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BackTable Women's Health

BackTable Inc.

The go-to podcast for OBGYNs, gynecologic surgeons, and healthcare professionals focused on women's health. Tune in every week for practical, physician-led conversations on common and complex clinical topics in women's health. Hear how experienced physicians approach real cases, and get practical advice from your peers in your field.

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  • 23 episodes
  • weekly
  • Avg 51 min
  • English

Episodes 23

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  • September 29 · 1 hr 4 min

    Ep. 135 Building the Career You Want in OB/GYN with Dr. Chitra Akileswaran

    What does it take to design a career in medicine that truly fits your values, your life, and your goals? On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Chitra Akileswaran, board-certified OBGYN and founder of Avaiyar Private Care, for a candid discussion on building a career that breaks the mold. Dr. Akileswaran traces her path from global public health and a joint MD-MBA to leadership in county health systems, digital health startups, and now direct pay practice, sharing how each chapter reflected her changing priorities. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 06:19 - Public Health and Global Work 10:33 - Residency and Early Career Choices 15:04 - Founding a Digital Health Company 19:48 - Ambulatory Operations Leadership 24:36 - Leading a County Medical Group 29:32 - Physician Needs and Retention 34:25 - Physician Compensation Overhaul 41:47 - Physician Unionization and Employment 46:25 - Pregnancy Loss and Perspective 49:09 - Launching a Direct Pay Practice 57:10 - Mentorship in Private Practice 01:03:28 - Closing Remarks --- More about this episode The conversation explores lessons learned leading hundreds of physicians, overhauling compensation and benefits, and navigating unionization and administrative change. Dr. Akileswaran speaks openly about personal milestones, including pregnancy loss, and how it drove her to redesign her life and practice. Topics include mentorship, apprenticeship, work-life integration, and the practical steps and mindset shifts needed to carve out a fulfilling, sustainable career in medicine. --- Resources Avaiyar Private Care, Dr. Akileswaran's direct pay OBGYN practice https://avaiyarprivatecare.com/ Cleo, the digital health company she co-founded https://hicleo.com/ ACOG Well-Being and Physician Support Resources https://www.acog.org/career-support/well-being AMA Physician Practice Benchmark Survey: Smaller Share of Doctors in Private Practice Than Ever Before https://www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever MGMA Provider Compensation Data Reports, the benchmarking source referenced on air https://www.mgma.com/mgma-data-reports Dr. Chitra Akileswaran, UCSF OBGYN Residency Alumni Profile https://obgyn.ucsf.edu/residency-program/chitra-akileswaran-md-mba --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • September 15 · 56 min

    Ep. 134 Shared Decision-Making in Overactive Bladder Care with Dr. Jannah Thompson

    Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Medtronic Pelvic Health https://urgencyisreal.com/ --- Timestamps 00:00 - Introduction 04:00 - Shared Decision-Making 06:51 - Clinic Efficiency 10:38 - Expanding OAB Therapy Options 12:27 - Long-Term OAB Care 17:41 - Building an OAB Program 18:18 - Staff Training and Follow-Up 25:32 - OAB Navigator Implementation 27:14 - Navigation Outcomes 28:39 - Scaling with Staff and Epic 30:35 - Algorithm Resources 34:08 - Neuromodulation Advances 38:37 - New Tibial and Battery-Free Devices 40:56 - Quality of Life in OAB Care 46:11 - Access and Adoption 51:22 - Streamlining Therapy Discussions 52:47 - Closing Remarks --- More about this episode The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey. --- Resources Patient navigation for overactive bladder improves access to care https://link.springer.com/article/10.1007/s00192-019-04085-7 --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • September 8 · 42 min

