Early Detection

Skipping screenings feels harmless until you learn how many serious problems start quietly and how quickly “later” turns into “too late.” We talk through preventive health screenings like mammograms, colon cancer screening, and routine checks, but we also get real about what prevention actually means: early detection that keeps treatment smaller, simpler, and more successful.

We also explain a frustrating detail that catches people off guard: a preventive visit and a problem-focused visit can be billed very differently. Bring up a new symptom during a “free” annual check and you might trigger a copay or deductible. That doesn’t mean you should keep quiet; it means you should understand how to schedule and advocate so you can get the care you need without surprises. Along the way, we share stories from the clinic and from real life, including how an endoscopy and colonoscopy done for GI symptoms uncovered an unexpected colon polyp in a 22-year-old, plus why incidental findings on imaging can sometimes be the clue that changes everything.

We zoom out to prevention in the modern world: telehealth can help you plan screenings and interpret next steps, and wearable health tech like the Apple Watch ECG can capture arrhythmias that short tests may miss. We also point you to a practical resource, the U.S. Preventive Services Task Force recommendations, and discuss why family history and risk factors can shift screening timelines earlier than the general guidance.

If this helps you think differently about your health, subscribe, share this with a friend who keeps postponing appointments, and leave a review so more people can find the show. What screening have you been putting off, and why?

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Transcript

unknown 0:24

All right.

Kelli 0:26

Hey everybody, welcome back to another episode of Tattoos and Telehealth. I'm Kelly White, Board Certified Family Nurse Practitioner. This is my good friend and colleague, Nicole Baldwin, also a board-certified family nurse practitioner. And

Welcome And Medical Disclaimer

Kelli 0:39

today we want to chat with you guys a little bit about kind of preventative health screenings, what that looks like. But before we get started, our attorneys make us say that watching andor participating in this podcast does not constitute a patient-provider relationship. We're just a couple of gals chatting it up. We do recommend that you follow up with your primary provider, whoever's taking good care of you. Do not implement anything that we talk about without discussing with them. And this does not constitute medical advice. So one of the things, Nicole, that, you know, I've been seeing, I've had a couple of provider friends talking about, you know, tis the season for preventative care by seeing their mammograms, bone scans, colonoscopies, et cetera, et cetera. But there's a big difference between going

Preventive Visits Versus Sick Visits

Kelli 1:18

and getting your preventative health screening, which is where you go in, you probably don't have a copay, it's covered by your insurance, but you are only there to do preventative stuff. If you talk about a problem, now you have a copay, now it goes to your deductible, it's a completely different issue. Preventative health screening is just that. It's to go in, get all of your prevention check boxes, do all the things like, are you doing this? Are you doing that? You don't like, did you get your vaccines? Did you, did you get your mammogram? Did you get your colonoscopy? Did you get your et cetera, et cetera? So what is it that sets preventative care apart from like sick care? What is it people should be thinking about in the world of prevention?

Nicole 1:57

So people, insurance want us to get preventative care, and doctors want uh you to get preventative care because it's exactly what is preventative. If you go in and get a mammogram

What Prevention Really Means

Nicole 2:12

at age 30, and they find something suspicious that's really just located in within the breast tissue, they can go in, take it out. Even if it is cancerous, a lumpectomy is very is very simple compared to five years later when you didn't know it was there and it's grown for five years. That's a way bigger problem. So the prevention is preventing the spread, right? So it's going in looking for stuff before it gets bad. So it's not that it really prevents the actual disease. It's really early detection, right? It's early, early detection because something abnormal, abnormal cells within the uterus, within you know the prostate or whatever, you have a much better survival outcome the earlier it is, right? If you're gonna get diagnosed with cancer, I want to know as soon as possible so that treatment can be as minimal as possible instead of all of these things that, you know, unfortunately patients wait on or don't take seriously, then they turn 4550, and now it's a huge problem, and their lifespan is extremely cut short, at risk, at least. And so preventative screenings are really more early detection of certain diseases. Yesterday, my daughter had to go to get a colonoscopy EGD, and she's not of age to normally have that. However, she'd had some GI issues, and the best way to figure out what's going on with her GI system was to go in and take a

