Recurrent yeast and why?


[00:00:00] It is Monday, the day after the 4th of July. I am gonna talk about Vaginitis. yet another of my favorite topics. She sounds so funny. The things I love to talk about, hpv, herpes, you're a be vagina and your discharge. Here's where I wanna talk about it. Maybe not even in all the clinical. Distinction, but the generalities about our vagina and vaginal discharge. 

And it came up because I just left the operating room and I actually got to be on a call with a reporter. I like doing this stuff. They call, they ask us a bunch of questions, they quote us in articles. We don't even know when the articles are gonna run. This article might run at the end of the week. I will let you know. 

Um, but she asked very apropo appropriately, um, curious questions. , recurrent BB and recurrent yeast. Mostly recurrent yeast. So here's what it reminded me cuz this is on my list of things to talk about anyway. This is what happens a lot for women when it comes to recurrent [00:01:00] vaginal, I'm just gonna say recurrent vaginal issues because many women get very frustrated appropriately so, and I wanna try to. 

What the levels of frustration come from, because I think you guys, as women and patients probably would say, I get frustrated because I feel like no one's listening to me and I get frustrated because I get a lot of vaginal issues, like vaginal infections and I don't know how to fix it. That's like your general, what you're frustrated about, right? 

Understandably so. Now, here's why I think you are frustrated. I think these are the layers that. A common scenario is you have some itching and you assume it's a yeast infection or maybe bv. If you're itchy, you assume yeast. If you have a odor, a fish odor, you assume bv, you're probably right. Let's just talk about itching for now, cuz that's easier. 

I'm itching. I assume itching is yeast because Dr. Google has told me it's most likely yeast. Chances [00:02:00] are you're right. Chances are if you just use an over-the-counter antifungal cream, you would fix your yeast. I. And you'll be none the wiser whether or not it was anything else. And you'll have saved yourself the time and the trip to the doctor and you'll have saved the doctor you being in her office. 

Right. Does that wor work often? Yes. Does it not work often? Equally, yes. actually, I don't know. Equally, yes, but a lot, yes, as you all probably know, is women, because what often happens is, I think it's a yeast infection. I tried the over-the-counter cream. A, the over-the-counter cream for whatever reason can really burn. 

I don't know why. I don't know if it's been studied. I don't think it's been studied. I've looked it up, but it can really burn your vulva. And when it burns your vva, you then are like, oh my god, fire crotch. It really burned. And then you try to do all kinds of things to stop the burning. Like you use all kinds of cortisone cream and all kinds of other stuff, and that just really makes it sometimes worse. 

I'm distracted cause I just saw someone with a really cool jacket walking by cuz I'm literally on the street [00:03:00] outside. So first you tried the over-the-counter cream. If it worked, great. If it didn't work, oh my god, it burns really bad. So now you've called your doctor's office and you said, I thought it was yeast infection and it didn't work. 

So your doctor's office in an effort to not put you out, may either say, come on in, because we'll do a quick culture because we wanna make sure you're okay cuz she thinks that's good for you. Which it is good. Because she's doing the appropriate thing to make sure you're taken care of and she thinks she's not putting you out by making it harder to just diagnose over the phone, or she doesn't wanna put you out by making you come in because either she's super busy and you're gonna wait in the waiting room or you are, don't have time to come in cuz you're working or whatever. 

So she says, I'll prescribe something over the phone. Now each of those can be good. Let's explore. Let's say she just prescribed something over the phone, so you've already tried the over-the-counter, it didn't work. Or you called them first and said, I think I have a yeast infection. They prescribed the [00:04:00] prescription, oral antifungal. 

It didn't work. Now we assume if it didn't work, you probably have BV instead of yeast. BV can sometimes cause itching, though that's not the most likely thing. Usually BV causes odor and discharge, but like, oh, you're still uncomfortable. We'll try something else. Now, again, I want you to keep in mind your doctor's office is not doing this because they're lazy. 

They're doing this cuz they think they're helping you by not making you come to the office. And just to be clear, like they're not even profiting from this. They're making zero money. They're taking the time for your phone call and to call on your prescription and making nothing. So before you go and blame them for like they just called something in, there are like 50% of the patients who just want something to be called in and they're happy about it and it worked. 

But the other 50% or 80% or 20% or whatever are annoyed that they're just getting something called in or it didn't. , but I want you to understand why your doctor's office did that. They did it either because they are so busy that they don't have a free spot that day and they feel bad for you, or because you don't wanna come in because you're busy with work or your kids, or you're on vacation or whatever.[00:05:00]  

Those are the constraints. That's option one. Second option is your doctor says, I don't do vaginal discharge over the phone. You need to. You're either psyched cuz you're like, great, I'm gonna have a visit. Or you're annoyed. And I hear both by the way, from my patients and from my followers, right? I hear people be like, that was so annoying. 

The doctor even may come in or, oh my God, I was so frustrated she just ordered something over the phone. As you can imagine, both are correct for different reasons. Both are, um, frustrating for different reasons. You as the patient or we as the doctor being annoyed or happy can be right and wrong. So now you go to the doctor. 

