and most people clear the
infection.
So 80% of women have beenexposed by age 50.
But sometimes if your immunesystem is bad, it can come back
out.
There's other causes,especially in midlife women, of
abnormal PAPs.
Particularly if they're low inhormones.
(09:53):
The cells can look abnormal.
So it's very important to getthis periodically checked and
I'm a big proponent and I know alot of our APPs.
Like we've had nursepractitioner Dana Leslie on in
the past and I think hopefullywe'll have her on in season
three again.
And we've had other nursepractitioners who are excellent,
(10:15):
like Kelsey Kennedy and BabsAlex Babushkak as well, to talk
about their advanced practice,nursing practice, and we usually
try to do a pap every threeyears, like I was just in to see
Dana myself, because five yearsis a long time, and so I think
(10:36):
if women have gone definitelymore than three years before
they've had the scrape and theHPV that they should talk to
their women's health team about,well, maybe I should get
another one, because maybe theywon't come back within that
five-year mark and we really donot want to miss cervical cancer
for sure.
So let's move on to the upperpart of the bikini area, the
(10:58):
breast area, and a lot of womenI'm sure that you talk to all
the time are having breast painand they wonder if they need a
mammogram.
And so talk a little bit abouthow you handle that from a
nursing perspective.
Speaker 2 (11:11):
So I think it's just like a common misconception as
soon as you have any type ofbreast pain you need to
automatically get a mammogramLike Cleveland Clinic, we have a
very impressive breast center.
Like Cleveland Clinic, we have avery impressive breast center.
So when someone is having painin like these locations, we have
(11:36):
these specialized centers forlike almost every body part here
.
So we do have a specializedbreast center which we do like
from time to time network withand trade notes with.
So in the event that you havebreast pain, we wouldn't
automatically give an ultrasoundor a mammogram and I didn't
want patients to think that it'sneglectful on our part not to
give you a mammogram because youhave breast pain right, because
it could be due to anything andwe want you to get that
(11:58):
thoroughly checked out.
So in general, we wouldgenerally refer you over to the
breast center to get furtherfollow-up.
Like, yes, a GYN can look atbreast and pelvic, but if you
want someone that specializes init to get a more detailed
examination and like diagnosisand referral to what you need,
(12:21):
it would be recommended to go tobreast center.
So generally we'll start withthat.
Speaker 1 (12:30):
And one thing of course it can be from hormonal
fluctuations.
I've seen a lot of women sincewe've been checking omega-3s and
seeing a lot of people aregetting too much of the
inflammatory omega-6 fats andnot enough of the omega-3s that
a lot of women are just takingfish oil and we've got podcasts
on nutrition and diet andomega-3s and I've seen women
develop breast cyst and breastpain from too much omega-3s,
even though a lot of peopledon't have enough and just
(12:51):
hormonal fluctuations wearing agood support bra, and so that
doesn't necessarily mean cancer.
But we have new legalrequirements in Ohio law in
terms of reporting out onmammograms and so I'm sure
you're going to if you're notalready getting lots of
questions from women.
(13:11):
It's getting much more detailedabout whether their breasts are
dense or not, whether they haveincreased risk for breast
cancer, whether they should havemore imaging, and there's a lot
of women who kind of fall inthis gray zone and I'm sure
that's going to generate a lotof confusion and questions and I
really like to direct to ourpatients to our
(13:33):
speakingwomenshealthcom sitebecause we have a lot of
proactive information aboutbreast health, reducing breast
cancer risk and who are thosehigh-risk people who do maybe
need more imaging, likeultrasound or MRI, or maybe even
need to see cancer genetics,and we do have a large
population in our center ofwomen that have genetic
(13:55):
mutations that do make them athigher risk for breast and
ovarian cancer.
So let's move on to anotherreally common question I know
you get asked all the time is ifI've had a hysterectomy and I
don't have a uterus or cervix,do I even need to come in for a
annual GYN exam?
Speaker 2 (14:14):
Oh, yes, that's very common too, yes.
So the answer, short answer,would be yes, you do, because
the annual exam does consist ofboth breast and pelvic and
vaginal exams.
So I do tell my patients justlike flat out, like uncandid,
like, even though you don't havea uterus, you still have a
vagina.
So be like that.
(14:36):
And a vulva, yes, and a vulva,and you're still prone to get
any of these items, you canstill get any type of infection,
like you still engage inintercourse and you may have
some problems problems likegynecological issues and you
want to be established with aprovider and see them every year
so that you can be up to dateon your exam, so we know what's
(14:57):
going on and then when you havea question or a problem does
arise, we're not likescavengering and looking around
for someone to see you rightaway.
When you have someone andyou've been seeing them yearly.
So, yeah, it's very important.
Like, um, we see people other,um, everyone, even if you don't
have a uterus.
Speaker 1 (15:17):
Yeah, you're still a woman and checking muscle tone,
rectal exams, maybe colorectalcancer screenings which, if you
didn't listen to our uh march of2024 podcast on colorectal
cancer screening, we're seeingit skyrocket and we're starting
to screen a lot younger womenlike 45 or even earlier and you
(15:38):
can't see certain parts of yourskin.
Also, weight and blood pressureand lab results, medication
refills A lot of people, I think, are busy, they don't want to
have to come in and pay a copayand they just want to get their
refills.
A lot of people, I think, arebusy, they don't want to have to
come in and pay a copay andthey just want to get their
refills.
So what's kind of yourguidelines on how you handle
when women call in for askingfor refills for birth control
(16:01):
pills or hormones or othermedications?
Speaker 2 (16:05):
Well, yeah, a lot of the time, like, we understand
that life gets in the waysometimes and things come up.
So a lot of the time we'lloffer like, for example, if
someone needs a refill on theirbirth control or HRT, if they've
been seen very close to about ayear ago, we usually will pen
(16:25):
the temporary refill to thatpatient.
But we do ask that theyschedule an appointment, have
one on the books within aboutthree months, because that's the
longest like a refill will go,especially like a mail order
pharmacy to get that fill in,just to have enough time and
give you adequate time toschedule, and then when you go
to your follow-up appointmentyou'll get the remainder of your
(16:47):
refills.
