Latest / A Lifetime to Learn / One in Four Women: Breaking the Silence on Pelvic Floor Disorders | Dr. Jasmine Tibon, Urogynecologist
Transcript
- Jasmine Tibon (00:00.172) I think I want women, especially in Northwest Arkansas, to ask questions, to be forthcoming, to tell their provider what is bothering them, to not sweep things under the rug, both with their health and other things. We often have so much to worry about and so much in our in our plate to digest. And taking a small time for yourself, whether that, you know, it's exercise, being outside, you know, going to the doctor if you haven't been in years, you know, it's just doing something for yourself to fill your own cup. And so, to be able to be successful in the household, in the job, in whatever endeavor you're going on, you have to feed kind of yourself first when it feels abnormal. This is a space where presence meets purpose, where we explore the moments that shape us. From entrepreneurs and change makers to women in leadership. It's about learning out loud, together, with honesty and humor. Where luminaries with real stories remind us how to live by our own rules. Because progress doesn't come from having all the answers, it comes from staying open. And we've got a lifetime to learn. I'm your host, Leslie Zanoff. Let's get started. There are moments in a community's history that are easy to miss. Quiet pivots where everything changes because one person showed up. And today that person is my guest. Dr. Jasmine Tibon is a fellowship trained urogynecologist and reconstructive pelvic surgeon, and she's the only one in Northwest Arkansas. She grew up here in Rogers, left to train at some of the best programs in the country, and came home to build something that this region has never had before. See, she specializes in pelvic floor disorders, conditions that affect millions of women and are rarely talked about. Yes, her work is clinical, but it's also about something deeper, helping women understand their bodies and trust their instincts while feeling confident. Leslie Zanoff (02:11.53) advocating for their own health. Women in Northwest Arkansas now have access to care that they have never had before and Dr. Jasmine Tibon is the reason why. So welcome to A Lifetime to Learn. Thank you for having me. What a wonderful, beautiful introduction. I'm so excited to be here. Good. I've been excited about this conversation since I met you at our little health, the women's health event where you were there. Okay, so I just want you to tell me a little bit about yourself. You grew up in Rogers here in Northwest Arkansas. Yeah. Gosh. It is so different. So, I like you said, I'm a Rogers native. I was born in the old St. Mary's in downtown Rogers. I, you know, danced at Ballet West Side in downtown Rogers, and that was like the only dance studio, you know, and things have changed so tremendously since then. But being able to come back and seeing that growth, but also still feeling the roots of where of what Northwest Arkansas is has been really amazing. And so You know, my journey started very young. I wanted to be a a doctor, you know, as some children do, and I kind of obviously stuck with that and did a lot of community volunteering in the area and just continued to follow that passion through, you know, college, led me to medical school and then kind of my journey took off from there. Leslie Zanoff (03:32.76) Okay. Yes, I know. That was one of my questions of like, did you always know you wanted to be a doctor or go to med school? I did and I don't know why, because my family, you know, sometimes there's, you know, families of physicians and kind of they fall into this tradition of being physicians. My family is not. They are, you know, have been in business or educators. My family owned at one of the only preschools that was in northwest Arkansas for a very long time and now you can't get into a preschool for over a year. You know, and so I just from a very early age was really interested in medicine and told my grandma. I think she tells this story like when I was six or seven that I wanted to be a doctor and she thought that was like out of left field because it's not what our family does. But I continued to follow that and wanted to, you know, help people. And that sounds very cliche, but that's where it initially originated. Okay. And so medicine, we you knew that was gonna be your path, but what about urogynecology? How I mean, how did that become the destination? Yeah. Yeah, because it's like a very niche field and not many people know what it is. Even the patients that I see are unsure as to what I do. When I was in medical school, I, you know, I'm a very artistic person at my core. I like to work with my hands. I did ceramics in high school and college, you know. So I'm very I love doing things with my hands. And I knew that I was interested in a surgical subspecialty. As I went through all my rotations, I took Jasmine Tibon (05:00.822) I tried to absorb as much as I could from each specialty to see what really fit. And that's the advice that I give medical students now is like, you might think you want to do something, but take in everything and appreciate everything. And that led me to either surgery or OBGYN. And I had a friend who said, you know, who had chosen surgery and she was like, I didn't want to give up caring for men. And I kind of did some self-reflection and I was like, you know what? I'm really passionate about women. I have no problem giving up giving for men. Okay. And so that's what led me to OBGYN. I had a wonderful mentor in medical school who was a urogynecologist. I had no idea what that was, but I saw the impact that she was making in patients' lives. I saw the impact that she made specifically in patients who are perimenopausal, postmenopausal, a time frame in a woman's life that women are honest often written off. You're no longer, you know, being pregnant. You're not young and desirable. You know, those are the stigmas that these women face. And I wanted to make a difference. And so I knew I was very interested. I did research with her and you know, on patient readability in that that time. When I went to medical school or I mean when I went to residency, sorry, I kind of had an idea that I wanted to do that. I was really interested in