Latest / Clearly Hormonal / Ep 16: Prevention is Power with Dr. Lindsay Ogle

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Ep 16: Prevention is Power with Dr. Lindsay Ogle · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health.
• 0:18
  Dr. Komal Patil-Sisodia: And recharge the conversations you are having with your healthcare providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your healthcare provider at your next visit.
• 0:39
  Dr. Komal Patil-Sisodia: Hi everyone.
• 0:40
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge on today's episode.
• 0:43
  Dr. Komal Patil-Sisodia: I'm really excited to have Dr.
• 0:45
  Dr. Komal Patil-Sisodia: Lindsay Ogle with me.
• 0:46
  Dr. Komal Patil-Sisodia: Dr.
• 0:47
  Dr. Komal Patil-Sisodia: Ogle is a family medicine and obesity medicine board certified physician, and she is currently practicing in Kansas city in the state of Missouri and has her own clinic called Missouri metabolic health.
• 0:59
  Dr. Komal Patil-Sisodia: She trained in Indiana and Colorado.
• 1:02
  Dr. Komal Patil-Sisodia: She also has a background in addiction medicine, which she feels very passionate about.
• 1:08
  Dr. Komal Patil-Sisodia: So welcome Dr.
• 1:08
  Dr. Komal Patil-Sisodia: Ogle.
• 1:09
  Dr. Komal Patil-Sisodia: Thank you so much for joining me today.
• 1:11
  Dr. Lindsay Ogle: Yeah, thank you so much for having me.
• 1:12
  Dr. Lindsay Ogle: I'm really excited to be here.
• 1:14
  Dr. Komal Patil-Sisodia: It's my honor to have you here.
• 1:15
  Dr. Komal Patil-Sisodia: And, we got a chance to connect prior to this episode and it was really nice to hear about your journey towards your current practice and how you went about developing that.
• 1:25
  Dr. Komal Patil-Sisodia: I'd love for you to just to take a few minutes to maybe highlight what your areas of interest are and how, in your words, how you got into developing your own clinic for metabolic health.
• 1:36
  Dr. Lindsay Ogle: Yeah, thank you.
• 1:37
  Dr. Lindsay Ogle: I think it is important to talk about, the path to getting here because it really does shape my approach to helping my patients and I really went into medicine just in general because I enjoyed science and I wanted to help people and thought that was a perfect, marriage of those two and I chose family medicine because I really like to outpatient care and establishing long term relationships with my patients and I really want to emphasize preventative health and Helping people achieve and maintain their health long term so they can live the lives that they want to and live longer lives and so I went into primary care and During my residency training in colorado our program was really amazing and that it gave us a lot of elective time and that's when I Worked with an obesity medicine physician and she really introduced me to this field pretty early on in my training Which I feel very fortunate about and so I worked with her and just saw how her patients were so happy and their care and they were really seeing improvements in their health and able to reduce their medications and just have a better quality life.
• 2:51
  Dr. Lindsay Ogle: So pretty quickly, I realized I wanted to have a focus of that in my career.
• 2:56
  Dr. Lindsay Ogle: After residency, I did primary care full time for two years.
• 3:00
  Dr. Lindsay Ogle: And during that period.
• 3:02
  Dr. Lindsay Ogle: I did my own studying in obesity medicine, went to the conference, sat for the boards, got that certification as well.
• 3:09
  Dr. Lindsay Ogle: And I knew I was going to be temporarily in California out here.
• 3:14
  Dr. Lindsay Ogle: So I knew that there would be an opportunity to work on or explore telehealth more.
• 3:19
  Dr. Lindsay Ogle: Also during this time I was contracted with QuickMD where I was really seeing patients for opioid use disorders.
• 3:26
  Dr. Lindsay Ogle: So I had that experience or exposure to telehealth and could see how it could really help touch patients who otherwise were not able to receive care, whether they had difficulty with transportation or lived in rural areas where they are limited in the amount of physicians that are in their area.
• 3:43
  Dr. Lindsay Ogle: And so I really combined my primary care preventative approach with the training that I had in obesity medicine and then the telehealth experience with QuickMD and created my current practice, Missouri Metabolic Health, where I help patients.
• 3:58
  Dr. Lindsay Ogle: Treat and prevent metabolic conditions through weight management, lifestyle optimization, and utilization of some of our highly safe and effective medications.
• 4:08
  Dr. Komal Patil-Sisodia: That's really wonderful to hear.
• 4:10
  Dr. Komal Patil-Sisodia: And it's so interesting how you can start off on one path and then just meet a mentor who changes your life, right?
• 4:16
  Dr. Lindsay Ogle: Yes, absolutely.
• 4:17
  Dr. Komal Patil-Sisodia: That's a great story.
• 4:18
  Dr. Komal Patil-Sisodia: And your patients are very lucky to have you.
• 4:20
  Dr. Komal Patil-Sisodia: And I'm excited to dive into our topic today around women's health screenings, because as we were talking about in our earlier conversations.
• 4:28
  Dr. Komal Patil-Sisodia: It is very hard for women to make time for themselves to actually go and see their doctors.
• 4:35
  Dr. Komal Patil-Sisodia: I know I was joking with you that, I didn't make it to a doctor after I had my son until he was like five years old.
• 4:40
  Dr. Komal Patil-Sisodia: So that's a long time to go between visits.
• 4:43
  Dr. Komal Patil-Sisodia: In your words and your opinion, why are routine health screenings and wellness visits so important for women?
• 4:48
  Dr. Komal Patil-Sisodia: I'd love to hear that from the perspective of primary care.
• 4:52
  Dr. Lindsay Ogle: Yeah, so although modern medicine has made so many advances, and we are getting better all the time at treating diseases, it's not perfect.
• 5:01
  Dr. Lindsay Ogle: And so whenever possible, we want to prevent conditions rather than treat them.
• 5:07
  Dr. Lindsay Ogle: And so that is where preventative screenings can be so powerful.
• 5:12
  Dr. Lindsay Ogle: And for something to be recommended to be screened for, it has to meet certain criteria.
• 5:18
  Dr. Lindsay Ogle: So it has to be fairly common in that population.
• 5:21
  Dr. Lindsay Ogle: and we have to have a treatment for it.
• 5:24
  Dr. Lindsay Ogle: So we're only going to screen for things that we expect, like I said, a certain amount of people to have in that population and we have something to do about it.
• 5:34
  Dr. Lindsay Ogle: We're going to be able to treat it and the earlier we identify it and treat it the better outcomes that our patients have.
• 5:42
  Dr. Lindsay Ogle: And so that's really our whole goal with preventative screenings in general.
• 5:47
  Dr. Komal Patil-Sisodia: That is a great explanation, right?
• 5:48
  Dr. Komal Patil-Sisodia: I think a lot of us just think I'm feeling well, so why do I need to go?
• 5:53
  Dr. Komal Patil-Sisodia: But that is a really great way of breaking it down, that these are conditions that are common, that we have to be screening for because they have a very long term impact on overall health and quality of life.
• 6:04
  Dr. Komal Patil-Sisodia: How do you break up the screenings, right?
• 6:06
  Dr. Komal Patil-Sisodia: What are the recommended screenings that women should have at?
• 6:09
  Dr. Komal Patil-Sisodia: There are different stages of life.