Speaker 1 (16:49):
Yeah, that's very important, I know I certainly
myself.
As soon as I have thatappointment, whether it's with
the eye doctor or with women'shealth or primary care, I make
the next year's appointment sothat it's within that 365 day
mark, because there's noguarantee that somebody will get
the prescription.
And I just think to beproactive.
(17:12):
I mean it's great that younurses help the patients out,
but I know that if they don'tcome in for appointments then
the prescriptions do getcanceled.
So that's a little bit of acautionary tale, mm-hmm.
So moving on to the women onhormone therapy, my field
patients many times might remarkwell, I'm on the estrogen, the
progesterone, and I love theestrogen, but I don't like how
(17:34):
that progesterone sometimesmakes me feel.
So is it okay, nurse Marissa,if I just stop the progesterone?
Speaker 2 (17:53):
Oh no, absolutely not , Especially if you have a
history of endometriosis or ifyou have a uterus, because we do
not want any changes to thatlining that can lead to we don't
like to say the c-word, but wedon't want anything to lead to
any type of gynecological cancer.
So if you feel like thatprogesterone just is not working
for you and you just need tostop it, you need to stop the
patch or the pill also estrogenpatch or the estrogen pill also
(18:14):
because you want to protect thatuterus.
Speaker 1 (18:17):
Absolutely.
That is such important advice,and I even have nurses and
physicians who you think wouldbe more up on.
Of course health and medicinedo that.
So all patients we treat thesame and we want to have that
high level of care for, andthat's why I think it's good to
bring in all your medicines, notjust say, oh, look in the chart
(18:37):
, because there can be a lot ofchanges about how it's dispensed
from the pharmacy, how thewoman takes it.
And to be very proactive, evenalso with supplements, is
important too.
And you've been listening to theSpeaking of Women's Health
podcast.
I'm your host, the ExecutiveDirector of National Speaking of
Women's Health, and with me isone of our absolute favorite
(18:57):
nurses, nurse Marissa Walker,who is a registered nurse, does
a lot of triage, does nursevisits, helps our entire team
and we're talking about commoncommon questions, our entire
team.
And we're talking about commoncommon questions.
And she says we don't like tohave to say the C word, which is
cancer, but we always have torule that out if there's
problems.
And that gets us to the B word,bleeding, and I know that you
(19:22):
and certainly I handle so manymessages and calls about
bleeding and women will tell uswell.
Well, I just missed my dose, orI was traveling, or my patch
fell off and then I bled.
So that's the reason, right.
But what does that buy them, soto speak, in terms of your
responses?
Speaker 2 (19:41):
oh, a lot of times.
So we can't ever like rule outthat there may be um anything
wrong.
We it can be anywhere from afibroid to a polyp, some changes
in your lining, once again toothick of a lining in the uterus.
So we do want to just rule outany changes that we can nip in
the bud right away that maycause the bleeding.
(20:04):
And also just to piggyback offof that question.
A lot of people will say, well,I had bleeding but it stopped,
so I'm good, I'm good, I canjust stay on my.
I'm like no, no, no, no, no, no.
We still recommend to either umschedule a follow-up exam or
you may have imaging doneanything like called an SIS, a
(20:26):
pelvic ultrasound.
Sis is like a saline-infusedultrasound where we look into
that endometrial cavity and wesee if there are any abnormal
structures in the uterus or inthat lining there and then from
there we'll see what we have todo after that, like if anything
needs to be removed or if it'shealthy for you to continue the
(20:47):
HRT or hormone replacementtherapy.
Speaker 1 (20:50):
Or maybe needs to be dose adjusted for women who
can't even tolerate naturalprogesterone, which is a small
percent of women.
Sometimes we use designerhormones like Duave, but we
can't make hormone changes,especially in a woman over 40,
if there's a possibility ofcancer or infection or
anatomical structural changes,and I know that's annoying to
(21:11):
have to undergo it.
I've certainly undergoneultrasounds and biopsies in the
office and DNCs.
It's just unfortunatelysometimes part of being a woman
and we have to woman up and youknow and deal with it.
And I know that a lot of ourpatients try to kind of beg you,
nice nurses, oh, it's reallyokay, it's really okay and they
(21:33):
just want your reassurance andmost of the time it is okay.
But we just can't do thatbecause we've all seen examples
and we don't want to miss things, regret it down the road.
So I really appreciate younurses being so understanding
and educational, but pleasantand firm, and it's kind of like
(21:54):
kind of how you have to besometimes with your children,
right, yeah, definitely, yes,yes.
So moving on to the pap smearresults, I know a lot of people
are really anxious to get theresults and they don't get them
right away.
It can take a week or two ormore for your pap, and then
sometimes people get the resultsof their blood work or their
(22:16):
pap smear even before theirdoctor or nurse practitioner or
physician assistant even has achance to take a look at it, and
so you get a lot of those,which really kind of slows your
day down and makes extra work.
So do you have any words ofadvice about patients taking a
deep breath and waiting and notjumping on the gun too fast?
Speaker 2 (22:35):
Yes, I always just say there's nothing wrong until
there's something wrong.
So, yes, well, I'm even one ofthose people I'll get my results
back and I'm like what is this?
Oh my, and then you'll have.
And then I'm like like I needto message my office, but it's
saturday night, so you know, Istill have to wait a moment.
Um, I do say stay away from,like dr google, because they are
(22:58):
not always reliable.
Um, and it's it is frustratingto have to wait.
Um, you should get response back.
When you get results,especially especially abnormal
results, back within at leasttwo days.
If it's urgent, you will get acall back very soon, very, very
soon.
(23:18):
If there's something critical,we actually get notified if
there are critical labs.
So in the event that somethingis super critical and an
intervention needs to be doneright away, we would be um
jumping on that, likeimmediately we get a call.
We have to respond within alike a certain amount of hours,
and I mean like single digits,like I think it's like two or
three hours.
So we would definitely get onthat.
(23:40):
Um, otherwise, it can takeabout like a day or two for the
physician or the nursepractitioner to get back to you
with those results.