that. I was very passionate about you know like the elderly community. Yeah. And when I did my rotation in as a resident, I was like, this is this is for me. This is exactly what I wanna do. I wanted to be a master of my skills, hone in on specifically like, you know, pelvic floor disorders and the r the rest is history. Okay. Okay. Yeah. Well and I had I had this thought too, as it's such a highly specialized field, I mean, how long is the schooling for that? Yeah. I mean, how how many years? Well Jasmine Tibon (06:45.39) Also I did, you know, college. Yes. I went to Hendrix in Conway, so also in Arkansas, you know, roots. I did medical school for four years. Then I did residency in OBGYN for four years. And that was in Kansas City. And then I did three additional years beyond that in fellowship where I only was doing pelvic floor disorders, only doing neuro gynecology. Okay. So it's seven years post medical school of training. Yeah. Right. Okay. Okay. I I knew that it was an extensive amount of training, especially as a surgeon. So all right. It's a long time. And that's why you have to be like committed because you know, I knew that this is exactly what I wanted to do. I was really passionate about it. And so the time flew by. Well, yes, I love that. Okay, well I want to make sure that and and help people understand what this specialty is, Eurogynecology and really what it's meant for women in this region to not have access to it. So you can can you kind of explain maybe first what Eurogynecology is? Absolutely. So urogynecology, we treat pelvic floor disorders. So what are pelvic floor disorders? So those are things like pelvic organ prolapse, urinary incontinence, fecal incontinence, pelvic muscle pain, bladder pain, anything that is held by the pelvic floor is what we take care of. Then people are like, Well, what is the pelvic floor? So the pelvic floor is a bowl of muscles. It holds your bladder, the vagina, and the rectum. And Jasmine Tibon (08:13.898) If any of that is uncoordinated or failing or the connective tissue fails, you can end up with one of these conditions. And so we, as urogynecologists, manage those conditions. I offer the, you know, a total menu of options because I'm a firm believer in not there's not a one size fits all management for these conditions. And so it can range from doing nothing because 99% of the time pelvic floor disorders are not dangerous to your health. It's all about your quality of life. Then we can do non surgical management options and all the way to surgical management options. And so I let I lay it all out, I lay the evidence out and let a patient choose what is best for them. Okay, and that but that brings me to another thought and question of okay, maybe it's not dangerous, but is it has it been something that, you know, for years, okay, well this is just part of aging, part of being a woman and we're just dealing with it. Thank you. See you next time. Yes. Yes. And that is one of my soapboxes that I talk to patients about because even when they come to see me with a complaint that they've been referred to to me from their primary care doctor or whomever, that they're bothered by these symptoms, leaking urine. I'm not going out with my friends. I'm afraid I'm gonna have an accident. I this is uncomfortable. But you know, maybe it's just normal with aging. But just because it's normal and it happens, well, what is normal, but just because it happens as we age does not mean that we have to deal with it. There are things out there to manage your symptoms so that you can enjoy this time of life. I often say, you know, these are the golden years. This is what you've worked so hard for. A lot of my patients are retired. I mean, I see a lot of younger patients too with these conditions. So it's not exclusively, you know, postmenopausal retirees, but Jasmine Tibon (09:58.54) that's kind of the biggest impact that I see that they're like not going to church. They're not doing, you know, game night. They're they're stuck at home. And to be able to give patients that quality of life back, while it's not medically dangerous, often these conditions, meaning it's not an issue with your heart or your kidneys, it, you know, there's a different type of danger, right? Of staying home and being depressed and and the mental impact of these conditions also is really, you know, remarkable. And and women do write them off as Chucking it up to normal, but it doesn't have to be normal. We don't have to endure these things. I think we're code trained to endure things as women, and we don't have to. too. Okay, yes. I'm like we don't have to endure things. Thank you for saying that. And the patient physician care, that's something that you've researched and that you've talked about. Will you talk about that a little But absolutely. One of my thesis projects in fellowship centered around this idea called the therapeutic alliance. And it was originally, you know, brought into fruition in physical therapy literature, where they identified that the stronger the relationship between the stronger perceived relationship between a patient and their provider or their therapist, the better their pain scores were. And so I specifically look, there's a certain condition that I treat that is pretty refractory to treatments, meaning, well, there's not a s one certain treatment that is good for everyone. It's a lot of trial and error. And it's a has to a lot of patient buy-in has to be involved to try the different treatment options. And so I was curious what, you know, how can we establish that relationship to strengthen it to later potentially improve patients' perception of pain. Jasmine Tibon (11:42.304) In my community, this condition sometimes is even even within neurogynecologists is written off as like, well, it's not surgical, it's not gonna generate a surgery, it's chronic condition, it doesn't always get better. And so why is there that stigma? You know, and so I did some research and some surveys to see kind of did patients' perception of pain relate to their perceived relationship with their provider? And these are things like, did the provider validate my pain? Did do I trust the provider? And these are I think really important concepts that traverse many different medical specialties, especially as access