A Surprise Polyp In Your 20s

Nicole 3:52

look through the colon and then also go down the throat. So an upper endoscopy and a lower endoscopy. And she had that done yesterday, and they actually, even though she's in her early 20s, they actually found a polyp. And the doctor said a colon polyp, right? A polyp in the colon. I'm not polyp and the colon. Said that, you know, we took it out, and you don't have nerve endings in there, so she's none the wiser. But he said it's a really good thing that you actually had this done because if I would have just if I would have found this at your normal screening time, which is I think age 45, where you're just due for a normal check, it could have been because polyps can frequently turn into cancer, right? So right now she doesn't have cancer, but if they didn't take it out, it it is at high risk for those cells mutating and turning into cancer. So if we had waited until normal time and not had any issues, which is a long time because she's 22, right? So over 20 years. Yeah. Long time. So imagine it growing for two decades. Long time. So polyps at that age are super rare. Well, I don't know, you know, I feel like people are just getting diagnosed so much earlier nowadays with those things. But the point is, is if something's going on, go get checked out. And was this polyp causing HI issues? No. But it was an incidental finding when they were in there. And so, you know, they took biopsies just to kind of send it out and kind of see what's going on, is you know, there's something underlying or something, you know. So, of course, everything, you know, is sent to pathology. But the point being is that if something's going on, don't ignore it. Number one. And number two, get your preventative things because early detection is key. It's just it can save your life, essentially. And a lot of these preventative things, hers wasn't preventative because she had a problem, right? Just like you were saying, now it's costing, so it's funny. We got up to the desk and the lady's like, did you get the message about your patient portion to pay? And she's like, No. And she's like, Okay, it's $500 for the insurance. $500 for the for the for the actual procedures, upper and lower together is $500, and then $40 for the copay, so it's $540. And she's like, I have insurance. And I'm just like that's with insurance, honey. Welcome to adulting. So right out of her mouth, the lady at the front goes, Don't grow up, honey. Yeah, don't grow up. And so she was like all sorts of bent out of shape because she still has the $540 bill. And she was all sort of bent out of shape.

Kelli 6:42

And I was just like, And that's before she gets the pathologist bill. This is not the pathologist bill. She's gonna get a bill from pathology. Yeah, yeah.

Nicole 6:51

Yeah. So she goes, now I know why people just don't just don't do shit. Now I know why people just don't get things done and they just live their life because this is bullshit. And I'm like, you're not wrong. You're not wrong. It is, it is, it is bullshit 100%. And and this is why this is, I mean, she has good insurance. She has she has good insurance. Her dad is a deputy sheriff, he has insurance through the sheriff's office. Full coverage. You know, he has her under under his plan. There's, you know, there's she's like, I'm calling dad. I'm like, you can call him, but this it's not gonna change. And she's like, well, maybe we could call and maybe they'll cover it. I go, wait a minute, wait a minute. They're covering it. They are covering it. They are covering it. Your bill would be thousands, thousands. So just let's just back it down a little bit. She was so bent out of shape. But the point being is that if something's wrong, go. I cannot tell you how many scans and tests I have seen that have incidental findings. It's like things happen for a reason. I remember an orthopatient that I had who's having really bad leg pain,

