Lets make a Health Connection Podcast 3 with Dr. Cynthia McNally

Podcast Transcript

LHC- Hello there and welcome to Let's make a Health Connection. Your Local Health Connect podcast series in Vancouver, Washington. In this series we interview and showcase the many healthcare providers and resources that are featured on our website localhealthconnect.com. For those of you who don't know us yet, Local Health Connect is a hub where our community can easily search local resources and connect with providers for mind, body and spirit health. Thanks for listening today. I'm Jennifer Barber, licensed clinical social worker in Washington and Oregon and I practice right here in Vancouver, Washington

Today we're talking to Dr Cynthia mcnally she is a board-certified ob Gyn and owner of Evergreen women's health right here in downtown Vancouver hi cynthia

CM- Hi Jen how are you?

LHC- I'm doing great, how are you doing?

CM- doing well thank you

LHC- Excellent! We are just wanting to get to know you, let the community know who you are, what you got going on here in downtown and I'm hoping that you can start….well let's just open this up…. What made you start your own clinic?

CM- Well, so i've been an OB/GYN for 25 years and most of that time I was doing the regular OB/GYN, thing delivering babies part of the time and doing women's health the other part of the time and then in 2014 I stopped delivering babies and most of the time was in Vancouver. Also, before that in the air force I started working in Portland and just focused on women's health care so no more obstetrics just Gynecology and I realized that there really was a need for providers that just focused on Gynecology and also I didn't miss delivering babies. I didn't miss the hours or the stress...so I was trying to decide if I wanted to move to Portland, because I was still commuting from Vancouver and so I wanted to decide, should I move to Portland or should I find a similar position in Vancouver because the commute was just getting really overwhelming and exhausting and I decided that I really loved the Vancouver community and I wanted to stay here. I could not find a clinic that just focused on women's health with kind of an emphasis on holistic care so I decided I would start my own.

LHC- So, do you just love Vancouver? I mean what was the reason to start it in Vancouver?

CM- Yeah, so I'm originally from the East coast. I grew up in the Washington DC suburbs and the Air Force sent me all over. When I moved to Vancouver almost 18 years ago I really saw it as just kind of a suburb of Portland and I always thought if I ever end up working in Portland, i'll move to Portland and then just over the years, Vancouver really grew on me and I realized that it wasn't just a suburb it wasn't just an offshoot of Portland that it had its own entity and then when that time came when I was working in Portland and where it would have been advantageous for me to live there I was like, wait a second, I actually like Vancouver more. Now I think it's more mellow and it's not so set on being different from every other place but it has its own vibe. I don't know if that makes sense but anyway I just it's a little bit slower than Portland and I just also felt more part of this community. Once I had my daughter, who goes to Vancouver schools, also I became more active in organizations in Vancouver, such as the Rotary Club, so I just felt more part of this community and I decided I really liked it better than Portland.

LHC- Vancouver rocks!

CM- I must say it gets better every year is the cool thing, I mean it's such a different place from when I moved here 18 years ago. It really is becoming more sophisticated and more artsy and I just really love it here.

LHC- Our Downtown Vancouver has changed so much in the last 20 years, maybe even in the last 10 years. It's just growing so quickly so much is going in and you are right downtown, aren't you?

CM- Yes I am. So that was a very conscious choice because I still have a lot of patients that come from Portland and I think probably close to half my patients are from Oregon and I think conceptually when they look at a map and they see that I'm just right over the bridge. It's not as big a deal versus there are other nice areas in Vancouver, like East Vancouver or Salmon Creek but they just look so much further away. So that was a big part of it but also I love how downtown has transformed and I love that I'm walking distance from cool shops and restaurants and there's so many other entrepreneurs that are doing their own thing and making downtown more unique. That was a conscious decision. I am moving my clinic in three weeks to a larger location just a block away. Right now we're on Main street and we will be on Washington street. We're expanding from about 1200 square feet to 2000 square feet and also, right now, we're sharing 1200 square feet with a Physical Therapy Group and so we'll be having 2,000 square feet all to ourselves and I've hired a nurse practitioner and a few other medical assistants and so we're just really growing. I definitely wanted to stay downtown.

LHC- That's wonderful! We're glad to have you downtown. So you said you did hire a nurse practitioner from the Oregon clinic and we're wondering what expertise will she add to the Evergreen Women's Health Clinic?

CM- So she's been working a lot with the Uro Gynecologist at the Oregon clinic so she actually has more expertise than me in fitting pessaries and doing testing for incontinence. She also has done a lot of extra training in sexual health including pain with sex, libido, and she also has done extra training in vulvar disorder so that would be chronic irritation, discharge, she just really complements my skills. I also have a lot of interest in vulvar issues but as far as sexual health, that's more her thing and then what I have more expertise in, that she does not, is bioidentical hormones and menopause management and perimenopause. There are just so many other providers that are scared to deal with that it's kind of more managed by Naturopaths. So I feel like having a board-certified Gynecologist that can offer bioidentical hormones but also knows about conventional hormone therapy is a real benefit. So that's my interest and Natalie does not do a lot of that. She's interested in it but that's how we complement each other. Then we both do just general Gynecology IUDS, pap smears, ovarian cysts. Surgeries, I do. She knows how to manage and refer. I think we'll work well together.