to information is so much easier for patients. And so there but, you know, we talked about social media, AI, all of those things cannot replace the relationship that you have with your provider and that trust that you need. Well, right. And I think as a woman, surely coming into your office and being a female, seeing the woman doctor walk through the door, that has to provide a certain amount of relief. Yeah. I mean, I would think so. Absolutely. And, you know, as you as you're saying that, I it makes me think when I was pregnant and I had always for years gone to a male gynaecologist. He's great, a wonderful physician. I loved him. And then something about being pregnant and have you know, I was like, I really want to see a female physician. And so I I switched. So Of course. Well, a and you know, my male colleagues are all wonderful, but I think that er there is something that is to say for a female physician because it for certain patients. Some patients love, you know, only seeing a male provider, but having a female who understands the anatomy on a more personal level obviously, who has you know, can kind of put themselves in their shoes and and really know what it would potentially be like. Yes. I think speaks volumes. Jasmine Tibon (13:35.372) I've had patients who have expressed how excited they were and how much more comfortable they felt speaking with a female about the cause these conditions are very personal. Right. Yes. Intimate. Yeah, exactly. And so it's very hard to be vulnerable and open up to someone that, you know, you might not feel comfortable with. And people, you know, certain percent of people have a history of trauma. So, you know, so you have to be really Cognizant of those issues to create a safe space for patients to feel comfortable. I have patients who they're like, this is embarrassing. And I'm like, I promise it's I have I promise I've heard it. You don't have to worry. It doesn't matter if you haven't shaved your legs or you haven't had a pedicure, you know, those little minute things, but pe it's amazing how people, you know, are not comfortable talking about these things because socially it's not a really comfortable subject to talk about. And not only that, do they not want to? You know, they're also surprised that they the person they're sitting next to at church or their girlfriend or whomever is honest often going through the exact same thing. Well yes, that's what I you know, I said to you. I was at my daughter's school function and this this woman was like, I just had bladder surgery and I said, I bet I know who you saw. She's gonna be on my podcast. And she said yes. And immediately when she said that, two or three other women were like, my gosh, I have this issue, I have this issue. And That was the first time and I'm in my mid forties that I had ha heard women even discussing it openly. Mm-hmm. Jasmine Tibon (15:08.148) Yeah. And that is very that is very common. And I have patients that come to see me. I mean, this is all I see. This is enough to sustain my career and getting a partner and and everything. And people are like, Have you seen this before? Do other women have this? And I'm like, This is, you know, the patient next door has this. This is so common. One in four women in their lifetime will have a pelvic floor disorder. And that's so that's twenty five percent of the population. And, you know It is so common and it's very common to not only sweep it under the rug and attribute it to aging and normal and also to feel alone because women don't talk about it's hard to talk about, you know, your pelvic region or your vagina or things like that. And so it's like but once they find someone who is experiencing the same things, they feel a sense of relief, you know. And so I encourage people, women to talk about it because you know, I don't want anyone to feel alone. Well right, and that's what I that's what I heard, just the fact from this mom saying, Yeah, I had bladder surgery and then several women chiming in, I have this happen, this is happening. Of course. And I was I was yeah, I was kinda surprised. Yeah. I think Yeah, see, and you're you're just as surprised, but it's very common. So, you know, hopefully the next time you, you know, won't be as surprised. So Which of what you treat, I mean, has been normalized by women as just part of being a woman? And and then I guess that's my question, because you you've already mentioned that, but are these conditions happening because of aging, lack of hormones, childbirth or is it a combination? It's a combination Jasmine Tibon (16:42.67) It's very multifactorial. It, you know, depends on the condition. You know, things like urinary incontinence, overactive bladder are very common as we age. Prolapse is common after, you know, inciting factors are childbirth, being pregnant in general. it runs in families. And so the specific collagen that women inherit from their families, which another thing that people don't realize, like my mom didn't talk about this, but I think she had bladder surgery, you know. and it runs in yeah. And it's more common in Caucasian and Hispanic women and and so those are the biggest kind of i factors, but you know, connective tissue disorders can predispose you to these things. So, you know. Okay. It it is very common. It's not just one thing. No. There's many. Okay. Yeah. And it's not a lack of key goals. Okay. A lot of pa a lot of patients say, Well, I do my key goals, you know. That is not I know and I've heard you say, talk about that. You can overdo it on the Kegels like Jasmine Tibon (17:40.834) You can. You can. You can overdo it. If you you know, the like I said, the pelvic floor, it's a bowl of muscles. If you work out those muscles over and over and over, they'll get thicker, they'll get tense. Some people, you know, and we can touch on this is carry tension in their pelvic floor and that can manifest in different types of symptoms. And so over kegling can be just as bad as, you know, under kegling. I don't like people to feel pressure that any one of these things happened because they didn't do kegels, right? You know. I know. Let's talk about that for a little bit. I think we do tend to and this is not something that I know a lot about, but just having some physician friends and women speak about