Speaker 1 (23:50):
Yeah, and a lot of times I know when I get the
messages well, the patient wantsto know what you think about a
lab value that's just slightlyoutside of normal range.
I haven't even looked at it yetbecause I'm seeing a full day
of patients, right, because ifit is a lab critical value
that's life-threatening, thenthe lab calls us and we have to
deal with it right away.
So most of the time, thankfully, it's not that, and sometimes
(24:14):
we just like to wait till wehave all the results back to get
the full picture to say this iswhat you need to do, and most
of the time, if you're getting acomprehensive evaluation, you
should already have a follow-upvisit, either in person or
virtually, to go over thoseresults and not expect that the
health team is going to justdrop everything for just minor
changes that are not emergency.
(24:35):
The flip side of that is,though, I have some women who
are real chill and real relaxed,and they're like I never heard
anything, so I thought it wasfine.
I mean, everybody should alwaysget reports of their PAPs, of
their ultrasounds, of theirblood work, and if you don't
hear back, maybe you're in ahealthcare system that you're
listening, that doesn't haveMyChart and that electronic
(24:57):
documentation and communication.
Maybe you're in a privatepractice or it's a send-out lab
and I do think that as anindividual patient you should
have that responsibility to makesure that the ends are
everything's wrapped up.
So one common abnormalityespecially in women over 50, is
getting a pap smear that showsatypical squamous cells of
(25:20):
unknown significance, so-calledASCUS, and if the HPV, either
direct or reflex, is negative,meaning you don't have the virus
that's associated withpre-cancer or cancer of the
cervix, it's just atypical cellswithout the virus.
I know you get lots ofquestions about I want to get my
pap smear again right away, orwhy do I need to wait a year?
Speaker 2 (25:41):
Yeah, because what people don't know is that those
oscar cells cells they can be adirect like a result of vaginal
dryness, menopausal hormonalchanges, having intercourse,
having any type of likeinfection, like maybe BV, which
(26:02):
can resolve on its own from timeto time.
I'm a yeast infection if you dohave any like STIs or STDs that
can cause some atypical cellsthere.
But a lot of time we don't liketo just keep repeatedly going
in unnecessarily billing you.
We don't like to do things likebe invasive when we do not have
(26:24):
to.
Like the ACOG guidelines do sayit's safe to wait a year,
follow up on a year with those,especially not with the HPV
infection, because the HPVinfection is what generally will
cause that cervical cancer, notthose atypical cells itself,
because atypical can happen fromalmost anything.
Almost a sneeze can give youthe typical cells.
Yes, it's very.
Speaker 1 (26:46):
It's very common.
And for those women that are inthe menopausal range, even if
they're not feeling vaginaldryness or pain with sexual
activity or bladder overactivity, I will always prescribe either
vaginal estrogen or vaginalDHEA for at least two months
straight before you come in forthat repeat pap.
There are some clinicians thatwill say, oh, you can wait three
years.
I think that's too longpersonally, just like I think
(27:09):
five years is a little bit toolong, and you know, people
change jobs, they might move,they have different healthcare
insurance.
I just think it's too long aperiod of time.
But our nurse practitioners arereally good.
They'll get you in within ayear.
But you have to take theresponsibility as the patient
and do that.
Whatever that vaginal treatmentis, and for those women with
common minor vaginal irritationsand conditions like bacterial
(27:31):
vaginosis, bv, yeast infectionswe've had prior podcasts on that
.
You can go onspeakingofwomenshealthcom and
under the search button put BVpodcast or just BV or vaginitis
or vulvar care.
Those are some of our mostsearched read information.
The next question as we'restarting to wrap up is can my
(27:57):
women's health nursepractitioner, physician adjust
my dose of hormones or oralcontraceptives just on their own
, without an appointment?
Speaker 2 (28:03):
Oh no, yeah, you definitely need an appointment
because we have to get furtherevaluation from the nurse,
practitioner and physician.
So if you feel like you need anadjustment that tells us that
something's wrong, likesomething's going wrong or
you're still feeling somesymptoms, we need to dig in
(28:25):
deeper a little bit and seewhat's the cause of those
symptoms.
Like we have to check some labwork, we have to talk to you
know what we need to order, wehave to see what else is going
on.
Um, so it's really important tohave, like, another visit on
the books before we get anyfurther blood work and then
before we adjust any dosages,because you may not need an
adjustment, you just may need achange in therapy altogether,
(28:47):
but we won't know that until yousee the doctor or the NP.
Speaker 1 (28:53):
Yes, and that kind of also goes along with people
wanting new hormone regimens.
I mean, maybe they have a newmedical problem, Maybe their
thyroid hasn't been checked,Maybe their blood pressure is
too high for certain types ofregimens there's so many
different factors that can betaken into effect.
I think the other question thatcomes through a lot is I think
I have an infection it seemslike the one I had before and I
(29:17):
just want a prescription.
I don't want to come in or Idon't want to go to urgent care.
Will you just give me theantibiotics now?
I mean, I know you get thosequestions.
Speaker 2 (29:26):
Oh yeah, that one too , yes, and the reason why we
can't just give an antibioticagain is because, well, it is an
antibiotic and we don't want totreat you with the wrong
treatment when it could besomething else.
Some of these like symptomsthat one may have, like the
itchiness or like the irritation.
(29:49):
It could be an infection ofyeast, it could be an infection
of bacteria.
We wouldn't know until after wetest you.
We want to ensure the propertreatment for your safety.
Have any type of like top, likea tolerance to the antibiotic
(30:12):
or resistance to the antibioticthey use because you're
overusing it, thinking that youhave, like this, recurrent bv?
Speaker 1 (30:16):
um, so, yeah, we always recommend coming for an
appointment that really, that isreally the best advice and what
I tell women who have um,who've been evaluated and and
and know in the past they've hadbv or yeast infections or maybe
bladder infections like aftersexual activity assuming they've
been previously evaluated andthey're a stable patient and
(30:36):
they know they're going to go ona cruise or they're going to be
away, you can ask at the timeof your annual visit whether
you're getting a pap or not,because maybe you need one,
maybe you don't.
