Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
From Conception to Menopause: Dr. Matthew Bialko Unpacks Women's Health
From Olympic-adjacent swimmer to dedicated OB-GYN, Dr. Matthew Bialko brings a wealth of expertise to women's healthcare with the same discipline that once propelled him through competitive waters. "Swimming taught me organization and focus that translates perfectly to medicine," Dr. Bialko reveals, reflecting on his journey from New Jersey pools to Georgetown University and ultimately to St. Luke's Medical Group.
Dr. Bialko's practice embodies the comprehensive nature of obstetrics and gynecology—equal parts delivering babies and addressing women's health concerns across all life stages. "What attracted me to this field was the ability to care from life to almost end of life," he explains, highlighting the unique continuity of care that defines his specialty.
Our conversation spans the entire spectrum of female health, beginning with preventative screenings. Pap smears starting at age 21 and HPV vaccinations (developed at Dr. Bialko's alma mater Georgetown) form the foundation of cancer prevention. We explore the complex world of menstrual health, where normal cycles range from 25-35 days but variations can signal anything from normal hormonal fluctuations to medical conditions requiring attention.
The discussion traverses contraceptive options beyond traditional birth control pills—injections, implants, patches, rings, and IUDs—each offering unique benefits beyond pregnancy prevention. For those planning families, Dr. Bialko emphasizes preparation through prenatal vitamins, cycle tracking, and addressing health concerns like obesity that can complicate conception and pregnancy.
The cesarean section conversation reveals the balance between necessary interventions and avoiding unnecessary surgeries, while our examination of postpartum mental health underscores the importance of support systems during the "fourth trimester." Dr. Bialko offers practical advice for friends and family supporting new mothers: "You can start by saying 'how can I help you?' because that's a way of just opening the communication."
As women approach menopause, symptoms ranging from hot flashes to more subtle changes like fatigue and brain fog can begin years before periods actually cease. Throughout these transitions, Dr. Bialko advocates for open communication with healthcare providers while respecting patient autonomy: "A little bit of skepticism is healthy. In medicine, our skepticism is what leads to profound breakthroughs."
Whether you're navigating adolescent health concerns, family planning decisions, pregnancy challenges, postpartum adjustments, or menopausal transitions, this episode offers valuable insights for understanding your body's journey through each phase of womanhood. Connect with a qualified OB-GYN to address your specific health needs and questions.
Hello, this is Jason Edwards and this is Doc Discussions. I'm here today with Dr Matthew Bialko. Matt, how you doing.
Speaker 2:Doing pretty well today.
Speaker 1:And you're an OB-GYN, correct?
Speaker 2:Yes, ob-gyn Been practicing with St Luke's for about four years now. Can't believe my anniversary is coming up in two weeks. Yeah, I'm telling you, time has been flying by. I've been loving my work here.
Speaker 1:You know, the first time I saw you, my wife, was working at. Slu at the time and it was during their awards ceremony for their residents and I remember you took home a couple of awards there I was fortunate enough to take home a little bit of them.
Speaker 2:a few sacks, yeah for sure.
Speaker 1:And so yeah, so we were excited to have you on staff here, and that's been good. Now, matt, let's start from the beginning. Where are you from and where'd you go to school at so originally?
Speaker 2:from New Jersey.
Speaker 1:The Garden State the.
Speaker 2:Garden State, grew up about 12 miles outside of Manhattan. I haven't lived in Jersey for a long period of time so you may not be able to hear the accent, but when I say talk and coffee and dog it does come out. But so I was born and raised in northern New Jersey, kind of about 12 miles outside of Manhattan. I am a twin. Myself, have an older sister, family still all in New Jersey Then did my undergraduate work at Georgetown. Did my graduate work at the.
Speaker 1:University of.
Speaker 2:Michigan, went to medical school through St George's University, did my training with SLU and SSM here in St Louis, so I definitely have been around, had a lot to experience, thankfully, Very good.
Speaker 1:Now you in college. I hear tell that you are a swimmer at Georgetown, right, yes, Yep and. Georgetown's, I'm sure, division one double A or not?
Speaker 2:Yeah, and, and there, when we were last at the final four, go Hoyas. Really so, so you, so they had a really good team there, oh yeah, yeah, and you know, thankfully, I mean, it was one of the things started swimming, oh Lord, aging myself around when I was six or seven years old. And then, you know, it was one of those things just kind of starting on the summer league and then family and friends were like you know, you got, you have a lot of talent, you guys should start doing year round swimming.
Speaker 1:And then, yeah, and then, thankfully, was able to swim through four years in college and you know it was fantastic.