Now here's the rub. Will she always do cultures? Maybe yes, maybe no. Why would she not do cultures well, if it's chunky, white discharge with itching, she may be of the mindset that she's trying to decrease the cost to the system and to you because of your insurance company, if you have a high deductible, so she doesn't do cultures because it looks like a yeast infection, in which case I believe she should then have a careful discussion with you and say, I'm not gonna do cultures.[00:06:00]  

Here's why I believe it's a yeast infection. We're gonna treat it as such, and if in the next 1, 2, 3 days you're not feeling better, then you need to call me because it could be X, Y, Z. Or we'll do culture. I don't think that's wrong, but I believe it just requires a careful discussion that she and you may not have the time for. 

So she might not do that. So she might be of the other variety. I actually do have the careful discussion cuz you guys know me. I talk a lot and I'm chronically behind in my office because I talk a lot, but I also almost always do the culture because I've found with yeast infections or any vaginal infection, you guys think it's always yeast and it's not. 

That it's not always yeast infection. There's other co-infections. It's not always so easy to treat and you don't always have time to come back and I don't have time to see you when you come back. So I'd rather just do the culture. But that requires a careful discussion of if you have a deductible, you might have to pay for this because your insurance company doesn't cover it. 

If it's a deductible, cuz it's not a screening test. And then here's the deeper layer that you guys don't even know we have to deal. And this is why your doctor will not always do a culture, or if [00:07:00] she does, it's not so easy. And I want you to understand this though, that you don't keep feeling like the biggest issue with the system is the doctors just don't care or the doctors just don't have time as if it's because the doctors are like off playing golf. 

Like very few doctors I know play golf. In fact, I know, I know one doctor that plays golf. Golf just takes a lot of time. I don't even like golf. So here's the thing, when you come into. And I see you even with my amazing medical assistants who'd really take the care to try to like leave the things I need in the room or be there with me in the room. 

Here's what has to happen. We need to know which insurance company you have. And based on your insurance company, we then need to know which lab we are allowed to send your samples to. And then based on that particular lab, we either need to use these culture tubes or these culture tubes, and we need to remember which culture tubes are for yeast and bv and which are for viral and which are for something called mycoplasma. 

Did you understand that? So the algorithm is dizzying. Which insurance company do you. [00:08:00] Which insurance company takes which lab. And by the way, that changes sometimes month to month, like all of a sudden, one insurance company no longer approves of this lab. And then which lab uses which culture tubes and which culture tubes culture for which infection. 

All that has to go into the thought process and all that also has to consider, do you have a high deductible? And regardless of where I'm sending it, are you gonna get charged for it? And do you know that you're gonna get charged for it? Because these things you might. Might cost hundreds of dollars for a vaginal culture. 

So you think you're just coming in for yeast infection and you could have just used over the counter, and now all of a sudden you're paying for an office visit, you're paying for cultures, and now you're pissed off. But on the flip side, had I just called something in over the phone for you and it didn't work, You would've also been printed off because now you're like, no one's listening to me and it didn't work. 

Now, I'm not saying that this is what's happening to all of you, but I do know this happens to a lot of you, and I'd like to believe it doesn't happen as much to my patients because I talk so much, but I'm sure patients have fallen through their cracks. I don't get to talk to [00:09:00] everybody, and I know that it happens to other doctors throughout the country because I hear what patients complain about and I hear what doctors complain about, and we have. 

Valid, right as doctors, and you have every valid right as patients, and it all comes down to the same thing, which is unfortunately lack of communication, but we have to understand why the lack of communication is occurring or we're never gonna fix it, and the lack of communication is occurring because the system is broken. 

Because we are dictated by these insurance companies who give us time constraints and make the situation confusing with the different labs and who covers what and who contracts with whom. And there's no centralized system and it is a hot mess, and I don't think it's gonna get better anytime soon. But I want you to understand the why behind it so that actually you can go into it with a little more, not more knowledge, as to why your Dr. 

May just call it in over the phone or she may just ask you to come in as to why when you come in she may do cultures or she. And the more educated you are, the better she's gonna be able to help you. You can't understand everything. She understands she's the doctor. That's [00:10:00] why she went to medical school. 

That's why I've been up all night for the last week. Right? But if you understand some of these constraints that she does not have the time to tell you, then you will collaborate better with her. And if you understand your insurance company, all of you call your insurance company, understand your deductible, understand which lab you're supposed to go to. 

It's by the way, not the doctor's job to know what lab you're supposed to go to. Do you know that you're supposed to come to me and say, by the way, Dr. Gorani Shiba, I'm supposed to use x, Y, Z insurance company. Please send all my my stuff to them. I'm not supposed to know about it. I'm supposed to just do whatever I need to do to take care. 

You are supposed to tell me which lab. Now, as a courtesy, we try to keep recall for our patients, but how do we keep track of it? We don't know your insurance, and each insurance plan is different and they change all the time. We're not profiting from any of that. You need to know that the labs do not give us any profit. 

So again, you should know. Your insurance company should find out, do you have a high deductible? What does that mean? What are you responsible for, what lab you should be sending it to? [00:11:00] And please Google the. Screening test so you understand what a screening test is. A screening test is a test that is done in the setting of no symptoms. 

That is the point of screening. I don't have any symptoms. I'm being screened for something. When you have symptoms, that's a diagnostic test. Why is that important? Because diagnostic tests are not covered if you have a high deductible. So annoying. I know I didn't make up the insurance. I myself have a $13,000 deductible, so I get it. 

Okay, I'm gonna go enjoy the rest of my day cuz I'm off and I'm not in the office and it's Monday, July 5th. Goodbye everybody.