01-22-24 Primary care and preventative care for women with Dr. Cara Swanson

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Episode Transcript

(00:00):
I have Good morning. It's ChristinaWolford. It is time for Lady Parts
with doctor Richard Villarreal of Adena Women'sHealth. Good morning, doctor Villareal,
Well, good morning to you.How are you today, Christine? Doing
great? Starting off the new year. Good. And we always talk about
health issues for women and it isno different today. You've got a special
guest that we're gonna be dealing withwomen's health today. Do And you know
what, it's really interesting because usuallyI get out this is probably every day

(00:24):
I get asked about primary care providersthat they're trying to find somebody. And
today we're lucky because we have oneof the brand new providers in town,
doctor Swanson, Doctor Karra Swanson.She's an internist and she is with the
Internal Medicine Group at Adena, soshe is home raised. She did her

(00:47):
residency at Adina in the internal medicineprogram, went to Lincoln Memorial University College
of Osteopathic Medicine. So we're veryexcited to have you here today. Kara,
Hi, thank you so much forhaving me. So what we're going
to do is we're going to talka little bit about Kara and what she
likes. We're going to talk aboutsome things that women are really forgetting about,

(01:07):
you know, because one of thethings that and one of the reasons
behind the show is that women don'ttake care of themselves and they're always too
busy with their families, their parents, you know, their kids, everybody
else. They take care of everybodybut themselves. And so I think one
of the main reasons behind this isto get them to understand that if they

(01:29):
don't take care of themselves, youknow, and something happens to them,
what's going to happen to their families. So what we want to do today,
we're going to get started, andso I'm really interested. You came
from Lincoln Memorial. Where is LincolnMemorial. It's located in Harrigate, Tennessee,
which is just outside of Knoxville,very fun area. Yeah, and

(01:51):
then you came to Adena and youdid your residency program. So why internal
medicine? So it's kind of funny. Actually I thought that I wanted to
do hospital medicine, and then Igot in the hospital, I quickly realized
that was not for me. So, but I liked the complexity of it,
to kind of puzzle pieces, puttingit all together, trying to figure

(02:13):
out what was going on. Yeah, well, you know the nice thing
about internal medicine, My wife isan internist also, and it's interesting because
you do you take care of alot more than the complex patients, you
know, with the hypertension and thediabetes and all the other big issues.
And it's nice, you know,especially having you here on the show.

(02:34):
She is taking patients, which isone of the nice things. And so
you know, she's very nice andso hopefully you'll get to know her a
little bit here on the radio showand want to call in and get an
appointment with her, so we cando that. But I think it's important
to realize that she is an internist, and you know, if you do
have medical issues, even if youdon't have medical issues, male or female,

(02:58):
that you can get into her andshe can help you. Absolutely.
Yeah, I love to see youso coming to a Dina. What did
what did you like about the communityaDNA and Chilicothee area and the Ross County
itself. Yeah, so I grewup in Tennessee and I spent a lot
of time, a lot of mytraining throughout medical school in smaller towns,

(03:23):
and Chillicothee has a lot of thesame vibes as the places that I've trained
before. And I remember my interviewday at Chillicothe. Here at Adena,
just the people that I talked to, I was like, man, these
are the kind of people I wantto work with. They were just so
friendly. I just instantly felt athome and I just didn't want to leave

(03:46):
and I never did, so that'swonderful. But yeah, I do we
when we bring people into interview,I think that's one of the biggest things
they come in. And we've donethe same thing because we've been interviewing in
of stetrics and gynecology, and thewomen that come in for us, they're
just like everybody is so nice,and they are. The providers are wonderful.

(04:10):
They're very nice. They want tolisten and take care of you because
you know, what's interesting, Whatpeople forget is that we're from here.
You know you are. I say, these are our peeps. Is why
I tell everybody there, these areour people. This is our community.
We see them outside at the shoppingcenters, at the grocery store downtown,
and these are people that we wantto take care of because we're around them

(04:33):
all the time. And it doesn'tmake sense to me why you wouldn't want
to go anywhere else because I seeyou on the street. I see you.
And the nice thing is when Igo out anywhere, you know,
women always runn up to me andsay, oh my gosh, I got
to make an appointment with you,you know. And so when you see
these primary care providers like Kara,you know, that's what you should be