Speaker 2:I mean it was. It really was a brotherhood and camaraderie and you know now whether I would want those early morning sessions and training sessions now. I don't know, but it was a fantastic experience.
Speaker 1:And I mean most of the swimmers I know were like pretty chill guys. Um, I don't know if it it it lends itself to that or I'll just all the hours in the pool, but you know, I think it really has to do with that.
Speaker 2:You know it's one of those things that you're so committed and it keeps you very organized and focused and diligent, both in your um, in your sports world, but also in your academic world as well. But then so, as a matter of socially, that's where you really get to relax and enjoy and that's when you should really be able to kind of find that time to relax. You know you're too serious everywhere else. So you know, when it comes to being a swimmer, being around swimmers, being around friends and family, you know just that's the time to relax and enjoy.
Speaker 1:That's crazy, crazy.
Speaker 2:so so were you like the state champion out of new jersey before you went to school. I did so it's kind of hard to say the state because it's all dependent on, so we have all different events and all things like that. I did compete. I placed top three state championships and nationally we did win first place, second place third place, so you know it was it was so, yeah, so you're.
Speaker 1:You came from a program that was very solid yes, thankfully, yeah, thankfully.
Speaker 2:You know it was one of those things. You know I knew it would never be kind of like something that would get me all the way to the olympics or anything like that, but you know it was something that kept me disciplined and you know I was successful enough that it got me through college and something that I can look back on fondly. And when I decided to get back in the pool and training, you know I could do that as well.
Speaker 1:So who?
Speaker 2:was the gold medalist that you competed against. So one, it was Cullen Jones actually. So we actually swam gold medalists on the relay team with Michael Phelps Swam. He was out of Newark, new Jersey, so we swam against each other when we were younger. Again, needless to say, I lost, but you know, it was one of those things, it's kind of a lot fun little facts about me, just kind of, and it's fun to talk with patients about that and trivia nights, you know well, that's a big deal.
Speaker 1:I mean, you know that hours and hours and hours of discipline and of course there's fun parts of it but there's also, you know, not you know getting in the pool.
Speaker 2:You know 5 am and know working on, but that's a.
Speaker 1:That's an amazing experience, matt.
Speaker 2:It really was and it's funny even, uh, friends and family, especially friends that I meet now, they're like you know, swimmers were always the most fun to be around, whether it was high school parties, college parties, and then, ironically enough, it transitioned into my life as an OBGYN resident.
Speaker 2:They're like the OBGYN residents just know how to have fun. I'm like cause, you know, it's the same kind of thing. It's that work-life balance. We're working so hard, so diligently, that when it comes time to relax and enjoy, we really, we really maybe take it to the extremes.
Speaker 1:Yeah, that's, that's good though. Um, and so describe your practice to me. Is it a general OBGYN practice?
Speaker 2:So it is, yes, a generalist OBGYN practice as part of St Luke's Medical Group. It does involve myself, as well as two medical doctor colleagues as well as two nurse practitioners. So we are technically a generalist OBGYN group. We can deal with some high-risk obstetric as well as some higher-risk GYN. But you know, for the most part, we kind of take care of our generalist population and then if for any reason needs to be seeing anybody, such as your wife, maternal fetal medicine specialist, we can send them out.
Speaker 1:Very good, very good, and so is your practice more obstetrics or more gynecology?
Speaker 2:You know, at this point I would say it's about 50-50, which is always really kind of a goal, as you're kind of building your practice. Initially you start seeing more GYN, but then, as you become busier, start seeing some more patients. It kind of builds towards that kind of that 50-50 split, which is a lot of fun. That's really the best part of being a generalist OBGYN.
Speaker 1:What attracted me to the field was that ability to kind of care from life to almost end of life, really kind of get that continuity. Yeah, I agree, I think having a lot of variability through your day is a really good thing, especially for your career, you know, to see a lot of different things, yeah, no, and ironically enough, I had no intention of going into obstetrics and gynecology.
Speaker 2:when I started in medical school I was thinking, you know, definitely something hands on, more procedural. But then, as kind of went through medical school, went through rotations, I was thinking you know, definitely something hands-on, more procedural. But then as I kind of went through medical school, went through rotations, I realized this is kind of everything all mixed into one. You have deliveries, you have surgery, you have emergency care, you have continuity of care, outpatient. So it was kind of everything all wrapped into one. It was like not coming from a family with any medical doctors or nurses, I didn't know what to expect. So I just kind of knew medicine based on what TV was like.
Speaker 1:Yeah, the training's difficult and it can be a difficult field to be in, but I would think it would be highly rewarding to have long-term relationships with patients. You can tailor your practice and change your practice over time.