• 6:11
  Dr. Komal Patil-Sisodia: Say when you're 20 versus 30 versus 40 versus 50.
• 6:14
  Dr. Komal Patil-Sisodia: How do you, how, what can women expect when they go in to see their primary care doctor in terms of recommendations?
• 6:22
  Dr. Lindsay Ogle: Yeah, absolutely.
• 6:23
  Dr. Lindsay Ogle: Before I go through that, you mentioned something I think is really important to highlight about screenings is that by definition, you're not having any symptoms yet.
• 6:32
  Dr. Lindsay Ogle: So if you're already having symptoms, that's not a screen, that's a diagnostic test and we may even do a different type of test.
• 6:40
  Dr. Lindsay Ogle: Really how you said, you're not experiencing any symptoms, you're feeling well, that's when we want a screen for your, for this condition.
• 6:47
  Dr. Lindsay Ogle: here at these conditions.
• 6:48
  Dr. Komal Patil-Sisodia: That's, that makes perfect sense, right?
• 6:50
  Dr. Komal Patil-Sisodia: And as a specialist, I always see people coming into my office with symptoms, right?
• 6:55
  Dr. Komal Patil-Sisodia: So that concept of screening is not necessarily there in my office.
• 6:59
  Dr. Komal Patil-Sisodia: I'm really always trying to work things up.
• 7:01
  Dr. Komal Patil-Sisodia: So that's a lovely way of breaking it down.
• 7:03
  Dr. Komal Patil-Sisodia: And I think that would make sense to most of our listeners as well.
• 7:06
  Dr. Lindsay Ogle: Yeah.
• 7:07
  Dr. Lindsay Ogle: Yeah.
• 7:07
  Dr. Lindsay Ogle: And then as far as, all of the screenings that are recommended for women.
• 7:11
  Dr. Lindsay Ogle: There are quite a bit and it can seem overwhelming and but I do think it's helpful for us to go through and even, as a primary care doctor doing this for many years, I often have like a checklist that I have for all of my patients to make sure that I don't miss anything that they need to be screened for.
• 7:32
  Dr. Lindsay Ogle: So we'll go through that together.
• 7:34
  Dr. Lindsay Ogle: And feel free to stop me for any clarifying questions or anything else along the way.
• 7:39
  Dr. Lindsay Ogle: But I'll start in the twos and definitely recommend for women to establish with a primary care doctor.
• 7:45
  Dr. Lindsay Ogle: In their early 20s, so they have somebody to go to and the main one during Main screening during your 20s is your pap smear.
• 7:53
  Dr. Lindsay Ogle: And so current recommendation is for that to start at age 21 And there is some evidence that may be able to be pushed back to 20, but that is not solidified yet So right now I'm age 21 And if pap smears are looking normal, it's about every three years in your twenties.
• 8:09
  Dr. Lindsay Ogle: And then we've also changed the way that we test once you hit 30 and it can be, again, if it's normal every five years, but sometimes if there's slight abnormalities, it may be more frequent than that.
• 8:20
  Dr. Komal Patil-Sisodia: Okay.
• 8:20
  Dr. Komal Patil-Sisodia: And you mean by if the result on the pap smear comes back normal, there's never any atypical findings.
• 8:26
  Dr. Komal Patil-Sisodia: That's when you can go to every five years later.
• 8:28
  Dr. Lindsay Ogle: Correct.
• 8:29
  Dr. Lindsay Ogle: Yeah.
• 8:29
  Dr. Lindsay Ogle: Once you hit your thirties.
• 8:31
  Dr. Lindsay Ogle: Awesome.
• 8:31
  Dr. Lindsay Ogle: Yeah.
• 8:32
  Dr. Lindsay Ogle: And pap smears screening for pap smears go up to age 65.
• 8:37
  Dr. Lindsay Ogle: As long as the last couple were normal, then you could stop at that time.
• 8:41
  Dr. Komal Patil-Sisodia: Okay.
• 8:41
  Dr. Komal Patil-Sisodia: Is there a recommendation for why you can stop there?
• 8:43
  Dr. Komal Patil-Sisodia: Is it, does the risk markedly decrease at that point?
• 8:47
  Dr. Lindsay Ogle: Yeah.
• 8:47
  Dr. Lindsay Ogle: So we know the main cause of cervical cancer is HPV, human papillomavirus.
• 8:54
  Dr. Lindsay Ogle: And fortunately, we do have a vaccine for that, that we are hopefully giving pediatric population around age 11 give or take a couple of years.
• 9:04
  Dr. Lindsay Ogle: And so that's helping to prevent cervical cancers in their lives.
• 9:08
  Dr. Lindsay Ogle: But not all of us, women now have had that vaccine but if with screening for with pap smears, a screening for cervical cancer that's what we added on to the testing at age 30.
• 9:22
  Dr. Lindsay Ogle: And so we know if somebody has those high risk strains of HPV and if they do not, and they're We call it cytology, but what the pathologist sees under the microscope, if that's normal and HPV has been negative, it is very unlikely that somebody is going to develop an abnormality or cervical cancer after age 65.
• 9:47
  Dr. Lindsay Ogle: And these things take a while to develop, so if it's not developed at that age, it's not likely to happen.
• 9:53
  Dr. Komal Patil-Sisodia: That's a great explanation.
• 9:54
  Dr. Komal Patil-Sisodia: That makes perfect sense, right?
• 9:56
  Dr. Komal Patil-Sisodia: One of the questions that I often get.
• 9:58
  Dr. Komal Patil-Sisodia: From my patients as well.
• 9:59
  Dr. Komal Patil-Sisodia: Why do I have to stop screening?
• 10:01
  Dr. Komal Patil-Sisodia: That can be a scary concept for patients, especially as they're getting older.
• 10:04
  Dr. Komal Patil-Sisodia: So thank you for explaining that so nicely.
• 10:07
  Dr. Lindsay Ogle: Yeah, I hear that a lot, too, for various testings or screenings, and this may be getting into the weeds a little bit too much, but with any test that we order, there's a possibility of false positives, too, so we always are thinking about that, and we want to make sure we're not putting you through additional testing that may not benefit you, and so we don't see those benefits after these certain cutoffs that we'll go through.
• 10:29
  Dr. Komal Patil-Sisodia: Okay.
• 10:30
  Dr. Komal Patil-Sisodia: That is great.
• 10:30
  Dr. Komal Patil-Sisodia: And I'm sure our listeners appreciate that, that reassurance.
• 10:34
  Dr. Komal Patil-Sisodia: So what's next on your list then, right?
• 10:36
  Dr. Komal Patil-Sisodia: So twenties is mostly pap smears.
• 10:38
  Dr. Komal Patil-Sisodia: So when women are hitting their thirties, what are other things that we're considering at that point?
• 10:43
  Dr. Lindsay Ogle: Yeah.
• 10:44
  Dr. Lindsay Ogle: So in the thirties that's when we start to think a little bit more.
• 10:49
  Dr. Lindsay Ogle: critically about do we need to screen for certain metabolic conditions like diabetes or cholesterol abnormalities so you may start doing that blood work at that time especially if you have a family history
• 11:02
  Dr. Komal Patil-Sisodia: yeah
• 11:02
  Dr. Lindsay Ogle: or if you've had a pregnancy before and you've had complications during your pregnancy like gestational diabetes or gestational hypertension.