(04:55):
able to do because she's going torecognize you. You know, you may
not recognize their name because they're newto you, but she'll recognize your face.
And then you can tell her andtell her little about yourself and say,
you know what you've been done agreat job, or you've been helping
me tremendously and this is what I'vedone. And that's the nice thing about
it, because we're here and that'swhat you want. So this way makes

(05:15):
it easier to get in. Theyknow, and they want to make sure
that you do well because if youdon't do well, it looks bad on
them anyways. And you know,if your doctor doesn't live in this town,
who cares, right, they're notgoing to know and they don't have
to see you. Accountability accountability,and your doctor's here. We have accountability.
We always do. And so Iyou know, I keep telling everybody,

(05:40):
I said, that's why it's important. So you do want these people,
but you know you're homegrown people.Your people that like the community,
that love the community, that lovethe people here. That's what's important.
So tell me a little bit moreabout yourself so we can talk to the
people about it a little bit.Well, like I said, I'm a
generally from Tennessee, so kind ofan Appalachian girl. And have you got

(06:09):
out in the community and done things. Yeah, So I love going to
the parks around here. I spenda lot of time, like I love
going to yok Tangy and Matauqua,like the reserves and stuff around here.
So it's beautiful nature. I liketo spend time outside. I have a

(06:32):
couple of dogs, spend a lotof time with them. Good. Yeah,
So, well, you know itis, this is the best place
to do that type of stuff.And if you get out to Hocking Hills,
that'd be fun. If you liketo hide. Oh yeah, yeah,
so that would be great. Well, let's talk about some of the
biggest opportunities as you're as a newinternist. What do you see and you're

(06:54):
getting these patients coming into you andthey're all new to you. What are
some of the biggest opportunities. Whatare some of the things that people are
getting to look at and take careof themselves. So there's a lot of
things, I think the just thebasics, Like I've had quite a few
patients come in, you know,they'll have something really cool that Adina does

(07:16):
is they'll go into workplaces and they'lldo screening. So I've had quite a
few patients who will have caught theirA and C being like thirteen fourteen just
from a work screening and they hadno idea. So blood sugar is being
really high. A lot of patientscome in their blood pressure is just off
the charts and they don't know andthey'll say, oh, well, I

(07:40):
feel fine, And that's really scarybecause blood pressure is one of those things
where you can feel fine for areally long time until something happens. And
then there's the kind of screening typestuff that people will kind of just let
fall through the cracks, things likecervical cancer screening. A lot of women

(08:00):
that I talked to you, I'llsay, oh, it was your last
PAP smear, I don't know,maybe ten fifteen years ago, you know.
And then something especially that I thinkis really important in this community is
lung cancer screening. And I thinka lot of people don't know that Adena
does lung cancer screening for free throughthe hospital. And so that's another thing

(08:26):
I see missed as a missed opportunity, Like my patients don't know first of
all, that they qualify for itand that we offer. Well, let's
talk about that, because I reallydon't know a lot about that. So
tell us a little bit about that. Yeah. So it's patients who are
age fifty or older who have sothey recently changed it, so I might

(08:48):
I might miss quote. I thinkyou have to have a twenty year smoking
history and pack your smoking history andor have quit in the last fifteen years.
Ok. So yeah, and thenso and then you do a yearly
low dose CT scan for lung cancer. Yeah, and Adina offers it for

(09:13):
free through the hospital. And theway to get involved with this is talk
with your primary care provider. Yeahand yeah, and we can give you
the information to call and schedule.So it's a really great program. That's
nice. I know you're saying thisis kind of neat because it's for this
area, and I know we wereon the outskirts of the Appalachian Area,
and I know we do probably havehigher smoking rates than all the countries,

(09:35):
So is that that may be oneof the reasons why they exactly qualify for
that absolutely, just higher smoking ratesin this area in general. For sure.
What are some of the other thingsthat you think that some screenings or
resources that you think people are missingout on that you can help them with
something else? And actually one ofthe I know a couple of the residents

(09:56):
last year in that I AM andFM pro we're involved in is women of
reproductive age screening for anxiety and depression. That's one of the most common complaints
that I see when I have patientsthat I see for the first time.
They'll come in and they're just theirmood's really low and they have been putting