LHC- What is Natalie's last name?

CM- Her last name is Mohler, Natalie Mohler. We will be accepting new patients, as of June 1st but we're already scheduling for her.

LHC- Yeah excellent excellent. So can you tell us how your clinic is different from most other OB GYN clinics?

CM- Yeah, so the biggest difference is because I don't do Obstetrics, I don't have to worry about getting called out for deliveries. When I was with some larger groups, it was very often that a patient would have scheduled an annual with me a month before and at the last minute. Oh sorry, Dr Mcnally has a delivery.. and so and that was obviously very frustrating for patients and frustrating for me too. I didn't like that and so one's always kind of torn, like okay, do I go across the hospital now and sit with somebody who's laboring and or should I? It was like a decision tree so that's gone. I now can 100% focus on the patient in front of me and I also have more time with patients because I'm not part of a large group. I don't have to answer to anybody else as far as seeing a certain number of patients a day or I'm making certain revenue markers. Some of the very large clinics in town were very focused on how many patients you saw and how much money you brought in and we don't have as much overhead as a larger clinic with the various managers and levels of bureaucracy. So I'm able to see more patients and see patients longer and not get distracted by other things like labor and delivery. I think a lot of people are out there hoping and wishing that when they finally do find a doctor, it's somebody who's going to take the time. Take the time to listen, take the time to really dive in. Some docs don't have the time and you've eliminated some things in order to make that time which is awesome. I think most doctors would like to have that time. I hear a lot of frustration from my patients about being rushed through visits and being dissatisfied with their providers but I think I know most of the doctors in this community and they're good doctors and I think they wish they had more autonomy and could spend more time with patients. So it's kind of the system that we are dealt with.

LHC- Absolutely. So I'm wondering what are the biggest misconceptions and health myths that you encounter with your patients?

CH- Oh so this is big. I spend a lot of time just educating women about the difference between a pap smear and a pelvic exam and why things have changed so much. So in 2012, up until 2012, women were getting a pap smear and a pelvic exam every year beginning around age 18. And some of them were getting like two pap smears a year if there was anything slightly off on their pap. And then in 2012 there was this radical change and it was based on science and research and the understanding now that HPV causes cervical cancer, so in 2012, they said, okay we don't need to do a pap smear on somebody under the age of 21. If a pap smear is normal between ages 21 and 29, you can do it every three years. You don't need to do it every year. Beginning at age 30 we had HPV testing which makes it an even more accurate test. And if your pap and your HPV are both normal or negative you can go five years without a pap. So that's like a huge jump and a lot of us are not a hundred percent comfortable with waiting five years between paps. But the PAP is just screening for cervical cancer, so it's not the rest of the pelvic exam. It's not feeling the ovaries. It's not looking at the vulva. It's not taking the menstrual history. It's just simply a screening test for cervical cancer. So there's a consensus on how often women need pap smears because cervical cancer is caused by HPV virus and that's very slow growing. So that's every three to five years but what there's not a consensus on, is how often a woman needs a pelvic exam. Which is everything else and it gets really confusing for women because they're hearing, oh you don't need an exam for five years and then other doctors are saying, oh no we may not do a pap every year but we're still going to do a pelvic exam every year. So it's just so confusing for women but I think the first thing is knowing the difference between a pap smear & a pelvic exam. And once you understand that, it's just screening for cervical cancer. It's not screening for anything else then you understand that a pelvic exam should not be only every five years, it should be more frequent, if for no other reason, just to take a history and just to check in. There's an OB/GYN who does a very popular blog and she uses the term check in, instead of check up. I think that's a really good way of seeing it because you're checking in and talking about your menstrual history. You're talking about your sexuality, you're talking about symptoms. Is this normal? Is this not normal? Should I be worried? You're talking about your family history. Okay my Aunt’s had breast cancer, Now should I get a mammogram earlier? So much of the importance of the visit is not just the exam, it's the checking in part and that that kind of leads me to this other thought. Seeing an OB/GYN, for a lot of people, is extremely vulnerable.

LHC-It's a vulnerable thing to come to a clinic and I think about our members of the community who may have had some sexual trauma and they know, they know, oh man it's been such a long time since i've seen my Gynecologist or maybe have never seen one and they're afraid. Right? They're afraid to come in and have that conversation and I'm wondering if someone were to come in for their first appointment with you and they had a history of trauma, sexual trauma. How could you help them begin to have that conversation or put them at ease, so that they could have an exam and feel safe?