Incidental Findings That Change Everything

Nicole 8:09

knee pain from the knee down, really bad. And on imaging, on a x-ray, I could see his calcified arteries. I could see them on X-ray. It was so calcified. I go, oh honey, the knee is not your problem. You need to go see vascular. And he came back a couple months later and said, I cannot tell you how much better I feel. And they had told me it is such a good thing that I got in when I did because it was really bad. My circulation was bad, and that was the issue. He wasn't oxygenating well, he wasn't getting good blood supply. The tissues were dying. He ended up with a couple of stents in his legs. And I can't remember if we ended up with uh a femme pop or whatever bypass. But anyway, it was just an incidental finding, right? And so you I was like, oh no, like this is beyond something with your knee. So there's so many things that are incidental that okay, for example, also now that I think about incidental findings, I had to get a menopausal, whatever, and I went in for a kidney ultrasound for whatever reason, doesn't matter. They found something on my liver, and so the for kidney ultrasound, so incidentally they found something on my liver, and I think it's just a hemangioma. I don't know, I'm waiting on the report, but the radiologist suggested an MRI, so then I had to go in for an MRI of the uh abdomen. And I I mean, I think it's a hemangioma. I think I knew about it from several years ago, but anyway, it was just an incidental finding. But you know, for you know, is it cancer? I don't know. I doubt it, but for some people it could be, right? It could be, right? So that's why this kidney ultrasound could easily turn into something with the liver, like having nothing to do with the reason why I initially got the ultrasound. So just at least do, if you're not having issues, at least do your prevention, yeah. Prevention, your early detection stuff. At least do that. And I'll let you touch on a couple of things, Kelly. I'm gonna look up the US uh recommendations, uh, U.S. task force.

Kelli 10:26

So there's a few things that I like to chat about. You know, we have several patients that you know, we see in telehealth a lot of different things. And the one thing about telehealth that I want to really hit home is you can do some preventative stuff. You know, obviously there's there's no replacement

Telehealth Plus Wearables For Detection

Kelli 10:41

for good hands-on care. And I'm not taking that away at all because Nicole and I both advocate for good hands-on care. Absolutely. Go get someone to put hands on you because someone needs to listen to your lungs, listen to your heart, put hands on your belly, check your pulses and look in your eyes. Somebody needs to be doing that for you. And if you go get your yearly preventative care and that provider hasn't put his his or her hands on you, make them. Make them. They need to listen to your lungs, your heart, let's feel your pulses, look in your eyes, your ear. Like they need to be doing that. But there's some things that you guys can do. So there's some wearable stuff you can do. There's smartwatches, there's continuous glucose monitors, there's some biosensors. Some of the biosensors that are out there, so I'm you all know you've heard me talk about health and wellness long enough to know that I work out all the time, almost every day, five, six days a week in the gym. There's some biosensors out there that will do stuff like monitor respiration, skin temperature, your sweat composition. Yes, that's a thing. It'll even monitor your blood pressure and eat. So there's a lot of stuff out there. There's arrhythmia detection. So some patients have come to me and said, I didn't know, and Nicole, I know you have a story about this if you care to share. Your smartwatch was picking up on your arrhythmias. Like a watch can pick up on an arrhythmia that sometimes you don't know what's happening. A halter monitor sometimes won't catch it because they don't wear them long, you don't wear them long enough. VO2 max estimates with the monitors that you wear, cardiorespiratory fitness, sleep and nocturnal metrics with the monitors that we have people put on. So there's there's all kinds of biosensors out there, whether it's a wearable blood pressure sensor, temperature, so many things that even that subtle shift, that subtle, subtle shift can let you know and you can let your provider know. And those are things that sometimes you don't pick up on that once-a-year appointment, or that one 12-hour snapshot of wearing a halter monitor, that one time they put you on the treadmill for a stress test, or whatever the case may be, sometimes those sensors pick up something. Like you may have an athlete, like I had an athlete tell me, or somebody who's very athletic, tell me they picked up on an abnormality in their oxygen exchange while they were doing a stress with their VO2 max on. They were trying to hit VO2 Max, they were doing this athletic test, figuring out what their push was. A healthy human, healthy, athletic. They had their mask on, they were on the treadmill, they were doing their exercise thing, pushing their VO2 max. The trainer was beside them, caught an abnormality and caught an early problem. This person could have easily collapsed at any point during a workout, easily, and it was caught because of that biosensor.

