When Care Goes Virtual: The Surprising Benefits of Video Visits

One thing Jillian Worth, MD, ABFP, can count on with teenage patients is their hesitancy to talk about serious subjects in the exam room. For teens coping with mood disorders, typical in-person appointments can feel artificial and discourage conversation. When the COVID-19 pandemic suddenly replaced office visits with video sessions, Dr. Worth noticed something remarkable: her young patients were opening up like never before.  

“What I’ve seen is kids on virtual visit in their bedrooms are more likely to talk about what they’re feeling, in the space where they have those feelings,” says Dr. Worth. “They’re willing to jump right into what they’re struggling with, instead of needing lots of warm-up.”

Another big benefit of video for young patients is flexible scheduling. Arranging an in-person appointment can delay care, when a quick video check-in has the power to turn things around for a teen. Adding a 15-minute virtual visit to the end of her day, says Dr. Worth, is much more doable than a regular visit, and takes care of the patient’s problem when it’s happening.

As a family medicine physician, Dr. Worth sees patients of all ages and backgrounds and surprisingly, video visits have proven beneficial across her diverse practice. Instead of having a patient seated in an exam room, video can offer a little window into their world, revealing the important objects, pictures and even people in their lives.    

“With longtime patients, at some point you stop asking social history questions, like who they live with,” says Dr. Worth. “But maybe you’ll see a grandkid running through the room on video and ask about them, and find out that family has moved in.”

Dr. Worth has discovered that asking her patients new questions that come up through video can lead to better patient care. Patients light up, she says, because they want to tell you more about who they are. They can also feel comfortable enough in their homes to admit problems they’ve never considered discussing in the office. If a patient reveals they feel unsafe in their relationship, for example, the care plan can include steps to address the situation.  

For elderly patients, occasional home visits can be a necessity, but before the pandemic they were usually limited to severely ill and homebound patients. Now that Dr. Worth sees most of her older patients on video, she looks out for them in new ways, such as noticing something in their environment that needs attention.

“I can have them pan around the room and see they have a loose area rug, or a dangerous step going down to their living room,” Dr. Worth says. “Maybe they use a walker and there’s a little dog running underfoot. Things I would never have known from an office visit.”

Then there are the patients who struggle more than others to even get to a provider’s office. Chronic conditions that involve regular appointments for care or medication management can be a challenge for those with debilitating illness, or for those who can’t get time off work. Visits using a patient’s smart phone can happen on a work break. People dealing with chronic pain can avoid a car trip and navigating a medical office building.

Another way virtual care boosts more equal access is the prevalence of smart phones across a diverse patient demographic. “It’s difficult for many working families to get themselves or their kids in for care, but most people have some version of a smart phone,” says Dr. Worth. “The flexibility and the capability of video on their device means they can hop on for a visit wherever they are.”

What’s clear is being able to see a patient when a visit might otherwise not have happened can change the course of illness and recovery. One elderly patient became bedridden and was considering hospice care. A family member held up her phone for a virtual visit with Dr. Worth from the patient’s bed.

“To see her in the office would have been impossible, but I was able to observe how it felt for her when she tried to move around,” says Dr. Worth. “I could see her pain and talk with her. Now we’ve got her in physical therapy at home and I see her sitting up in the living room.”  


Jillian Worth, MD, ABFP, is board-certified in Family Practice and currently practices at the Virginia Mason Bainbridge Island Medical Center. Dr. Worth specializes in family medicine, primary care, pediatrics, preventive medicine and transgender health.

10 Goals to Help You Prioritize Your Health

**By Kristopher Dunbrack, MD**

Prioritizing your health is important at any age, and the good news is that any time is a good time to start. If you’re wondering where, or even how, to start, the following tips are for you. While many of us have fallen out of routine during the pandemic, the below can help center us in areas of our lifestyle that we might not be giving the attention it needs.

The reality is that we are facing a mental health crisis in our country and the pandemic has had a substantial impact on the lives of all Americans. While none of us can control the future of our country, we can prioritize our health—and that can have a significant impact on our wellbeing.

Try a few of the below goals this week and see how you feel.

Physical Activity: Find an activity you like and do it daily.

The best medicine for nearly everyone is physical activity. Daily exercise can be a fun chance to unwind, enjoy the outdoors and do something that makes you happy. Tips:

  • Go for variety
  • Buddy up
  • Pace yourself
  • Talk to your doctor
  • Involve your family
  • Increase gradually
  • Take it outside

Portion Sizes: Increase healthy portions and decrease unhealthy ones.

