well hello and welcome to HealthLine this Tuesday evening.

I'm Jennifer Blomquist.

Thanks so much for tuning in.

I know you're going to love the show.

You will walk away learning something.

I can guarantee that.

So if you're new to the program I want to explain how it works.

We are live in the studio and we keep our phone number up at the bottom of the screen.

Actually two phone numbers for you because we encourage to participate during the show.

We have a guest with us tonight.

We're doing a women's health program which is great.

We haven't had the opportunity to do too many of those in recent years so I'm excited to be able to do that tonight we have a euro gynecologist here this evening and he'll be more than happy to answer your questions.

So here's how you can do it.

You can either call Salmat phone number (969) 27 two zero.

>> You'll talk to a call screener first you can ask the question life which is great because the doctor may need to get more information from you.

Maybe he can give you a better answer.

You can have a nice conversation and I really like that option.

But I understand if you prefer to just give your question to the call screener, they will relay that to me and then we'll get your question answered that another new option we just started it this past winter is to tax a lot of people really like doing that.

That's a little different phone number it's (969) 27 three zero and I want to show you your phone number will remain private.

We absolutely will not put that on the screen if you feel comfortable, give us your name maybe where you're calling from and your question and again, that's a great way to get your answer.

So let's go ahead tonight and introduce you to our guest again.

I said he's a euro gynecologist.

Dr.

Scott Boyd, thank you so much for coming on.

>> Appreciate it.

Thank you.

I'm sure most people watching will say oh gynecology.

I know that is euro gynecology maybe not so much so why don't we just before we get into some of the topics we were going to discuss, just talk about what that specialty is and why somebody might need a guide your gynecologist.

>> So it's a it's a specialty outside of Jilian so you can UN residency programs and then you get specialty training in female pelvic reconstructive and medical problems.

So it's focused on female pelvic problems such as incontinence prolapse, not just the surgical aspect but even the medical aspects.

>> OK, so would you say in general it's going to be an older population that would need the specialty or do you feel like not so much.

>> It's more common in the 60 plus but there are plenty of women who will have issues even in the childbearing ages so we don't tend to see it in the twenty year old.

But anybody beyond that starts having problems the younger the patients in the younger areas tend to be a little bit more better at noninvasive techniques as far as getting good outcomes they tend not to have much prolapse and surgical needs but yet starts in the probably 20s and 30s and beyond.

>> OK, so can you kind of discuss what what is the pelvic floor?

>> Is it just or is a muscle or I don't know people probably hear it but don't know exactly what that is.

>> You're a good analogy I think for for patients and people to think of it as a trampoline.

>> So in the end a trampoline scenario you have the frame of the trampoline I think of that frame is as the bone of the pelvis and then you have the springs of a trampoline and think of that as connective tissue and ligaments and then you have the mat the trampoline and think of that as the muscles and all of that is there supporting the whole bottom part of the of the pelvis and that includes things like your bladder, the uterus, the.

>> And so that's kind of the structure and there can be issues.

>> So people have probably maybe heard of the the prolapse is what exactly happens when there's prolapse?

Is it all based on something with the muscle?

It can be yeah.

So any of those structures I mean we typically don't see it in the bone but and the ligaments connective tissue in the muscle you can have defects in those areas and then that can lead to things beyond the normal terms a dropped bladder.

Yeah so that's we call that system Seale's but you'll have a falling down of those structures.

So the is in some ways herniate sitting down or falling down.

It could but it doesn't have to be just the bladder.

It can be the uterus.

You can get uterine prolapse, it can be on the bottom part of the.

We call it ACL.

We're think of this think of these as like herniation of the vaginal wall or the pelvic floor.

>> Do most women know right away if there's an issue or could you have this issue and not know until maybe have an exam?

>> Both OK, so if you think about no wise any any woman who has had a vaginal delivery 50 percent so one in two of those women will have some degree of pelvic floor prolapse most of time it's asymptomatic so early on they don't have symptoms they may not know it's there and that's OK.

That doesn't have to be addressed.

>> But later if they do have the prolapse as long as they're not happy, it's really mild.