it, but we do carry tension in our hips and in our pelvic floor. So will you will you talk why is that? Just from stress we're Yes. Yes. So similar to how people can get neck pain when they're stressed. They can carry tension in their neck. They can carry tension in their jaw and get TMJ. The pelvic floor, similar, you know, to all these other muscle groups, can carry tension and stress can manifest in that tensity or you know, the stress can kind of transform into that tense muscles and that c manifests into bladder pain. It can cause urinary frequency, but it's really not a problem of like bladder spasticity. It's a problem of tight pelvic floor. It can cause pain with intercourse. It can cause constipation. And so relaxation of the pelvic floor is something I talk to women all the time about, honestly more so than than strengthening. Okay. Mm-hmm. I know and talk about bladder pain. Is this this is something you've done a lot of research around? I remember reading this. So tell me about Jasmine Tibon (19:19.918) that. Yeah. So bladder pain syndrome, it's also known as interstitial cystitis, is kind of there's multiple names for it, but it's basically where your, you know, what is norm what's supposed to normally happen is your bladder fills with urine. It fills, fills, fills, fills, fills. It tells your brain, I'm full. I need to empty. Your brain suppresses that signal until you get to the bathroom. If there is a disruption in that brain bladder connection, it can potentially lead to overactive bladder. And it can also cause, you know, manifest in bladder pain. So what happens is as your bladder fills, some people have pain and if they get the then it tells the bladder tells the brain, I gotta empty, I'm uncomfortable and then you go start going to the bathroom every thirty minutes. But it's not because you're afraid you're gonna have an accident. It's because of the discomfort, of the you know, I can't ignore that urge or it's painful and it gets better when I empty. And that is a condition that That's the one that I looked at in terms of the patient provider relationship and the therapeutic alliance because there's not there's different phenotypes and certain people can fall into different buckets and some respond to treatment better than others, but there is kind of that centralization of pain component that can be because of stress. It can be, you know, you know, well, as we said, suppressing anxiety, stress and curing the tension in the pelvic floor and kind of interpreting those signals as painful when they're truly not. like pathologically painful. Okay. And can some of these things be managed with medication? It's not always surgery or Jasmine Tibon (20:53.01) yes. Yeah. So this condition specifically is y like I said before, it's not surgery usually not cured with surgery. Yeah. It does again require a lot of patient buy-in because it's changing in diet, managing stress, which is very difficult, especially in this day and age. And I tell my patients, this is not me saying, This is in your head, this is made up, you're not you know, it it truly is a manifestation of pain from a source of potentially stress, anxiety, tension. you know, trauma. and so retraining the brain to not interpret those signals as pain. A lot of times I talk to patients about mindfulness, about meditation, about yoga. And there has been studies on that that these conditions can't improve. But you have to have patient buy-in because those things are hard. Changing your diet is hard. You know, taking the time to, you know, step outside for ten minutes to breathe is hard. And so you that's where we ha I have to kind of Educate patients on what it's not necessarily even just a pill, it's not a surgery that can fix those problems. It takes work. And do you think sometimes on some of that that maybe we dismiss that of it cannot be as simple as and I say as simple 'cause it it is hard to change your diet, but as your diet, maybe some exercise, going outside, these things where it's like, is that truly are those things helpful? I mean It truly is. It truly is. And and it's hard to sometimes patients are like totally bought in, you know, that you have two spectrums of patients. You have one that like wants the holistic approach. Right. And then you have one that wants the surgery, the pill, I wanna fix this. This is not normal. And and sometimes, you know, you have to get those patients to kind of understand that this has been go often going on for years. I see this a lot in patients who are caregivers who cannot take time for themselves. Right. Jasmine Tibon (22:49.258) And r you y you know, you have to. There is only so much that medicine can do when, you know, we have so much stress on our plates, when we're not taking care of ourselves, when you're, you know, consuming bladder irritants. That's something I talk to patients a lot about. And and it's hard. It's hard work. Yes. Okay. Yeah. And I appreciate you saying that. That's what I mean. Like to have people buy in on that of like, surely you're not telling me to just XYZ. Yeah. I mean I get it. Part of it is education. It's not like I'm not just like you need to cut these things out of your diet. Right. See you next time. I say why, you know, and and really explain to patients that if they have a tense pelvic floor and I recommend pelvic floor physical therapy, I have to tell them why. I can't just say it. Some people are like, I don't want to do that. You know, I don't want to take time. And I respect that patients have to take time to go out of their way to go to these therapies or do these things and you know. Patient buy-in is really important. And I think the to to achieve that and to build trust is to explain to them the path somewhat the pathophysiology. Like I'm not doing a whole lesson, but explaining why this is happening and why it makes sense and and and oftentimes patients do see improvement if they try the things that I try say to try. And I mean just physical therapy cannot be overstated, I feel like it's so beneficial but it is I know why we tend to avoid it because it's another appointment, it's time and it's often not covered by insurance. True. Jasmine Tibon (24:21.826) That is that is true. And that is a whole other I'm sorry. But I'm like I've seen the benefits of So and it