Speaker 2:Yeah, and that's actually kind of what a lot of OBGYNs kind of tend to do. They kind of do that 50-50 split. As you kind of work a little bit closer to retirement, sometimes you may kind of pull back on the obstetrics. It is long hours, unpredictable hours, but it is certainly rewarding. I know we kind of say in the field if you get to the point in your practice where you're delivering babies babies that you delivered you've made a full circle.
Speaker 1:Yeah, for sure. And so let's kind of start from the bottom. You know when, with your younger patients, one of the first things is screenings. And so what's? What's the deal with pap smears and HPV screenings?
Speaker 2:Sure, absolutely so routinely we do start pap smear screening or any pelvic examinations at 21. That is the recommendation per CDC as well as ACOG to start pap smear screening or any pelvic examinations at 21. That is the recommendation per CDC as well as ACOG to start pap smear screening looking for abnormal cells on the cervix at 21, unless there are particular risk factors, specifically things like untreated HIV, chronic immunosuppressed conditions that we would want to tailor sooner than that With pap smears.
Speaker 2:then routinely every three to five years, depending on age, starting after 30, we do look at the presence of HPV on pap smear as well, because we know it is something that can affect cervical health long term. In terms of actually doing like other examinations for younger patients, those that are under 21, routinely, unless there's a problem, we just kind of talk through things.
Speaker 2:That just kind of had like having a conversation with the patient, letting them know that we're there to support them in whatever decisions they make in terms of their medical care or whatever needs they may have based on the problems that they're having.
Speaker 1:Very good, and so one of the things that kind of came out when I was in medical school was the HPV vaccine, and so we're talking about HPV, human papillomavirus. It's a virus that infects cells, and most of the time our bodies clear it, but sometimes it can cause cancer, and so they came out with a vaccine with the idea of trying to prevent cervical cancer. When do they usually give the HPV vaccine in young girls?
Speaker 2:Sure, so I do have to interject a little bit here. I do have to give a little shout out to Georgetown University where I did my undergraduate. I graduated there in 2009. And actually that is where the first HPV vaccination was created and distributed through the Lombardi Cancer Center. So very cool.
Speaker 2:With regards to HPV vaccination, it has evolved a bit since its initial iteration back in 2006. Vaccination it has evolved a bit since its initial iteration back in 2006. But currently recommendations are for any individuals male, female starting at nine years old all the way up until 27 years old. It does, depending on the timing that you get it. Those that are under 14 routinely get it as a two vaccination series Between 14 and 27,. It's a three-step series and then more recently they've actually come out with recommendations that in select patient populations between 27 and 45, you can consider and talk about HPV vaccination. There was initially a thought that you needed to have the vaccination before potential exposure to the virus, but we've actually found through studies over the past almost 20 years that even if you've had prior exposure, we know the vaccination can be helpful for preventative measures past that timeframe.
Speaker 1:Very good and so, and the reason we use it in boys is they can get anal canal cancer, penile cancer, which is very rare, and then head and neck cancers, all from the HPV virus. And so now, what about abnormal menstrual cycles? And so you know there's, there's, you know, typically like one cycle a month, but but it doesn't always go like that.
Speaker 2:Yeah. So and it's kind of weird because abnormal bleeding is kind of a very large, broad category for a gynecologist to manage. We consider a normal menstrual cycle anywhere from 25 to 35 days, which for a lot of patients is kind of surprising, like oh, it's kind of that broad and then having like an actual like bleed anywhere from three to seven days is considered normal, and that does really kind of fit the majority of our patients once they're educated on what is a normal cycle. Now, if you're having irregular bleeding going more than those 35 days without bleeds or having bleeding less than that, it depends in terms of the evaluation or trying to figure out what may be causing that. We kind of separate that into different age groups.
Speaker 2:Some of it is just kind of what we call an HPO access naivety, where the body's getting used to experiencing hormones that the brain is stimulating the ovaries and the uterus to have a cycle. Similarly, patients that are getting closer to menopause same kind of thing. So those that are starting and those that are ending their cycles. Other things can be bleeding disorders in patients. Pregnancy actually is one that can lead to irregular bleeding that you can have even being pregnant, sure. Other anatomical things, things like fibroids, polyps these are very common conditions for patients that are diagnosed either clinically or surgically with endometriosis can have irregular bleeding. Patients that have had prior uterine surgery, c-sections, those have been pregnant before, things like adenomyosis. That have had prior uterine surgery, c-sections, those that have been pregnant before things like adenomyosis these are all concerns that we can have in terms of the irregular bleeding, abnormal bleeding, and we always try and do a workup. We can start with lab work and an ultrasound, pretty less invasive all the way up to surgical intervention.