It’s a fact: we eat more when served larger food portions. Portion sizes have dramatically increased in the U.S. over the past decade. Because eating can be an automatic behavior, portion control is the first step toward healthier nutrition choices. Tips:

  • Understand portion size vs. serving size
  • Use visual cues to determine a serving size
  • Focus on food quality
  • Eat mindfully and enjoy your food
  • Try new healthy recipes

Preventive Health Screenings: Verify your immunizations and health screening tests are up to date or make an appointment to do so.

Regular health screenings are an important part of your health care. Results provide a snapshot of your health and reveal opportunities to make healthy changes. Here are a few of the recommended screenings:

Get Adequate Sleep: Make 7-8 hours of sleep per night a priority.

Sleep is vital for good health and well-being. Adequate sleep is important for your personal safety and that of others on the job or while driving. Sleep impacts mood but it also impacts our immune system, our weight and our risk for serious medical illnesses. Tips:

Try Something New: Do something new each month—challenge your mind and body.

New experiences can be both exciting and scary, but overcoming your fear, embracing your strengths and nurturing your curiosity will help you reap the benefits of personal growth and discovery. Tips:

  • Overcome your fear
  • Build on past successes
  • Leverage your strengths
  • Find the fun

Strength and Flexibility: Add strength training and flexibility to your workout twice a week.

Flexibility and strength aid in improving performance, preventing injury and achieving personal fitness goals. We lose about 10 percent of our lean muscle mass per decade starting around age 30. Fortunately, this can be counteracted with regular strength training. Tips:

Laugh: Laughing every day improves overall health and well-being.

Research shows laughter offers us health benefits in four health dimensions.

  • Physical: Boosts the immune system, promotes healing, helps us cope with serious illness and promotes an overall sense of well-being
  • Intellectual: Boosts excitement, self-assurance and cheerfulness; increases intuition, creativity and imagination
  • Emotional: Reduces stress by providing a positive way to view problems
  • Spiritual: Universal language that fosters connection and compassion

Family and Friends: Invest time in the people who matter most to you.

Having close friends and family has far-reaching health benefits. A strong support network can be critical to destress during tough times. It not only wards off lonelinessit increases your sense of self-worth. Tips:

  • Reflect and focus on relationships
  • Be active and spend time outdoors with those you care about
  • Time invested in friendships can pay off for your health
  • Avoid people that drain your energy

Hydrate: As a rule, men should drink 13 cups of water daily and women 9.

Water needs depend on your health, activity level and where you live. Every system in your body needs water. It flushes toxins, carries nutrients and moisturizes ear, nose and throat tissues. Tips:

  • Exercisers need extra water
  • Keep replacing fluids after exercise
  • Hot/humid weather requires more water
  • Drink one glass with each meal and one between
  • You’re generally hydrated if urine is clear or light yellow

Quiet Your Mind: Find a quiet place, take 10 deep breaths daily.

Quieting your mind is about non-reacting. It’s not eliminating problems or emotions, but rather cultivating a healthy response. It requires a sense of exploration and daily practice. Tips:

  • Seek silence by doing nothing for five minutes a few times a day
  • Breathe deeply 10 times without thinking and notice your experience
  • If your mind wanders, just notice and return to your breathing
  • Practice the “just do it” principle and smile


Kristopher Dunbrack, MD, is board-certified in family medicine and currently practices at Franciscan Medical Clinic – Enumclaw. He specializes in both family medicine and pediatrics.

Hit Me With Your Best Shot: 4 Reasons to Consider Getting Your Flu Shot This Year

**By Christopher Baliga, MD**

The flu is a contagious disease caused by influenza viruses that infect the nose, throat and lungs, causing mild to severe illness and, in extreme cases, can lead to death. Fortunately, there is a way to mitigate both your own risk from the flu and the risk of those around you, too – enter the annual flu shot. These influenza viruses tend to mutate year-after-year, meaning that every flu season is different and warrants a new vaccine each year.

The CDC estimates that in the U.S., flu season can begin as early as October and as late as May, and is most rampant between December and February. The ideal time to get your flu shot is in the weeks leading up to the start of flu season but can still be effective if received later than this.