• 11:12
  Dr. Lindsay Ogle: If that was present in your history, then you're at higher risk for developing diabetes or high blood pressure or heart disease.
• 11:20
  Dr. Lindsay Ogle: So we want to be more aggressive in screening for those conditions early on.
• 11:25
  Dr. Lindsay Ogle: So that would be something that may be screened for in your 30s.
• 11:29
  Dr. Komal Patil-Sisodia: Those are great recommendations.
• 11:31
  Dr. Komal Patil-Sisodia: There are so many women who come to see me in my office who are in their 40s or 50s and had that history of gestational diabetes or high blood pressure during their pregnancy and they were never given that counseling and then they end up with these issues that they're now having to treat instead of something that you can proactively manage.
• 11:48
  Dr. Komal Patil-Sisodia: So that's great counseling that you're giving to your patients.
• 11:51
  Dr. Komal Patil-Sisodia: Now, moving into our 40s, since we're going by decade here.
• 11:56
  Dr. Komal Patil-Sisodia: Obviously I'm thinking that as long as patients don't have symptoms, these screens are continuing on a yearly basis with you, correct?
• 12:05
  Dr. Lindsay Ogle: Yeah, it's really recommended to be seen every year, even if it's not one of those years that you need your pap smear, because there are so many things that we're checking for, and if you are going each year, then you're able to make sure that none of that is falling through the cracks, and you can slowly get some of this done over time, versus if you wait until you're So if you're 50, then you have a lot of catching up to do, and it can be really overwhelming.
• 12:29
  Dr. Komal Patil-Sisodia: Yeah, that, that makes perfect sense.
• 12:31
  Dr. Komal Patil-Sisodia: And now what are your thoughts for our women who are now entering their 40s?
• 12:34
  Dr. Komal Patil-Sisodia: What are the things that you're recommending that they be screened for and things that they should be looking out for?
• 12:40
  Dr. Komal Patil-Sisodia: Because I think by this time, a lot of women are starting to slowly develop symptoms of things, right?
• 12:45
  Dr. Komal Patil-Sisodia: And are at that main set of time, the two decades prior where we can catch things before they.
• 12:52
  Dr. Komal Patil-Sisodia: before they're starting to become symptomatic.
• 12:55
  Dr. Lindsay Ogle: Yeah, so two big ones in your 40s are breast cancer screening and colon cancer screening.
• 13:00
  Dr. Lindsay Ogle: Breast cancer screening, it depends on which societal guidelines you're looking at, but the earliest recommendation for the general population is age 40.
• 13:10
  Dr. Lindsay Ogle: There are some that are a little bit later, but I definitely start talking to my patients about breast cancer screening at age 40.
• 13:17
  Dr. Lindsay Ogle: Again, going through family history and any symptoms that are, pertinent to them.
• 13:22
  Dr. Lindsay Ogle: And typically, and again, this varies to how often we recommend mammograms.
• 13:28
  Dr. Lindsay Ogle: It could be either every year or every other year.
• 13:32
  Dr. Lindsay Ogle: I think most breast screening programs end up doing it annually.
• 13:38
  Dr. Lindsay Ogle: Which I totally, support.
• 13:40
  Dr. Lindsay Ogle: So breast cancer screening is huge in this decade and that goes through age 74.
• 13:47
  Dr. Lindsay Ogle: Again, for the general population, sometimes there are reasons that we go beyond that.
• 13:51
  Dr. Lindsay Ogle: And then colon cancer screening starts now at age 45.
• 13:55
  Dr. Lindsay Ogle: It used to be 50.
• 13:56
  Dr. Lindsay Ogle: That was a big change.
• 13:58
  Dr. Lindsay Ogle: Yes, yes.
• 14:00
  Dr. Lindsay Ogle: In the last couple of years, we made that change from 50 to 45.
• 14:05
  Dr. Lindsay Ogle: Because unfortunately, we were seeing more and more colon cancer at younger ages.
• 14:09
  Dr. Lindsay Ogle: And that was the reason that got moved up.
• 14:12
  Dr. Lindsay Ogle: There are a couple of different ways to screen for colon cancer now.
• 14:15
  Dr. Lindsay Ogle: So not everybody has to go straight to the colonoscopy.
• 14:18
  Dr. Lindsay Ogle: I know that's a big mental hurdle for a lot of people.
• 14:22
  Dr. Lindsay Ogle: Or, you have to take time off work and be under sedation.
• 14:25
  Dr. Lindsay Ogle: It can be very invasive.
• 14:26
  Dr. Lindsay Ogle: We have some other options that are available for the right person.
• 14:31
  Dr. Komal Patil-Sisodia: Do you mind breaking those down a little bit, right?
• 14:34
  Dr. Komal Patil-Sisodia: Because I hear names and again, I don't.
• 14:36
  Dr. Komal Patil-Sisodia: Do the screenings in my office, but you know the colonoscopy is there.
• 14:39
  Dr. Komal Patil-Sisodia: There's one I think called Cologuard, and then is there a fit test?
• 14:43
  Dr. Komal Patil-Sisodia: Is that the other one?
• 14:44
  Dr. Lindsay Ogle: Yeah, you've got it.
• 14:45
  Dr. Lindsay Ogle: I'm starting
• 14:46
  Dr. Komal Patil-Sisodia: to slowly prep for my board exams because I think my internal medicine research is coming up in a few years.
• 14:52
  Dr. Komal Patil-Sisodia: So I've been trying to slowly start to read.
• 14:53
  Dr. Komal Patil-Sisodia: But yeah, if you could break those down and who would you would recommend each of those tests for, right?
• 14:59
  Dr. Komal Patil-Sisodia: Because I think a lot of my patients who are in their mid forties are like, why can't I just wait till I'm 50?
• 15:04
  Dr. Komal Patil-Sisodia: Do I have to do it?
• 15:05
  Dr. Komal Patil-Sisodia: And the bowel prep for a colonoscopy just seems so daunting to people, let alone the procedure itself.
• 15:13
  Dr. Lindsay Ogle: Yeah, absolutely.
• 15:15
  Dr. Lindsay Ogle: So the colonoscopy is still considered our gold standard.
• 15:18
  Dr. Lindsay Ogle: It is what we have done.
• 15:20
  Dr. Lindsay Ogle: for, the most period of time, and it gives us the most information.
• 15:23
  Dr. Lindsay Ogle: So it's the only option that we have that's really going to look at the inside of the colon, and if there is anything abnormal going on, the GI doctor is able to, get that biopsy right away, and we'll know what that is.
• 15:36
  Dr. Lindsay Ogle: So this is definitely what's recommended for anyone with a family history of colon cancer, or if you're having any symptoms, so it changes in your bowel movement Dark sticky stools blood in your stool.
• 15:49
  Dr. Lindsay Ogle: Definitely.
• 15:50
  Dr. Lindsay Ogle: You're going to want to do a colonoscopy Also, if you have anemia, that's another indication that we may want to do a colonoscopy The reason being, if there is a polyp or some abnormality along the colon, the GI tract, it could slowly bleed, like be irritated and bleed over time and that can lead to anemia.
• 16:08
  Dr. Lindsay Ogle: So we want to make sure that that's not the reason that you have a low red blood cell count.