    Ep. 133 Advances in Endometriosis: Diagnosis & Management with Dr. Hugh Taylor

    Advances in endometriosis research are reshaping how clinicians diagnose, understand, and treat this complex multisystem condition. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Hugh Taylor for an in-depth discussion of the systemic nature of endometriosis, including its metabolic, psychological, and cardiovascular effects, as well as central pain sensitization and bowel and bladder symptoms. They also explore how animal models and biomarkers like microRNAs are deepening our understanding of these connections. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:26 - Endometriosis Beyond the Pelvis 05:17 - Understanding Systemic Symptoms 10:35 - Why Diagnosis Takes Years 12:54 - Key Clues to Endometriosis 14:35 - Emerging Noninvasive Diagnostics 18:13 - Pain Versus Disease Stage 19:33 - Precision Medicine Approaches 24:04 - Treatment Strategies and Follow-Up 27:17 - GnRH Antagonists and Add-Back Therapy 29:45 - Danazol and Surgical Options 34:26 - Future of Immune-Based Therapies 37:49 - Fertility Counseling and Egg Freezing 40:17 - Wrap-Up and Key Takeaways --- More about this episode Given that many patients wait years for a diagnosis, Dr. Taylor emphasizes the importance of presumptive clinical diagnosis and selective imaging to expedite treatment. He highlights emerging biomarkers that may offer more noninvasive diagnostic options and help clarify pain mechanisms. The conversation reviews current management strategies, including continuous oral contraceptives, the challenge of progestin resistance, and the promise of blood-based tests to predict treatment response. They also discuss GnRH antagonists, Danazol, surgery for refractory cases, and future directions such as immune-based therapies targeting the inflammation and immune dysfunction at the root of endometriosis. --- Resources Clinical evaluation of the oral gonadotropin-releasing hormone-antagonist elagolix for the management of endometriosis-associated pain: https://pubmed.ncbi.nlm.nih.gov/31434540/ Circulating microRNAs as potential biomarkers for endometriosis: https://pubmed.ncbi.nlm.nih.gov/25772772/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • September 1 · 48 min

    Ep. 132 Gynecologic Cancer Surveillance: Best Practices & Updates with Dr. Ritu Salani

    Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:05 - Evolving Guidelines and Consensus 10:02 - Lead-Time Bias and Cost Considerations 12:05 - Maintenance Therapy and Surveillance Nuances 14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam 20:24 - Key Takeaways from the TOTEM Trial 24:04 - Future Tools, Lifestyle Counseling, and Shared Care 27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance 31:13 - Hormone Therapy Considerations 34:37 - ctDNA and MRD Testing 37:39 - Emerging Technologies and Limitations 43:22 - Rapid Fire Takeaways 45:33 - Closing Thoughts --- More about this episode The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy. --- Resources TOTEM Trial https://ascopubs.org/doi/abs/10.1200/jco.22.00471 2010 Ovarian Cancer CA-125 Trial https://pubmed.ncbi.nlm.nih.gov/20888993/ Society of Gynecologic Oncology Clinical Practice Statement on Surveillance https://pubmed.ncbi.nlm.nih.gov/41308226/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • August 25 · 55 min

    Ep. 131 Cliteracy for Clinicians: A Clinical Guide to Sexual Health & Clitoral Anatomy with Dr. Christine Vaccaro

    Are we addressing sexual health in clinical practice? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner is joined by Dr. Christine Vaccaro, a double board-certified urogynecologist and sexual medicine specialist, to discuss the evaluation and care of women’s sexual health concerns. They highlight the importance of open conversations, patient empowerment, and a multidisciplinary approach to support well-being and improve quality of life. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:01 - What Is Sexual Medicine 07:58 - Understanding Libido, Arousal, and GSM 15:54 - Clinic Visit Structure and Patient Counseling 19:17 - Clitoral Exam, Adhesions, and Anatomy Education 28:17 - Addressing Stigma, Patient Education, and Myths 32:03 - Tools for Patient Empowerment: Apps and Self-Examination 39:55 - In-Office Procedures, Pain Mapping, and Hormonal Considerations 46:37 - Managing Complex Cases and Multidisciplinary Collaboration 53:47 - Closing Remarks --- More about this episode The conversation explores practical strategies for evaluating and managing issues such as libido, arousal, orgasm, and sexual pain, with a focus on genitourinary syndrome of menopause (GSM) and clitoral anatomy. Dr. Vaccaro shares her approach to assessing clitoral adhesions, pelvic pain, and hormonal changes, as well as effective ways to educate patients about anatomy and self-examination. They discuss the importance of reducing stigma, addressing misconceptions, and using a multidisciplinary approach to improve patient outcomes. The episode also highlights the role of clinician training, patient-centered counseling, and collaborative care in supporting women’s sexual health across the lifespan. --- Resources International Society for the Study of Women’s Sexual Health: https://www.isswsh.org/ Female Orgasmic Disorder: Current Understanding and Clinical Management: https://pubmed.ncbi.nlm.nih.gov/42314165/ OMGyes: https://www.omgyes.com/join You Are Not Broken by Dr. Kelly Casperson: https://kellycaspersonmd.com/you-are-not-broken-book/ Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women's Health Providers Should Routinely Examine the Glans Clitoris - https://academic.oup.com/smoa/article/6/2/115/6956478?login=false Clitoral Adhesiolysis: Technique and Patient Selection - https://www.vjsm.info/videos/all/clitoral-adhesiolysis-technique-and-patient-selection Female Orgasmic Disorder: Current Understanding and Clinical Management - https://pubmed.ncbi.nlm.nih.gov/42314165/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • August 18 · 41 min

