Participants: Don Mackintosh (Host), Christina Salter
Series Code: HFAL
Program Code: HFAL000209
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00:01 The following program presents principles
00:03 designed to promote good health and 00:05 is not intended to take the place of personalized 00:07 professional care. The opinions and ideas 00:10 expressed are those of the speaker. 00:12 Viewers are encouraged to draw their 00:14 own conclusions about the information presented. 00:50 Hello and welcome to Health For A Lifetime. 00:51 I'm your host Don Mackintosh and today 00:53 we are gonna be talking about gynecological 00:56 health and that just means female health 00:58 and so we're glad that you're joining us today 01:00 and we're also thankful that Dr. Christine Salter 01:03 is with us from St. Louis, Missouri. 01:05 We're glad you're with us today. 01:07 Thank you I'm delighted to be here. 01:08 Now you practice in family medicine. 01:10 That's right. And I'm sure that both men and 01:14 women come to see you, but I'm sure that 01:15 you see a lot of women as well in the practice. 01:17 I do. And we're gonna talk about women's 01:20 health issues today. What are we gonna talk 01:22 about specifically? We're gonna talk about 01:24 the ovaries, the uterus and the cervix. 01:28 Okay and these things, these parts of the 01:30 female anatomy have special 01:33 blessings and challenges. That's right, 01:35 absolutely, we can't do without the ovaries. 01:38 The ovaries is where they produce a lot of 01:39 the hormones and so they're a important part 01:43 of the what makes a woman a woman comes 01:46 from the ovaries. And what makes a man 01:49 a man, if we don't have the ovaries, we wouldn't 01:51 have any men either. That is true. 01:54 Right so. So yes, small, small organs but very, 02:01 very powerful and then the uterus which is very 02:03 important for carrying babies, so a good 02:07 uterine help, but they can be problems too 02:09 then also with the cervix and so we want, 02:12 to talk about those things and. 02:16 Well, let's talk about then in that order, 02:18 ovarian, ovarian problems, what kind of 02:21 things can develop. What's the significance 02:24 of that. Okay, well you know the ovaries that 02:26 can develop some simple cyst, they can 02:28 become painful and easily treated okay and 02:34 beside those are benign, they're 02:36 just problems, painful. But then that the most 02:39 concern is ovarian cancer and the problem 02:44 with ovarian cancer is that it's not easily 02:47 detected, there is no real screening for it and so 02:50 that's what makes it, even though it's not a 02:52 frequent cancer it is the most deadly cancer. 02:56 Once you get it. Once you get it. 02:57 So and the reason there is no screening is 02:59 because it's right in the middle there, you can't 03:01 touch it, you can't feel it, it doesn't really bump 03:02 up against anything. Right, exactly and even 03:04 when we do an internal exam you know it's 03:06 really hard to feel, unless there is a huge 03:08 growth there then it becomes very obvious 03:11 but by the time it's gotten to that size, 03:13 then usually it's already spread to other areas. 03:15 So if there is no way to screen it, but 03:17 what can be done about it? Well my concern is my 03:22 burden is that woman recognize symptoms 03:26 of ovarian cancer and they're very benign 03:30 symptoms, vague abdominal pain. 03:34 So a new onset pain that's just nagging 03:37 and it just won't go away, we want you to 03:39 go and get that checked out. 03:41 Something new abdominal pain, 03:43 the other thing is going to the bathroom frequently. 03:45 Now that happens a lot. And a lot of things can 03:48 cause that, but one of them could be this. 03:51 One of them could be ovarian cancer then 03:52 the other symptom is bloating. 03:56 Now some times we get bloated after eating 03:58 a meal that doesn't quite set with us, 04:00 but that bloating goes away. 04:03 The bloating we're talking about is a 04:04 bloating that comes and it stays and just 04:07 get worse, you know, then your belt gets tight 04:10 and your clothes not fit in quite well, 04:12 still got that vague abdominal pain, 04:14 you know, still going to bathroom more frequently. 04:19 We want, we want women to come in, 04:22 get checked, get those symptoms evaluated. 04:24 It could be that we might catch it early 04:27 and that it may not have spread 04:29 you know far and so. So, the bloating, 04:33 vague abdominal pain and what else? 04:36 And urinary frequency. Okay and now when 04:39 someone comes in and tells you those three 04:41 things you said well what do you then? 04:43 So, what I do is I of course do a physical 04:45 exam and will also send them for a ultra sound, 04:49 of the ovaries. Of the ovaries, 04:51 and then, actually the entire uterus. 