• 16:14
  Dr. Lindsay Ogle: So those would be the people that I would recommend a colonoscopy for.
• 16:18
  Dr. Lindsay Ogle: Another good thing to know about a colonoscopy is that if it's normal, you don't need to do another one for 10 years.
• 16:25
  Dr. Lindsay Ogle: Yeah, that's a huge positive.
• 16:27
  Dr. Lindsay Ogle: So it can be really reassuring again, because it gives us so much information, we're reassured that we don't need to do another one for 10 years.
• 16:34
  Dr. Lindsay Ogle: If there are polyps or abnormalities, it depends on how much and which kind and that could vary follow up from anywhere from as close to one year to seven years after
• 16:43
  Dr. Komal Patil-Sisodia: that.
• 16:43
  Dr. Komal Patil-Sisodia: Most
• 16:44
  Dr. Lindsay Ogle: commonly I see three to seven, but you have to do the bowel prep.
• 16:48
  Dr. Lindsay Ogle: Everybody talks about that.
• 16:49
  Dr. Lindsay Ogle: You have to, yeah.
• 16:50
  Dr. Lindsay Ogle: Drink fluid or take medicine to get all the stool out So we can have a successful test that the GI doctor can actually see the colon And then you have to take time off of work and have somebody drive you back after the procedure
• 17:02
  Dr. Komal Patil-Sisodia: Okay,
• 17:03
  Dr. Lindsay Ogle: and then of course with any procedure there's some complications there that your GI doctor would talk to you about the other option is or one of the other options is polo guard.
• 17:13
  Dr. Lindsay Ogle: And this has become more and more popular.
• 17:15
  Dr. Lindsay Ogle: This is a kit that gets mailed to your house.
• 17:19
  Dr. Lindsay Ogle: And it gives you all the instructions on how to collect a stool sample, a piece of your poop, and you put it back in the box and then you mail it in.
• 17:27
  Dr. Lindsay Ogle: And then the lab tests for blood and some DNA markers that may indicate.
• 17:33
  Dr. Lindsay Ogle: Either colon cancer or high risk polyps.
• 17:35
  Dr. Lindsay Ogle: And that one, yeah, that one you do every three years if it's negative.
• 17:40
  Dr. Lindsay Ogle: And then if it's positive, we need to find out why and do a colonoscopy.
• 17:45
  Dr. Komal Patil-Sisodia: Okay.
• 17:47
  Dr. Lindsay Ogle: It's a great option, much more convenient, I would say.
• 17:50
  Dr. Lindsay Ogle: Some people don't want to do, that
• 17:52
  Dr. Komal Patil-Sisodia: mailing their poop in a box.
• 17:54
  Dr. Lindsay Ogle: Yes.
• 17:55
  Dr. Lindsay Ogle: Yes.
• 17:55
  Dr. Lindsay Ogle: But it's a great effective way to screen.
• 17:58
  Dr. Komal Patil-Sisodia: Yeah.
• 17:59
  Dr. Lindsay Ogle: I will say, and I know where I was practicing primary care in Missouri, they had recently passed a law because It was previously not required for insurance to then cover that follow up colonoscopy, which
• 18:14
  Dr. Komal Patil-Sisodia: is fascinating
• 18:16
  Dr. Lindsay Ogle: Because the colonoscopy then was not screening.
• 18:20
  Dr. Lindsay Ogle: It was a diagnostic colonoscopy because we had that previous positive screening test.
• 18:26
  Dr. Lindsay Ogle: And so that would put people in a really tricky situation where we know they need a colonoscopy, but then the colonoscopy is really expensive.
• 18:33
  Dr. Lindsay Ogle: So I would check your state laws and ask your primary care doctor.
• 18:38
  Dr. Lindsay Ogle: So you're not stuck in that situation.
• 18:39
  Dr. Lindsay Ogle: And hopefully that's being, more.
• 18:42
  Dr. Lindsay Ogle: consistent across every state that the follow up colonoscopy is covered.
• 18:46
  Dr. Komal Patil-Sisodia: Yeah that's really good information to know, right?
• 18:49
  Dr. Komal Patil-Sisodia: I think in this day and age where insurance is a little bit more in the news than we've seen it before, it's good to know what patients will have to work through just in case and have you found any ways prior to the passing of that law?
• 19:01
  Dr. Komal Patil-Sisodia: I know sometimes we can code things differently so that patients can get stuff covered, or was it, they just wouldn't even cover a diagnostic colonoscopy in your state.
• 19:11
  Dr. Lindsay Ogle: Yeah, those patients that happened for, it just, it wasn't being covered and I know those patients were just waiting, until they met their deductible and then maybe they were going to get it at the end of the year.
• 19:22
  Dr. Lindsay Ogle: It was really unfortunate.
• 19:24
  Dr. Lindsay Ogle: That's
• 19:24
  Dr. Komal Patil-Sisodia: terrifying and awful for them, right?
• 19:26
  Dr. Komal Patil-Sisodia: Because you're sitting there thinking, gosh, I have this negative result and then now what am I going to do?
• 19:31
  Dr. Komal Patil-Sisodia: I'm glad to hear that law passed, but that's great advice to check with your insurance to make sure that all of those things will be covered.
• 19:38
  Dr. Komal Patil-Sisodia: What exactly is the fit testing and who would fit into, no pun intended, who would be the ideal candidate for that?
• 19:46
  Dr. Lindsay Ogle: Yeah.
• 19:46
  Dr. Lindsay Ogle: So somebody that would be a good candidate for the fit test is pretty similar to the Cologuard.
• 19:53
  Dr. Lindsay Ogle: So that it's a true screening test, you're not having any symptoms.
• 19:57
  Dr. Lindsay Ogle: And the fit test is very similar in that it's a sample of someone's.
• 20:02
  Dr. Lindsay Ogle: stool and, but the way that this is tested, it's not as, precise as the Cologuard.
• 20:08
  Dr. Lindsay Ogle: And so you have to do it more frequently.
• 20:11
  Dr. Lindsay Ogle: So it's every year you would do the fit test.
• 20:14
  Dr. Komal Patil-Sisodia: Okay.
• 20:15
  Dr. Komal Patil-Sisodia: Okay.
• 20:15
  Dr. Komal Patil-Sisodia: Got it.
• 20:15
  Dr. Lindsay Ogle: And it's also much less expensive than the other option.
• 20:18
  Dr. Lindsay Ogle: So if somebody does not have insurance, that's definitely the recommended way to be screened.
• 20:23
  Dr. Komal Patil-Sisodia: Okay.
• 20:24
  Dr. Komal Patil-Sisodia: My guess would be is it doesn't have those DNA markers to the same degree.
• 20:28
  Dr. Komal Patil-Sisodia: Okay.
• 20:29
  Dr. Komal Patil-Sisodia: Okay, that's good to know.
• 20:31
  Dr. Komal Patil-Sisodia: And did you ever run into issues that if that was positive they wouldn't cover the colonoscopy for those patients either or was it mainly just a cost issue with the Cologuard?
• 20:41
  Dr. Lindsay Ogle: I think it was the same.
• 20:43
  Dr. Lindsay Ogle: I did not do a fit as much in my practice, just for my patient population, but I would assume it was the same.