    Ep. 130 Recurrent UTI: Diagnostics & Management Strategies with Dr. Glenn Werneburg

    What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:05 - Case One: Recurrent UTIs 05:19 - Workup Basics 08:50 - Non-Antibiotic Prevention 11:42 - Antibiotic Prophylaxis Options 15:16 - Case Two: Asymptomatic Bacteriuria 19:14 - Case Three: Complex Patients 19:58 - Male vs. Female UTIs 21:22 - Neurogenic Bladder Workup 22:52 - Elderly Patients and ID Consults 25:01 - Case Four: Transplant ESBL 25:23 - Machine Learning for Antibiotics 29:49 - Catheter Biofilms 31:55 - Embedded Bladder Reservoirs 35:23 - Recurrent UTI Vaccine 36:23 - Future of Recurrent UTIs 39:04 - Wrap Up --- More about this episode The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic. --- Resources Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025) https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • August 11 · 58 min

    Ep. 129 Clinical Hypnotherapy Applications in Women's Health with Dr. Sonia Gupte

    Have you ever wondered what role the mind could play in treating women’s health conditions? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Sonia Gupte, a family medicine physician and board-certified clinical hypnotherapist, about how clinical hypnotherapy can help patients access the subconscious, resolve emotional barriers, and rewire patterns that affect both body and mind. Dr. Gupte discusses the use of hypnotherapy for a range of women’s health concerns including PMS, postpartum depression, hot flashes, infertility, and chronic pelvic pain, highlighting the potential for more holistic care. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:40 - Discovering Hypnotherapy 08:59 - What a Session Looks Like 13:02 - Remote Sessions and Results 17:27 - Follow-Up and Maintenance 20:13 - Women's Health Examples 28:05 - Talking to Patients 30:47 - Hypnosis vs. Therapy 33:07 - Pap Smear Trauma Case 37:28 - Breathwork Reset Tool 42:42 - Uncovering Repressed Trauma 46:17 - Burnout and Stress 49:12 - Barriers to Success 53:21 - Call To Action 54:58 - Live Demo Plans 55:50 - Closing Remarks --- More about this episode Dr. Gupte shares how her mother’s experience with cancer, depression, and a suicide attempt inspired her to explore hypnotherapy and ultimately bring it into her medical practice. She describes what a typical hypnotherapy session involves, including relaxation, guided visualization, identifying emotional roots, and using protocols to help patients “reboot” their mental patterns. The discussion also covers practical aspects of integrating hypnotherapy into women’s health care, such as determining treatment frequency, offering remote sessions, setting patient expectations, and addressing common barriers to success. --- Resources Within: Finding Yourself, Fixing What's Broken, & Finally Reclaiming True Health https://enso-nia.com/about-sonia/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • August 4 · 45 min

    Ep. 128 Integrating OB Hospitalists in High-Risk Maternity Care with Dr. Katie Fung-Yip