04:53 Of the uterus and the ovaries and I may even 04:56 do a CT scan to really evaluate, then I may 04:58 do a blood test. To look for some 05:01 of the markers of ovarian cancer. 05:04 So what do you see in the blood? 05:06 There is a particular hormone that's released. 05:10 I see, that is elevated and then we can test if 05:13 we have ovarian cancer. It's not a good screening 05:16 test but it's a reasonable test if you're suspecting, 05:19 it's call CA-125. Now a lot of women, 05:23 and you get that, there is a email that's going 05:24 around saying get your doctor to check 05:26 CA-125, it's not a great screening test because 05:30 other conditions like fibroids and 05:32 endometriosis can also raise the CA-125. 05:36 So we don't routinely screen using that test 05:38 and say well it's elevated, better go 05:40 get your ovaries out. Right. But if you are 05:42 suspecting ovarian cancer that one of the 05:44 tests that you would do in addition to the 05:47 imaging study. So the vague pain, 05:49 the bloating, the urinary frequency would cause 05:53 you to look for that now why would they have 05:55 urinary frequency because of the bloating 05:57 then pushing on the bladder or what? 05:59 Pushing on the bladder, just the proximity of 06:02 the reproductive organs and the irritation that's 06:05 going on, is gonna irritate the bladder. 06:08 Okay. And the bladder is easily irritated. 06:10 And I suppose I mean you could screen 06:12 everybody with a CAT scan and different 06:14 things but that's highly expensive. 06:15 It's highly expensive and highly damaging 06:17 because CAT scan is radiation, so we don't 06:19 want to do, expose people to unnecessary radiation. 06:23 MRI. MRI that comes very expensive. Yeah. 06:28 You see so. That's why they don't screen like that. 06:30 And that's why, that's why it's not screened for. 06:32 So what ages does this usually develop? 06:34 This is in the older women, so we're talking 06:37 greater than 50. Now, young women can also 06:41 develop a type of ovarian cancer and that 06:45 would rely on the index of suspicion of the 06:47 physician. You know having those symptoms 06:50 or an irregular menstrual cycle and irregular 06:53 menstrual bleeding, that will alert the physician 06:55 to just dig a little deeper in a younger woman, 06:58 but certainly in older women and the 07:02 suspicion is much higher and we go 07:05 looking for these and especially if she's been 07:07 on hormone replacement, if she is at this estrogen 07:11 dominance, again that driving force we really 07:17 want to look for that. It is a deadly cancer, 07:21 you know, it really. Once it gets started, 07:23 not too much to do, unless it's still within 07:26 the ovary. Within the ovary, they're taken 07:28 out and it's 100% cure of that. 07:31 Okay so that's, that's one concern we have, 07:34 so that we've covered the 07:35 ovaries, anything else about them? 07:39 No I think that's good, I think we can move onto the. 07:42 Okay, we have our next one, uterine health. 07:46 Talk to us about that. Okay well, uterus, 07:49 a common condition of the uterus are fibroids. 07:52 Lot of women have fibroids, very common, 07:55 again estrogen driven. And so woman having 07:59 menstrual cycles throughout their, 08:03 their reproductive life, then they go into 08:05 perimenopause, when the cycles, you know 08:07 when the ovaries are beginning to shut down, 08:10 okay and so then the cycles become irregular. 08:12 Right. Okay. So that time is a little bit of a 08:16 dangerous time because the endometrial lining 08:20 can develop malignancy and cause bleeding, 08:23 so is it because. You're having your monthly 08:26 or it is because of this bleeding. Right. 08:29 Okay. Then you get into the post menopause, 08:31 menopause is defined as no menstrual cycle for 08:34 12 months. Okay. Okay, so then my 08:38 concern is a women could have endometrial 08:41 cancer and have may be one or two spots of 08:44 blood, which she may completely ignore 08:47 because it's not, most women are thankful 08:49 than not having this menstrual cycles anymore. 08:52 Right. And so then they see this little drop of 08:55 blood and think oh you know, it's just a little 08:57 drop and they ignore it. But that little drop of 08:59 blood may signal an endometrial of the inner 09:04 lining of the uterus cancer. 09:06 So this is after you've gone through, 09:08 I mean kind of that no man's land you could 09:10 have a problem too. But this is especially 09:13 for the person that has not had a 09:15 period for 12 months. They're actually consider 09:18 postmenopausal. Right, exactly. 