(10:20):
up with that for a long time, and we we do try and screen
for that for a first time meeting, especially for women of reproductive age,
they're just really, really more likelyto suffer from anxiety and depression. So
and then you can take care ofit once you screen them. Absolutely,
if they meet a certain criteria,they can be started on medication. Or

(10:41):
anything medication and reperfer therapy things likethat, absolutely perfect. Anything else,
I keep keep putting her on thespot. That's okay, So well let's
talk. Let's go back. Then, let's let's do some about diabetes.
Let's start there. Okay, Sodiabetes screening. So you said you've caught

(11:03):
a number of people whose A onec's were quite elevated. So that's just
part of your screen package that youdo when they come in. So not
everyone necessarily has to be screened fordiabetes, but usually patients who are overweight,
then we do screen for diabetes.But you don't have to be overweight
to be diabetic. That's true,That is true. And anyone who's symptomatic,

(11:28):
we will scream. And if yousay symptomatic, what are you talking
about? So drinking a lot,peeing a lot, excess fatigue, numbness
or tingling in your hands and yourfeet, those kinds of things. Okay,

(11:48):
let's go hypertension, So we screeneveryone for hypertension. So anyone who
it's pretty normal practice at the doctor. You come in, get a blood
for your stuff slapped on your arm. So, uh, blood pressure,
everyone gets screened for that. Doyou believe in white coat. I do.
I'm a I'm a real generous withmy blood pressure management, kind of

(12:16):
different from some of my other colleagues. I usually the first time I meet
a patient, unless things are reallysevere, I am. I like to
give people a blood pressure log andhave them monitor at home for a few
weeks and then have them come backbecause I do think that white coat hypertension

(12:37):
is absolutely a thing I've had.You know, I've had several patients that
when I send them home and whenthey come back with their logs, they're
not like that. At home,it's not nearly as high. That's why
I quit wearing a white coat.I just wear grubs as well. If
it makes you a little bit lessnervous with me walking in, I won't
wear a white coat. Let's justdo that. So I haven't worn a

(12:58):
white coat probably twenty five years.Yeah, So that's all it takes be
nervous. Well, that happens tome, and I have been diagnosed with
high blood pressure, but I'm managingit now. But every time I go
into the doctor, I get nervousthat it's gonna be high because I'm like,
Okay, it's been really good athome, but I know when he
takes it's going to be high,and then I freak out, you know.

(13:18):
So they take it and then therewas like, oh it's a little
high. I'm like, I promiseit's not that high. So we just
sit there and we talk a littlebit usually, and my doctor knows this
of me. So then he aboutfifteen minutes later before I leave, he's
like, yeah, we're going todo that again, you know, and
he takes again and it's always down. So yeah, I think a lot
of people do that. I dothat. You know. They always check
the women's bloodressure before they come infor their public exams. It's always high.

(13:39):
Just repeat it. Afterwards they go, oh, that wasn't that bad,
right, you know, yeah,because you're nervous about what h that
wasn't bad, And then afterwards theirblood pressure's good. Yeah. I don't
put a lot of stock in thatinitial blood pressure reading. So yeah,
So let's see, we've covered diabetes, hypertension, depression, anxiety, anxiety,

(14:01):
lung cancer screening. Yeah, good, a lot there. That's good.
So what about colon cancer? Okay, you know colon cancer screening,
it's it's a hard sell. Howdo you convince somebody to do a colonoscopy
or versus a coli guard. Let'sgo there. So first of all,

(14:22):
there's what who can qualify for acoal guard is a big thing. So
patients who are symptomatic already, Soif they have blood in their stool or
they've had any changes in their vowhabits recently, I just go ahead and
say, you know, that's it'snot gonna don't qualify for. Or if
you've ever had an abnormal colonoscopy inthe past and this isn't an option for

(14:45):
you, or if you have anyfamily history of colon cancer, then this
isn't on the table for you.So uh, that's we start there.
And and you know, it's it'sjust a matter of I see it as
what what can I do. I'lltake what I can get. So if

(15:07):
they'll if they'll do a coli guard, I'll take it. And but you
know, I will explain the patientsthat colonoscopy is it's going to give you
the best picture if you're worried thatsomething's going on. This is even though
it's a more invasive exam and theprep is you know, nobody likes to
do it. It's going to giveyou the best answer. They're going to