Right?

So there's degrees of prolapse and early early degrees are OK.

That's not anything that necessarily needs to be addressed.

If they bring it up with their physician or you're a gynecologist, we can encourage them to do things that are simple like kegel exercises.

Physical therapists know noninvasive techniques if it advances then it tends to become symptomatic.

>> Is it painful for women or is it just something that's maybe more of an annoyance?

>> It's something in between.

So if it's something that's terribly painful then we tend to think there may be something else going on.

They need a different or a more inclusive specific workup but it can be painful.

It can create back pain, low back pain.

A lot of times women describe pelvic pressure feels like something is falling down a pelvic pressure.

It's a lot of times associated with bladder dysfunction so either leakage of urine or retention of urine.

So more often than not it's just more of just a vague kind of pressure, discomfort, heaviness where they look and they see something coming out of the vaginal space, you know, and I was wondering if it happens gradually or can it be sudden or can you have both?

>> Yeah.

And so most of the time I would say it's more of a gradual process and that's a problem.

Right, because then you start to learn to live with it and then I've been living this for the average amount of time that a patient a female patient will live with this before they even mention it to the physician for the first time is about seven years.

So that's huge.

Now flip that coin over.

It can be very sudden.

I have a number of patients that will come in weekly and they'll they'll pinpoint I had a patient a couple of days today.

They can pinpoint the day in the time.

OK, so sometimes whatever structure is breaking, whether it's a ligament, usually it's a ligament dysfunction that becomes more acute like hey I was fine and then all of a sudden boom.

>> So now do you have to do any imaging or scans to be able to diagnose it or can you just go through a pelvic exam?

>> Most of it you can diagnose with a good pelvic exam and a good history and just talking to the patient there are some specialty tests that will do especially as it pertains to bladder dysfunction.

So if you start getting into the realm of leakage of urine since there are so many different reasons why you can have leakage of urine, we'll do some very specific testing.

But for the most part it doesn't require a whole lot of imaging.

You know, we don't typically we're not typically ordering CT scans, MRI and ultrasounds, most of which just a good physical in history.

>> So you know, people don't like to have surgery.

We were talking about this before the program most and you know, it's it's recovery time I think surgery I mean I'm sure it's not scary for you because you're a surgeon but for most patients it's just something you would dread.

So you kind of mentioned you if they're a candidate you would start with conservative treatments.

Can you touch a little bit more on the Kegl exercise?

Wait years and years ago we did have a physical therapist who kind of specialized in that and so I had never heard of it before but she was telling people that yeah, you can gain she talked about like regaining control of your pelvis.

>> Yeah.

So Kukali exercise it's the stats on that.

So about half of women who we're trying to train on cool exercises will ask him how do you do you do.

He goes Oh I do Kiehl's I've been doing it since I delivered and then you start coaching them on it and you'll find out that about half of them are doing it wrong.

They're actually pushing not polling.

So it's the best way to think about it.

I think if you're trying to hold back a gas and you're like clenching your whole pelvic floor as tight as you can so you're trying to clench and pull upwards of your pelvic floor and you don't want to hold your breath.

You don't want to push or actually trying to do it without straining it.

And a lot of times again fifty percent of people are actually pushing which makes worse than that.

>> So a lot of times we'll send patients to a formal pelvic floor physical therapist that can help coach them on those things.

>> Will there be any other conservative treatments you can try beyond that or even of medications or injections so much from a medication standpoint relative to prolapse?

There's a lot of medication options when it comes to different types of leakage problems when it comes to prolapse we'll look at sort of risk profile as this patient chronically constipated and straining what's her workout routine weight can be an issue so are trying to eliminate and alleviate strenuous chronic strain on the pelvic floor and I want to continue this conversation but we did have somebody text in a message so this is interesting.

So this is from Wesley from Fort Wayne basically what was of gynecology can handle that specialty would handle the issue of kidney stones.

>> Short answer is no.

OK, we kind of bridge the gap between gynecology and urology.

Yeah.