09:19 Don't ignore just that one spot. 09:21 Right but then lets, let's also discuss the 09:24 risk for endometrial cancer. 09:26 Okay let's talk about that. Okay so women who 09:27 is obese. Okay. And woman who has 09:30 hypertension, diabetes, they're at risk for 09:34 endometrial cancer. And again this is about, 09:37 this all to do with, with the hormones and 09:39 there's hormonal changes that occur in 09:41 those metabolic conditions. So especially if a 09:44 woman who is obese and though often the 09:47 diabetes and the hypertension go 09:49 together, and they may have high 09:50 cholesterol too. The deadly cortex. 09:54 Exactly, exactly and so if a woman like 09:58 that represents and she has some you know 10:01 some menstrual bleeding, oh then that 10:03 red flag goes up. Okay, so we want women 10:07 to know that you may not have any pain, 10:11 it may just be that one drop of blood, 10:13 we want you to go and see a physician. 10:15 And then when they go see their family 10:18 medicine specialist. Okay. What there, 10:20 what happens? Again we do an internal 10:22 exam, we often do a Pap smear to look for 10:25 abnormal and the endometrial cells that 10:27 maybe shown on the Pap smear that may 10:28 come through and then we do the ultrasound. 10:31 Again we do that diagnostic ultrasound 10:34 to identify and will show us the lining, 10:36 that endometrial line, will show us is there 10:38 an area of irregularity in there and if we do 10:41 see that, we can actually go in and biopsy the area. 10:44 And you can do that in your office. 10:45 Now in my office I can do an endometrial 10:47 biopsy and I do that but if I really am 10:52 suspecting that this is endometrial cancer 10:55 I do send them on to the gynecologist and have 10:58 them go and then they go I should do 11:00 dilatation and curettage and really clean the 11:03 entire area off and look at those cells and if 11:06 there is any thing abnormal then they 11:08 will proceed to hysterectomy. 11:11 Okay, so to avoid endometrial cancer 11:15 to start with, avoid obesity, proper diet, 11:21 exercise. All the things that would be normally 11:24 something we do to be healthy. 11:25 Exactly so all those things and then 11:28 of course the hormones, really not using 11:33 unopposed estrogen 'cause unopposed 11:36 estrogen and that's why a woman who has a 11:38 uterus if she's given estrogen, must also be 11:42 given progesterone, okay because if the 11:46 progesterone is not there is going to drive 11:48 that process for endometrial lining. 11:51 So we want to look at the hormones, 11:54 make sure she is exercising, so she's 11:55 not getting obese, make sure she doing all the 11:58 lifestyle for high blood pressure. 12:00 Which is the same thing exercising fruits and 12:02 vegetables, whole grains or low salt diet, 12:05 avoiding alcohol, 'cause that contributes to high 12:08 blood pressure and really creating the 12:12 hormonal milieu that will not promote growth 12:16 of the endometrial lining. Okay and then avoiding 12:19 ovarian cancer, what can we do to avoid that, 12:22 same kind of stuff. It's going to put the same 12:23 kind of thing, because of the estrogen 12:26 that's driving it. So you know we're exposed 12:30 to toxins all the time. Right. So the very best 12:33 you can do is to do those lifestyle factors 12:37 and then you know if there is a family history 12:40 okay, if there is family history for ovarian cancer. 12:43 Especially if there is also a family history 12:45 of breast cancer and again with colon 12:47 cancer, then again your individual suspicion is 12:50 much higher. Okay, some women choose 12:52 to have prophylactic, prophylactic 12:55 ureterostomies, mean they get the 12:57 ovaries taken out. And would you suggest 13:00 that, it's a very drastic measure and that's 13:03 something that I have really have them pray 13:05 and discuss you know. Because of the all the 13:07 hormonal changes that come, it just kind of 13:09 change their personality maybe. 13:11 Exactly, exactly, I have woman where they've 13:14 done that and it's just, it's hormonally 13:17 devastating to them, so they've got to really 13:19 look you know of that risk versus benefit to 13:22 make that decision about that. 13:25 We're talking with Dr. Christine Salter, 13:27 we're talking about woman's health and 13:29 we have learned some important things when 13:31 we come back we will talk some others issues. 13:33 I know you won't want to miss it. 13:37 Are you confused about the endless strain 13:39 of new and often contradictory health 13:42 information? With companies trying 13:44 to sell new drugs and special interest groups 13:46 paying for studies that spin the fact, 13:49 where can you find a common sense approach 13:51 to health. One way is to ask for your free 13:54 copy of Dr. Arnott's 24 realistic ways to 13:57 improve your health. 