• 20:49
  Dr. Komal Patil-Sisodia: Okay.
• 20:50
  Dr. Komal Patil-Sisodia: That's good to know.
• 20:51
  Dr. Komal Patil-Sisodia: All right.
• 20:52
  Dr. Komal Patil-Sisodia: We'll move into anything else that we need to be doing for our patients in their face.
• 20:56
  Dr. Komal Patil-Sisodia: So it seems like with each decade, what you need to have done each year is building to make sure that we're keeping you healthy.
• 21:02
  Dr. Lindsay Ogle: Correct.
• 21:03
  Dr. Lindsay Ogle: Correct.
• 21:03
  Dr. Lindsay Ogle: And again, why it's so important to start early.
• 21:05
  Dr. Lindsay Ogle: So you are staying ahead of yourself.
• 21:08
  Dr. Komal Patil-Sisodia: Absolutely.
• 21:09
  Dr. Komal Patil-Sisodia: So then let's go to this and beyond what are the next stage of screenings that we can recommend?
• 21:16
  Dr. Lindsay Ogle: So staying along the lines of cancer screening lung cancer screening starts in your fifties at 55.
• 21:23
  Dr. Lindsay Ogle: If you have a history of tobacco use or Quit yeah, so if you are actively smoking or quit within the last 15 years, then you may qualify for lung cancer screening and that would be a low dose CT scan of the chest and if you decide to get screened, then that's once a year up until 80 for lung cancer screening or 15 years from when you ended up stopping smoking.
• 21:54
  Dr. Lindsay Ogle: That's a really
• 21:55
  Dr. Komal Patil-Sisodia: important one.
• 21:55
  Dr. Komal Patil-Sisodia: Oh no, sorry.
• 21:56
  Dr. Komal Patil-Sisodia: So what about for the people who don't who don't smoke, right?
• 22:00
  Dr. Komal Patil-Sisodia: There's no need for screening.
• 22:01
  Dr. Komal Patil-Sisodia: We often hear oh, there are non smokers who are getting lung cancer.
• 22:05
  Dr. Komal Patil-Sisodia: Is there any way to proactively screen for those?
• 22:07
  Dr. Komal Patil-Sisodia: Or are we waiting until they unfortunately have symptoms and then going from there?
• 22:12
  Dr. Lindsay Ogle: That's a great example of the decision about how common is the condition.
• 22:18
  Dr. Lindsay Ogle: So we know it's much more common in people who have that smoking history versus people who don't.
• 22:25
  Dr. Lindsay Ogle: So the risks and the benefits of screening people who have a smoking history, well the benefits outweigh the risks.
• 22:32
  Dr. Lindsay Ogle: Yeah.
• 22:32
  Dr. Lindsay Ogle: But in a population who has not smoked, then the risks of screening outweigh the benefits.
• 22:39
  Dr. Lindsay Ogle: And so we do not screen in that population.
• 22:41
  Dr. Komal Patil-Sisodia: That makes perfect sense.
• 22:42
  Dr. Komal Patil-Sisodia: Thank you for explaining that for our listeners.
• 22:44
  Dr. Komal Patil-Sisodia: Okay, outside of, these like cancer specific screenings, what else are you looking at?
• 22:49
  Dr. Komal Patil-Sisodia: Where's your primary care brain going for how you're keeping your patients healthy?
• 22:54
  Dr. Lindsay Ogle: Yeah.
• 22:55
  Dr. Lindsay Ogle: So at each visit, we're also checking blood pressure.
• 23:00
  Dr. Lindsay Ogle: So this is really important to screen for and monitor because we know that high blood pressure one, you don't feel it.
• 23:08
  Dr. Lindsay Ogle: If you have high blood pressure, most people don't feel it because it usually increases slowly over time.
• 23:14
  Dr. Lindsay Ogle: And so you get used to having that higher blood pressure, but as If it goes untreated, it can increase your risk for heart disease, stroke, kidney disease, lots and lots of complications there.
• 23:28
  Dr. Lindsay Ogle: And so we want to identify it and treat it as early as possible.
• 23:31
  Dr. Lindsay Ogle: So we're checking that at every single visit, no matter what the age.
• 23:36
  Dr. Lindsay Ogle: We're also screening for mental health concerns.
• 23:40
  Dr. Lindsay Ogle: Depression is one that we definitely need a screen for.
• 23:43
  Dr. Lindsay Ogle: Most primary care offices screen that at every visit, and so we want to address that too.
• 23:48
  Dr. Lindsay Ogle: Typically, I also try to check in on anxiety and also substance uses.
• 23:53
  Dr. Lindsay Ogle: So we mentioned smoking, but also excessive alcohol use marijuana use, opioid uses other substances, screening for those, and then treating if we need to.
• 24:05
  Dr. Lindsay Ogle: And then vaccines are another big one that we want to make sure our patients are up to date on.
• 24:12
  Dr. Komal Patil-Sisodia: That's great.
• 24:12
  Dr. Komal Patil-Sisodia: That's great.
• 24:13
  Dr. Komal Patil-Sisodia: And did you mention the bone density scans as well for I know that there, I read so many of the guidelines for what I see in my practice, right?
• 24:20
  Dr. Komal Patil-Sisodia: And what we do in the endocrine space versus with, osteoporosis foundation versus what the World Health Organization recommends.
• 24:28
  Dr. Komal Patil-Sisodia: There can be a little variation in bone density screening.
• 24:31
  Dr. Komal Patil-Sisodia: What is your approach when you see women who need a bone density scan?
• 24:34
  Dr. Lindsay Ogle: Yeah.
• 24:35
  Dr. Lindsay Ogle: So my typical recommendation is age 65 or older to be screened.
• 24:42
  Dr. Lindsay Ogle: And potentially earlier if they have risk factors.
• 24:47
  Dr. Lindsay Ogle: And I'm assuming this recommendation comes from The American Academy of Family Physicians, if you're seeing other ones so I'm not sure which one, if that aligns with any other societies.
• 24:57
  Dr. Lindsay Ogle: Yeah,
• 24:57
  Dr. Komal Patil-Sisodia: We have the American Association of Clinical Endocrinologists, and then I think there's the Osteoporosis Foundation?
• 25:05
  Dr. Komal Patil-Sisodia: I'm not sure what the other society is called, I just know I've read multiple guidelines on
• 25:09
  Dr. Lindsay Ogle: this Yeah, it's interesting how they can vary and it can, kind of complicate things, but it also can allow us to tailor to, the patient that's in front of us.
• 25:17
  Dr. Lindsay Ogle: So, yeah, higher risk are Caucasian race, low body weight, smoking history, family history, certain medications.
• 25:27
  Dr. Lindsay Ogle: We may want to screen at a younger age.
• 25:29
  Dr. Komal Patil-Sisodia: Yeah, I see that in Southeast Asian women as well.
• 25:32
  Dr. Komal Patil-Sisodia: Their bone density tends to be lower too.
• 25:34
  Dr. Komal Patil-Sisodia: I've had a few women who have ended up with osteoporosis in like their 30s.
• 25:38
  Dr. Komal Patil-Sisodia: So I've had a few that were diagnosed very early and we couldn't really find out, find a contributing cause to it.
• 25:45
  Dr. Komal Patil-Sisodia: But yeah, definitely interesting.
