06-19-23 Obstetric Care and Gynocological Care With Dr. Neely Wade

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Episode Transcript

(00:00):
Mix one oh six five. Goodmorning, it's Christina Woolford. Welcome to
Lady Parts with doctor Richard Villarreal ofAdina Women's Health. Good morning, doctor
Villarreal. I'm doing great now areyou today? I'm doing wonderfully. Thank
you. So, as always wedeal with topics related to women's health,
and we've got a special guest today, can you we do? I have
doctor Neelie Wade. She's wonderful.You'll enjoy talking to her or listening to

(00:24):
her today. She is a graduateof Ohio State, the Ohio State University,
from medical school. She went toMount Carmel for her internship. Actually
was in the Navy and she didgeneral medicine there. She did her OBI
GIN residency in Arlington, PA.And she's been at Adina now for four
years, which it's gone fast,so it's wonderful. So welcome, welcome,

(00:46):
welcome man. We're glad, thankyou, doctor el So today we're
going to do something fun. SoI thought we're just going to talk about
the difference between obstetric care and ginnacologiccare and who needs what and you know
it's really funny. I was talkingto one of our partners, doctor moorehead
about this, and you know howhe is, and I see. I
said, well, we're going totalk about this, and he said,
well that's easy. He says,either you're pregnant or yanked. And I

(01:10):
said, well, I said,he took my thirty minute radio show down
to five seconds. So I said, well, there's a lot more than
that. We want to talk abouta lot more than that today. So
what we're gonna do today, doctorwaited, We're gonna just talk a little
bit about First, we'll start withobstetrics and talk about some of the things
that we do at Adena. Youknow, when we when I started,
gosh almost pushing twenty five years,we didn't do a lot of the high

(01:33):
risk stuff. It was just verybasic. But now, you know,
things have changed tremendously, So we'lllet you talk a little bit about what's
going on. So the really nicething that we have at Adena is our
high risk obstetricians from Ohio State areactually coming to us, you know,
weekly, and so they're at themain campus three wednesdays a month, and

(01:57):
then they're at the black Water ouroffice the other day of the month.
So every Wednesday we have high riskat our fingertips. So it makes it
nice because we've seen, you know, over the years, our population has
changed and we're seeing more and morepatients that have more comor abilities or more
problems, which is fine because youknow, we've come to the point where

(02:19):
we're very comfortable with it, we'reused to it, and we don't really
don't have problems taking care of them. You know, all the physicians are
comfortable with this, We have themidwives who are comfortable with this, and
then all of our nursing stuff isgreat and they do a wonderful job with
it. So um, talking onceyou talk a little bit about some of
the things that we do or someof the women that we see and what
we can do. So I thinkwhen I was thinking about this topic and

(02:44):
what to talk about, I thinka lot of women may not realize that
that first prenatal visit is actually aguyiny visit, you know, because they're
there because they are late for theirperiod. They missed their period, and
so a lot of them are comingin with a positive home pregnancy test,
but not everybody, so some ofthem, yes, that first visit is

(03:09):
actually a gynecologic visit because we're confirmingtheir pregnancy and figuring out how far along
they are, and then they startseeing us for their prenatal visits or their
obstetric visits, and at that firstvisit, I mean, every obstetrician in

(03:30):
midwife is different how they how theydo it. But for me, that
first visit, I'm breaking down onceI confirm the pregnancy and how far along
they are, I'm breaking down whatrisk factors they have and their pregnancy that
may complicate their pregnancy, and thenI know whether to initiate that referral to

(03:52):
the high risk doctors. So yeah, it does make a difference. So
you know, that's the nice thingabout when you come in, so we
only will go through your history.We'll go through what we have, We'll
ask you a lot of questions.A lot of times, our nursing staff
we'll ask you. They have lotsof questions that they ask and we'll run
through everything with you, and thenthe physicians or midwives will go through all

(04:13):
that with you and then make recommendationsfor you. You know, it's always
it's your pregnancy, it's your choiceon things. But you know, usually
what the providers talk about just becausethey've had years of experience and the education
and they only want it the bestfor you. So so when we if
we figure out that you are fallinginto that high risk category, we have