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If you're looking for help, 14:25 not hike then this booklet is for you. 14:27 Just log on to 3abn.org and click on free offers 14:31 or call us during regular business 14:32 hours, you'll be glad you did. 14:37 Welcome back we're talking with 14:39 Dr. Christine Salter, she's specialist in 14:41 family medicine, she practices in 14:43 St. Louis we're glad that you're with us. 14:45 Thank you, I'm glad to be here. 14:46 And we've been talking about women's health issues. 14:48 Yes we have. We've talked about ovarian 14:50 cancer and you know that you really can't 14:54 screen for it, but bloating, unusual pain, 14:58 going to the bathroom a lot, these are signs 15:00 to go to see someone. Exactly. Get it checked 15:03 out and then we've talked out endometrial 15:06 cancer and now we want to move on. 15:10 We wanna talk about cervical cancer. 15:11 Cervical cancer absolutely, 15:15 my concern about cervical cancer is that 15:18 no woman should die of cervical cancer, because 15:21 it's so easy to screen for it. 15:24 By a pap smear of a woman exam. 15:27 But lot of women do not want to come in 15:30 for a well women exam, they say oh no, 15:33 I don't have that time you know and they 15:36 feels it is invasive somehow. 15:39 But it's not invasive, it is very simple, 15:42 it should be relatively painless and it just 15:47 taking a little sample of cells so we can send off 15:50 and look for premalignant lesions, 15:53 you know. But woman don't come in for that, 15:56 then the lesion, then the cancer comes and 15:59 advances and it's a, it's a kind of cancer, cervical 16:03 cancer doesn't spread in the distant, it doesn't go 16:07 to the brain, to lungs or like that. 16:09 It's local invasion. And I have taken care 16:12 of patients like that, it's just a horrible way to 16:15 die and to think that it could be completely 16:18 avoided with regular pap smears. 16:21 So what is the risk for a typical lady in Western 16:26 society or America from cervical cancer? 16:29 Well it's very common and the problem is that 16:35 the risk really from the sexual transmitted 16:36 diseases okay. Okay. The human 16:38 Papillomavirus is been implicated in this 16:41 and usually that occurs from multiple sexual 16:45 partners and usually what happens, a woman 16:49 may have had multiple sexual partners in a 16:51 young age and then develop cervical cancer 16:55 later on, so now she is changed her lifestyle, 16:59 is now married and you know not doing that. 17:03 Right. And then decide why don't I get pap 17:05 smears done because you know I just don't 17:07 have that you know the speculum put into me. 17:10 And she's the one that maybe harboring a high 17:13 risk human Papillomavirus that's gonna turn into 17:16 cervical cancer. So especially if you've 17:22 been involved in you know multiple sexual 17:25 partners you need to be checked. Absolutely. 17:28 But even if that's not the case you need to be 17:30 checked and when is that do you need to start 17:32 getting these pap smears. Well usually the American 17:38 college of gynecologists, they recommend age 18 17:41 and even the use of preventive task force. 17:44 I personally do not press a woman to do 17:47 that if she is not sexually active. 17:49 Okay so if she is sexually active go for sure. 17:53 No matter what age you are. Right. 17:55 Okay and we hope that you know everything 17:56 16 and being sexually active we would want 17:59 the young ladies to wait until the marriage. 18:02 But whenever sexual activity occurs that's 18:05 when the screening needs to start okay. 18:08 And we screen for those, with abnormal 18:10 cells and we also look for the high risk human 18:13 Papillomavirus, and if you don't have it and 18:16 it's inactive, then we say you do annual test 18:19 and if three or normal then we can spread it 18:22 out to maybe every couple of years. 18:25 But there are some lifestyle factors that do 18:27 effect cervical cancer. Well of course one of 18:30 them has to do with sexual activity but what 18:32 are some of the others? Smoking. 18:35 Smoking again. Smoking again increase 18:37 the risk for cervical cancer. 18:39 It's amazing I mean you wouldn't think 18:40 I mean it's the opposite end. 18:42 It's the opposite end exactly. But it does. 18:45 But it's got toxins and carcinogens. 18:49 Also the diet, they found that, woman 18:52 who have high levels of antioxidants in the 18:55 blood stream, vitamin C, beta-carotene, 18:59 that they have low risk for cervical cancer. 