CH- That's a very good question and it basically addresses trauma-informed care and so, for one thing, I see many women who have a history of trauma who haven't had a pelvic exam ever or haven't had one in 10 years and the first thing is they're embarrassed about it. Not only they're embarrassed about the trauma but they're embarrassed that they haven't been seen and they feel like they'll be judged for that. I always tell them that. No, I have plenty of patients who haven't been seen in 10 years. Which is true. And it's great that you're here now, I mean, it's great that they showed up. The other thing is we never force anything. I will recommend the pelvic exam but if somebody is uncomfortable with that, then no problem, we don't have to do that today. We can wait till you're ready. And then addressing the trauma. Asking about, do they have pain with sex? Are they able to use a tampon and when the answer is yes to pain or no they can't use a tampon, then very often before I even do any kind of exam, I will refer them to a pelvic floor specialist. Ao a physical therapist who specializes in pelvic floor disorders and many of them also specialize in trauma. They will work with a patient getting them comfortable with the pelvic exam and often that involves biofeedback. It involves vaginal dilators. Sometimes, I'll order a suppository to help relax those vaginal muscles. So it's just a step-by-step process but the main thing is. Number one, they're not embarrassed by not being seen for so long and then, number two, just taking it gradually. No rush. We don't need to be doing a pelvic exam the first time that they see me and then addressing the pelvic pain and the tension, the pelvic tension and knowing that there are ways to treat that is really important.

LHC- Thank you so much for explaining that. I think that could potentially put a lot of people at ease to just make that first call and come on in.

CH- Natalie Mohler also. She is definitely trauma informed. Definitely very good with women who've experienced trauma.

LHC- Okay great. I have a question for you that I think maybe you're not quite expecting but I'm going to add it in here. Okay. I'm wondering if you have experience working with the trans-community and if you have experience with people who are transitioning or have transitioned from female to male and yet they are still needing to come in to have their checkups. What's your experience and can you tell us a little bit about that.

CH- So I do have some experience and I'm kind of learning as I go and actually I learn a lot from my trans patients. I ask questions. When I was working in Portland, I became acquainted with that community more and I remember I had a very friendly trans male who saw me for menstrual issues. He still had a uterus and was having some bleeding problems and he had a full beard and had stopped testosterone years before and I was really confused. I mean this is nothing. I graduated from medical school in 1995 and this is not anything that we learned about. It's getting better. The OB/GYN community definitely. There's a lot more continuing medical education about it. There's a lot more practice bulletins recommending how we treat that community but in any case so for this particular patient. I just started asking questions, like okay, well how do you still have a full beard if you stop testosterone injections and he explained well once you get that process going? You don't need to have testosterone anymore, that kind of thing. So it was great because he was like, ask me anything, and so that was kind of the beginning of my education. Since then, if a patient is receptive, I'll ask them questions, maybe if I'm not clear on it because I haven't had any formal training. So to answer your question, I haven't had any formal training. All of it has been kind of as I go on with the experience of treating these patients. Just learning as I go. But I am interested. I mean they definitely are, they definitely need good care, often Gynecologic care. I think especially, in a more traditional community, like Vancouver they can be more hesitant to seek that care in Portland where there's a larger trans community. I think they feel more comfortable and also there are some clinics that specialize in trans health. I think Legacy has a good clinic in Portland and so there definitely are some things that I don't know and I'm just gonna tell like I've had a few phone calls whether I could deal with this issue or that issue regarding testosterone. I don't have experience and so we'll refer them to the clinic in Portland.

LHC- Okay good good to know. Alright, is there anything else that you would like our community to know about you, your clinic or your new practitioner that's coming in?

CH- Let's see. I think I've said a lot. I feel like I've talked a lot. Appreciate it. Not just we are, we are still accepting new patients right now while we are building out the clinic and that's been a lot of work and we're going to be moving in a few weeks and we're closing our clinic for a few days. So right now if a new patient calls they'll be told that I can see them in July. But that's going to change a lot once Natalie joins. We're going to have a lot more accessibility. We also, beginning in September, we'll have two Saturdays a month that we're open half days. I was doing that before Covid hit. I was open one Saturday a month for women who are really busy with work and just need to have that option. Then we decided we wouldn't do it right away also because of summer but in September we will have that again. So I did want to mention that.

LHC- Great absolutely. Okay. Dr Cynthia Mcnally. Thank you so much for joining us today and people can find you right downtown. Can you give us your new address again?

CH- Yes. Our new address will be 1207 Washington street and we're basically in the same building as Amaros table but just facing Washington street instead of main street. We're across from this beautiful church and there is street parking. We don't have designated parking unfortunately but there's almost always street parking available.

LHC- Wonderful okay and then we will add this to the show notes but can you tell everybody what the website address is.

CH- Yes it is www.Evergreengyn. com. GYN as in short for Gynecology. Our previous name was Evergreen integrative Gynecology, PC and we changed that to Evergreen women's health. But the website is still Evergreen Gyn.

LHC- Excellent and we'll put that in the show notes so people can find that too. Alright thank you so much for your time today.

CH- Thank you. I really appreciate it. Bye.

LHC- [Music] Thank you again for listening to Let's make a health connection. Find us on the interwebs at localhealthconnect.com. Also search for us on Facebook, Instagram and Twitter. Links and show notes for this interview are available on our podcast page. I really enjoy putting these interviews together and I hope you made a health connection. We'll talk again next time.
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By Local Health Connect 6-3-2021