(04:38):
you meet with the high risk obstetritionand that's when you get a detailed anatomy
ultrasound and the high risk doctor willsit down and go through, you know,
the ultrasound findings with you and gothrough your history and kind of help
lay out a plan going forward forme and the patient and you know,

(05:00):
what would be the best way tocontinue your prenatal care that makes perfect sense,
you know, And not everybody thenfalls into this category, because we
have some patients that are just youknow what does call them a vanilla?
They're just nice, easy pregnancies,very straightforward exactly, and they come in
and no problems, healthy as canbe, and we just go right through

(05:21):
the pregnancy, get your blood worksand your ultrasounds and everything else, and
we don't have to worry about that. But then, you know what,
we're really trained for these complicated cases, you know, So when somebody comes
in and has more issues, youknow, whether it goes to obesity,
it comes down cardiac diseases, lungdiseases, you know, advanced maternal age

(05:44):
age. Yeah, I mean there'sa lot of issues that come into play
beds. So we're comfortable with thisbecause we've taken care of this for a
long long time and we do itevery day. And even the midwives,
if they have a high risk patientthat has to see the maternal fetal medicine
specialist, the patient will follow upwith one of us obstetricians and we'll kind

(06:09):
of go over everything and a lotof the time they can still be managed
by their midwife and they just collaboratewith us, you know, on those
high risk pregnancies. So it's it'sjust a really nice working relationship we have
with our high risk specialists and ourmidwives too. See. I think we're
very fortunate to have a high statedown here, you know. I think

(06:31):
most people are most of the communitydoesn't realize that they're there with us,
and we do have this special bondthat we've had with them for years and
they've been coming down for a longtime helping us take care of our patients.
I know a lot of general obGYNs that are very envious of our
situation here at Adena. Yes,and so we're very fortunate and we're it's

(06:59):
good. Let the community know thatwe have this most rural rural ob GYNs.
When their patients are high risk andhave to meet with the specialists,
they have to travel right to meetwith them and then come back to their
obstetrican and then go from there whatto do. But we're super lucky,
yeah, Or it gets to thepoint where, you know, the patients
are are complicated, and since thepatients have to keep traveling, for example,

(07:23):
to Columbus or Cleveland or Cincinnati,you know, the high risk doctor
saying, better you just stay here, you know, the high stakes,
not like that, And they realize, you know, we have good obstetricians
here, and we have a greatfacility, and so probably you know,
nine out of ten or nineine outone hundred patients stay here with us.
So it makes it very nice.So they can deliver close to home and

(07:44):
with their families. Yes, ifthey're not super pre term or have some
type of cardiac issue, maternal cardiacissue, they're generally able to stay here
at Adena. So for their delivery, we deliver what from thirty two weeks
on correct. So and the otherissue, you know, and the other
that people really probably don't know isthat our nick you we have Children's Hospital

(08:09):
here, so Children's Hospital Man's areneon natal intensive care units. So all
the babies that we deliver are seenby the physicians that work at Children's.
That's really nice. So again that'sanother thing that really hasn't been too marketed
or publicized. But we are soblessed to have Children's Hospital, you know,

(08:33):
here with us every day. They'rehere twenty four seven and so they're
they're they're taking care of the babies. So we're doubly blessed with what we
have and the community should be,you know, should be very very happy
with what's gone on and transponded justwith everybody coming in and how they've worked
things out. So it's all tobenefit our people and we're very happy about

(08:58):
that. So we take care ofall these high risk patients. We take
care you know, we have themidwives that take care of things. Let's
talk a little bit about our laborand delivery and postpartum. I think we
have something special to offer there.We have great nursing care and we have
the nurse anesthesis that are there twentyfour seven. Also, so our triage

(09:20):
is our emergency room for our pregnantpatients. Then patients are seen there from
twenty weeks and beyond with any kindof belly pain as long as they're not
having shortness of breath or chest painin their past twenty weeks. Generally they
are seen in our triage and andwe can consult just like any er,

(09:46):
to have specialists come and see ourpatients if it turns out their issue is
not obstetric. So if it isan obstetric issue and we have any question
at all, we reach out toour high risk obstetritions who are available to
us twenty four seven at Ohio State. So we have a really nice setup