Speaker 1:Yeah, wow. So that's a lot more than I kind of anticipated and so you kind of have a really wide range of things, some of them very benign and normal and some of them more concerning, but it sounds like if you're having abnormal uterine bleeding or something that seems abnormal, you should probably get in touch with your OB-GYN and especially you know I always tell patients this and of course you know this but post-menopausal it's never normal to have uterine bleeding.
Speaker 1:Never normal, that's almost always the presenting symptoms for patients with uterine cancers that start in the uterine lining. And so let's kind of go down the road. So your patients were kind of going from young to old, and so what about like contraceptive contraception and then family planning? Sure.
Speaker 2:So in terms of contraception, I mean it's one of those things and I kind of even put the broader kind of scope over to just calling it hormone control, because ultimately that's what it is and we're using it now.
Speaker 2:Historically we've used it mostly just for contraceptive purposes, family planning, but we do know it can help with things like abnormal uterine bleeding, it can help with mood regulation, but in terms of the contraceptive efficacy or the family planning aspects, thankfully, over the past I think it's been about 75 years since the first oral contraceptive pill came out and since then we've obviously had a major transition in terms of using pills, combined pills, estrogen and progesterone, progesterone-only pills. We now have injections, implants, patches, rings, intrauterine devices. So it's a broad range of what is available there for contraceptive purposes, and a lot of that is dependent on what the patient's goals are. Some patients like the idea of taking a pill every day, the regularity of it and having a period every month to ensure that they aren't pregnant. Others like the idea of just taking something, maybe once every three months, like a shot. Others like the idea of an intrauterine device where they may not have periods and that's a blessing for them as well and know that they have that contraceptive benefit as well.
Speaker 1:Yeah, so a lot of options there, and so if you have thoughts or preferences, you guys sound like you're able to meet them with multiple different modalities.
Speaker 2:Yeah, we definitely encourage patients, even if they're not having problems and that's kind of going back to what we were talking about previously is our younger patients, our adolescent patients. If they're interested in just wanting to be on a contraceptive because they're starting to become sexually active, we encourage them to come in, even if we're not doing an exam, to just talk about the different options and it's kind of eye-opening for a lot of patients what is available out there, Because a lot of times they'll go based on what they've heard of either their mothers, their sisters, their friends, what they've used before. But the one thing with contraceptive is it's not a one-size-fits-all.
Speaker 1:So you know, listening to you talk about this A, you clearly know a lot about each subject matter. It kind of underscores a big part of medicine, and that is it's always a lot more complex than you think it is, and so it's better to get in talk to a professional, especially somebody who's nice and easy to talk to, like yourself, and get some good information. We live in a high information era, but it's still when I have patients who look things up using an AI or a search engine, it's still very difficult to actually hone in on their specific situation. You really got to know the right questions to ask, and it can be difficult and a lot of things are gray areas and are nuanced as well. Yes, so if somebody's trying to get pregnant, what are some things they can do to kind of prepare their body for that?
Speaker 2:Sure. Well, the first thing is come off your contraceptive, but no, routinely. One of the big things that we encourage patients are obviously trying to manage any prior health conditions you have Now.
Speaker 2:ideally, we're always hoping for the perfectly healthy Couple, but we know that's not reality. We know that things have changed in the past, however many years, that each patient comes into pregnancy differently. But one of the things we do encourage is keeping track of your menstrual cycles. Are they regular? Are they not regular? Keeping kind of a lot of things out there. We have apps on your phone, we have the aura ring. We used to do basal body temperatures, but that seems to be a thing of the past. Starting on a prenatal vitamin I talk to a lot of patients when they come in. Like you know, I'm thinking about getting pregnant. I'm like get started on a prenatal vitamin because ultimately and that should be at minimum three months before you're even thinking about getting pregnant to build up the things that your body will need to support a pregnancy.
Speaker 1:What about obesity? I mean, that's been a big deal over the past few decades and the rate's gone up a little bit. Is that a pretty big hurdle for patients? It?
Speaker 2:tends to be. It's one of those things that a lot of patients that are obese tend to have irregular cycles. They tend to have anovulatory cycles where they're not actually releasing an egg during their cycles, and you know, that's kind of the kind of the main point of getting pregnant is releasing the egg and that. So that has become a problem in terms of, one, getting pregnant and then two, health during pregnancy, cause we know obesity can lead to problems with the pregnancy, problems with delivering preeclampsia and the whole bit right now preeclampsia, pre-gestational diabetes, diabetes in pregnancy yeah, so these are, these are more, and then it makes delivery itself more difficult, whether it's vaginal or cesarean section, and so that's another thing.