That's the time at the annualvisit to say getting a pap or
not, because maybe you need one,maybe you don't.
That's the time at the annualvisit to say can I have a
prescription that I can justhave on hand?
Okay, but when you call in withnew symptoms and new problems,
we're obligated to do a newevaluation.
(30:58):
And so I think that's a littlebit of insight, information and
that might be a way for womenwho truly have already been
evaluated.
But it's not fair for thetriage nurse or the covering
physician or covering nursepractitioner who doesn't have a
relationship with the patient,to be just demanded that they
get a prescription.
And I know that that's anuncomfortable situation that
(31:19):
sometimes that you're involvedin.
And the other issue is whenwomen say I want to get an
appointment right now, but theysay I have to wait three months.
What advice do you have forthose women?
Speaker 2 (31:33):
So if the provider that you prefer to see is
completely booked up or bookedout, we have a team here.
Yeah, we can refer you out tothe other providers on our WHI
team here that can see you andthat can help treat you if you
(31:58):
need anything and evaluate youand assess your symptoms.
Speaker 1 (32:04):
So you're saying that you might not get to see the
person that you want to see, butif you're flexible and it's
urgent, usually you can get anappointment, either in person
there are some providers thathave a little bit of a sooner
availability than others stillbuilding up their patients and
clientele here.
Yes.
Speaker 2 (32:23):
Yeah, and they're completely confident,
knowledgeable and they can treat, they're completely confident,
knowledgeable and they can treatWell.
Speaker 1 (32:30):
Thank you so much, Marissa, and you are such a gem
and I really appreciate youjoining us on this Speaking of
Women's Health podcast, and Iwant to thank our listeners for
tuning in.
We're so grateful for yoursupport and we hope that you'll
support our podcast, Share itwith others, Forward it to your
(32:51):
friends, Leave us a five-starrating.
You can even donate on ourspeakingofwomenshealthcom site
and to catch all the latest fromus, make sure you subscribe.
It's free, Just hit the followbutton.
Anywhere you listen to podcastsApple Podcasts, Spotify tune in
(33:11):
.
That way, you won't miss anyfuture episodes and we'll see
you next time in the SunflowerHouse.
Remember be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am glad to be back in the
Sunflower House for a newepisode.
For a new episode.
(00:28):
Joining me on this new Speakingof Women's Health podcast
episode is one of our favoriteCenter for Specialized Women's
Health nurses, marissa Walker,and, I think, somewhere in the
background, beth, you want topop up?
Beth is my daily nurse thatworks with me with patients.
Where are you hiding Beth?
There she is.
I love these ladies.
They're so great.
So a little bit about Marissa.
(00:50):
She has her bachelor's ofscience in nursing and she is a
registered nurse and she is anurse in the Center for
Specialized Women's Health atCleveland Clinic in our OBGYN
and Women's Health Institute.
Marissa is a mother of two boys.
She's a boy mom, like I am, andher boys are so cute.
(01:12):
You just want to pinch them.
They've had fun meeting mygranddaughters and Marissa and I
kind of share a guilty pleasurewith nails, right?
Oh, yes.
Speaker 2 (01:24):
Yes.
Speaker 1 (01:24):
And sometimes we'll post both of our hands together
on our Speaking of Women'sHealth social media.
If you don't follow us onpodcast or if you don't follow
Speaking of Women's Health onour Facebook or X, formerly
known as Twitter, or Pinterestor LinkedIn, we're also on
YouTube and Rumble channels.
(01:45):
So if you're listening to thispodcast and you want to see
Marissa and her pretty eyelashes, you're a girly girl.
I see Beth sneaking out,probably to get some patients
ready for clinic.
Anyway, welcome, Marissa.
We're so excited to have you asa guest on the Speaking of
Women's Health podcast to talkabout a lot of the common
(02:07):
questions that you field everyday.
You work as a facilitator withDr Batour's virtual shared
medical visits.
You work in triage, so tell usabout some of the work that you
do in our center and some ofyour areas of expertise of the
work that you do in our centerand some of your areas of
expertise.
Speaker 2 (02:28):
Oh yeah, so background, I do have experience
in emergency medicine, laborand delivery, and I've been in
gynecology women's healthmenopause for the last three
years, now Coming up on threeyears.
Speaker 1 (02:48):
You're a very smart cookie and you also have
expertise in helping a lot ofour patients who get bone
infusions and you do nursevisits as well.
Yes, yes, so we're going to goover some of the common
questions that I think you fieldmost every day.
So tell our listeners what'sthe difference between getting a
GYN annual exam and getting apap smear?
Speaker 2 (03:11):
Oh yes, now this question is so common because I
know back like not even aboutmaybe five or six years ago.
We used to get our paps in ourannual exams, like at the same
time every year.
Because medicine is changing,these guidelines are changing,
we have to change things up fromtime to time.
(03:32):
Common misconception is thatyou have to get a pap smear
every year.
They found that you don't haveto get it that often.
A pap smear is a gynecologicaltest that will screen for
cervical cancer and we tend todo it typically every three to
(03:52):
five years.
Now an annual GYN exam that'sgoing to consist of your breast
exam and your pelvic exam andthat will be done annually,
hence the annual yearly everyyear.
So a pap smear is justsomething that may occur in one
of those years, but notnecessarily every year, unless
(04:14):
there is something that needs tobe followed up on.
Speaker 1 (04:17):
And that is such an important point and I find a lot
of my patients think they had apap smear simply because they
saw a woman's health clinicianor a gynecologist and had a
speculum put in the vagina tolook at their vagina and cervix.
It doesn't mean that it wasscraped.
And for our listeners whohaven't heard, the interview I
did with Dr Sharon Sutherland,who is a gynecologist and she's
(04:38):
in charge of our cervical cancerprevention program and the head
of our gynecology ultrasound,which we may talk also about,
since we order lots of pelvicultrasounds that's a good
podcast to go back to listen to.