(10:09):
in our triage, we really do. And then on labor and delivery,
we have the nurses that some ofthose nurses have been there for years,
you know, and as long asI've been around longer, but they've been
there for a long long time,and it's really nice and the same one
postpartum and always having smiling faces,and it's a good thing. And we

(10:30):
also have a nice pediatric unit overthere, so we've been growing our pediatric
unit, you know, just notjust with children's hospital, but they also
help take care of the kids,so it does work out really well.
So let's turn our attention. Sowe we've kind of given them a nice
little synopsis of our obstetric care thatwe do basically everything. It's it's we
take care of very high risk patients. We have a higher state, we

(10:52):
have children's hospital, and but nowgynecologically, so we'll take care of those
patients that aren't pregnant. And wedo a wide range of gynecologic care.
So as far as with the gynecologistsand the midwives, we can take care

(11:13):
of just about anything. And I'lllet you talk a little bit about some
of the things that we do.So of course, you know we're going
to handle your preventative care with yourclinical breasts exam, ordering your mammograms,
We're going to be completing your papsmayors when they're due, and you know,

(11:37):
checking blood pressure, doing a physicalexam and including a pelvic exam and
screening for STDs when that's necessary,and you know, screening for depression and
any any other issues with that routineannual. And then you know, we
see problem visits can anything from menstruyor regularities to vaginal discharge, concerns,

(12:07):
pelvic pain, so any any kindof gynecologic issue. We're going to have
problem visits for that. So Ithink, you know, we can douced
about anything. So like so,like Neelie was saying, you know our
regular annual examinations, we have thoseevery year for most of the women.

(12:30):
And you know, I've taken careof women all the way, you know,
from twelve years old, and we'llsee them that early because they can
start having problems with our mensis allthe way up. I remember our oldest
patient at one time was one hundred. She came in and she says,
I'm not dead yet and I wantmy guyacologic care. So she came in
and she wanted taken care of.And I don't blame her because she could
walk on her own and she couldthink, and she could do everything,

(12:52):
and she would said, I justwant to make sure I'm okay, right
perfect. You come in and beseen and we will take good care of
you. And so it's like doctorwhat was saying, we do about everything
and we're there for you. Wetake care of you know, the breath,
the whole body and uh. Andfor a lot of the patients,
I think we do a lot oftheir primary care because a lot of patients

(13:13):
that we see don't have a primarycare doctor, and we try to get
them referred into one right away,right but we end up taking care of
a lot of that. And soshe started, you know on a few
of the things that will take careof, but there's everything from you know,
infections and I forgot to mention contraception. We offer all all forms of
contraception, including sterilization and and soyou know, patients can have their entry

(13:43):
or and device or their implant theirnext one on um inserted in the office
and removed in the office. Sowe offer basically all the forms of contraception.
And so we like that because youknow, there's a lot of misconceptions
a lot of times about some ofthe contraception that we use. And you

(14:05):
know, for example, the IUDs, they're so simple to place, and
we have now we have IUDs forwomen who've had children, and we have
IDs for women who haven't had children. There are different sizes and we have
you know, the ones for thewomen who have never had children last five
years. The ones for women whohave had children are up to now eight
years. And then we have theParaguard, which is a larger IUD,

(14:28):
which is ten years, So there'sa lot of great options. We have
the implants in the arm, whichis called an xplan on which the obstetricians
and the midwives also place. Andthen as she mentioned, we have all
the pills, and we have therings, and we have the patches and
the shots. You name it,we've got it. And the other really
nice thing about our offices as wehave an office ultrasound, So if our

(14:54):
patients have any kind of problems wethink ultrasound would be helpful and figuring out
the problem, we can set themup for an ultrasound, and if it's
an urgent problem, we can sometimesget that ultrasound the same day. Yeah,
and that's awesome because our sonographers areamazing and that's all they do is

(15:16):
gynecologic obstetric ultrasound versus that you areultrasounds, which those sonographers are going to
be doing ultrasounds of the whole body. And our specialized sonographers are excellent.
And the impressive point of this wholething is that they have just been recertified
as far as it's called AIUM,which is the American Institute of Ultrasound Medicine,