(15:28):
see it. If there's something there, you want to see it exactly.
That's what I tell my patients isthe same thing. And everybody's so scared
of the colonoscopy, and I don'tunderstand why. I mean, they're not
that bad. It's just, youknow, it's the prep that everybody hates.
Yeah, and but I mean theprocedure itself is quick. Actually you
don't remember because you're a sleeping youwake up. Boy. I feel good,

(15:50):
you know, And I'm like,I was ready to eat. Let's
go. Empty my vowels and empty. I'm like, I can eat whatever,
let's go. It's great. Butno, I've only seen it,
had great experiences with it. Youknow. My wife just had hers done
and I took her and it wasjust hilarious because I mean she was like,
ready, let's go, let's goshopping. You know, she's yeah,

(16:11):
so but really nice and good results. But I agree with you.
If somebody has got a family historyof polyps of cancer, you know,
familiar polyposters, anything like that,you need the colonoscopy. That's silly to
even do anything else, right,you know, and then the coli guard
itself. I just think is funnythat you're gonna poop into that thing and
the you're gonna ship in the mail. But you know, I feel bad

(16:33):
for that UPS driver going to takeit, but I think it's worse for
the person opening the box. Well, this is true, this is true.
I'm sure the PS driver has knowsthat little logo in the box handle
with care. But but yes,but I just think, but they're life
saving, their life saving, andthey're so important to do, and people

(16:56):
should not be scared of doing thesethings and get them taken care of,
because life is fragile, life isshort, and you want to make sure
that you, you know, enjoyyour life, and you don't want to
things that you know we can takecare of. Why would you let that
get you? So? You know, it's hard to convince of my older
women the same thing. I said, why you're so healthy? I think
it's kind of an embarrassment. MaybeI don't know, you know what the

(17:18):
women are thinking. Of course,if they're coming to see you, come
to see you. The same thingI go, and I said, I
know all these people, I say, I'll show them my butt. I
don't care. I said, thisis the one guy gave me. It's
all I got. Sorry, theyenjoy it or not, I don't care.
You know, this is the onlybody I have. And you know,
I'm sorry if you don't like lookingat it, but it's okay.

(17:41):
Well, when my husband went toyou know, wherever they do it,
and you know, I don't know. They have like a wing and that's
all they do all day long.You know, it's no big deal to
them. It's that's just what theydo. You know, it's not a
big deal to them. Maybe abig deal to you, but it's not
the folks women they have their papsmears and all that stuff. I said,
you know what, we do thisevery day. Yeah, and we

(18:02):
see so seven of them every day. For me, I am not going
to remember, you know, becauseyou hear the jokes about all that all
the time. We're not going toremember that, you know, unless there's
something bad that we got to takecare of. But otherwise, no,
it's not significant. It's important.We got to make sure you're okay,
and we do everything because this iswhat we do for you to make sure
you're healthy, and so the samething we need you to come in to

(18:23):
your family doctors your internests to makesure because all these other issues, you
know, I can't take care ofthat. That's all we need them.
They're good about this. This iswhat they do. They take care of
your hypertension, They take care ofyour thire, They take care of your
blood pressure, or your your sugars. They take care of all this stuff.
And it is so important to getyou taken care of, and especially

(18:44):
the women so you can take careof your families. Right, So we
really want this, So let's talkabout what else are we missing some screenings?
What other screenings, you know,because women are bad about screenings and
men too, you know for thatbecause women you need to get your husbands
and your significant others and your fathersand everybody out there to get themselves taken
care of. Yeah. Another oneis Dexa scans for the once you hit

(19:11):
sixty five, which is for usbones. Yeah. When that one doesn't
get talked about very much. Idon't think a lot of ladies are.
They have no idea what I'm talkingabout when I bring it up. Why
is that important? Uh, it'sit's super important. I actually had a
really good conversation with one of myeighty something year old patients. I remember,

(19:37):
she's super healthy, just spry,so spry probably you know, in
better shape than I am. Andshe never had a DEXA scan, and
I was like, oh, youhave to have one because you know,
if you do have osteoporosis, wehave to have you on medication because you
if you have a fall and youbreak a bone, it's it's going to
be life changing for you. Itwill take you out because you're so healthy