Whether we like it or not, flu season is right around the corner. Read on for four reasons why you should consider getting your flu shot this year.

It can lower your risk of contracting the flu

I’ll start with the obvious – getting your annual flu shot is your best defense against catching the dreaded flu as it allows your body to harbor and build up the necessary antibodies to protect against each new strain. According to the CDC, when the vaccine viruses are similar to the viruses going around, flu shots have proven to reduce the risk of flu-related doctor visits by 40-60%.

 It’s important to note that while the flu shot doesn’t guarantee full protection, it’s still worth getting.

It reduces the severity of flu-related illness

How your body responds to each flu shot varies from person to person. For example, it tends to be more effective for people under the age of 65, as older folks may develop less immunity after receiving it than their younger counterparts.

But, even if the shot doesn’t completely prevent the flu, it can still weaken the severity of illness if you do end up catching it. It can also lower your risk of developing serious complications that could eventually lead to hospitalization. And naturally, reducing the severity of flu-related illness can also lead to fewer hospitalizations on a macro level.

Getting vaccinated helps protect those around you, too

Receiving a flu shot allows you to play a role in protecting those around you who may be more vulnerable to serious flu-related illness, such as young children, older people and those with chronic medical conditions. It helps train your immune system to fight these nasty germs, which in turn diminishes your risk of transmitting them to those around you.

The flu is expected to have a nasty return post-COVID

Thanks to masks, social distancing and heightened hand hygiene across the U.S. amid COVID-19, other germs were kept at bay – including the flu. But, as these preventive measures begin to ease up, cold and flu viruses are expected to make a nasty return, making this year’s vaccine more important than ever before. Getting your flu vaccine at the same time as your COVID-19 vaccine? No problem – it is safe to get both.

Now that summer has come and gone, it’s time to shift attention to protecting ourselves, and those around us, from the flu’s return by receiving a flu shot. If you’re unsure of where to go for this, check out the HealthMap Vaccine Finder or talk to your doctor.


Christopher Baliga, MD is board-certified in Internal Medicine, with a subspecialty in infectious diseases, and currently practices at Virginia Mason Medical Center. He also specializes in travel health and HIV/AIDS care.

Have fun in the sun and keep your skin safe from harmful UV rays with these 3 tips

**By Natalie Moriarty, MD**

Whether it’s summer or not, every day you are outside is a good day to protect your skin. It might be surprising, but you can still get a sunburn when it’s cloudy outside. Ultraviolet radiation (UV rays) comes from the sun and causes sunburns, and worse, skin cancer.

Damage from UV rays is cumulative, which is why it is important to wear sunscreen even on a cloudy day. While skin eventually recovers from a sunburn you might get over the summer, some damage will remain. This can lead to wrinkles, age spots, rough skin texture and eventually, skin cancer.

The good news is that the U.S. Environmental Protection Agency tracks the level of UV rays by city. Each day, a number between 0-15 is assigned reflecting the strength of the UV rays throughout the day. The lower the number, the less risk. As you might expect, UV rays are stronger during spring and summer months, as well as between the hours of 10 a.m. and 4 p.m.

Read on below for some quick tips, so you can enjoy the weather, steer clear of harmful rays and stay safe this summer and beyond!

Know your skin type

Those at higher risk of skin cancer tend to have lighter eyes and pale skin, many moles or a family history of skin cancer. These individuals should be extra careful with sun exposure, avoid sunbathing and stay on top of regular visits with their dermatologist. It’s also a good idea to monitor your own skin monthly for new skin moles, bumps, scaly spots or places where your skin has changed color. Call your doctor if you notice any of these changes.

Skin cancer is much easier to treat when it is caught early, so get to know your skin, actively watch for changes and check in with a dermatologist routinely.

Use sunscreen appropriately

Every sunscreen is assigned a sun protection factor (SPF), which rates how well it blocks UV rays. In general, you should use a product with SPF 30 or higher, with the words “broad-spectrum” on it. Higher numbers indicate more protection, and a broad-spectrum sunscreen will block both UVA and UVB sun rays (both are harmful). When possible, look for a sunscreen containing zinc or titanium, and choose lotions over sprays. 

If you are around water, snow, at elevation or just prone to sunburns, consider a sunscreen with an SPF 50 or higher.

Remember to reapply often! The protection from sunscreen wears off in about 90 minutes, or faster if you are swimming or sweating.