Speaker 2:We do talk to patients, you know, if we're really committed to wanting to become pregnant, then we do say you know, we do encourage you to try and focus on your overall health, focus on diet, physical activity, just to help improve your weight. Or even if you're not necessarily seeing significant weight losses, that you're transitioning from more body fat to more muscle, lean body type.
Speaker 1:And you're going to need that strength and stamina to deal with those kids. And so it's better to deal with it on the front end. Are they using the ozempic-like drugs in these patients to prepare them for pregnancy, or what's going on?
Speaker 2:there. So we're still kind of in the part. We haven't really been using our ozempic-like drugs as part of like an obstetric gynecology management for obesity. Now there are OBGYNs in the field throughout the country that are starting to prescribe treatments for patients, but really just more so for weight loss at this point not necessarily weight loss with goals for pregnancy, but we are seeing those benefits. Even patients that are on these medications through their primary care doctors, their internal medicine physicians, their weight loss providers we're seeing that as they're losing the weight, they're feeling better, their numbers are improving, their cycles become more regular. So we are seeing the significant benefit of these medications from an obstetric and a gynecologic standpoint. Very good.
Speaker 1:Very good. And then you know one of the things that you see out there is people talk about population decline and I know this is like a little bit outside of your realm, but I'm going to push you a little bit, and so are we are. Is that palpable? Are we seeing that at all in the clinic? Or what are your or what are your thoughts?
Speaker 2:So you know, I mean it's obviously it's not family planning of 100 years ago, where you start having kids at 15 and you have 10 of them by the time you're 35. And so things have changed, you know. We do know fertility rates have declined, whether that's as a result of just epigenetics changing as a result of our environment. We do know that there was a significant decline during the pandemic. That was just a natural response to what we were dealing with. But numbers have started to go back up.
Speaker 2:I think part of it is one that it's more expensive to raise a family now. It is more difficult. I think it's also the autonomy of our patients. Women are more focused now on wanting to earn degrees, become successful physicians, businesswomen, teachers, and they're delaying their child bearing as a result of that, for no other reason. They still want to become mothers, they still want that ability to become pregnant and grow a family. But we also do know that there is a natural decline in fertility with aging. So I think there's a lot of factors in play there that are influencing kind of the numbers of our births just nationwide. We know that numbers are going down because of a number of factors.
Speaker 1:Yeah, yeah, I mean like even working from home. I mean, if you work from home, it's like you may be less likely to get pregnant. You know, I mean you need to be around people. But yeah, there's a lot of reasons for that, that for sure. And and obesity, you know, was an issue during the pandemic too and so you know there's a lot of things and kind of hard to nail down one thing.
Speaker 2:Yeah, we do like we said, we do know that the like chronic illness now hypertension, diabetes, obesity um, we do know these are all issues that can make pregnancy more difficult. Um costs of fertility treatments are also hindering for a lot of patients. Yeah, you know a lot of um yeah, that's not cheap.
Speaker 1:No, it is not psychologically it's a very difficult thing to go through yeah, um, and so so you have a patient who's pregnant. Um, one of the big things has always been the C-section rate, and so you know, depending on your institution, maybe what 20% to 30%, and or I'm probably off on these numbers, but but the idea is to try to get that rate down to have a higher percentage of vaginal deliveries. What's the story with?
Speaker 2:that. So historically, c-section was a scary thing. It's one of those things and ultimately, looking now, we actually just had our OBGYN department meeting about this and nationwide the goal is less than 25% cesarean sections.
Speaker 2:And we do know, because cesarean sections are basically their major abdominal surgery. They're not without the risk, but they're not without the reward, Because ultimately we talk to our patients about our goal for you is a healthy mom and healthy baby at the end of this. Now, the reason why we are trying to avoid C-section is because, again, it is a major abdominal surgery and in a lot of cases it does lead to repeat cesarean section.
Speaker 2:So, ultimately, our goal is to try and keep you healthy throughout the pregnancy, so that a vaginal delivery is our end goal Now there are a number of reasons why we have to proceed with cesarean section. I won't get into all of those now but it's one of those things we try to avoid as much as we can because, again, we do know chronic illnesses, obesity, you know those are things that can hinder your ability to heal appropriately, to then care for the newborn.
Speaker 1:Is the baby ever in a worse position because of a C-section or a vaginal delivery? Or is that kind of a wash it's?
Speaker 2:kind of a. It really depends, um, and it depends on the indications for the c-section really, or the vaginal delivery. We do know ultimately where our goal is vaginal delivery, but it's all.
Speaker 2:But we do know that's not without its risks as well, depending on, again, the specific clinical scenario for a patient yeah, yeah, somebody has a small kind of inner pelvis, or whatever the term is and it's you know, it's just not happening yeah, and it and it's ironic I was actually reading last week there was a interesting article out that talked about that the female pelvis is actually shrinking compared to what it was maybe 40, 50 years ago.