So think of gynecologists are people who are dealing with female pelvic problems such as bleeding, birth control, hysterectomy and then you have urologists and urologists typically will take care of men and women and they'll be involved in things like kidney surgery to include kidney stones, bladder cancers, incontinence for both men and women, prostate issues.

And so we bridge that gap but we're still solely focused on female care and one of the things that we do not do is kidney stones.

>> OK, they have us interesting we did have a urologist out a few months back and I was surprised when he said I thought he was going to say he just treatment but he said he does he does treat the women for the kidney stone so.

>> All right.

Well thank you, Wesley for that question.

Just a reminder you can call us and ask a question (969) 27 two zero you can text like Wesley did.

That was great.

(969) 27 three zero.

And again, just want to remind your phone number does stay private if you want to do the texting route.

So when you were talking about, you know, conservative methods and then going into the surgery before we I want to ask you about some exactly what happened during the surgery.

Do you find that this tends to be a hereditary thing if your mom or sister had it?

>> Are you at a higher percentage?

Yes, the answer one question I get pretty much every time a patient has significant prolapse is y yeah.

How this happened what did I do?

Why and sometimes in medicine we don't know like we we might not have the Y in this case.

I always tell them it starts with genetics so ultimately it's a genetic predisposition.

So for whatever reason their genetic predisposition genetics basically predisposed to have some weakness in that trampoline somewhere and then a lifetime of risk factors.

Right.

So and the risk factors can be as simple as coughing, walking ,running, laughing, sneezing but then you start thinking about childbirth, multiple babies, big babies, long laborer's birth trauma.

What kind of a job are you are you living on a farm and you're lifting stuff all the time repetitively?

You work in a factory, anything that creates chronic pressure and the pelvic floor could even chronic constipation which we see a lot of so but it starts with genetics and so and when I say that most of the time the patient will say oh yeah, my mom's had this oh my grandmother had all my sisters had this.

>> Yeah.

When you were talking about women having a lot of children what if you've had only C sections does that change your your risk factors statistically yes.

>> So because you have that scar tissue in there too I didn't know because I think they will do up to why I've had four but I know three.

>> Yeah they're going to go five or six.

The short answer is yes they it's not a guarantee.

I've had patients who've never been pregnant and have prolapsed but most time if you look at the profile most patients have had multiple vaginal deliveries by having a C-section and avoiding the birth trauma it definitely reduces your chance but it's not eliminate and it's there are some countries Brazil is a good example where women will elect to have primary C sections pretty much almost universally and part of the thought process behind that is they're trying to save the pelvic floor even in in America a patient can elect to have a primary C-section or any C-section.

>> She can just say hey, I want to I want I want a C-section and there that's OK to do C and I thought that I remember reading about that issue years ago that people were doing it not so much for the medical aspect of preventing pelvic issues but just for convenience sake.

You know, I want to make sure you know, socially we have other children like I my situation was different.

I didn't elect I had to but but I didn't know that you were given the choice anymore if that was just kind of a culture that they give them the choice.

>> But if you if you if you bring the choice to the physician they want honor that so there's a lot of pressure and it's it's less invasive.

I mean C-section is a significant surgery.

Yeah.

So I wouldn't advocate to everybody, you know, follow the Brazil path where they just everybody's getting C sections .

But to answer your specific question yeah.

If you have if you have a C section there is some thought and some data that says it reduces your chance again not zero.

I wouldn't advocate to assure you to avoid vaginal births and just everybody at C section so yeah, I wouldn't advocate for that.

>> Well it's just interesting to hear about how countries you know, look at things too from the medical perspective.

So what if you are in a situation where you're going to have to have some reconstructive surgery?

I realize there's probably not a cookie cutter formula.

Everybody's probably different.

But in general, can you talk about what you need to do in the surgery and is it done laparoscopically?

>> Yeah, so it's it's definitely not cookie cutter.

It's very one of the very much one of those things that it's very personalized sometimes we are figuring out exactly what to do when we're actually operating.

We generally have a very good idea of our approach but you know, it's it's a reconstructive process.