• 25:47
  Dr. Komal Patil-Sisodia: So I like that there is some variation so that we're able to tailor it.
• 25:51
  Dr. Komal Patil-Sisodia: Anything else that we're missing, in preventative screenings that I think we did a pretty thorough job of going through those.
• 25:58
  Dr. Lindsay Ogle: Yeah, there's a lot.
• 25:59
  Dr. Lindsay Ogle: Another important thing for women is checking in on menstrual cycles and family planning so ideally, being proactive about that as much as possible.
• 26:09
  Dr. Lindsay Ogle: And if somebody is wanting various, types of birth control, we go over those options there and, offer that.
• 26:15
  Dr. Lindsay Ogle: So that's another really important thing for women.
• 26:17
  Dr. Komal Patil-Sisodia: Yeah, that's great.
• 26:18
  Dr. Komal Patil-Sisodia: And, along the lines of reproductive health, our women, perimenopause and menopause are finally having their moment, I think, in, in all of the, in all of the medical information that's out there.
• 26:30
  Dr. Komal Patil-Sisodia: coming out.
• 26:31
  Dr. Komal Patil-Sisodia: What can a woman who is coming during perimenopause or menopause expect to expect to talk to you about?
• 26:38
  Dr. Komal Patil-Sisodia: How do you go about educating them that this change is coming for them?
• 26:43
  Dr. Lindsay Ogle: Yeah, this is an area I probably could I have done a better job at, and hopefully continue to learn more about.
• 26:51
  Dr. Lindsay Ogle: And it's often not until patients bring it up to me that we talk about it, and unfortunately I think that's common in primary care.
• 26:59
  Dr. Lindsay Ogle: We do have so many other things that we are addressing, so sometimes we don't.
• 27:03
  Dr. Lindsay Ogle: just don't have time.
• 27:04
  Dr. Lindsay Ogle: But also, like you said, it's something that we did not always have education on.
• 27:08
  Dr. Lindsay Ogle: And so it's one of those things that we may not feel as confident about helping our patients with.
• 27:15
  Dr. Lindsay Ogle: And that's where talking with a specialist like yourself can be so helpful.
• 27:19
  Dr. Lindsay Ogle: But I'll say what I've been learning with lately about, this transition is that it lasts much longer than I think we are the.
• 27:30
  Dr. Lindsay Ogle: general public beliefs.
• 27:32
  Dr. Lindsay Ogle: It's kind of like presented as a year, two, maybe three year transition, and it really is more like 10 year transition.
• 27:42
  Dr. Lindsay Ogle: A year
• 27:42
  Dr. Komal Patil-Sisodia: plus, right?
• 27:44
  Dr. Lindsay Ogle: Yeah.
• 27:44
  Dr. Lindsay Ogle: For some of it,
• 27:45
  Dr. Komal Patil-Sisodia: I'll say, I, when I first started.
• 27:48
  Dr. Komal Patil-Sisodia: practicing, I was in my late twenties and you just don't have that context because you haven't lived that piece of it yourself.
• 27:56
  Dr. Komal Patil-Sisodia: And I often think back, gosh, how many more women could I have helped had I actually known, but there was, one, a training deficit and two, it's hard to understand what somebody is.
• 28:07
  Dr. Komal Patil-Sisodia: is going through during that time unless they are openly talking about it, right?
• 28:10
  Dr. Komal Patil-Sisodia: And you can help them navigate and look for patterns and things like that, but I think that's fantastic that is something that you're proactively thinking about now with your patients.
• 28:21
  Dr. Komal Patil-Sisodia: Now let's jump a bit to your obesity medicine background I know that this is something that you're very passionate about and we know that for people who struggle with overweight or obesity, they are at risk for so many other conditions like insulin resistance, heart disease, cancer.
• 28:40
  Dr. Komal Patil-Sisodia: I, how do you break that down to somebody and how do you start having that conversation with somebody?
• 28:45
  Dr. Komal Patil-Sisodia: Because, to your point earlier about, screening versus diagnosis.
• 28:49
  Dr. Komal Patil-Sisodia: People may not be feeling symptoms from dealing with overweight or obesity when they're younger, but then that starts shifting.
• 28:57
  Dr. Komal Patil-Sisodia: So how are you explaining those links and how are you trying to get people into a more proactive mindset?
• 29:04
  Dr. Lindsay Ogle: Yeah, great question.
• 29:06
  Dr. Lindsay Ogle: I will say, so with The primary care practice I was working at before, I was able to list my areas of interest in how I helped patients.
• 29:17
  Dr. Lindsay Ogle: And one of the main ones was weight management.
• 29:19
  Dr. Lindsay Ogle: And so I definitely had a lot of really motivated patients make appointments with me to specifically discuss this.
• 29:28
  Dr. Lindsay Ogle: And so they made it easy for me in that way because they often, my patients often brought it up.
• 29:35
  Dr. Lindsay Ogle: Which created a really, safe space and productive environment for those visits.
• 29:43
  Dr. Lindsay Ogle: But I definitely, in general, always try to tie our goals back to health and how weight is impacting or related to health because also I would have some patients who may have a little bit of excess weight, but they were very healthy and right.
• 30:04
  Dr. Lindsay Ogle: We have to take some time to tease out, what is important for health versus, more aesthetic weight loss.
• 30:10
  Dr. Lindsay Ogle: There is definitely a big difference there.
• 30:12
  Dr. Komal Patil-Sisodia: There is.
• 30:12
  Dr. Lindsay Ogle: Like I said, always keeping health at the focus is definitely a priority.
• 30:17
  Dr. Komal Patil-Sisodia: So in your practice, what are the links that you're seeing commonly with people who are struggling with overweight or obesity and what types of chronic diseases can they potentially expect to be diagnosed with?
• 30:31
  Dr. Komal Patil-Sisodia: What are you actively looking for?
• 30:35
  Dr. Lindsay Ogle: I think the biggest link is insulin resistance.
• 30:38
  Dr. Lindsay Ogle: Yeah.
• 30:38
  Dr. Lindsay Ogle: And we hear a lot about this recently and I think for good reason, and there's a lot of benefit that can come from more education around what insulin resistance is, why it's developed, and how to manage it.
• 30:54
  Dr. Lindsay Ogle: I think this is why there is that association between Excess weight and obesity and type 2 diabetes and I think a lot of people in the field of obesity medicine would agree that it's almost like one in the same and maybe it's somebody's genetic predisposition whether they developed type 2 diabetes or not, but most people very close to all have insulin resistance.
• 31:18
  Dr. Lindsay Ogle: I would totally
• 31:20
  Dr. Komal Patil-Sisodia: agree with that, right?
• 31:21
  Dr. Komal Patil-Sisodia: I think the way that I look at it is it's almost like a spectrum of disease, right?
• 31:25
  Dr. Komal Patil-Sisodia: You start with insulin resistance, you go to prediabetes and then it goes to type 2 diabetes and how quickly you progress and, depends a lot on genetics and lifestyle and all of those different things.
• 31:39
  Dr. Komal Patil-Sisodia: But, and it's a hard conversation to have with people, right?
• 31:42
  Dr. Komal Patil-Sisodia: I think it, it freaks them out a little bit.
• 31:44
  Dr. Komal Patil-Sisodia: And sometimes there can be a little bit of denial about the potential health.