Practice sun-protective behaviors

Even with proper sunscreen use, some UV rays can still get through. Because of this, sunscreen is only one part of sun protection. The other important sun protective behaviors are seeking shade and covering up with sun-protective clothing.  

In fact, when the sun is the strongest between 10 a.m. and 4 p.m., try to avoid direct exposure altogether. During this time, everyone is at risk for skin damage. If you can’t stay in the shade, be sure to wear a lightweight long-sleeve shirt, sunglasses and a wide-brimmed hat to protect your skin. Choose a pair of sunglasses with a UV400 rating or “100% UV protection” on the label, as these sunglasses block more than 99% of UVA and UVB radiation.

So, the next time you are outside, will you think about protecting your skin? We hope so!


Natalie Moriarty, MD is board-certified in dermatology and currently practices at Virginia Mason Medical Center. She specializes in detection and treatment of skin cancer, eczema, psoriasis, infections of the skin, pediatric dermatology and preventative and restorative cosmetic treatments.

How to Ensure You Get the Health Care You Deserve

**By Jane Dunham, MD**

While your health care team does everything in their power to provide appropriate care, the fact is, nobody knows your body better than you. Therefore, it’s important to be a partner in your medical care: speak up about your needs, concerns, and desires, particularly if something feels off or you have lingering questions.

We know that seeking health care (let alone playing an active role in it) can sometimes feel intimidating, especially if you’re not quite sure about the specifics of your condition. Below, we’ve outlined some tips to help empower you to get the health care you deserve, on your terms.

Educate yourself on your condition or diagnosis

Patients equipped with the proper information regarding their diagnosis may have an easier time playing a role in the care they receive. If you’ve received a diagnosis that’s new territory for you, we encourage you to read about it and ask questions as they arise. Ask your doctor if they can point you toward resources that will help you understand your diagnosis and what to expect. The same goes for medications you are prescribed: Know what you are taking and why you are taking it. Keep an updated medication list with you for reference and be sure this includes any over-the-counter medications or supplements that you take. This information can help to avoid harmful interactions with food or other medications that you may be prescribed.

Ask questions about your care plan

It’s well within your rights as a patient to fully understand any care being prescribed to you. Having a clear understanding of the details of your care plan helps you ask informed questions, aids your care team in setting goals that are realistic and achievable, and helps you provide specific feedback to your care team about how things are going. If you’ve asked a question and still don’t understand, don’t be afraid to ask again. Ask for a written copy of your care plan whenever possible so that you can refer to it as needed.

Consider asking a friend or family member to be your advocate

You don’t have to manage your health care alone. Ask a trusted friend or family member to assume the role of your advocate. Having an advocate can provide incredible support, particularly if you are anxious about your diagnosis or are experiencing any sort of issue that might make it difficult to advocate for yourself. Advocates can attend appointments to help ensure that you get all the information you need and make certain that you don’t forget any questions or important areas to address. It’s not uncommon to forget something when you feel nervous or anxious, and an advocate can help ensure you’re receiving the best care possible.

Participate in every decision regarding your health care

Of course, your medical professional is considered the expert, but YOU are the expert on yourself. If your provider suggests a course of treatment you don’t feel comfortable with, let them know and inquire about other potential treatment options. If something doesn’t feel right to you, we encourage you to speak up rather than just going along with things and feeling uneasy or unsure.

Remember, you are the most important person when it comes to your health. The right health care professionals understand this and will help in any way they can to ease your concerns and ensure your experience is positive. Never be afraid to ask questions. Advocate for yourself and always speak up to receive the health care you deserve.


Jane Dunham, MD is board-certified in internal medicine. She practices at Virginia Mason Medical Center and specializes in preventive medicine and primary care.

Warm Weather Stresses Your Heart: Tips to Stay Cool

**By Mariko W. Harper, MD, MS, FACC**

Did you know that warm weather can put stress on your heart? When temperatures rise, the heart must work harder to keep the body cool. This isn’t great news for those living with heart disease because these individuals will have a harder time adapting, leading to a greater risk for heat stroke than their heart-healthy peers.

Additionally, when the body sweats to cool itself down, you tend to lose water and important minerals, like sodium and potassium. These minerals are necessary for muscle contraction and maintenance of fluid levels. Certain common heart medications, like diuretics, beta-blockers and calcium channel blockers, can also affect how the body responds in warm weather.