So as you get in and you start to reconstruct and find out some more of the specifics anatomy sometimes you have to change your plan.

It varies.

There are, you know, vaginal purely vaginal techniques.

There are open abdominal techniques.

Most of the surgeries that we are doing is utilizing robotic or minimally invasive surgeries nowadays.

>> Yeah, I didn't even know if they would still do the traditional incision, you know, incision where it's very rare.

>> OK, I've done this for going on 30 years now.

I can't tell you the last time I've done a big open incision I don't remember when it was yeah I know the minimally invasive is definitely the way to go.

>> Years ago I remember the whole controversy about the mesh.

I'm sure a lot of women would recall that there were issues you know and you see these commercials on TV from these legal firms like if you had a mesh put in between such and such a time and experience complications you may be able to to sue.

>> So there were complications I don't remember the exact time frame but if you want to talk about that and is that something you still use and should people be worried?

>> Sure.

Long topic but I can give you a 60 second to talk all night.

>> I could think of it this way.

So in twenty nineteen the FDA took a specific mesh product off the market or made them force them to do it.

That mesh product was a what we call a transvaginal mesh product meaning that mesh was inserted in through vaginal incisions OK and it was that specific product and pretty much that only specific product that that created that whole storm of fear.

>> And we've literally been diving we've been digging out from underneath that now for many years now.

So ultimately the mesh products that we use currently there are decades of use some of the mesh products we've been using for 50 plus years well study great data and depending on the degree of prolapse if you have to use a mesh product such as something called a sacred kopeks which we're using mesh to secure the whole that is still the gold standard but again that's that's a very specific extreme form of prolapse.

So most of our prolapse surgeries we're not using mesh but we we do use it.

>> It's still appropriate, safe and effective.

But it really kind of comes down to trying to eliminate some of this fear that still exists.

It's gotten better since but the mesh that's been taken off the market is it was just one mesh product and really it wasn't so much the mesh itself is sort of the technique of how they're putting it in and that's where you could get in the hole long our conversation.

>> But suffice to say we still use mesh very appropriate to use in the right patient and very safe and effective.

>> So as the mesh I had read something that said it acts like a sling.

Is that is it true so much you think of it that way a sling is a very specific term that we use.

There's a sling which is a specific small little tiny piece of mesh that we use to support the urethra for leakage.

>> Sure.

Then there are vaginal mesh that we use for significant prolapse most of the time what we're doing for patients and may vary a little bit from your gynecologist, your gynecologist but most of time depending on a degree will we'll try to do a well called native tissue repair.

So we're trying to avoid putting any foreign body in and then if the if God forbid that fails because about 10 percent of the time these things can fail, then we would opt more for a you know, a mesh type procedure or if it's a really bad prolapse we're like hey, your trampolines gone.

>> There's nothing I can use and we'll have to opt for mesh.

Interesting.

Thank you for clarifying that.

So I want to quickly take another question we received through text was from Nellie from Fort Wayne .

She was asking what are your dynamics and she wanted to know if tests are required before and appointment or if you're required to go through some testing before you can have an appointment with a gynecologist.

>> You're so you're dynamic's is a very specific test that you're all just due to.

>> But it's it's most in the realm of you're a gynecologist and it's a test that's looking at the reasoning behind leakage .

>> So if a female patient is having incontinence or leakage of urine like I said earlier, there are multiple different reasons or problems that can lead to the leakage and the dynamic test is something that will help us delineate the specific cause and then we can get really specific in in the solution and as far as the what's the other part of the question of testing, testing, testing before you can have before so so typically if a patient is having any of these issues they can either go see their primary care and then their primary care can do a quick initial evaluation then refer if they are hey I know I'm leaking right now I have a prolapse.

They can just skip that come right to the your gynecologist.

We'll start with a very thorough history physical exam and then from there we'll decide if any further testing is is warranted and your dynamic's is definitely something that we utilize quite a bit.

>> All right, great.

They just showed me the card.

We have five minutes left.

I told you it goes very fast.

It does go extremely quickly.

So but that's plenty of time to get some questions answered.