Speaker 1:Yeah.
Speaker 2:Just as a result of the fact that we are more mobile, that we're getting that as a species, we're getting taller, that the pelvis is working because we're walking more, that we're needing to utilize it for other things than just childbirth.
Speaker 1:Do you think there's a selection pressure and that you've done C-sections in the past and, and you know, maybe these people wouldn't be able to reproduce, and so now you have more.
Speaker 2:you know who knows right and the other part is, I mean, uh, I mean being in St Louis. Thankfully, we have a lot of providers. We really want to pursue the best outcomes for patients, but we do have a lot of our patient population is from more rural areas where the idea of potentially doing a vaginal birth after a C-section and that C-section may have just been for a breach they didn't labor or anything like that, but we know that was the safest route.
Speaker 2:They just don't feel comfortable with it and ultimately they then have subsequent cesarean sections after that. So again, it also is not necessarily just patient and physician, but it's also location and where you have access to resources.
Speaker 1:You bet, you bet, and so I cheated a little bit on this next question. I asked my wife what are some good questions I can ask you? And she said what's?
Speaker 2:the deal, she better not have gone too hard.
Speaker 1:She said vitamin K for babies. Everybody is refusing it these days. What's the story on that?
Speaker 2:You know it is hard because, obviously, as providers, we greatly encourage it. A baby's natural vitamin K or ability to clot, doesn't really start on its own for seven to 10 days after delivery. So you know there is a risk for bleeding, and especially if you've had a traumatic delivery whether it was a vacuum assisted delivery or a laceration or something from a traumatic C-section you know we want to help the patient, the baby's ability to clot, I think again that access to information that we were talking about earlier. You know you kind of go down a rabbit hole via either social media or on Dr Google, and you see that there may be additives in these injections that are worrisome, that can be harmful for the baby, and you know I mean, as physicians, we're not looking at everything that's in each of these different kind of vitamin K injections, which, ultimately, really is just vitamin K. So I think there's that fear of vaccination, which is, again, that's something for a different talk, and I think maybe that is what the concern is.
Speaker 2:I don't necessarily think it's the vitamin K itself. I think it's more the concern with it's another shot, it's another vaccination. One thing that it comes down to, though, is an OB, If you have a baby boy, you want a circumcision. If they don't get their vitamin K shot, they're not getting a circumcision, because that is a procedure that increases the risk of bleeding and we don't want to put the baby through that. Yeah, yeah for sure.
Speaker 1:And, and I mean I would assume the vitamin K shots been around for decades and I can't imagine a lot has changed over time. Um, you know I'm going to, I'm going to kind of zoom out and you don't even have to make a comment on this. But you know there's some studies are out showing there's excess mortality after COVID and you know people could say, well, it's from the vaccine or it's from this or that. You know I'm willing to kind of hazard a bet that some of that's from not listening to your doctors.
Speaker 1:And not that doctors know everything and not that doctors are going to be right 100 percent of the time, but odds are your doctor is right and the guy on the podcast is, you know, probably statistically less right than your doctor. Now I'm not saying believe everybody. I'm not saying don't be skeptical, but it's something that's been done forever and hasn't changed at all. And we've done, millions of people have done something. It doesn't mean you can't ask questions and that's totally fine, it's a smart thing to do. But everything is more complicated than you think. Ob-gyn is more complicated than I think it is. And so you know, with stuff like this, and especially you know with your physicians, just have a conversation, don't worry about looking silly or whatever. I just you know. I think some of that number is due to skepticism, which may be well earned and maybe well, not you know I'm not going to get into that, but but just have the talk with a professional.
Speaker 2:Yeah, and I, you know, I think just medicine in general is a lot. There's been a big change, even just over the past 30 years, to more autonomy for the patient. It's not necessarily just paternalistic of this is the best for you, this is what you're going to do. I'm giving this to you. You need to do it. There's been more conversation that have been more autonomy for the patient to say you know, why am I doing this or what are my options. And you know, a little bit of skepticism is healthy. You know, in medicine, our skepticism is what leads to profound breakthroughs. You bet Science is skepticism.
Speaker 1:The opposite of skepticism is being naive. You don't want that, but it exists on a spectrum and you don't want to be too far on one side or the other, and so, yeah, it's good to question things, as part of informed consent is knowing what you're doing and what's going on. But just, the life is probabilistic and the likelihood that you're going to come to the right conclusion is higher if you're talking to somebody who's done something a thousand times. Um, but anyway, that that's, that's my rant. So, um, I'm not saying we're all going to be right all the time but, that's your, but that's your best shot at getting it right.