(20:02):
and I don't want you to losethis level of health. So osteoporosis and
an elderly patient, it's something thatwe can reverse and we can give you
some of that bone strength back,so if something like a fall does happen,
we can prevent it from being somethingthat changes your quality of life.
Well. And for women that arepostmenopausal, I mean you're losing a significant

(20:22):
amount of bone every year. Absolutely, so every year your bone your strength
decreases and it's like you know,one to two percent a year is significant.
And so if you don't monitor yourblood, i mean, your your
bone strength, you can be inbig trouble. And so you've got to
make sure. You know, forall these women, they are taking their
biomin D and calcium every day whenyour postmenopausal. And then please get your

(20:45):
bone scans. That's important. Soat sixty five you have to do one
or you don't have to do whatyou should do one because you need to
know. Yeah, so I thinkthat's a significant thing. Other issues that
you can think of that we're missing. I think cholesterol screening is another one
that we start. I'm not sure. It kind of depends. There's some

(21:11):
different factors that would depend on whatage we start, but you know,
lipid screening to make sure that yourcholesterol levels are where they should be because
that can affect younger people also,right, so if they have a family
history of that or you're just lookingat some people, you can tell.
But other people have high cholesterol andthey're thin as a rail, right,
Yeah, so you just can't tell. I mean, you could be thin,

(21:34):
look healthy, whatever, and yourcholesterol is sky high. So and
then you're a setup for heart attackand everything else that goes along with that.
So yeah, and with that,so then you know, we can
manage that with diet and exercise,and sometimes you know, we need to
intervene with medication. So that's anotherthing that you don't exactly feel bad when

(21:56):
your levels are off. So it'simportant to get that blood work done.
I think it's important too, andthat's just another reason for people to go
to the doctor, right really,so you want to get checked. But
I think this year is going tobe important you for twenty you know,
twenty twenty four, we're going totalk a lot about your health, and
we're going to talk a lot aboutyou know, taking care of yourself and

(22:18):
things that you can do to helpyourself because it is important. And you
know, one thing I was thinkingabout, you know, if you have
issues or you think there's something thatyou'd like us to talk about on the
radio, you know, you canget ahold of the marketing department and they'll
get it to us, and wecan always try to come up with some
ideas and talk about some other thingson the radio. Well, you know,

(22:41):
some of the things I know youare passionate about is geriatric care,
yes, and LBG TQ. Ithink I got that right care, which
is important because we have to takecare of the population also. So but
I think you like that niche.It's a nice one, especially the jeriactor.
We don't see a lot of thegeriatricians anymore. Yeah, and that's

(23:03):
a hard, harder population to takecare of. So it's the elderly and
in this area, you know,the name that everybody remembers as doctor Sidensticker,
you know, and because he's likethe guru of all of that,
you know, and wonderful, wonderfulphysician, and so the geriatricians we just
don't see a lot of and peopleit don't have the time. But it's

(23:26):
nice to see a young provider whowants to take care of this population.
Yeah, it's something I'm really passionateabout. Well, just as a population,
our population is aging, so it'sit's something we should all be prepared
for it and be passionate about becauseit's you know, it's very important so

(23:49):
and kind of inescapable, right,we're all going to get older. Yeah,
So but I I enjoy it.I enjoy the complexity of the of
the medicine part, you know,the kind of all the medicines. Lots
of elderly people are on lots ofmedications, And I enjoy the brain part

(24:11):
of that. But more so Ienjoy the quality of life conversations and kind
of talking to people and getting toknow them and their stories and learning their
priorities as as they get older.That's what I like. That's what I
like, and I enjoy just talkingto people and getting to hear what life

(24:33):
has been like for them and workingwith them to create you know, goals
and of care for them. Soyeah, I think it's wonderful. And
it is when you when you dohave some of the elderly population or all
the elderly populations, I mean,they like to talk and you need to
spend the time with them. Yeah, and so it's nice to have somebody

(24:53):
who wants to do that. Soagain, you know, if you don't
have a provider, I've got agreat one here right beside me that that
would like to see you and thatwill take care of you and doesn't mind
talking to you and finding out aboutyou. Yeah. And then LGBTQ care
is also something I'm really passionate aboutin lots of different ways, but mostly

(25:19):
just like creating a safe space.Just knowing that they are providers that you
can come to and know that youcan be open and safe with. That's
something I just want to make surepeople know. That's important. And I
think that you know, knowledge judgmentaland yes, and just to feel comfortable.