    Every OBGYN, whether in the hospital or community, may face a high-acuity obstetric emergency. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner interviews OB hospitalist Dr. Katie Fung-Yip to explore the evolving role of OB hospitalists and the obstetric emergency department (OB ED) in managing critical situations. They discuss how in-hospital coverage, multidisciplinary teamwork, and dedicated triage protocols can improve emergency response and patient outcomes. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:42 - Breaking Down OB Roles 06:01 - MFM and Hospitalist Collaboration 07:35 - Inside the OB ED 12:31 - High Stakes Emergencies Overview 18:02 - Amniotic Fluid Embolism 21:33 - Cardiac Arrest Pearls and Drills 24:44 - Team Leadership Under Pressure 29:19 - Emotions Debrief and Bonding 37:48 - Simulation Practice and Mentorship 40:18 - Early Career Fit and Support 43:10 - Wrap Up --- More about this episode Dr. Fung-Yip explains how the hospitalist role differs from community OBGYNs, emphasizing the value of continuous in-hospital coverage for urgent and high-risk cases. She describes the spectrum of care, from routine pregnancies to complex emergencies requiring collaboration among hospitalists, maternal-fetal medicine specialists, and multidisciplinary teams. The discussion covers OB ED operations, the Maternal Fetal Triage Index, hospital design for rapid response, and review of critical emergencies such as postpartum hemorrhage and amniotic fluid embolism. Dr. Fung-Yip highlights how these events can escalate to maternal cardiac arrest, requiring immediate ACLS, team coordination, and sometimes resuscitative hysterotomy. She stresses that preparedness depends on ongoing education, simulation, mentorship, debriefing, and strong teamwork. --- Resources Maternal Fetal Triage Index (MFTI) https://www.awhonn.org/education/hospital-products/maternal-fetal-triage-index-mfti/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • July 28 · 1 hr 24 min

    Ep. 127 Approaches to Menopause and Hormone Therapy with Dr. James Simon

    Hormones aren't the problem. Misunderstanding them is. On this episode of BackTable Women’s Health, Dr. Karen Toubi sits down with Dr. James Simon to discuss menopause, sexual medicine, and his career journey from early IVF research to treating aging women. They also unpack his Green Journal paper with Dr. Barbara Levy, challenging common misconceptions about hormone therapy and explaining why treatment should be individualized because not all estrogens and progestogens are the same. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:11 - Why Menopause Medicine 07:51 - Hormone Therapy Paper 11:48 - Counseling Perimenopause 16:14 - Unopposed Estrogen Strategy 23:01 - IUDs And Progesterone 26:54 - Estrogen Types Explained 34:59 - Thrombosis Risk Approach 43:11 - Oral Estrogen Use Cases 44:48 - Breast Cancer Risk Counseling 46:49 - Estrogen Risk Myth 48:11 - Pregnancy and Breast Cancer 50:09 - Counseling BRCA Patients 53:26 - Duavee: Who Benefits? 55:32 - Bazedoxifene Access Limits 57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM) 01:00:37 - Dryness Explained 01:02:41 - Thrombosis Risk Screening 01:05:01 - UTIs and Vaginal Estrogen 01:07:18 - Starting HRT After 60 01:12:47 - Window of Opportunity 01:14:46 - Staying on HRT 01:16:43 - Blood Levels and Absorption 01:20:13 - Clinician Takeaways --- More about this episode The conversation explores strategies for managing perimenopause, including when hormonal contraception is the best option and when symptom-focused hormone therapy may be more appropriate. They cover practical guidance on using transdermal estradiol, Mirena and Liletta for contraception and endometrial protection, and how thrombosis risk differs depending on the type and route of hormone therapy. The episode wraps up with a discussion on newer treatments for genitourinary syndrome of menopause, when to consider hormone therapy, and why clinical experience is so important in menopause care. --- Resources A Contemporary View of Menopausal Hormone Therapy https://journals.lww.com/greenjournal/abstract/10.1097/aog.0000000000005553~a-contemporary-view-of-menopausal-hormone-therapy?redirectionsource=fulltextview --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • July 21 · 45 min

    Ep. 126 Personalized IVF: Optimizing Outcomes in Advanced Maternal Age & Low AMH with Dr. Jennifer Makarov