And the thing that I emphasizeto a lot of my patients and new
patients and I know that ourwhole team, like our
(04:59):
administrative assistant, julieStahl, who's been on our podcast
to talk about how to get anappointment at the Cleveland
Clinic, is she'll send outmessages on MyChart asking
people and women to bring intheir records and bring in their
actual pap smear results andkeep copies so that we have them
Because we can't see, even ifit's an electronic system, of
(05:19):
another system.
Do you want to talk a littlebit about MyChart and how
patients access and interactwith you on MyChart?
Speaker 2 (05:27):
Oh yeah, so from time to time we'll get a phone call
and that will be like throughour admins.
They'll leave us a message andwe'll get back to them, usually
within 24 hours.
And then if there's a questionnon-urgent or non-emergent, um a
medical question our patientswill type in that question in my
(05:47):
chart and we'll answer it now.
Sometimes it does take up toabout three days to get a
response, typically for that,because we have such a like
large patient flow, um but um,we get questions that have to do
with um menopause concerns,like symptoms that one may be
(06:08):
having, or questions about theirmedication, about refills,
trouble getting their medicationfrom a pharmacy, like pretty
much anything.
It's like a large range ofquestions that we get.
Speaker 1 (06:24):
Yeah, you get a whole wide variety and I know that
the other day, uh, when leadnurse Alexandra was there, she
was like there's not not anyonein triage right now and
everybody's box is overflowingand there's hundreds and
hundreds of questions, and soour nurses just really work so
hard and that's one reason whyI'm so grateful that we're able
(06:46):
to put out so much great contenton Speaking of Women's Health,
to empower women to be strong,be healthy and be in charge,
because a lot of these answers.
I bet people could go on ourspeakingofwomenshealthcom
website and just type in and getsome simple answers that they
need, as opposed to overlyrelying on the nurses.
And certainly for emergencysituations, people need to call
(07:10):
911 or go to the emergency roomfor heavy bleeding, you know,
chest pain, those kind of things.
I think it's very important forpeople to understand how to
utilize electronic securecommunications with their
healthcare team, how to utilizeelectronic secure communications
with their healthcare team, andI do believe that the clinic
has instituted sometimes chargesfor MyCharts.
(07:32):
Is that right?
Speaker 2 (07:35):
That is correct.
So if there is a MyChartmessage that requires more time
from the physician or from theadvanced practitioner, then
generally they will charge acertain amount to the patient's
insurance.
To answer that question,because it just kind of counts,
it'll be like equivocal, to likea telephone visit or a virtual
(07:59):
visit almost depending on howsensitive the question is.
Speaker 1 (08:02):
Yeah, yes, yes, and so that's why I think this
podcast is so important to goover a lot of questions that
maybe people can get answeredahead of time and not have to,
you know, go online and wait,you know, a few days to get an
answer.
So this other common questionis my doctor states that my pap
smear was normal, but on mychart it says yes for HPV reflex
(08:24):
.
What does HPV reflex mean,nurse Marissa, yes, Okay.
Speaker 2 (08:29):
So HPV is a STI or STD that we test for.
Generally when we do a PAP it'sautomatic for everyone after
the age of 30, as of right now.
So reflex just means in theevent that something is abnormal
, we will go and test for thisitem.
(08:50):
So when you get that messagethat says hey, yeah, your pap
smear was normal follow-up inthe year, you're fine to go.
It does and you see the reflex,yes, hpv.
It's just meaning that in theevent that you would have had an
abnormal pap smear, they wouldhave saw some atypical cells,
(09:10):
some cell irritation on thecervix or some low-grade cells
on the cervix, anything of thatnature.
They'll go ahead and test tosee is HPV the culprit of that?
We'll test for it, but itdoesn't necessarily mean that
you have it to indicate whetheryou have HPV.
Your actualV test you'll seewhere it will say detected or
not detected.
You will go by that.
Speaker 1 (09:32):
Excellent that is so excellent.
And most all women do getexposed to HPV, even if they
only have one sexual partner,and most people clear the
infection.
So 80% of women have beenexposed by age 50.
But sometimes if your immunesystem is bad, it can come back
out.
There's other causes,especially in midlife women, of
abnormal PAPs.
Particularly if they're low inhormones.
(09:53):
The cells can look abnormal.
So it's very important to getthis periodically checked and
I'm a big proponent and I know alot of our APPs.
Like we've had nursepractitioner Dana Leslie on in
the past and I think hopefullywe'll have her on in season
three again.
And we've had other nursepractitioners who are excellent,
(10:15):
like Kelsey Kennedy and BabsAlex Babushkak as well, to talk
about their advanced practice,nursing practice, and we usually
try to do a pap every threeyears, like I was just in to see
Dana myself, because five yearsis a long time, and so I think
(10:36):
if women have gone definitelymore than three years before
they've had the scrape and theHPV that they should talk to
their women's health team about,well, maybe I should get
another one, because maybe theywon't come back within that
five-year mark and we really donot want to miss cervical cancer
for sure.
So let's move on to the upperpart of the bikini area, the
(10:58):
breast area, and a lot of womenI'm sure that you talk to all
the time are having breast painand they wonder if they need a
mammogram.
And so talk a little bit abouthow you handle that from a
nursing perspective.
Speaker 2 (11:11):
So I think it's just like a common misconception as
soon as you have any type ofbreast pain you need to
automatically get a mammogramLike Cleveland Clinic, we have a
very impressive breast center.
Like Cleveland Clinic, we have avery impressive breast center.
So when someone is having painin like these locations, we have
(11:36):
these specialized centers forlike almost every body part here
.
So we do have a specializedbreast center which we do like
from time to time network withand trade notes with.
So in the event that you havebreast pain, we wouldn't
automatically give an ultrasoundor a mammogram and I didn't
want patients to think that it'sneglectful on our part not to
give you a mammogram because youhave breast pain right, because
it could be due to anything andwe want you to get that
(11:58):
thoroughly checked out.
So in general, we wouldgenerally refer you over to the
breast center to get furtherfollow-up.
Like, yes, a GYN can look atbreast and pelvic, but if you
want someone that specializes init to get a more detailed
examination and like diagnosisand referral to what you need,
(12:21):
it would be recommended to go tobreast center.