shouldn't be accessible to only those who can't who have insurance that covers it. Yeah. It should be accessible to every and I think there's going to be a change. I know where we're at where I'm at now, we're really trying to advocate for access to pelvic floor physical therapy because I'm a firm believer it should not be for the few. It should be available to all. Doctor Tibon, before you were here, before women or before you went Northwest Arkansas, maybe women here went without care or they had to travel far, you know, to get it. What does that kind of gap cost women? Maybe talk about the physical or emotional toll. Well That's exactly it. I mean, there are I think our community has done a really good job in terms of providers who are not necessarily fellowship trained filling gaps to make some care accessible here. But if you want subspecialty like fellowship trained care, you would have to drive, you know, a couple hours, Kansas City, Tulsa, Little Rock. And there are wonderful providers there, some of whom have trained me. But do you really wanna is someone gonna drive? Jasmine Tibon (25:41.72) three hours to see someone, to maybe have surgery in a place that they're not familiar with, to, you know, follow you know, that's a lot of driving a lot. And you know, if a patient can't afford to drive that far or have a hotel stay, or, you know, that I think that women probably even more so were like, you know, I'll just with it. Yes. Absolutely. Because of yes, the convenience of someone being here. I mean, I see that all the time with you know, with my own personal physician visits. Okay, well is this person here? What or okay. And it probably does tend to lead women and men to just okay, well, there's not someone here so I'll manage. Because like I said, you know, th this is quality of life and it's amazing how much women can take, right? And it's not life or death. And I and it and that being, you know, said, if there was an issue with your heart, you probably would drive three hours, you know, but that's it's easy for people to say, I'll just deal with it. I'll buy more pads. I'll cancel my trip. I you know, 'cause I'm afraid to fly with this significant discomfort or this significant incontinence. I think Northwest Arkansas Is doing such a great job and we are on such a turning point, especially being from here and seeing like where we were to where we are now to really providing subspecialty care. We're growing, you know, there is a catch net area around us that's underserved. And I think it's gonna continue to grow and get better. And I'm really excited to be kind of on the, you know, cusp of that change. I mean, we have a medical school here for goodness sake. I mean, I would never have thought that. When I was training, you know, UAMS and Little Rock was the only medical school. Now there's multiple in the in the state, but to have one right here where we're really growing, changing, bringing in all of this business, all of this innovation. I mean medicine just has to follow. Leslie Zanoff (27:30.028) I know. You're you're absolutely right. It's an exciting time to be here. And I know that we're so glad you're back in this area. Yeah, of course. And you know, I think I talked to my pa you know, this is my community. This is why the community that raised me, that, you know, gave me opportunities, that I got scholarship from. And you know, so to come back and to be able to take care of the women of the community that, you know, know my grandparents or knew, you know, three times remove my friend or my friend's mom, you it it's wonderful and I feel very honored to take care of these patients, but Also, I feel very called to do so, you know, to give back, to bring access to the community that I'm so passionate about. Okay, thank you for saying that 'cause that was something I wanted to to ask you about of just what does it what did it feel like coming home, right, to be back in Northwest Arkansas. So Yes. And it it's so interesting. The now looking back and kind of reflecting on my years and years and years of travel and journ you know, medical training, everything feels so temporary. You know, you know you're going to the next place, you can't put down roots, you don't know, you know, where you're gonna go next, but you know you're not gonna stay there. And, you know, my husband and I are both from here. We met at Elmwood I guess middle school now. It was a junior high when I was there, but Leslie Zanoff (28:45.462) Yes, I like. Jasmine Tibon (28:49.814) you know, we wanted to be with our family. And so it feels like coming home. There's a calm that comes with that. We're putting down roots. We're we, you know, bought a house for the first time, had a baby, did all of this in like a six month time frame. But, you know, it's really wonderful. And in some ways, coming back to a very familiar space, but also a very somewhat unfamiliar space in places. I have to use my maps to get around you know, this part of town. If I go downtown Rogers, I know my way around, you know. But it it's just so exciting to be back to feel at home, but also have some of the city amenities that I was kind of sad to leave Kansas City and San Antonio for. But it's wonderful. It's wonderful. All right. I want you to talk about your research that you focused on the therapeutic called the therapeutic alliance. You mentioned that, but just the relationship between a physician and patient and how it affects outcomes. Will you talk about that? Yeah, absolutely. I mean, I think it's hard in medicine these days because the the kind of pressure is to see more in less time frame, right? Which really significantly changes it, you know, most physicians do not want to rush through your visit. We don't want to cut you off. We don't want to, you know, make you feel unheard. But it's really challenging with the way the system is in terms of like the pressures that we feel to be productive, to see more patients, to you know, we see I I think I saw something on you know Instagram from one of my mentors that it's like walking in the room, you know, oftentimes visits are 15 minutes and every 15 minutes you have a new meeting. So if like in your in business and you have every 15 minutes you have new meetings, in that 15 minutes you have to talk to the person. Jasmine Tibon (30:37.368) Get their history, you have to document it, you have to charge for it, and you have to close it and see the next patient. And so that really doesn't foster the ability to create a relationship, but physicians are trying, right? And so in my research, it was, you know, a survey looking and we talked about the bladder pain to see if the way that the physician kind of made that patient feel in terms of validation, trust, respect, validating their concerns, you know, did that. potentially transform into improved perception of control of their condition or control of their pain. And we, you know, found that the more trustworthy a provider was or the better their the relationship were, did somewhat translate into their perception of how well their p condition was controlled. And so in my day to day, I really try to not discredit patients' symptoms. You know, pa yeah people have different experiences and I hear all different kinds of things and how they characterize their Complaints, validating concerns, but also redirecting and telling them what I think, you know, the next best step is. And so I think creating that relationship, especially in my line of work with quality of life, is really important because you know, we don't have to do anything, but these are the things I think we could make you better. And having patients buy into that is where the therapeutic alliance kind of comes up. Yes, the quality of life though we can't understate that, I don't think. Right. And I want in the end I want patients to walk away from my clinic appointments feeling Leslie Zanoff (32:08.174) Hopeful. excited, you know, trust me with their care. I think that's really important. And I feel really honored that patients do feel that way. Hopefully most of the time. Of course yeah, of course they do. What does shared decision making look like in your exam room? I mean, what does that feel like maybe for a woman who's never experienced that kind of care? I know you've you've touched on it, but let's maybe go little deeper. Of course. So, you know, I I am not a one size fits all clinician. There are a lot of different ways to manage these conditions. Some in the literature have been objectively better than others, but I think that patients might not need the most invasive, the most involved procedure. I like to present a menu of items to my patients, and my job is to give them the evidence, the data. This is the pros and cons to this, the pros and cons to this, this is, you know, here are lay them out for you. And we make a decision together. They ask questions, you know, what do you think about these concerns or this risk or and you know, sometimes they say, well, you choose. And I often say, I can't, you know, I and it's hard because I think patients do want to trust and like they don't want to make the decision. But in my line of work with like Jasmine Tibon (33:27.928) Quality of life, it is about me meeting your goal. I ask every single patient, what is your goal? That's like the last line of my the first part of my documentation is goal. And I copy it forward on every single note so that I can look back and say, Are we achieving your goal? And if your goal is not surgery, well, I'm not gonna recommend surgery for you. If your goal is not to have mesh placed, then that's probably not the best repair for you. You know, so I make that decision with them. And even though patients will say, sometimes they'll say, What do you think? And I'll be like, Well, considering this, this, and this, this one might be better for you. But I give you the options to choose. And so that's where shared decision making, I think, is important to give patients the information. I educate them on their anatomy, because you know, the pelvic region, the vagina is really hard to see as a patient. You don't know what's going on. Right. And so I tell them. what stage prolapse they are or what I saw on exam or any abnormalities so that they understand and feel, you know, ownership in their own treatment plan. Okay. And a as you're saying that I'm thinking, of course women are coming in to you saying, Can you just tell me what to do? Because we're so mentally exhausted from managing ourselves, maybe our aging parents, our children, our work, all the things. So I understand that. I mean I know you do too, but I'm like Yes, of course. Because sometimes we just want someone to say, Here's what you want, here's what you need to do. So I mean, decision you take is real and analysis paralysis is real. But, you know, my goal is to empower women to underst you know, it's amazing what women don't understand about their own body or about what's going on. And so first and foremost it's education for me. And then if we get down to it and they, you know, need me to point them in a direction, I will be honest, but I don't say, You have this, you need this, see you next time. Leslie Zanoff (34:55.423) Decision material. Jasmine Tibon (35:22.156) Or see you in surgery. You know, I I really want patients to understand what's going on and understand the risks and understand the benefits and what to expect with any of these interventions because I don't want them to us to be misaligned where you might think a surgery is gonna fix this, but it it's really not going to, you know. So I think educating patients and having them feel comfortable in the decision that we make together, right? is important. That Leads me to my next thought of what you mentioned that so much of what you do involves helping women pay attention to their bodies in a new way, right? To stop overriding signals that maybe we've been taught to ignore or we just have been ignoring. But do you think there's a connection between how well a woman knows herself, maybe emotionally, mentally, and then how she shows up? Mm-hmm. Yeah, for her physical health? I don't know. Absolutely. I mean I think like we said, discrediting or pushing under the rug or normalizing symptoms is very common. And some women are very in tune almost too much to different functions. And we have to do some educating on like, well, you don't need to like, you know, sit and try to avoid for 30 minutes. You know, just go go to the bathroom and move on and see what happens. You know, or you have some people that are like, This isn't a big deal, you know, I'm