(15:37):
They've now been certified twenty one yearsin a row, and that's very
difficult. It's a very difficult awardto get. And there's not many places
in the state of Ohio that havethis and have been doing this for this
long, so very impressive. They'rea very impressive group. And everybody had
to work really hard to keep this. All of us have to all the

(15:58):
OBGI have to maintain our certification andyou know, continue our study of ultrasound
to maintain that certification. So everybody'sup to date, so you know that
everybody is studying, everybody's reading,everybody's always looking at things, so you
know, all your providers are upto date on everything, which makes it

(16:18):
nice and it should you know,it makes everybody little more comfortable realizing,
well, I'm not just sitting backbeing lackadaisical, and it really expedites patient
care, you know, to identifyproblem, get an ultrasound on a timely
manner, and go from there withtheir plan going forward instead of well they
go to the hospital radiology department andthen they come back to see you and

(16:41):
then you've got to find the report. You're actually looking at that patient's images
and it's very nice. Yeah,so if we take care of it right
then and there. So somebody's gota problem, it's done, and then
we know what we're doing, sodo something we follow is it somebody that
needs to go to surgery? Youknow, what do we do? And
it does? It expedites everything forus for the patients, so there's the
less time that they have to hurtor have problems or concerns. And then

(17:04):
we also have issues, you know, sometimes we do things and we find
cancers. And we have great friendsup at Ohio State and some of the
other facilities that we refer up toregularly and they take care of our patients
wonderfully. And yes, and we'reall on the same electronic medical records system
as of November, which is awesomebecause you can see when they go to

(17:29):
the specialist, you're going to seethat chart. You can just see it
so easily. When they come backto see you, you open right into
their documentation from their specialists and whatthey did in the OAR and their pathology
report and every we know everything thathappened. So I did. I had
a patient that I saw, Isaw I went on vacation and I saw
her before I left, and Iknew she had a cancer. So and

(17:52):
I got her ship to Columbus andI'm like, did she go? Did
she have you know, I didn'tbecause I haven't seen anything. I've been
going back when you can't see it, So this was perfect. I just
pulled up her name, looked onthe chart. I saw that she saw
the guynacological on collegist. He's gother schedule for surgery and she's ready to
go. So it makes it nice, so nice. I mean, they
were good at communicating with us beforewe shared the system, but now that

(18:15):
we are on the same system,it is so nice. So people don't
know how you know it's so nice. I mean, if you go back
to the way I used to doit when I first started, I mean
everything was paper, you know,that tells you it's back in your stone
age, And so you really didn'tknow, I mean you would you could
lose track. I mean, whenyou see patients over the course of a

(18:36):
month or whatever, you lose trackof names or who did what, or
you know, you don't have away of keeping all these records, and
did somebody go to this person?Did they not follow up? You know,
because sometimes people just get scared andthey don't go it's nice too.
On the other tail end of that, so my patient went to the gynecologic
oncologists for her cancer diagnosis and treatment, and then she had to go to

(19:00):
the emergency room here at Adena forsomething after her treatment, and I was
able to send a quick note toher gynecologic oncologists saying, hey, she
got admitted to Adena, this iswhat's happening, right, and so the
nice thing back and forth. Yeah, so we can do that. And
what people don't realize is if wedo send you up for cancer care,
we follow up with you afterwards.You know, we'll still be your gynecologist.

(19:22):
We'll still take care of you.You are our patient. We love
you, and I tell my patientsthat all the time, and we'll just
keep following up with you. It'snot a problems. We're incorporated into your
surveillance after your treatment. So itmakes it really nice. So we start
seeing women for gynecologic care, howearly have you started telling them? I

(19:45):
tell my patients when they've had theirperiod start, they can come in.
I think between thirteen and fifteen isa good time to discuss how is the
period going and is their period intheir cycle normal? But I will say

(20:07):
that most of the pediatricians are doingthat. So in general, I don't
usually see that young of a patientunless the pediatrician refers her and her mom
to me to go over their periodhistory and what's happening, because the pediatricians
are addressing the menstrual cycle as thefifth vital sign essentially once that teen is