So again you could text us (969) 27 three zero call us (969) 27 two zero case.

I forgot to tell you this if you're outside of Fort Wayne still free college just put six in front of there and won't cost you a cent so we can get another question or two answered easily since we were talking though in the meantime about leakage and I want to ask you what urinary incontinence which before the show we were you were saying that a lot of people just kind of learn to live with it and they don't bring it up.

It's kind of embarrassing and I think, you know, I just hear a lot of women say, oh, you know you know, if you laugh or you know, sneeze or cough when you're older you're just going to leak.

>> That's just the way it is.

So can you talk about there are two kinds you said emotively to common ones.

Yeah, I would start with very common but not normal.

OK, at least one in three women will have some form of incontinence problems.

You can start early so you'll get a lot of women again around the childbirth that you can have women who've never been pregnant who are young athletes, great running at full bladder they can leak the younger the patient we tend to be very successful and just teaching them Cagle's doing some physical therapies later on in life , especially if it's been a chronic ongoing problem.

If it's getting worse they will do your genetic testing to see kind of what it is and as we delineate the different types, medicines can be very helpful.

So there are different types of medicines for leakage.

OK, that's for what we call an overactive bladder which is like got to go.

>> I got to go.

Got to go.

Yes.

So that urge and but bladder retraining and teaching patients how to double void how to bladder retrain so they can expand the bladder it's a very good technique's avoidance of things that can be bladder irritants, caffeine, chocolate, acidic foods for what we call stress incontinence, physical therapy, Cagle's and even slings which is that minor surgical procedure for that.

But we also have injections sometimes an overactive bladder of the more conservative things fail.

Then you start thinking about Botox injections.

>> I read that that was interesting Botox as a cosmetic inject that into the bladder or even something called sacral nerve modulators which are like little pacemakers for the bladder.

>> All right.

So you have a lot of different options of tools and you were saying it's not normal because a lot of people think that a little bit is OK.

>> But I mean will it if you have just a little bit is it going to get worse as you get older if you ignore it or could it just stay as a minor issue for fifty fifty fifty fifty so but still even good enough even if you have a little and you're noticing it again and see your doctor and they can start coaching you on some conservative therapies to try to keep it from getting worse.

>> I remember years ago doing a story when I was a reporter television reporter that there were some women that wouldn't they wouldn't go anywhere, you know, they they got to the point where they were so nervous about having an accident that's happened.

>> So I mean twice a week I have a patient come back from either surgery or some successful therapy and not always in tears but a lot of times they'll be in tears and they'll literally say thank you.

>> You gave me my life back.

Yeah, People don't think about those huge social medicine to us so we just have a couple of minutes left.

>> So I was wondering if you can just kind of quickly give the audience an idea of what is going to happen when you go to your gynecologist because it's not something a lot of people go to are a lot of women they go to and they may be a little scary.

So is there kind of a routine exam is like a complete physical or do you just focus in on whatever the issue is?

>> Yeah, I think probably think of it it is just like going to see your gynecologist and having a pelvic exam.

It's really no different than that in some ways not even as bad.

OK, so that's the worst part of it.

So most women you know for better or for worse have gotten used to that but the see so yeah nothing to be afraid of .

We're not doing anything that's weird or painful.

It just kind of a good pelvic examination, normal pelvic examination and then from there even if you have to do your dynamic's it's just a very small catheter so it's not a it doesn't require anesthesia or recovery .

So most time it's probably less of a nuisance than even just a routine annual exam.

>> All right.

So sometimes if hold you back so hopefully people will if you're out there maybe it's yourself or somebody you know or care about share this information with them for sure.

Absolutely.

And the show is over which is sad because it goes so quickly and we have so much wonderful information to share.

So again, Dr.

Scott Boyd, really appreciate you coming on tonight.

Thank you and many thanks to all of you for watching and great questions.

We have a wonderful audience.

I certainly appreciate that.

Have a good night and we will be back here next week with Dr.

Patricia Clark.

She is a surgeon.

She'll have a great amount of information to share with you as well.

>> Take care.

Have a good night.

Bye bye.