Don’t worry, though, as this doesn’t mean you or your family cannot enjoy some fun in the sun! Here are a few tips to protect yourself and your heart when the temperature starts to heat up.

Before engaging in vigorous exercise, consult with your physician

Unless you are an avid exerciser, it’s always a good idea to check with your physician before attempting vigorous exercise in the heat. You might be taking up a new sport or hobby, or perhaps it’s just been a while since you’ve had a check-up. Either way, schedule a quick appointment to get your doctor’s approval. You can also consider shaking up your workout by doing it earlier in the morning or in the evenings when it’s not as hot outside.

Drink plenty of water, even when you don’t feel thirsty

Many of us struggle to get enough water throughout the day, so it’s a good idea to find ways to help remind yourself to stay hydrated. This might mean filling up a large water bottle that you can carry around all day or setting reminders on your phone. You can also “eat your water” by enjoying fruits and vegetables like watermelon and cucumber.  

Avoid being in the sun during the hottest time of day

This one might be a no-brainer, but the best way to prevent overheating is to avoid being in the sun when it’s the hottest, typically from 10 a.m. to 2 p.m. If you must be in the sun during these hours, cover your skin with light-colored and lightweight fabrics, such as cotton, and find shade as often as you can.

Avoid alcohol and caffeine

Both alcohol and caffeine can contribute to dehydration. Stick with water and other non-caffeinated beverages.

Heat presents danger for anyone, but particularly those with heart conditions. If you have a serious heart condition such as congestive heart failure, it is best advised to limit your exposure to extremes of temperature.  If you start to feel dizzy, nauseous or disoriented, get out of the heat immediately, apply cool water to your skin and drink water to rehydrate. If you don’t start to feel better, call your doctor, or seek care immediately.

By remembering these tips and taking extra caution when outside in the sun, a summer of heart-healthy fun and fitness awaits you! If you have any concerns about your heart or overall health, there is no time better than now to reach out to your doctor prior to engaging in new activities. 


Mariko Harper, MD is board-certified in internal medicine, cardiovascular disease, nuclear cardiology and echocardiography. She practices at Virginia Mason Heart Institute. Dr. Harper specializes in general cardiology, echocardiography, nuclear cardiology and hypertrophic cardiomyopathy. 

The COVID-19 Vaccine and Kids: A Pediatrician Weighs In

**By Derrick L. Soong, MD, FAAP**

As research on COVID-19 continues, how the virus affects adults is more widely apparent than how it affects kids. Preliminary studies have shown us that children are seemingly not transmitting the virus as easily as adults are, however, we’re still discovering the specific variants most commonly spread among kids.

While it’s true that kids who’ve contracted COVID-19 don’t exhibit as severe symptoms as adults, we must not downplay this result. A small percentage of children who’ve had the virus can develop MIS-C, multisystem inflammatory syndrome in children.

Being a pediatric doctor, I get questions from parents every day, ranging from if and when their kid needs to wear a mask, when the vaccine will be available for kids or when they can play with friends and hug their grandparents again.

To help parents navigate these tricky conversations with their young ones, I wanted to share some of the most common questions I’ve received from parents and the research that other doctors and I have been doing to understand more about kids and COVID-19.

superkid

Is it safe for my child to attend in-person school?

There are pros and cons when it comes to in-person learning, but as long as the child is following CDC guidelines, they should be safe. In-person learning provides an environment for kids to foster social interactions, make friends and build relationships, acquire critical thinking skills and participate in activities that children need to be successful later in life. Adding to this, not all children have the ability to self-motivate or the discipline to keep up with online school while avoiding surrounding distractions.

The progress that the U.S. has made in terms of vaccine rollout for teachers and essential workers is encouraging, and as long as those teaching in-person are vaccinated, parents can feel some ease sending their kids back.

Though children are generally at a lower risk of contracting COVID-19 than adults, this does not mean they are immune. If parents and households are following all CDC guidelines, such as unvaccinated people wearing masks when outside of the home, the risk for children is greatly reduced, even when attending in-person school. When at school, masks should be worn at all times, and kids should try to maintain social distance.

How safe is the vaccine for kids and when are kids able to get it? 