fine. You have patients who are have so much on their plate that they don't even have the bandwidth to take on taking care of themselves or putting any attention to these things that aren't necessarily dangerous in terms of pathology to their health. And I think s kind of bringing people back to this like center to understand their own bodies, to know what's going on. with their anatomy to know, you know, what the physiology of things are is really important to kind of empower women to make the decision. I see patients all the time with like no prolapse and they have all these symptoms that might be considered prolapse. And I'm like, well, I don't think that this is what you have. These are what you you know, and kind of redirecting and and shedding light. Again, it's like the importance of education and empowering women. And I think that's one of my missions being from here. Jasmine Tibon (37:30.41) And coming back to this area is educating women, you know, empowering women to make their own decisions, to advocate for themselves. You know, we talked about kind of social media and the role that that's playing now in up you know, upcoming generations is you know, most people get their news from social media. Right. And they get information from Facebook, Instagram, you know, TikTok, things like that. And, you know, it I always tell my patients, Google light. So like It it is okay to do your own research. It is okay to listen to different people online. But I also think that's where that kind of alliance comes into play and trusting your provider and you know, bringing in information to me. I saw this, is this helpful? And I I validate those things. If I don't think it's harmful, I say it's not a problem to try. You know, if someone says marshmallow root is gonna help your symptoms, I don't discredit that. I think that's fine. It's a benign kind of supplement, you know. And so, you know, bringing women to understand, to advocate for themselves, to do their own research, but also kind of collaborating is really important in my practice and kind of where my research has been. I was gonna say how much time are you spending educating the patients? Like this sounds like a lot you're still doing a lot of educating, which I I understand in it's a complicated these are complicated issues that you're dealing with, but I bet it sounds like you spend a lot of time educating. I Do. And it is a balance because I still have my metrics and things that I have to do. And I have pa I have my I can't even tell you how long my wait list is right now, but I know that, you know, it might be a long wait even to s get to see me, even in the waiting room to see me. But I give every patient the time and an you know, my new patient vis consults are forty minutes, which you know, usually the that's a little bit on the longer side for, you know, patient visits, but I give patients the time that they need. Jasmine Tibon (39:24.256) Especially at the new patient visit. And then we can kind of we might not address every single thing at the fr at the outset. We might have to take it takes a long time to get to where they see me, not necessarily waiting for me, but like these conditions they've had for twenty years. It takes time to kind of understand and get better, you know. Sure. Okay, I wanna talk about you a little bit more just in your personal stories that you play the guitar. Is this something you've done and you mentioned you were creative and so I'm like, Okay. Yeah. Great. Have you always like played since you were little or No, I'm a very amateur guitar player. My husband, he plays a ukulele. His family is very musical and very envious. And so I picked up the guitar. I know a handful of chords, but it's amazing how many songs you can play with a handful of chords. But I love I love having I have to have a creative outlet. I like to think of kind of my time and my be, you know, my personality, who I am, in different buckets, right? I have like my career bucket, I have my new mom bucket, I have my creative outlet bucket. And I have to fill each one of those periodically. And sometimes one bucket has to be more full than the others. And then I come back and it's just like it's a balancing act. And so I have to have a creative outlet. I also have to always kind of be learning something new. I'm kind of crazy like that. And I think it's you know, as I talk to my other patients, it's like It's never too late to learn things. So, like I, for example, have a new sewing machine. It's not been used yet because things have been crazy. But, you know, I just like to always have a new skill and have a creative outlet. And so playing the guitar music is really therapeutic for me. You know, I remember in medical school and in residency when I was really super stressed. Like my husband would come in with the ukulele and play a song. And I'm like, I love it. Immediately, like feel better. And and I think it's important to Jasmine Tibon (41:13.664) incorporate those things into one's life, especially, you know, people with demanding careers, people who are mom stay at home moms and have, you know, have a entire household to manage, anybody in between. It's like you have to serve yourself and the foundation to be able to for me to be able to take care of my patients. And then I have to fill my cups to take care of my family. And you know, it and it's a balancing act. So I always have to have a creative outlet. Absolut. I love that. There is a book that I read. It's called How to Have a Good Life. And he talks about that. I'm like, are you filling all these buckets? And that that was the next thing I was gonna talk to you about, about how you stay connected and care for yourself while you're managing all of these. It is really challenging. I think this past year I took on an awful lot. I, you know, graduated from fellowship, moved back home, bought a house, had a baby, started a new job, which is a lot to do in such a small amount of time. But, you know, there's nothing like jumping in the deep end feet first. But I mean this is a lot Jasmine Tibon (42:20.032) I have to kind of always if I feel unbalanced, I am thankful I have a very good support system around me. My husband is one of which he's he has taught me a lot about like control I can only worry about things I