So generally we'll start withthat.
Speaker 1 (12:30):
And one thing of course it can be from hormonal
fluctuations.
I've seen a lot of women sincewe've been checking omega-3s and
seeing a lot of people aregetting too much of the
inflammatory omega-6 fats andnot enough of the omega-3s that
a lot of women are just takingfish oil and we've got podcasts
on nutrition and diet andomega-3s and I've seen women
develop breast cyst and breastpain from too much omega-3s,
even though a lot of peopledon't have enough and just
(12:51):
hormonal fluctuations wearing agood support bra, and so that
doesn't necessarily mean cancer.
But we have new legalrequirements in Ohio law in
terms of reporting out onmammograms and so I'm sure
you're going to if you're notalready getting lots of
questions from women.
(13:11):
It's getting much more detailedabout whether their breasts are
dense or not, whether they haveincreased risk for breast
cancer, whether they should havemore imaging, and there's a lot
of women who kind of fall inthis gray zone and I'm sure
that's going to generate a lotof confusion and questions and I
really like to direct to ourpatients to our
(13:33):
speakingwomenshealthcom sitebecause we have a lot of
proactive information aboutbreast health, reducing breast
cancer risk and who are thosehigh-risk people who do maybe
need more imaging, likeultrasound or MRI, or maybe even
need to see cancer genetics,and we do have a large
population in our center ofwomen that have genetic
(13:55):
mutations that do make them athigher risk for breast and
ovarian cancer.
So let's move on to anotherreally common question I know
you get asked all the time is ifI've had a hysterectomy and I
don't have a uterus or cervix,do I even need to come in for a
annual GYN exam?
Speaker 2 (14:14):
Oh, yes, that's very common too, yes.
So the answer, short answer,would be yes, you do, because
the annual exam does consist ofboth breast and pelvic and
vaginal exams.
So I do tell my patients justlike flat out, like uncandid,
like, even though you don't havea uterus, you still have a
vagina.
So be like that.
(14:36):
And a vulva, yes, and a vulva,and you're still prone to get
any of these items, you canstill get any type of infection,
like you still engage inintercourse and you may have
some problems problems likegynecological issues and you
want to be established with aprovider and see them every year
so that you can be up to dateon your exam, so we know what's
(14:57):
going on and then when you havea question or a problem does
arise, we're not likescavengering and looking around
for someone to see you rightaway.
When you have someone andyou've been seeing them yearly.
So, yeah, it's very important.
Like, um, we see people other,um, everyone, even if you don't
have a uterus.
Speaker 1 (15:17):
Yeah, you're still a woman and checking muscle tone,
rectal exams, maybe colorectalcancer screenings which, if you
didn't listen to our uh march of2024 podcast on colorectal
cancer screening, we're seeingit skyrocket and we're starting
to screen a lot younger womenlike 45 or even earlier and you
(15:38):
can't see certain parts of yourskin.
Also, weight and blood pressureand lab results, medication
refills A lot of people, I think, are busy, they don't want to
have to come in and pay a copayand they just want to get their
refills.
A lot of people, I think, arebusy, they don't want to have to
come in and pay a copay andthey just want to get their
refills.
So what's kind of yourguidelines on how you handle
when women call in for askingfor refills for birth control
(16:01):
pills or hormones or othermedications?
Speaker 2 (16:05):
Well, yeah, a lot of the time, like, we understand
that life gets in the waysometimes and things come up.
So a lot of the time we'lloffer like, for example, if
someone needs a refill on theirbirth control or HRT, if they've
been seen very close to about ayear ago, we usually will pen
(16:25):
the temporary refill to thatpatient.
But we do ask that theyschedule an appointment, have
one on the books within aboutthree months, because that's the
longest like a refill will go,especially like a mail order
pharmacy to get that fill in,just to have enough time and
give you adequate time toschedule, and then when you go
to your follow-up appointmentyou'll get the remainder of your
(16:47):
refills.
Speaker 1 (16:49):
Yeah, that's very important, I know I certainly
myself.
As soon as I have thatappointment, whether it's with
the eye doctor or with women'shealth or primary care, I make
the next year's appointment sothat it's within that 365 day
mark, because there's noguarantee that somebody will get
the prescription.
And I just think to beproactive.
(17:12):
I mean it's great that younurses help the patients out,
but I know that if they don'tcome in for appointments then
the prescriptions do getcanceled.
So that's a little bit of acautionary tale, mm-hmm.
So moving on to the women onhormone therapy, my field
patients many times might remarkwell, I'm on the estrogen, the
progesterone, and I love theestrogen, but I don't like how
(17:34):
that progesterone sometimesmakes me feel.
So is it okay, nurse Marissa,if I just stop the progesterone?
Speaker 2 (17:53):
Oh no, absolutely not , Especially if you have a
history of endometriosis or ifyou have a uterus, because we do
not want any changes to thatlining that can lead to we don't
like to say the c-word, but wedon't want anything to lead to
any type of gynecological cancer.
So if you feel like thatprogesterone just is not working
for you and you just need tostop it, you need to stop the
patch or the pill also estrogenpatch or the estrogen pill also
(18:14):
because you want to protect thatuterus.
Speaker 1 (18:17):
Absolutely.
That is such important advice,and I even have nurses and
physicians who you think wouldbe more up on.
Of course health and medicinedo that.
So all patients we treat thesame and we want to have that
high level of care for, andthat's why I think it's good to
bring in all your medicines, notjust say, oh, look in the chart
(18:37):
, because there can be a lot ofchanges about how it's dispensed
from the pharmacy, how thewoman takes it.
And to be very proactive, evenalso with supplements, is
important too.
And you've been listening to theSpeaking of Women's Health
podcast.
I'm your host, the ExecutiveDirector of National Speaking of
Women's Health, and with me isone of our absolute favorite
(18:57):
nurses, nurse Marissa Walker,who is a registered nurse, does
a lot of triage, does nursevisits, helps our entire team
and we're talking about commoncommon questions, our entire
team.
And we're talking about commoncommon questions.