Given the mRNA mechanism for how Pfizer and Moderna vaccines work, I do expect that they will be safe for kids without causing significant issues. According to Pfizer, the vaccine has so far been 100% effective in trials for preventing COVID-19 in children aged 12-15. On Monday, May 11, the Food and Drug Administration authorized the use of the Pfizer vaccine for this age group in the United States, and on May 12, the Centers for Disease Control and Prevention approved the Pfizer vaccine for children aged 12-15.

For younger children ages 11 and below, Pfizer has said that it is currently testing the vaccine and performing trials on children as young as six months old. This group could become eligible as early as end of this year or early next.

For more information on mRNA vaccines, check out this blog written by Benaroya Research Institute at Virginia Mason Principal Investigator Adam Lacy-Hulbert, PhD.

Can my kids see their vaccinated grandparents?

Not traveling is the safest thing to do. If you must travel, you should take precautions.

Yes, grandkids may visit their vaccinated grandparents, but we still recommend masking up. Having to still wear a mask might be frustrating for some, but it’s important to understand that there is still a possibility you could get COVID-19 despite being vaccinated. This virus is still very new, and research is still being performed.

For vaccinated grandparents considering traveling to visit family and friends, driving is still the safest option. If you must fly, double-masking is recommended. Overall, I would advise holding off with traveling until cases drop down in your region/destination and more people are vaccinated.

What will summer look like?

Sentiments are largely positive heading into the summer compared to last year and will remain positive so as long as vaccine efforts continue. It’s imperative we continue encouraging hesitant members of our community to get the vaccine. This, along with more outdoor and socially distanced activities, will help to greatly reduce our positive-case counts this summer.

Hopefully, most of the population will have antibodies to the virus when June rolls around. Better weather and more activities and events outdoors should result in a happier summer for all.


Soong_Derrick_2017Derrick Soong, MD, FAAP, is board-certified in pediatrics and currently practices at the Virginia Mason Issaquah Medical Center. Dr. Soong specializes in obesity, ADHD, general pediatrics and primary care.

Get the Pelvic ‘Floor-One-One’

**By Kathleen Kobashi, MD, FACS, FPMRS**

While pelvic floor health disorders can seem alienating, it is important to know that you’re not alone and there are a variety of ways to treat bothersome symptoms.

The pelvic floor is a group of muscles in the pelvic region, that can be described as a “hammock” of ligaments that sling between the pubic bone in the front and the tailbone in the back. For women, these muscles and ligaments work to support and control the uterus, vagina, bowel and bladder; whereas for men, they support just the bowel and bladder.

As a multidisciplinary team, the members of the Pelvic Floor Center at Virginia Mason treat virtually every pelvic floor health issue that can be experienced by both men and women. In this article we’ll dive into common health problems associated with the pelvic floor and why maintaining pelvic floor health is so important. Pelvic floor disorders can become huge quality-of-life issues that can interfere with our daily activities. It is vital for us to be aware that there are successful, minimally invasive treatment options available.

Common health issues associated with the pelvic floor

When it comes to pelvic floor health issues, there are several key terms to remember, like incontinence and prolapse. Incontinence is the lack of control of bladder or bowel function resulting in leakage, while prolapse is the displacement or dropping of pelvic organs through a weak pelvic floor, much like a hernia. There are other pelvic floor disorders that may result in the opposite problem of difficulty emptying the bladder or bowel.

Mother and daughter drinking coffeeThe two most common forms of urinary/bladder incontinence are stress and urgency leakage. Stress incontinence is the involuntary release of urine from coughing, sneezing or other similar actions and is commonly (but not exclusively) experienced by women who have had vaginal delivery of babies. Aging, genetics and gravity can also play a role. Conversely, urgency incontinence is exactly as it sounds – when nature calls, you don’t always have a say in when you answer, and it is urgent. This form of incontinence can be caused by the consumption of dietary irritants, such as coffee or wine, that aggravate the bladder, as well as hormonal changes that make the bladder more irritable. In men, urgency can also be related to prostate enlargement.

Fecal/bowel incontinence (aka accidental bowel leakage) is an involuntary loss of bowel control that can result in stool abruptly leaking from the rectum. Disorders associated with bowel function can range from constipation to complete loss of control of the bowel, and everything in between.

Prolapse occurs when pelvic organs – such as the bladder, uterus, bowels, vagina or rectum – drop down into or outside of the anus or vaginal canal. Prolapse can be due to a number of issues, including pregnancy, childbirth, obesity, chronic respiratory issues, constipation and cancer in the pelvic region.