(25:40):
I think that's very important. Sogood for you. That's wonderful.
I think it's easy to get aholdof providers now careen. There's also a
number of other providers that have beenin the ADINA program that have stayed in
town. So both internists and familypractitioners, all of these young providers are
taking pay. And so you know, to remind you, these are m

(26:03):
d's and d os that have beento medical school and so you can't go
wrong with them. You can't gowrong with them. So to get them,
you can call a DINA. Youcan get seven to seven nine fined
f I n D, and youcan hook up with a provider and they'll
get you in and I'll get youscheduled right away. Maybe for somebody who

(26:26):
doesn't know so much, what isthe difference between an MD and a do
O? And I even I gosee a certified nurse practitioner even as my
primary care physician. So what's thedifference. Is there a prerequisite or something?
Who should go to who? Ordoes it really matter? So I'm
a do O, So the trainingfor a do O and an MD is

(26:49):
very similar. Doos do some additionaltraining in soft tissue manipulation, so is
like that additional training. But likeI am, I took the same board
certification as like an MD would forinternal medicine, so the training is very
similar. We just do like alittle bit of yeah osteopathic yeah, which

(27:15):
which is nice that you know theycan do that. A lot of them
don't you do it. But thenas you get older, you know,
I've talked to a lot of mydear friends, they don't do that as
well, and Mark their practices arejust too busy and they don't have time
to do the manipulation any longer.But you know, you know, long
ago there was a big difference nowadays, No, there's not a difference between
MD's and d os. Both arewonderful. They both have the same education

(27:37):
in medical school, residencies, thewhole works and are here in town.
There's a number of them that aretaking providers, nurse practitioners not you know,
they're excellent. We have a numberof them in town. They're all
taking providers and our patients excuse me, and they practice alone. Some are
under the unnerve physicians, but wehave great nurse practitioners are around here also,

(28:00):
So no I whoever you're more comfortablewith, we'd love to get you
in. You know, I'd liketo keep our young physicians busy, so
I'd like to get them because especiallylike care and then they're just so nice.
And I just think, uh,you know, if you are complex,
have do complex issues, I thinkthat the physicians are probably a better

(28:21):
choice for you because they've had thetraining for that. But that's just my
personal, you know, opinion.But they're all great well, and that's
one over the other. That's agood thing too, is you know,
Adina is so connected. If yougo to someone and they're like, that's
a little out of my expertise,I'm going to refer you to a specialist.
You've got so many different fields rightthere to Dina. It's the great

(28:45):
thing. And and I love themy chart that Adina has where you can
you can look up everything. Myoptometrist even sent my results to my doctor
and they showed up in my chart, you know. And this Optometris is
not affiliated with Adina, and Ijust think it's great how that care is
all connected. Did and so youknow, my doctor got a copy of
my eyes. You know, Ihave diabetes, so they wanted to check
that and everything, so everything isright there and it's connected and I just

(29:07):
love how Adena does that all thatinformation smaller with the system that we have.
Now, yeah, that's true,so we can see everything, you
know, any of most of theother hospital systems we can see, so
it makes it really nice. Isit's super nice. So but anyways,
Caroen, I want to thank youvery much, thank you for coming and
talking with us a little bit today. I do you know if you are

(29:29):
looking for a provider seven seven ninefined at Adena. Uh. Doctor Swanson
works in internal medicine with doctor Coatesand some of the other internists. So
we look forward to big things outof you and so nice to meet you.
And again I do recommend you knowif you're looking for a provider to
call and get in with her.Absolutely. You can also find it right

(29:52):
there at Diena dot org. Ilove the website as you can find everything
right there Adena dot org too.Okay, can thank you so much,
Doctor Kara Swanson. This has beenLady Parts with doctor Richard villarreal It.
Here's the third Monday of every monthat ten am on Mix one O six
five in Chilicothee. You can alsocatch the podcast anytime on iHeartRadio. Just
open the free iHeartRadio app, clickon podcasts and do a search for Lady

(30:12):
Parts with doctor Richard Villarreal