19:02 So more carrots, more apples, lots, variety of 19:06 fruits and vegetables to raise the antioxidant 19:10 levels in the blood streams and food grade 19:13 nutritional supplements to raise those antioxidant 19:15 levels to protect the cervix. 19:19 Now we want to mention that the early, 19:22 that sexual activity occurs the more 19:24 damaging that it is because the immature 19:29 cervix has those cells that are more 19:32 susceptible. Because they're still developing. 19:34 Because they're still developing on the 19:35 outside so they are more susceptible to the 19:37 papillomavirus, they're more susceptible to the 19:39 AIDS virus. They're most susceptible to 19:42 those organisms, to the chlamydia and 19:45 gonorrhea okay so, we want to leave sexual 19:48 activity the latest possibly till we got. 19:52 Well I mean look I mean also sexual 19:54 activity with people that don't have chlamydia 19:57 and gonorrhea and Syphilis and all these 19:59 things. Exactly. I mean, so watch who you're 20:01 running with, that's a lifestyle factor. 20:03 That is exactly and remember whoever 20:06 you have sexual activity with you also having 20:08 sexual activity who they've had sexual 20:10 activity with. Right, so we want young 20:15 ladies to be careful who they choose and make 20:19 sure they know about their previous activities. 20:23 I mean so they never need to get this for a 20:25 number of reasons, not just screening but 20:27 because I mean God intended. 20:30 I mean if you read Leviticus what is it 18 20:33 and you just follow it, which is no until yes. 20:36 Right, exactly. And all those different 20:38 variations there then you're safe. 20:41 I bet you have some pretty frank talks with 20:43 people in your office. Yes I do, yes I do. 20:46 I like point blank you know, ask about sexual 20:50 activity and encourage a lifestyle of chastity, 20:52 not just abstinence, it's not enough I'm being 20:55 abstinent, we want a lifestyle of chastity. 21:00 The very behaviors you know some may not 21:03 have gone to full grown sexual activity but they 21:06 may be doing other things that is not a 21:09 lifestyle of chastity. So we want the young 21:14 people to be chased, keeping themselves 21:18 pure and safe sexual activity for marriage 21:22 in the way that God intended it. 21:23 You know I don't know if you ever when I, 21:26 I used to work in an emergency department 21:27 and that chapter, Leviticus 18, 21:30 that just goes through all those things, 21:32 I don't know that you can improve on that. 21:35 If you just go through it, you just you reach 21:37 people and they just, they say hey look 21:39 you know if you're involved in any of these things, 21:41 you know check yes or no. That's right. 21:42 Then if you are, you know you're in trouble. 21:47 Exactly, exactly. So, I mean you know I think 21:50 it's great that you can, you can talk with 21:52 with people about these things, I mean it 21:55 sometimes might be considered a touchy 21:57 area but look if you don't tell people what's 22:00 up they can really get into problems. 22:02 They really can. So we need to find out 22:05 this information, we need to find out you 22:07 know the sexual history and screen perfectly. 22:12 The woman who is 60 who thinks she does not 22:15 to be screened, when we find out you know 22:18 how many several problems she's had in 22:20 her life time that puts into the high risk 22:23 category and it's important that she is screened. 22:25 Okay, so we've talked about having the pap 22:29 smears, we've talked about knowing what 22:33 your history has been, hopefully not a long 22:36 history but if you said now if it's more than 22:39 5 people during your life time you're at 22:40 very high risk. Yes, you're at higher risk 22:42 absolutely. And then what were the other risk 22:45 factors, we need to talk about lifestyle things. 22:47 So we've talked about diet, having lots of 22:51 antioxidants in the blood stream, right, 22:53 from fruits and vegetables and 22:55 a recent study was done on the use of birth 22:58 control pills that long term use of birth control 23:00 pills may also increase the risk for 23:04 premalignant transformation. 23:06 So we tried to look at things all in context 23:10 and really get a bird's eye view at the patient, 23:15 see how aggressive we need to be 23:16 in their screening. So, for some women 23:19 there will always be annual and other 23:22 women if they're at low risk and they've had 3 23:24 normal pap smears then we can you know. 23:27 Maybe back it off every 2 years. 