(20:33):
starting or cycle. So in general, I'm seeing patients that are that young
because their periods haven't started out normallyright. And you know, you're really
good at it, as are alot of the alnutricians and midwives are very
good at making them feel comfortable becausethis is a normal part of growing up
as nothing abnormal. Sometimes you know, things just don't work quite right and

(20:56):
you kind of fix it and nothingwrong with that, and so they you
know, we try to make themunderstand that you should never be ashamed of
problems. And you know, andI always tell the women, you know,
even these young girls, you know, you need to learn about your
body, need to know your body. And you know, I'm old enough
that I've been here, you know, you know, pushing twenty five plus
years. I've had a young ladydie at sixteen and eighteen, a breast

(21:17):
cancer, you know, and peopledon't realize that you can get breast cancer
this early. And what happened withboth of those young women is that they
were afraid to tell anybody that theyhad a mass. And so I think
it's part upon us to let everybodyknow how important this is that there's nothing
wrong with your body. That youneed to be very comfortable with your family,

(21:37):
with your parents, and be comfortablewith your doctors, that you can
tell anybody when you have an issue. And so I think that's why,
you know, part of this radioshow is that this way the mothers know,
the grandmothers know that you can passthe word on that you need to
be able to talk. And alsothe other big thing that they need to
talk about is when they start havingboyfriends, you know, and things like
that they need to talk about,you know, because things happen, and

(22:00):
we understand all of that. Butyou know, what I tell the young
women is your mom is your bestfriend. You know, no matter what
you do, she's still going tolove you. So you have to be
able to talk to her. Youhave to be able to talk to her
about when you're planning on doing somethingor if you have a study boyfriend,
and you want to try to dosomething, you know, you need to
talk so that we can have youprepared so that we don't have a baby.

(22:23):
You know that's kind of important,but that that comfort level has to
be there, and doctors like doctorWade are really good about that and they
can help you work you through that. So and I routinely am not doing
a public exam on that first visit. I am right literally just finding out

(22:45):
what's going on. And most ofthe time my teens don't need to have
a public exam, And if thereis a need for a public exam,
we work our way up to it. Once the teen's comfortable and she is
having an issue where it's going torequire an exam, we're taking it at
her pace and you know, doingit when she's comfortable, right, And

(23:07):
it's the same way I think justabout everybody is. But we you know,
I think most of them are afraidto come in because they're afraid they're
going to have to have a pelfectexam. Exactly. We don't don't and
we can even see what we needto see on ultrasound with a trans abdominal
ultrasound doesn't require vaginal probe. Soyes, that's not something that the teens

(23:27):
should be panicked about. So wewant to make sure they're comfortable and they
come in and we get them takencare of because we have another great providers
and just with the physicians and themidwives, they'll be glad to take care
of them for all these issues.Another point I want to make is that
a lot of women think that oncethey have their hysterectomy, they don't need

(23:52):
to see their obgyn anymore. Sothat's another hurdle that I think we have.
Besides, the team says, onceyou have your uterus out, you're
not dead, right, you stillhave a vagina, you still have parts,
you have Lady Parks. Possibly youstill have Lady Park. You got
to take care of your exactly.And I know a lot of the family

(24:14):
doctors that my patients see, theyaren't even getting undressed. They're just going
and talking and they're you know,getting their blood work drawn and they're going
over all their history and chronic medicalproblems. But they aren't getting an exam.
And so they can't forget to cometo us to get their exam.
And you know, we gotta takecare of yes, So make sure you're

(24:37):
around for your children, for yourgrandchildren, so that you're here for a
long long time. So it's veryvery important because bad things can still happen
when you don't have a service oruterus. You know, bad things still
happen. So we want to makesure that nothing happens so that you can
stick around to it. If there'ssomething is going on, we'll catch it
early. So I do want tobring up though, Um, doctor Wade

(24:59):
does have an offer us in Circleville. So you know, we have opened
up sites in Circleville for you know, steptric ND kind of coologic care.
Um. The nice thing is thatwe have ultrasound up in Cirville, which
is fabulous and since we have wearen't that busy yet. Since we just
started. We are basically having patientscome in and if they need an ultrasound,