Speaker 1:Um so, when we're talking, what are some? So postpartum, you know, one of the things that people deal with is postpartum depression, and is it? I mean, I would imagine the hormones play a huge part of that, and then also, it's just, especially if it's your first child, it's just dramatic life change. What's your take on postpartum depression? Sure.
Speaker 2:And you know I mean postpartum depression is something it kind of goes on a spectrum. You have everything from the blues which we do expect as a result of your hormonal fluctuations, your hormonal shifts, your new responsibilities, all the way to a severe postpartum depression or postpartum psychosis. And we do risk stratify patients during their pregnancy. So we're very proactive about it during the pregnancy to kind of look at what are your current resources that you have around you?
Speaker 2:Do you have a good support system? Because ultimately we do consider that four to six-week postpartum period as kind of what we call the fourth trimester. It still requires care by providers to be actively involved in kind of that next stage and a lot of it.
Speaker 2:You know it's difficult because I had a patient age just kind of talking through things that after being pregnant it kind of brought her back to some of her losses, you know, and she was like I had time to reflect on that. You know to be thankful for what I have. But we do know depression or kind of frustrations are real and it is understandable. The good thing is there's ways to help with that. I always say utilize the resources around you, utilize your family, utilize your providers. We can talk, they have. We have therapists out there. There are treatment modalities, whether that's complimentary, using supplements or medical treatment, and that doesn't necessarily mean it's something that we need to continue long-term, but just something to make sure that we're keeping you in a healthy frame of mind to care for yourself importantly and your newborn.
Speaker 1:You know one of the things that I think would be good for people to know, and I don't know if you have an answer to this or not but what are some things like friends or like parents could do for somebody who just had a child? And then, because I think part of the problem too is you're expected to be elated all the time and you're walking around with these crazy hormone fluctuations and you've slept two hours and like life's and and and you know, throw in financial stress or something you know other things in life on top of that, and it can be, even though it's supposed to be the happiest moment in your life.
Speaker 1:it could be really tough and it can be hard to admit that.
Speaker 2:Yeah, I think the first thing goes with don't compare yourself to anybody else, because what your experience was with your labor and your delivery and your postpartum period is something that can be very different from your sister, your daughter, your friend. That's one of those things that you have to consider. So everyone is different. So don't project what your experience was onto somebody else, because we know everyone's experience is a little bit different.
Speaker 1:Yeah.
Speaker 2:You can start by saying how can I help you?
Speaker 2:Because I think that's a way of just opening the communication. Sometimes patients are just like you know, I just need an hour to sleep, yeah, yeah. Other patients will say I don't know what I need, so you can say you know, well, maybe let me just give you 30 minutes so you can go take a shower or let me go get you some food. Because these are the things that, as you're caring for a newborn and the worries of changing diapers, washing, caring for yourself, you know you kind of lose track of the everyday kind of responsibilities that can start to harp on you or just even say you know, can I do a little laundry for you, because it's incredible, after seeing so many babies, how quickly they can go through their onesies in a couple of days.
Speaker 1:So even just something like that, just saying can I do the laundry for you, yeah, or can I, can I take you for a ride somewhere, just kind of getting out of that monotony of I'm home, the baby's eating, sleeping crying, pooping, you know, just kind of getting out of that for a day or two can be really nice, yeah, and I think that the there's no shame in reaching out and saying, hey, I'm having a tough time and and and you know, a lot of us have a tough time asking for help but it's.
Speaker 1:It's not a personality issue, it's not a behavioral issue. You've got all kinds of crazy physiological things going on in your body and there's help out there for you. Sometimes it's very minimal help, if that's all that's needed, and sometimes it can be very intensive.
Speaker 2:And actually I mean I even talk to the patients. They come and see me for their postpartum visits, whether it's within a week or six weeks. You know I always talk to the patient initially. I do encourage their partner to come, their partner, their spouse to come with them, because I also then ask them how do you think they're doing?
Speaker 2:Because how the patient might perceive how things are going could be very different from an outsider perspective of saying you know, and I have a lot of patients, like you know, they're very kind of, independent, very type A personalities and you know, again goes back to the idea of asking for help is not something they're used to. But this is a very different scenario. You're mentally, physically, physiologically going through something that your body, yes, it's meant to go through, but it doesn't mean that it's not without its struggles.
Speaker 1:Yeah, I think one of the worst and you kind of touched on this one of the worst things patients can do or people can do is to say, oh well, hey, I went through it too and it's like, yeah, but it still was difficult for you. Like we can kind of sympathize with people as they're going through these kind of troughs of life and most problems in life. You know, it's kind of pull yourself up by your bootstraps, gut it out. I don't think mental health's like that.