Nicole 13:12

Yeah, it definitely is. It definitely can be. Yeah, the arrhythmias. I was having palpitations at night, and I I had my Apple Watch, and you can set your Apple Watch to where you just you click the arrhythmia and you just hold your finger to the to the wheel, and it will give you a one lead, and it will tell you it doesn't detect heart attacks, of course, and it gives you that disclosure, but it can detect a fib. And so I also have a home six lead. And so at night I was trying to catch this, you know, like it goes on your leg and then you put your fingers on it, and I was trying to catch this arrhythmia because I could feel it in my neck. But my watch was was definitely a really, really good tool for that. And my husband's cardiology actually, cardiologist actually said, Wear your watch while you sleep, and then when you come back, I'm gonna look at what it's told me. So he, even the cardiologist has said, look, let's use this. Let's use this as a tool. So Kelly's absolutely right. I mean, you can use those as a tool, not the end-all be-all, but a tool to help you. The website to look up what prevention is due for your age. Uh, it's the US Preventative Services Taskforce.org. And you can actually go on there and put in

Using USPSTF To Plan Screenings

Nicole 14:35

your age, put in your weight, height, gender, all the things, you know, tobacco use, sexual, all the things. So recommend there's 14 uh see 14 A grade recommendations, and it'll tell you cervical cancer, age 21 to 65, colorectal, age 50 to 75, uh, hepatitis B if you're pregnant, HIV, adolescents, and adults age. So like it tells you all kinds of things that you should have done. Some are specific for smokers, some are specific for if you're if you're if you're pregnant, and then you can go over to B and like men age 65 to 75 who have ever smoked are due for an abdominal aortic aneurysm screening. So there is different things that can certainly be related to you specifically, and it actually gives you a search on the left side. So it's the US Preventative Task Force, and you can, it says there's even an app. So, you know, breast cancer screening, women age 40 to 74. So, you know, all those things. But if you have a specific family history, you are gonna want to get tested for things sooner. So this is not this is a very general age. So, like breast cancer of 40 to 74, but if you have a first or second degree relative that has a history of breast cancer, you're gonna want to get screened way sooner. Don't wait until you're 40, right? So, like my like my kid, now that she has a polyp, she has to go every five years for uh a colonoscopy instead of 10, because we don't want anything to grow for 10 years, right? And it typically they grow slow, and so five years is fine. But it's you know, now you know, you know, right? She has that risk factor. So if you have certain risk factors, like you are a smoker, you ever smoked in your life, or first degree, second degree relative, like there's so many different things. So there's even tests if you're sexually active and if you're not, like there's certain things that you should be screened for. And and the the US Preventative Task Force tells you that. So that's a really, really good place to go. It tells you the recommendation, the summary, the risk factor, and the frequency of what you need. And it's it's really, really great tool. I think we should actually put this link in for our patients, especially for our primary care patients. We don't have too many primary care patients because we tend to not yeah, there's a lot in primary care, like your primary care, God love them. And you really need a hands-on in-person primary care, but for a very few patients for for whatever reason, they don't have that. And so we do provide it for a few patients. And I think this is a good link to give them.

Kelli 17:22

Yeah, we can link it in our channel.

Nicole 17:24

Look up their look up their own because it's just you click it and you go. So I I think it's I think it's a it's a great resource. But anyway, early detection is key, and that's why it is super important. Your insurance would rather pay for a small, small something versus five years later a big something. And that's why they're so vested in this. But it it also works out for you as the patient. They they want you to get these preventatives. You know, your doctor's gonna ask you, when was your last this? When was your last that? But it truly is for your benefit to get it done. And that's not something that we take lightly at all. We we, if there's something wrong, let's get it now and catch it now, and you can go on with your life. And yeah, and that's it.