Signs to look out for and when to see your doctor

If you’re concerned you might be dealing with a pelvic floor problem, here are a few signs and symptoms:

  • Urinary/bladder incontinence – symptoms can include leakage of urine with coughing, sneezing or exercise, and can also be associated with a sudden, intense and often uncontrollable urge to urinate. Other lower urinary tract symptoms may include frequent urination, slow or dribbling streams of urine or the inability to completely empty your bladder.
  • Fecal/bowl issues – symptoms can include chronic bloating, constipation, diarrhea or involuntary loss of fecal matter.
  • Pelvic organ prolapse – symptoms can include a feeling of fullness in the pelvic floor or vagina, a feeling that something is “falling” out of the anus or vagina, discomfort with sexual intercourse, urinary or fecal incontinence, a sense of trapping of stool or the inability to completely empty your bowels.

It’s important to note that any combination of the symptoms above can occur.

The importance of pelvic floor health

Given the critical bowel, bladder and sexual functions these muscles support, keeping your pelvic floor healthy and strong is crucial. There are a variety of exercises that can be done to improve overall pelvic floor health and functionality, with some of the more common ones being Kegels. Working your pelvic floor regularly is especially important for women in order to minimize the risk of developing prolapse, incontinence or other pelvic health issues that stem from pregnancy or aging.

If you’re experiencing any one or combination of the symptoms discussed above for an extended period of time, it may be time to call and arrange a visit with your doctor. From there, they can work with you to decide your best course of treatment, whether that’s pelvic floor therapy or proceeding with some tests that can help identify the root cause of your problem and facilitate treatment planning.


Kathleen.KobashiKathleen Kobashi, MD, FACS, FPMRS is board-certified in urology with a subspecialty certification in female pelvic medicine and reconstructive surgery. She is the section head of Urology and director of the  Pelvic Floor Center at Virginia Mason. Dr. Kobashi is a urologist/urogynecologist who specializes in the treatment of pelvic floor disorders, including urinary and bowel incontinence, pelvic organ prolapse, and urinary tract fistulas, with expertise in pelvic floor reconstruction through open and robotic surgery.

Q&A with a Family Doctor: Tips for a Happy, Healthy, Safe Birth

There are lots of articles out there about birthing styles, the best ways to give birth and how to prepare for birth. However, despite what they might tell you, it turns out there is not one “right” way to give birth.

We sat down with Dr. Juliana Wynne, a family doctor at Virginia Mason Edmonds Family Medicine, to talk about some of the choices when it comes to giving birth, common questions her patients ask her and any advice when it comes to handling the unexpected … when you’re expecting.

What are some ways patients can prepare for birth?
The best way patients can prepare for birth is by educating themselves. I recommend that patients bring up any questions they have about it with their provider. Patients can take birth classes – these can be accessed virtually, including at Virginia Mason. Expecting parents can talk to friends and family about their experiences. I recommend finding reliable resources about birth, such as the book “The Mommy Docs’ Ultimate Guide to Pregnancy and Birth” by Yvonne Bohn, MD; Allison Hill, MD; Alane Park, MD and Melissa Jo Peltier. In general, I think it’s important to feel informed going into labor.

What are some common questions your patients have? 
Patients often ask me about my role as an FM/OB (family medicine obstetrics) provider. I am a family doctor that provides prenatal, obstetric, postpartum and newborn/pediatric care. At my office, patients tend to see one prenatal provider. Our goal is to be the provider that is present for their labor and delivery in the hospital. I believe that the biggest benefit of seeing an FM/OB provider is the continuity of care, from the first prenatal visit, to the baby’s birth, to the newborn care in the office and the post-partum visit, to pediatric care as the child continues to grow older. I really get to know the patient and her baby, and often get to know the whole family. This leads to a whole-person and Ethnic toddler listening to her mothers pregnant tummywhole-family approach to care. 

Patients also ask about who will be in the room with them during the birth. Generally, the people in the room include their partner, me, their nurse, and a nurse for their baby. If needed, we have additional support staff available at all times, including additional nurses, the NICU (neonatal intensive care unit) team, and an obstetrician on call.

 What birthing styles are out there? 
Just like every mom and baby is unique and different, so is every birth. There is no one right way or style to give birth. As a provider who cares for women who are delivering babies, my goals are to do everything to ensure that mom and baby are safe, and that mom feels informed and in control.