Speaker 2:That's just been my observation of you know, like thousands of patients going through cancer care.
Speaker 1:And so what about pelvic health? And so you've had the baby and you know maybe you're right afterwards or a few years afterwards, but you can. You have these pelvic muscles that sometimes can be stronger and sometimes weaker. What's the deal with that?
Speaker 2:So with that I mean, thankfully, there has been a much larger focus and attention on pelvic health, even just in the past couple of years, awareness of what it's used for.
Speaker 2:We use it for strengthening after delivery. We use it for strengthening if there's concerns for urinary challenges, pelvic pain. You know we have a lot of reasons why we use pelvic floor therapies to help patients. A lot of my patients will actually now come in and ask specifically while they're pregnant, can I start doing some pelvic floor therapy to help strengthen floor labor for the postpartum course? Because we do know that having a baby, whether it's C-section or vaginally, can increase your risk for pelvic floor weakness and prolapse.
Speaker 2:So we do encourage that as soon, as you're feeling comfortable going to see a pelvic floor therapist, just like if you had surgery on your shoulder or on your knee or on your hip or on your back. You need physical therapy. The pelvis is just that. It's taking on the brunt of your weight throughout the day, throughout your life, and the weight of gravity, so it does take a little bit of time. And then through nine months, it carries a baby and then you have a delivery. So we do encourage our patients.
Speaker 2:It's a good opportunity to kind of restrengthen those muscles, learn. We have the infamous Kegel exercises but nine times out of ten a patient's doing the Kegels wrong and then you're actually backtracking and not helping to improve your overall pelvic health. So we definitely encourage seeing a pelvic floor therapist for assessment or, thankfully for the internet, there are videos out there through YouTube, through other avenues that can actually kind of talk you through, teach you through different exercises, cause again, in the postpartum period, time is not, time is not your friends. So even just something at home that you can do to start learning how to kind of help your body along for longer term health is wonderful.
Speaker 1:That's great that there's. I mean, to me, I think it's probably worthwhile to go see an expert for an hour, just one time at least, but it is great knowing that there's things out there on YouTube and there are medical professionals. I actually used Epley maneuvers to get rid of my tinnitus or tinnitus however you want to say it and it and it worked, and so that I got from. I think it was like a physical therapist from University of Colorado is what I used, but anyway, okay, and so now we're kind of at the end of the line as far as what do? As far as like perimenopausal or postmenopausal. What are the main issues people are dealing with there?
Speaker 2:Sure. So it's one of those things I mean we do know menopause is a natural state of life. When that occurs we can never guarantee. We know average age menopause 51 in the United States. The majority of women will go through that menopausal transition between 48 and 54. But again, studies have shown symptoms can arise all the way from 10 years prior to your body actually going through those changes, all the way to 10 years after you actually go through having your last cycle. The biggest things historically have been your hot flushes, your night sweats, your mood swings, vaginal dryness, change in libido. But we're learning more now that patients are coming in and saying I'm feeling more fatigue, I'm feeling more brain fog or inability to focus, I'm noticing more joint pain, and these are kind of things that it's hard because we do have our testing, we look at your hormone levels and you know.
Speaker 2:We say you know, your hormones look good but that doesn't necessarily mean that they can't be fluctuating more regularly. I have patients that come in and say well, I'm still having regular cycles, but I'm having the hot flushes and the loss of libido. And I always tell patients our bodies are made imperfectly, our timelines are made imperfectly Because, as your body is also transitioning through this physiologic change, you're also at a different stage in your life. When you're in your 40s and 50s, life stressors change. You're caring for children, you're caring for parents. There's a lot of effect on that. It kind of goes back to that mood thing that we were talking about, not necessarily just mood changes after delivery, but throughout your life and out there. We know there are multitudes of treatment that could help with that depending on what your goals are.
Speaker 2:Some patients just want menstrual regulation until they get through their menopausal transition. Others are like well, my periods are fine, but these hot flushes are keeping me awake, I can't sleep anymore and as a result, it's affecting my everyday life. So we kind of talk through and again encourage you to come talk to your provider about what are your symptoms. We can start with simple blood work. We can talk through different treatment options if interested. Some patients just accept this is kind.
Speaker 2:This is kind of how life is and I just want to kind of see how things go and they go through there. But just knowing that there's options out there, that there are treatment regimens, hormonal, non-hormonal supplements that can be helpful for you, just depending on, again, what are your most common symptoms or what are your goals short and long term.
Speaker 1:Very good, matt, I appreciate your expertise, short and long term. Very good, matt, I appreciate your expertise. You're a wealth of knowledge no-transcript.