Kelli 18:07

Yeah, absolutely. So, speaking about that, we have a special guest next week. So, transitioning women specifically, that are done with childbearing andor not having kids or done having kids, don't want to have kids, whatever, but you're out of

Next Week On Urogynecology For Women

Kelli 18:22

that, you're out of that realm. And maybe your lifestyle has changed a little bit. We are going to bring in a specialist who is kind of a sub-specialist, if you think about it, kind of a sub-specialist of a specialist. Yeah. So there are providers out there that sub-specialize in certain specialties. She is specifically a Euro gynecologist who's going to join us next week to talk about what that looks like and what her subspects what her subspecialty is, what types of patients she sees, what types of services she offers, why that subspecialty is so incredibly important, and what type of patient population she feels like would benefit. Because I think that oftentimes women are so behind the bar when it comes to their own health care and health and health maintenance. We just simply don't take care of ourselves and we don't take the time to take care of ourselves. And sometimes we don't even know what's out there, what's available to us. What technology is out there to help make our lives just a little bit better. So next week she's gonna join us, Nicole. Who is this? What is her name?

Nicole 19:23

I I don't, I don't want to say, I don't want to say it wrong. Okay.

Kelli 19:30

But she's gonna join us next week, right?

Nicole 19:31

Yeah, she's gonna join us next week. And then I will I will verify with her how to say her name. She is precious, she is absolutely wonderful. She is local to me, and she is so freaking smart and so knowledgeable. And I think for women who are out of the childbearing age, a Eurogynecologist is so more focused on health, generalized gynecologists. Generalized health, but for women who are out of childbearing age. So OBGYN is a they deal with labor and delivery and gynecological stuff. But after you're childbearing, you really are focused more, your focus changed to bladder health. There's too often patients deal with urine frequency, bladder prolapse, different things like that. And she can do that. So it's not like you're going to a uh regular GYN or OBGYN and going to a urologist. You can go to one. Yeah.

Kelli 20:35

I think of it as like gynecologic longevity. That's what I think of it as. Gynecologic wellness and longevity. Because that's truly what she's doing for women. She's helping us get over the hump of what happens to us after we hit a certain age.

Nicole 20:49

Mm-hmm. Mm-hmm. Because we don't need the OB part of it anymore, right? But we are going to need, you know, women, especially in menopausal. You get more frequent UTIs. You have, you know, trouble with urination, whether it's, you know, frequency or urgency, whether, you know, you after you have babies, you sneeze and you tinkle. Like, like that is something that she specifically addresses and she has a special, she specializes in. So I think it's super amazing. I have in the last 10 years really come to appreciate that specialty. And so I actually asked her because I said, you know, I'm going to be due for my my PAP. Can I switch from my OBGYN to Euro G Y N? And she's like, absolutely. And that's what made that's what makes sense for me. And so it's going to save me a visit because she's such a good sub-specialty and just amazing. So especially people that are menopausal, Euro G Y N is where it's at.

Kelli 21:45

And I also want women to hear this. You don't have to have had babies birthed children to have these problems. I have never birthed a child. I have these problems. It's called gravity and straining to have a bowel movement. They create the same problems. So let that let that simmer for just a minute and think about it. It creates the same problems. So I'm definitely going to pimp her just a little bit about those topics when we get her in here next week. Because I think there's a lot of women that have never birthed a child that have those problems. And I'm curious to see what she has to say about it and maybe encourage some of our women that are also experiencing those same problems to have a place to go.

unknown 22:19

All right.

Nicole 22:20

So menopausal women, stay tuned. And I mean, all women also, all women also, because you are eventually gonna have, I hope you don't, but all women eventually are gonna have a bladder issue if you live long enough. So true. It it just is, you know. And I noticed that like there's a lot of urologists that are that see a lot of men too. But I just love her. I just, I just I just love her. So we're excited to have her next week.

Kelli 22:44

So wonderful. All right, guys, stay tuned. We'll talk to you next week. Have a good week. Bye.