And she says we don't like tohave to say the C word, which is
cancer, but we always have torule that out if there's
problems.
And that gets us to the B word,bleeding, and I know that you
(19:22):
and certainly I handle so manymessages and calls about
bleeding and women will tell uswell.
Well, I just missed my dose, orI was traveling, or my patch
fell off and then I bled.
So that's the reason, right.
But what does that buy them, soto speak, in terms of your
responses?
Speaker 2 (19:41):
oh, a lot of times.
So we can't ever like rule outthat there may be um anything
wrong.
We it can be anywhere from afibroid to a polyp, some changes
in your lining, once again toothick of a lining in the uterus.
So we do want to just rule outany changes that we can nip in
the bud right away that maycause the bleeding.
(20:04):
And also just to piggyback offof that question.
A lot of people will say, well,I had bleeding but it stopped,
so I'm good, I'm good, I canjust stay on my.
I'm like no, no, no, no, no, no.
We still recommend to either umschedule a follow-up exam or
you may have imaging doneanything like called an SIS, a
(20:26):
pelvic ultrasound.
Sis is like a saline-infusedultrasound where we look into
that endometrial cavity and wesee if there are any abnormal
structures in the uterus or inthat lining there and then from
there we'll see what we have todo after that, like if anything
needs to be removed or if it'shealthy for you to continue the
(20:47):
HRT or hormone replacementtherapy.
Speaker 1 (20:50):
Or maybe needs to be dose adjusted for women who
can't even tolerate naturalprogesterone, which is a small
percent of women.
Sometimes we use designerhormones like Duave, but we
can't make hormone changes,especially in a woman over 40,
if there's a possibility ofcancer or infection or
anatomical structural changes,and I know that's annoying to
(21:11):
have to undergo it.
I've certainly undergoneultrasounds and biopsies in the
office and DNCs.
It's just unfortunatelysometimes part of being a woman
and we have to woman up and youknow and deal with it.
And I know that a lot of ourpatients try to kind of beg you,
nice nurses, oh, it's reallyokay, it's really okay and they
(21:33):
just want your reassurance andmost of the time it is okay.
But we just can't do thatbecause we've all seen examples
and we don't want to miss things, regret it down the road.
So I really appreciate younurses being so understanding
and educational, but pleasantand firm, and it's kind of like
(21:54):
kind of how you have to besometimes with your children,
right, yeah, definitely, yes,yes.
So moving on to the pap smearresults, I know a lot of people
are really anxious to get theresults and they don't get them
right away.
It can take a week or two ormore for your pap, and then
sometimes people get the resultsof their blood work or their
(22:16):
pap smear even before theirdoctor or nurse practitioner or
physician assistant even has achance to take a look at it, and
so you get a lot of those,which really kind of slows your
day down and makes extra work.
So do you have any words ofadvice about patients taking a
deep breath and waiting and notjumping on the gun too fast?
Speaker 2 (22:35):
Yes, I always just say there's nothing wrong until
there's something wrong.
So, yes, well, I'm even one ofthose people I'll get my results
back and I'm like what is this?
Oh my, and then you'll have.
And then I'm like like I needto message my office, but it's
saturday night, so you know, Istill have to wait a moment.
Um, I do say stay away from,like dr google, because they are
(22:58):
not always reliable.
Um, and it's it is frustratingto have to wait.
Um, you should get response back.
When you get results,especially especially abnormal
results, back within at leasttwo days.
If it's urgent, you will get acall back very soon, very, very
soon.
(23:18):
If there's something critical,we actually get notified if
there are critical labs.
So in the event that somethingis super critical and an
intervention needs to be doneright away, we would be um
jumping on that, likeimmediately we get a call.
We have to respond within alike a certain amount of hours,
and I mean like single digits,like I think it's like two or
three hours.
So we would definitely get onthat.
(23:40):
Um, otherwise, it can takeabout like a day or two for the
physician or the nursepractitioner to get back to you
with those results.
Speaker 1 (23:50):
Yeah, and a lot of times I know when I get the
messages well, the patient wantsto know what you think about a
lab value that's just slightlyoutside of normal range.
I haven't even looked at it yetbecause I'm seeing a full day
of patients, right, because ifit is a lab critical value
that's life-threatening, thenthe lab calls us and we have to
deal with it right away.
So most of the time, thankfully, it's not that, and sometimes
(24:14):
we just like to wait till wehave all the results back to get
the full picture to say this iswhat you need to do, and most
of the time, if you're getting acomprehensive evaluation, you
should already have a follow-upvisit, either in person or
virtually, to go over thoseresults and not expect that the
health team is going to justdrop everything for just minor
changes that are not emergency.
(24:35):
The flip side of that is,though, I have some women who
are real chill and real relaxed,and they're like I never heard
anything, so I thought it wasfine.
I mean, everybody should alwaysget reports of their PAPs, of
their ultrasounds, of theirblood work, and if you don't
hear back, maybe you're in ahealthcare system that you're
listening, that doesn't haveMyChart and that electronic
(24:57):
documentation and communication.
Maybe you're in a privatepractice or it's a send-out lab
and I do think that as anindividual patient you should
have that responsibility to makesure that the ends are
everything's wrapped up.
So one common abnormalityespecially in women over 50, is
getting a pap smear that showsatypical squamous cells of
(25:20):
unknown significance, so-calledASCUS, and if the HPV, either
direct or reflex, is negative,meaning you don't have the virus
that's associated withpre-cancer or cancer of the
cervix, it's just atypical cellswithout the virus.
I know you get lots ofquestions about I want to get my
pap smear again right away, orwhy do I need to wait a year?
Speaker 2 (25:41):
Yeah, because what people don't know is that those
oscar cells cells they can be adirect like a result of vaginal
dryness, menopausal hormonalchanges, having intercourse,
having any type of likeinfection, like maybe BV, which
(26:02):
can resolve on its own from timeto time.
I'm a yeast infection if you dohave any like STIs or STDs that
can cause some atypical cellsthere.
But a lot of time we don't liketo just keep repeatedly going
in unnecessarily billing you.
We don't like to do things likebe invasive when we do not have
(26:24):
to.