23:29 Every 2 years exactly. So you know I'm kind 23:35 of glad I'm a man but then I'm very glad there 23:39 are women too you know what I mean, 23:40 but there is just some more variables to think 23:43 about for the female. Yes there is and if a 23:47 premalignant lesion is found, it's easily 23:49 treated. I mean that's the really great news 23:52 about being screened for cervical cancer, 23:55 it is easily treated that as soon as they can 23:58 freeze you know and depend on the extent 24:01 of it, they may just do a surgical procedure 24:03 to remove part of the cervix that has those 24:08 malignant cells, otherwise that 24:11 malignancy is just going to track and 24:13 invade and it invades locally. 24:16 So there are things, there are things that 24:18 can be done. Wonderful, now you 24:21 know talking about all of these issues with 24:24 women's health, there is just the overall message 24:26 here is to just have good health through exercise, 24:30 diet all those different things and if you just 24:33 leave by the book so to speak, you can avoid a 24:36 lot of these problems but even having said 24:38 that we live in an age where there are so 24:42 many things, so many factors that are in 24:44 applying, it's wise to be checked. 24:47 It is, you know I've had patients say, 24:49 but I'm healthy, I eat really well you know 24:52 I do this, I do that but still it's important to be 24:58 screened and just say it's important to be 25:00 categorized and say, are you low at risk or are 25:02 you high at risk, just look at everything, 25:05 where are you in the risk category? 25:09 And based on that we'll go forward. 25:10 It's not enough just say well you know I eat 25:12 healthy and I don't think I'm going to have that, 25:14 because you're not gonna have any 25:15 symptoms until it's spread. 25:18 You'll have no symptoms until it's not 25:20 locally invading. So and we don't want 25:23 you to wait until those symptoms. 25:24 You know I can't think of a more important 25:27 person I might I mean this is gonna sound bad 25:29 to all the guys out there, then a mom. 25:33 Then the mom in the home. 25:35 I mean I think the guys are important too 25:38 I mean but I'm just saying when mom's not 25:42 happy, no one is happy, as the saying goes. 25:44 That's right. And there's so much 25:46 glue there you know holds things together 25:49 that, that we really want the, the women 25:51 listening today to take this to heart. 25:54 We really want them to, we want that their 25:57 husbands encourage women to take care of 25:59 themselves, encourage them to go and get that 26:01 well women exam, encourage them to get 26:03 that annual preventive exam, so they're doing 26:06 all those things, encourage them, 26:09 be an accountability partner. 26:11 You know with exercise, with eating well. 26:14 Do all those things that will encourage her health. 26:17 What do you says to the woman that maybe has 26:18 developed cervical cancer recently? 26:22 What kind of things happen right then, 26:24 you know maybe someone is just really 26:25 anxious and they're thinking, what's the 26:27 next thing that's gonna happen? 26:28 Again, that depends on how far gone it is, 26:32 but probably she will need to have surgery 26:35 and if it's pre-malignant, if it's advance 26:38 pre-malignant lesion, they'll just take off part 26:41 of the cervix. If it's really, fairly extensive 26:44 then they will actually do a actual 26:45 hysterectomy and take the entire uterus out. 26:50 So the cervix is the neck, cervix means 26:53 neck, so it's the neck of the uterus. Right. 26:55 Okay, and so they can just go in and 26:57 take off small parts. If it's you know, 27:01 if it's you know we say it, it's not invaded, 27:05 so they can take off small parts, but if 27:07 there's a Frank cancer they we will 27:09 need to go in and take. Another reason to get it 27:12 checked before hand, especially in those 27:14 people that haven't had children or maybe 27:16 wanting to do that, you want to make sure that 27:18 these kind of things are taken care of. 27:20 Exactly and during pregnancy we always 27:21 check in the initial obstetric visit, 27:24 we do a pap smear to make sure that everything 27:27 is gonna be fine for those next 9 months. 27:30 So the real message then is prevention, 27:33 absolutely, and akin that seriously. 27:36 Absolutely. Thank you so much for 27:37 spending time with us today, and thank you to 27:40 your patients and also to your 27:42 husband and your fine children. 27:43 Thank you. It's a pleasure to be here. 27:45 And we're glad that you've been with us as 27:46 well. This has been an important program, 27:49 don't minimize it. If you haven't had a screening, 27:52 if you haven't had that Pap smear or been 27:54 checked, take care of it. Make the appointment 27:57 today, and have health that lasts for a lifetime. |
Revised 2014-12-17