(25:19):
they're getting it that same day.Yeah, so it's pretty awesome right
now to get what you need veryquickly up in Circleville on Wednesdays. So
how did they get in to seeyou in Circleville? Well, it's pretty
easy. Um. You once youcall, Yeah, you call the Adena
O G Y N number and youknow, if you prefer to be seen

(25:44):
in a quick fashion, or youlive near Circleville. In Circleville, it's
going to be nice because you canget your care pretty quickly at this point.
Well, the other interesting thing isthat you're one of the physicians at
aDNA that does robotics, you know, And that's something we need to mention
because we're is a big thing rightnow. It's minimally invasive, and you're
one of our experts. You anddoctor Buckley and doctor Moorehead and doctor Knolly.

(26:07):
I think you're the four that dothem right. And I'm an old
timer. I don't I don't dothis anymore. But yeah, robotics is
fun. It's it's just like doingyou're like, I say, tari because
I'm that old. But you knowthese video games that they play with and
it's great. It is. It'sa lot of fun. And I have

(26:30):
only ever done robotic hysterectomies. Ireally haven't done straight stick laparoscopy, which
is the like that's what mentally invasivetechnique preceding robotic surgery. I guess,
yeah, And um so I justknow that that I didn't have very much
experience with that technique. It waspretty much straight robotic training that I had

(26:56):
at Abington and it's it's it isreally cool surgery and it's exciting because my
patients are basically I would say eightyninety percent of my patients are going home
after their surgery the same day,which is a big change from like I

(27:17):
mean, not so much the straightstick laparoscopic approach, but when patients were
getting their open hysterectomies, they're lookingat a recovery in the hospital at least
two nights, you know, ifnot more. So things are changing now
not everybody qualifies for robotic hysterectomies,but yeah, because we still do We'll

(27:37):
still do abdominal procedures, but it'sa nice option, you know, if
you're a good candidate for it.And so doctor Wade does do that.
So we just wanted to make sureeverybody understood that. But I think there's
so much that we offer now aToadina that we did and we've had such
a wide range specialists that can dogreat things for you. We want to
make sure just people understand to comein and get your care, you know,

(28:00):
take care of yourself, take careof your loved ones, so that
you're there for your the rest ofyour loved ones. We've got wonderful accolades.
If you haven't heard about Adena andthe Women's Service Line, you know,
one of the most recent ones isthat, you know, we got
the Joint Commission's perionatal certification and that'sfor obstetrics for the eccentric unit. And
only one in four hospitals in thestate of Ohio have this. Are one

(28:22):
of four there, We're one offour, So only four hospitals have this,
So we're one of the four inthe state of Ohio, which is
amazing and it takes a lot ofwork and you have to have all these
things. You know that they makesure that line up and that you're good
at and we can do it andbecause we have a great team. So

(28:44):
but with everything else there o HighState there Children's Hospital there, you can't
beat it. You can't beat it. We're so fortunate to have all these
providers and nursing staff that are therefor us to take care of everybody.
So before we you know, finishtoday, is there anything else you want
to talk about? I mean,there's so many good things I would say,
you know, the hurdle is gettingour teams comfortable to come in,

(29:07):
getting our patients that have had hysterectomiesto know that they still need our care.
And I would say making sure ourmoms look out for themselves, not
just everybody else, right, Andthat's the main thing that Christina and I
talk about that constantly. Always takecare of everybody else in love themselves.
And so our goal is to getthe women in. Take care of yourself

(29:32):
because if you're not there, who'sgoing to take care of your families?
Exactly? So please take care ofyourselves. Please come in, please be
seeing, get your loved ones in, get the kids in to be seeing,
get them taken care of. Welove babies, but we don't want
them too early. So all right, good, thank you, Thank you
so much, thanks for coming.Thank you again. This has been Lady
Parts with Doctor Richard Villareal and ourspecial guest, doctor Neely Waite. Lady

(29:56):
Parts with Doctor Villarreal air's the thirdMonday of every month at ten am on
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