Like the ACOG guidelines do sayit's safe to wait a year,
follow up on a year with those,especially not with the HPV
infection, because the HPVinfection is what generally will
cause that cervical cancer, notthose atypical cells itself,
because atypical can happen fromalmost anything.
Almost a sneeze can give youthe typical cells.
Yes, it's very.
Speaker 1 (26:46):
It's very common.
And for those women that are inthe menopausal range, even if
they're not feeling vaginaldryness or pain with sexual
activity or bladder overactivity, I will always prescribe either
vaginal estrogen or vaginalDHEA for at least two months
straight before you come in forthat repeat pap.
There are some clinicians thatwill say, oh, you can wait three
years.
I think that's too longpersonally, just like I think
(27:09):
five years is a little bit toolong, and you know, people
change jobs, they might move,they have different healthcare
insurance.
I just think it's too long aperiod of time.
But our nurse practitioners arereally good.
They'll get you in within ayear.
But you have to take theresponsibility as the patient
and do that.
Whatever that vaginal treatmentis, and for those women with
common minor vaginal irritationsand conditions like bacterial
(27:31):
vaginosis, bv, yeast infectionswe've had prior podcasts on that
.
You can go onspeakingofwomenshealthcom and
under the search button put BVpodcast or just BV or vaginitis
or vulvar care.
Those are some of our mostsearched read information.
The next question as we'restarting to wrap up is can my
(27:57):
women's health nursepractitioner, physician adjust
my dose of hormones or oralcontraceptives just on their own
, without an appointment?
Speaker 2 (28:03):
Oh no, yeah, you definitely need an appointment
because we have to get furtherevaluation from the nurse,
practitioner and physician.
So if you feel like you need anadjustment that tells us that
something's wrong, likesomething's going wrong or
you're still feeling somesymptoms, we need to dig in
(28:25):
deeper a little bit and seewhat's the cause of those
symptoms.
Like we have to check some labwork, we have to talk to you
know what we need to order, wehave to see what else is going
on.
Um, so it's really important tohave, like, another visit on
the books before we get anyfurther blood work and then
before we adjust any dosages,because you may not need an
adjustment, you just may need achange in therapy altogether,
(28:47):
but we won't know that until yousee the doctor or the NP.
Speaker 1 (28:53):
Yes, and that kind of also goes along with people
wanting new hormone regimens.
I mean, maybe they have a newmedical problem, Maybe their
thyroid hasn't been checked,Maybe their blood pressure is
too high for certain types ofregimens there's so many
different factors that can betaken into effect.
I think the other question thatcomes through a lot is I think
I have an infection it seemslike the one I had before and I
(29:17):
just want a prescription.
I don't want to come in or Idon't want to go to urgent care.
Will you just give me theantibiotics now?
I mean, I know you get thosequestions.
Speaker 2 (29:26):
Oh yeah, that one too , yes, and the reason why we
can't just give an antibioticagain is because, well, it is an
antibiotic and we don't want totreat you with the wrong
treatment when it could besomething else.
Some of these like symptomsthat one may have, like the
itchiness or like the irritation.
(29:49):
It could be an infection ofyeast, it could be an infection
of bacteria.
We wouldn't know until after wetest you.
We want to ensure the propertreatment for your safety.
Have any type of like top, likea tolerance to the antibiotic
(30:12):
or resistance to the antibioticthey use because you're
overusing it, thinking that youhave, like this, recurrent bv?
Speaker 1 (30:16):
um, so, yeah, we always recommend coming for an
appointment that really, that isreally the best advice and what
I tell women who have um,who've been evaluated and and
and know in the past they've hadbv or yeast infections or maybe
bladder infections like aftersexual activity assuming they've
been previously evaluated andthey're a stable patient and
(30:36):
they know they're going to go ona cruise or they're going to be
away, you can ask at the timeof your annual visit whether
you're getting a pap or not,because maybe you need one,
maybe you don't.
That's the time at the annualvisit to say getting a pap or
not, because maybe you need one,maybe you don't.
That's the time at the annualvisit to say can I have a
prescription that I can justhave on hand?
Okay, but when you call in withnew symptoms and new problems,
we're obligated to do a newevaluation.
(30:58):
And so I think that's a littlebit of insight, information and
that might be a way for womenwho truly have already been
evaluated.
But it's not fair for thetriage nurse or the covering
physician or covering nursepractitioner who doesn't have a
relationship with the patient,to be just demanded that they
get a prescription.
And I know that that's anuncomfortable situation that
(31:19):
sometimes that you're involvedin.
And the other issue is whenwomen say I want to get an
appointment right now, but theysay I have to wait three months.
What advice do you have forthose women?
Speaker 2 (31:33):
So if the provider that you prefer to see is
completely booked up or bookedout, we have a team here.
Yeah, we can refer you out tothe other providers on our WHI
team here that can see you andthat can help treat you if you
(31:58):
need anything and evaluate youand assess your symptoms.
Speaker 1 (32:04):
So you're saying that you might not get to see the
person that you want to see, butif you're flexible and it's
urgent, usually you can get anappointment, either in person
there are some providers thathave a little bit of a sooner
availability than others stillbuilding up their patients and
clientele here.
Yes.
Speaker 2 (32:23):
Yeah, and they're completely confident,
knowledgeable and they can treat, they're completely confident,
knowledgeable and they can treatWell.
Speaker 1 (32:30):
Thank you so much, Marissa, and you are such a gem
and I really appreciate youjoining us on this Speaking of
Women's Health podcast, and Iwant to thank our listeners for
tuning in.
We're so grateful for yoursupport and we hope that you'll
support our podcast, Share itwith others, Forward it to your
(32:51):
friends, Leave us a five-starrating.
You can even donate on ourspeakingofwomenshealthcom site
and to catch all the latest fromus, make sure you subscribe.
It's free, Just hit the followbutton.
Anywhere you listen to podcastsApple Podcasts, Spotify tune in
(33:11):
.
That way, you won't miss anyfuture episodes and we'll see
you next time in the SunflowerHouse.
Remember be strong, be healthyand be in charge.
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