How do you help moms choose the best birthing style for them? 
Again, there is no one right way to give birth and there are many options when making a plan. There are options for who you see for your care. You can see a midwife, an obstetrician, or a family medicine physician that does prenatal care, like myself and my colleagues at Virginia Mason Edmonds Family Medicine. There are options for where you give birth. You can give birth in a hospital, in a birth center, and some women choose to give birth at home. There are different people to lean on for support during labor, whether it be your partner, family, friends, doula, provider, nurse or a combination of all of these people. There are different ways to cope with pain during labor, which include utilizing a birthing ball, a hot bath, movement (walking, dancing), utilizing your breath, using nitrous oxide which is available in some birth locations, IV pain medicine or an epidural. When it comes to the actual delivery, there are also different positions to try.

A birth may not go as expected. How can patients prepare for this? 
It is helpful to keep an open mind going into your labor. Sometimes our plans change. For example, I hoped very much to have a natural vaginal delivery myself. However, after a long labor, I had a healthy baby via cesarean section. I felt that I did everything in my control to have a vaginal delivery, and yet was prepared for the possibility of needing a cesarean section (my little one was projected to be 9 pounds, and he was!). 

It’s important to share your goals with your provider so that we can best help you achieve them and advocate for you. Helping you to achieve your goals is our goal. 


Juliana WynneJuliana Wynne, DO is a family medicine doctor who provides prenatal, obstetric, women’s health, adult and pediatric care at Virginia Mason Edmonds Family Medicine. She is board certified by the American Board of Family Medicine.

A Smile is Worth A Thousand Words: The Benefits of Virtual Health Care

**By Nicholas Moy, MD**

Virtual care is changing the way we think about health care. According to the CDC, there was a 50% increase in the number of telehealth visits in the first three months of 2020 as compared to the same period in 2019. As an internal medicine doctor at Virginia Mason Franciscan Health, I see the benefits of telehealth firsthand as we continue to weather the pandemic. In particular, my patients who have been concerned about leaving home have appreciated the convenience and the security of getting the care that they need.

There are other, more surprising benefits to virtual care. Video visits allow faster access to care in some cases. When I or one of my colleagues has an opening for an appointment, we can quickly invite someone into an appointment without having to worry about travel time, check-in time, traffic or other reasons for being late. In some cases, patients have forgotten about their in-person appointments, and instead of rescheduling them to come in weeks later, we can send them a video invite that very minute and complete the visit.

“Video visits allow faster access to care in some cases.”  –Dr. Moy  

Telehealth proves that not all care has to happen in-person. Any visit where I don’t need to physically examine a patient makes sense to start out as a video visit appointment. We have even been able to complete Medicare Annual Wellness Visits. If I feel during a video visit that there is a need for a physical exam, or something more in-depth is needed to further diagnose or treat a patient, we can schedule tests and an in-person follow-up. 

If you haven’t experienced a telehealth appointment before, no need to worry – it feels just like an in-person doctor’s appointment, just over a video call. A few tips I have for someone looking to schedule their first virtual appointment with Virginia Mason Franciscan Health would be to:

  • Mom and child on computerCheck to ensure you have Virtual Mason (our app for virtual care) downloaded onto your phone or tablet. If using a computer, make sure to use Google Chrome as your web browser.
  • Confirm the best phone number and email address for us to get ahold of you. We will call you if we don’t see you in the virtual exam room at the time of your appointment in case you need help!
  • Make sure you have a camera, microphone and speaker or headset. 
  • Make sure your Wi-Fi is working. 

There are a few routine or common screenings that aren’t available to do via telehealth. These include Pap smears, mammograms and colonoscopies. If you need blood work done, contact your provider to complete blood work before your visit or you can always stop by the lab after your video visit.

Just because there is a pandemic doesn’t mean routine check-ups or health problems should be ignored. Telehealth and video visits have been a productive way to connect patients and providers, especially in a time of high stress and the unknown. Despite all the fears and concerns, it is so worth it to see my patients’ smiles once the video connects. Those smiles are worth a thousand words!


Dr. MoyNicholas Moy, MD is a primary care physician and the Associate Chief Medical Informatics Officer at Virginia Mason Hospital and Seattle Medical Center. He is certified by the American Board of Internal Medicine.