can control, you know, filling up my cups, not being so hyper focused on one thing. And sometimes things need my attention more than others. And there are sacrifices and but it's i it's a balance. And for example, my my support staff currently it They are wonderful. And my nurse is like, you need to put your 2027 vacations on the books because I'll just keep going along and not take a vacation and be like, I'm so tired, you know, and then realize, I have all this vacation to take. But, you know, it's just to having a good support system around me to kind of keep me balanced and it's so important because it's hard for me to do it myself sometimes. It takes a village. It's It does take a minute. Okay, well what do you want women listening to this conversation to just walk away knowing maybe they didn't know or feel before? I think I want women, especially in Northwest Arkansas, to ask questions, to be forthcoming, to tell their provider what is bothering them, to not sweep things under the rug, both with their health and other things, you know, being direct and and taking control of you know, we often have so much to worry about and so much in our in our plate to digest and Taking a a small time for yourself, whether that, you know, it's exercise, being outside, you know, going to the doctor if you haven't been in years, you know, it's just doing something for yourself to fill your own cup, you know, because like I said, there's all those different buckets and you have to fill each one and and oftentimes we d ignore ourselves. And so to be able to be successful in the household, in the job, in whatever in endeavor you're going on, you have to feed kind of yourself first when it feels abnormal. Jasmine Tibon (44:23.318) And so that's kind of the figurative thing that I want people, you know, listening to hear. But also if you are having any of these public floor conditions circling back, you know, don't sweep them under the rug. You know, there are people out there that can help. There are, you know, we are here to help you and here to serve. And like I said, I'm this is my community. This is what I'm passionate about. I want to be here for the my the women of Northwest Arkansas. Love it. I that and I love that you said you love to learn and since the show is called A Lifetime to Learn. I was thinking are there things or is there something, many things it's taken you a lifetime to learn? Lessons you're still learning. Yeah. Jasmine Tibon (45:02.99) yes. my gosh. I mean the obvious is like the medical journey. Looking back now, it's like, wow, that was a really long time. And it takes, you know, a lot of resilience to kind of make it through. I'm not like tuning my own horn, but like any journey that takes a long time. You have to kind of be diligent and resilient. But I mean, I think it's always a balance for me and in terms of not getting overly stressed, seeing the forest through the trees, you know, I can get really honed in on something and and hyper focused and very anxious about it, but kind of stepping back and looking at the big picture and, you know, controlling what I can control. I think having really good, you know, my family as a support system, my husband, my mentors, it's really hard for women to ask for help and to, you know, like we said, com you complain about something or mention something, but I have learned that you have to kind of lean on the people around you. You have to if something is bothering you, I've learned to just be direct and and address it, you know, instead of like I I often can like mull over it and like talk about it incessantly until like someone's like, You have I had a a friend in residency, something bothered me and I was just like incessantly talking about it. And she's like, Okay, you have five more minutes to talk about this. And then we're moving on. And I'm like Okay, so you know, those things you it's can it's a it's practice, you know, and like you you know, with you with meditation it is a practice it you know, to continue to kind of improve. I think one thing I do that I find really beneficial is every year I don't s have resolutions, you know, New Year's resolutions, but I have intentions for the year. And I set out, you know, I think it's like Jen Atkin, you know, she's like a celebrity hairstylist, but she does this and that's where I got this idea from. Like health, career, family, you know, recreation and the things, the intentions that I have for the year. And you know, usually around six months I look back and like, what have I achieved? What have I not? And it's continuing to grow and to like challenge myself. I think like camping has been on there for the last like three years. I haven't done that yet, but like, you know, just and and every year I can look back and move things forward and you know, this is what I achieved this year. And and I think that's really Jasmine Tibon (47:22.85) You know, it's not like a resolution to lose weight or do one thing. It it's just like continuing to grow and that is a practice. And so those are things that like I continue to have to challenge myself to do because I don't I wanna keep growing and learning new things and you know important. Yeah. I love that. Yes. I love that. Thank you so much for being here today. This has been great and I'm excited for people to listen to this. Absolutely. And you know, I'm here for the lot you patients asked if I'm leaving. I don't think I will be. I I'm this is where I'm from, this is where I'm putting roots down. And so if you have any urogynecologic complaints, yes look me up. Thank you so much. Jasmine Tibon. Yes. Thanks for being here on a lifetime to learn. If today's episode inspired you or sparked a new thought, please share it with someone who might need it too. And if you haven't yet, be sure to subscribe to get notifications when we launch new episodes. I've got conversations with extraordinary people lined up, and I can't wait for you to listen. For more information on how to work with me, visit LeslieZanoff.com. It's where I share resources to help you lead with presence and live with intention. Because remember, we're not here to have it all figured out. We're here to keep showing up with open hearts and open minds because we've got a lifetime to learn. Until next time, friends, be well.