• 31:48
  Dr. Komal Patil-Sisodia: issues that are starting to pop up and the association that it may have.
• 31:52
  Dr. Komal Patil-Sisodia: What do you think about risks of heart disease and cancer?
• 31:55
  Dr. Komal Patil-Sisodia: I know we hear a lot about how overweight and obesity can be linked to those conditions as well.
• 32:03
  Dr. Lindsay Ogle: Yeah, so I actually just read an article about this through the Obesity Medicine Association with our, renewing our certification.
• 32:11
  Dr. Lindsay Ogle: We have these articles we can read now and take resources on and I read one about this.
• 32:16
  Dr. Lindsay Ogle: And it just was talking about, what you and I know is that fat cells, adipose cells are not benign cells.
• 32:25
  Dr. Lindsay Ogle: They don't just sit there.
• 32:26
  Dr. Lindsay Ogle: They are.
• 32:27
  Dr. Lindsay Ogle: Hormonally active and they're releasing hormones and inflammatory markers that affect our whole body
• 32:34
  Dr. Komal Patil-Sisodia: Yeah
• 32:34
  Dr. Lindsay Ogle: And we're learning more and more that it's that dysfunction in those fat cells the adipose cells that are leading to these conditions specifically Cardiovascular disease and cancers and so there are direct links between excess weight cardiovascular disease and cancer and so that article was really I guess, scientifically interesting, but really sobering and highlights the importance of treating and managing obesity so we can then prevent cancers, which are becoming, like I mentioned earlier, colon cancer is becoming more common at a younger age there's direct links to breast cancer, uterine
• 33:15
  Dr. Komal Patil-Sisodia: cancer.
• 33:16
  Dr. Komal Patil-Sisodia: Yeah, it's scary.
• 33:18
  Dr. Komal Patil-Sisodia: I have a lot of my patients who once they hit their fifties and sixties, and even if their periods have stopped, I've seen a few come back with bleeding, even though they've been menopausal for a while.
• 33:29
  Dr. Komal Patil-Sisodia: And there is a strong association with that endometrial or uterine cancer if they are struggling with overweight and obesity.
• 33:35
  Dr. Komal Patil-Sisodia: Definitely things for women to know about and to watch for because it can have such a profound impact.
• 33:41
  Dr. Komal Patil-Sisodia: I guess my next question would be around, women in general.
• 33:44
  Dr. Komal Patil-Sisodia: have such a hard time when they come into a doctor's office, right?
• 33:48
  Dr. Komal Patil-Sisodia: One, because the visits are so short, and I think that's why you have launched your clinic so that you get more time with your patients where you can have more in depth discussions.
• 33:57
  Dr. Komal Patil-Sisodia: It's why I am working on launching my own clinic on the side to help women who are struggling with metabolic disorders around perimenopause and menopause.
• 34:05
  Dr. Komal Patil-Sisodia: How can women Advocate for themselves if they feel like they're not being taken seriously or they're not being heard or there's not enough time in a visit, both in, I think a lot of people are in the traditional insurance system, but even say you're going to another provider and they're just not hearing what you're saying.
• 34:22
  Dr. Komal Patil-Sisodia: How can people advocate for themselves in those scenarios?
• 34:27
  Dr. Lindsay Ogle: This is such an important question and thank you for asking.
• 34:31
  Dr. Lindsay Ogle: One, patients should feel empowered to ask questions and so if there's something about your care that you don't understand or if, like you said, if you're not feeling heard, it's okay to ask questions and if the doctor that you're seeing does not make you feel comfortable or is not answering your questions, then it may be time to either get another doctor in that.
• 34:54
  Dr. Lindsay Ogle: Yes.
• 34:56
  Dr. Komal Patil-Sisodia: Yes, that is what I tell my patients all the time.
• 34:59
  Dr. Lindsay Ogle: And so it may be time to do that because I feel like doctors are getting a bad rep right now and it's so sad.
• 35:07
  Dr. Lindsay Ogle: And with any, profession, there are good eggs, there's bad eggs.
• 35:12
  Dr. Lindsay Ogle: And there are so many amazing, caring, knowledgeable doctors out there.
• 35:18
  Dr. Lindsay Ogle: And so if you are not feeling that from your current doctor, then We are out there, look for us, and I know you'll be able to, find one.
• 35:28
  Dr. Lindsay Ogle: And asking your friends and family, like, who do they see, and get the referrals that, you're going to find somebody that you trust.
• 35:35
  Dr. Lindsay Ogle: And also, you can always bring, a loved one with you to be a support system to help ask some of those questions if you don't feel comfortable.
• 35:44
  Dr. Lindsay Ogle: Although, like I said, you should feel comfortable asking your doctor, but having a support person there.
• 35:49
  Dr. Lindsay Ogle: Can be really powerful as well.
• 35:51
  Dr. Komal Patil-Sisodia: Those are really great tips and I totally agree with you.
• 35:54
  Dr. Komal Patil-Sisodia: I feel like if patients are not getting what they need from that doctorate as well within their right to go see somebody else.
• 36:01
  Dr. Komal Patil-Sisodia: And I often tell my patients if at any point during our relationship, you feel like we're not connecting in the way that supports your health, I will very happily like I have.
• 36:12
  Dr. Komal Patil-Sisodia: No ego about this.
• 36:13
  Dr. Komal Patil-Sisodia: I think you should probably go see somebody else for a different opinion.
• 36:17
  Dr. Komal Patil-Sisodia: They, you feel like you're connecting with, because I think that's so important.
• 36:20
  Dr. Komal Patil-Sisodia: And unfortunately, with the way the system has gone, it's become much less personalized.
• 36:26
  Dr. Komal Patil-Sisodia: And I know that is so painful for the patients.
• 36:30
  Dr. Komal Patil-Sisodia: It's also painful for the doctors who went to school in order to develop these relationships, in order to have those interactions.
• 36:37
  Dr. Komal Patil-Sisodia: Feel like we were truly making an impact in someone's life.
• 36:40
  Dr. Komal Patil-Sisodia: So those are some really great tips.
• 36:41
  Dr. Komal Patil-Sisodia: Thank you for that.
• 36:43
  Dr. Lindsay Ogle: Yeah.
• 36:44
  Dr. Lindsay Ogle: Absolutely.
• 36:44
  Dr. Komal Patil-Sisodia: Yeah.
• 36:45
  Dr. Komal Patil-Sisodia: We've talked a lot about screenings and, what to do around perimenopause, menopause, other metabolic health stuff.
• 36:53
  Dr. Komal Patil-Sisodia: Let's talk a little bit about mental and emotional health and how do you start talking to your patients specifically your female patients about their stressors and how do you encourage them to open up about their mental health, emotional health, other things that might be going on in their lives, but affecting their health.
• 37:10
  Dr. Komal Patil-Sisodia: right?
• 37:10
  Dr. Komal Patil-Sisodia: I think we really downplay how much stress adversely affects the body, how much it can cause other conditions to get worse if we're not managing stress.
• 37:20
  Dr. Lindsay Ogle: Yeah, 100%.
• 37:21
  Dr. Lindsay Ogle: So screening for them, asking the questions especially open ended questions and hopefully, having that therapeutic relationship that you mentioned, which is so important between the patient and the doctor so patients can feel comfortable sharing those.
• 37:38
  Dr. Lindsay Ogle: Vulnerable concerns and symptoms that they're having.
• 37:41
  Dr. Lindsay Ogle: I think another key thing that I try to do is to normalize these struggles because it's obvious to me.
• 37:50
  Dr. Lindsay Ogle: I see, so many patients in a week and I see how common these concerns and feelings and, stressors are, and, but we're set up in our society, we're set up to feel like we're the only one struggling through it.
• 38:05
  Dr. Komal Patil-Sisodia: I know, it's so isolating, isn't it?
• 38:08
  Dr. Lindsay Ogle: Yeah, yeah, absolutely, and normalizing it, making sure that people are not feeling like it's just them.
• 38:15
  Dr. Lindsay Ogle: And encouraging my, especially my female patients to take the time to prioritize themselves and their health and doing things that for them that they enjoy and something that doesn't have to be productive.
• 38:28
  Dr. Lindsay Ogle: It's not in service of others.
• 38:30
  Dr. Lindsay Ogle: It's truly just for them that they enjoy and carving out that time, whether we're only starting with five minutes a week, if that's all, we feel like we have time for or can.
• 38:42
  Dr. Lindsay Ogle: You know handle that one moment because we're so used to helping others Those five minutes are so important to schedule and just build in that routine and then we can go from there
• 38:52
  Dr. Komal Patil-Sisodia: I love that advice.
• 38:53
  Dr. Komal Patil-Sisodia: That was probably some of the best advice I got from a friend and colleague as well as my own primary care doctor was to truly carve out that intentional time and I kept thinking, gosh, that it feels so selfish to schedule it on my calendar as me time.
• 39:08
  Dr. Komal Patil-Sisodia: The more I started doing it, the less I felt bad about it.
• 39:11
  Dr. Komal Patil-Sisodia: And the more I felt like I needed that in order to be able to get through my day.
• 39:16
  Dr. Komal Patil-Sisodia: So that's a fantastic piece of advice.
• 39:19
  Dr. Komal Patil-Sisodia: And I could say that from personal experience.
• 39:21
  Dr. Komal Patil-Sisodia: So I want to end with, and I think this is really a hard thing right now with the way that the medical landscape is working.
• 39:29
  Dr. Komal Patil-Sisodia: We know that there's a primary care shortage in my area that I live in.
• 39:32
  Dr. Komal Patil-Sisodia: There's an endocrinology shortage there.
• 39:35
  Dr. Komal Patil-Sisodia: There are so many barriers just in terms of access.
• 39:37
  Dr. Komal Patil-Sisodia: What are other barriers that you see for women, going out and seeking help for themselves and what can they do to overcome that?
• 39:49
  Dr. Lindsay Ogle: Yeah, the limited access is really scary and definitely true in most areas and I think highlights the importance of early on finding that primary care doctor that you trust and starting it at a young age or if you move somewhere to, be proactive about finding that person.
• 40:09
  Dr. Lindsay Ogle: And another tip, you need to see them at least For most clinics at least every three years or you're considered a new patient and if they're too busy and not accepting new patients Then you can't schedule with them.
• 40:21
  Dr. Lindsay Ogle: So you have to be seen at least every three years.
• 40:23
  Dr. Lindsay Ogle: That's really important.
• 40:25
  Dr. Komal Patil-Sisodia: Yeah
• 40:26
  Dr. Lindsay Ogle: Ideally once
• 40:26
  Dr. Komal Patil-Sisodia: a year, right?
• 40:28
  Dr. Lindsay Ogle: Yes, ideally once a year, but for sure at least every three years and I think Yeah, just like scheduling.
• 40:36
  Dr. Lindsay Ogle: I'm a big fan of scheduling.
• 40:38
  Dr. Lindsay Ogle: I Yeah, my calendar tells me what to do.
• 40:41
  Dr. Lindsay Ogle: And so Making those appointments and scheduling those visits ahead of time and then making it a habit of following through with what you scheduled for yourself to take care of yourself is so important.
• 40:54
  Dr. Lindsay Ogle: I mean we hear you can't Pour from an empty cup and all the time, but it is so true You have to take care of yourself first before you can take care of others your other Responsibilities and so it is not selfish.
• 41:08
  Dr. Lindsay Ogle: It definitely needs to be a priority
• 41:11
  Dr. Komal Patil-Sisodia: Thank you for holding that space for people and giving them permission to take care of themselves.
• 41:15
  Dr. Komal Patil-Sisodia: I think so often, especially as women were waiting for somebody else to give us permission to do that.
• 41:21
  Dr. Komal Patil-Sisodia: So this has been just a fantastic discussion.
• 41:24
  Dr. Komal Patil-Sisodia: The takeaways that I got from it is, especially now that we are hearing so much more about well, what can I do to prevent these things?
• 41:31
  Dr. Komal Patil-Sisodia: Really what I'm hearing from you is jumping on the screenings as early as possible and establishing that care with somebody that you trust are going to be the First steps that you can take and probably the most important ones.
• 41:46
  Dr. Komal Patil-Sisodia: Do you have any other takeaways that you want our listeners to walk away with around the importance of women's health screenings or, just anything about the messaging that you've put together right now, it's been so wonderful hearing all of your recommendations and advice around this.
• 42:03
  Dr. Lindsay Ogle: Yeah, I think those are great takeaways, and I love this conversation.
• 42:06
  Dr. Lindsay Ogle: I feel like we could talk for another hour.
• 42:08
  Dr. Komal Patil-Sisodia: Yeah.
• 42:09
  Dr. Lindsay Ogle: But another thing I would say would just be that you don't have to, Check all of these screenings and recommendations off at one time.
• 42:19
  Dr. Lindsay Ogle: This is an ongoing process.
• 42:21
  Dr. Lindsay Ogle: Health is an ongoing journey.
• 42:23
  Dr. Lindsay Ogle: And so we'll start with small goals, start with the most important things, and then over time build up on that foundation that we've created.
• 42:33
  Dr. Lindsay Ogle: And you'll be amazed about how much better you feel, how much more confident you are in your health once you've Slowly worked on that over the course of your whole life, really.
• 42:44
  Dr. Komal Patil-Sisodia: I really love that.
• 42:46
  Dr. Komal Patil-Sisodia: Health is a journey.
• 42:47
  Dr. Komal Patil-Sisodia: You heard it here from Dr.
• 42:48
  Dr. Komal Patil-Sisodia: Ogle, health is a journey.
• 42:50
  Dr. Komal Patil-Sisodia: And I hope that everybody who's listening today has gotten as much value as I have out of this conversation and that's, and I have gotten tremendous value out of it.
• 42:59
  Dr. Komal Patil-Sisodia: So thank you again for your time.
• 43:01
  Dr. Komal Patil-Sisodia: And I hope to have you back for another episode at some point.
• 43:05
  Dr. Lindsay Ogle: Yeah, I would love that.
• 43:06
  Dr. Komal Patil-Sisodia: All right.
• 43:06
  Dr. Komal Patil-Sisodia: Thank you.
• 43:08
  Dr. Komal Patil-Sisodia: I'm going to hit stop.
• 43:10
  Dr. Komal Patil-Sisodia: Alright,
• 43:11
  Dr. Lindsay Ogle: that was fa