    The standard infertility timeline does not apply to every patient. When should infertility counseling begin, and when is it risky to wait? OBGYN Dr. Nicole Faulkner and REI specialist Dr. Jennifer Kulp Makarov discuss how age, irregular cycles, endometriosis, recurrent pregnancy loss, and male factor infertility should shape counseling and referral decisions on this week’s episode of the BackTable Women’s Health. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:37 - Launching a New Practice 04:23 - When to Refer Patients 06:23 - Basic Infertility Workup 08:39 - Counseling Patients Over 40 14:05 - Personalized IVF Protocols 17:59 - Embryology and PGT-A 23:54 - Egg Preservation Timing 28:20 - Using Frozen Embryos Later 31:36 - Components of Personalized IVF 33:30 - Patient Experience and Education 37:25 - Alternative Fertility Options 40:46 - Approaching Recurrent Miscarriage 42:28 - Key Takeaways --- More about this episode Dr. Kulp Makarov reviews when patients should be referred to an REI based on age, while emphasizing that earlier referral is appropriate for patients with irregular cycles, endometriosis, recurrent pregnancy loss, or known male factor infertility. Although anti-Müllerian hormone (AMH) testing can be a useful initial assessment, it should not delay specialist evaluation. The discussion also explores how advances in reproductive medicine have expanded fertility treatment options. Dr. Kulp Makarov highlights personalized IVF protocols, embryo banking, and preimplantation genetic testing, while emphasizing both the benefits and limitations of these approaches. She also shares practical guidance on egg freezing, pregnancy in the mid-40s, and when donor eggs, gestational carriers, or other fertility treatment options may be appropriate. Finally, she explains how REIs approach the evaluation and management of recurrent pregnancy loss. --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • July 14 · 47 min

    Ep. 125 Genetic Carrier Screening Explained: What Every OB/GYN Should Know with Dr. Mary Kate LoPiccolo

    How can OBGYNs navigate the complexities of modern prenatal carrier screening? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Mary Kate LoPiccolo, a pediatrician and medical geneticist at Mount Sinai, to break down the essentials of prenatal carrier screening in OBGYN practice. They discuss what carrier screening is, when to order it, and how to manage and interpret results in real-world clinical settings. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:03 - Understanding Carrier Screening 04:40 - Partner Testing: When and Why 06:22 - Selecting the Right Panel Size 08:27 - Managing Time Constraints and Making Referrals 10:52 - Pretest Counseling Essentials 16:44 - Decoding Results and Effective Reporting 20:52 - Limits of OB Counseling 26:19 - Navigating Common X-Linked Pitfalls 30:11 - Equity, Costs, and Over-Testing 36:11 - Tele-Genetics and Lab Resources 43:43 - Final Takeaways --- More about this episode Dr. LoPiccolo reviews the evolution from Tay-Sachs screening in Ashkenazi Jewish populations to today’s pan-ethnic expanded panels, emphasizing carrier screening as a blood-based screening test for recessive and X-linked conditions ideally performed preconception and for both partners. The conversation covers panel size selection, best practices for pre-test counseling, common pitfalls with X-linked results, documentation and report interpretation, cost and equity barriers, and the value of referrals, telegenetics, lab genetic counselors, and resources like GeneReviews to optimize care. --- Resources GeneReviews - https://www.ncbi.nlm.nih.gov/books/NBK1116/ Open Evidence - https://www.openevidence.com/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • July 7 · 51 min

    Ep. 124 Continuous Glucose Monitoring in OBGYN: Practical Counseling & Clinical Applications with Dr. Nicholas Canelo

    As over-the-counter continuous glucose monitors (CGMs) become more common, clinician guidance matters more than ever. In this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Nicholas Canelo, a family medicine physician and founder of the Perlman Wellness CGM program, to discuss how to effectively guide CGM use in OBGYN practice, from preconception and PCOS to pregnancy and perimenopause. They highlight the importance of interpreting data trends, setting realistic glucose targets, and supporting patients through the practical and emotional challenges of CGM use. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:58 - CGMs in Women’s Health 07:33 - OTC Data Sharing Issues 09:52 - Pregnancy Glucose Targets 16:20 - Accuracy and Variability 20:10 - Anxiety and Eating Disorders 24:41 - Counseling and Follow-Up 28:29 - Prescription and OTC CGM Picks 37:24 - False Lows and Sensor Errors 41:23 - Alarm Settings and Logging 44:06 - Interpreting Metrics and Limits 46:44 - Provider Dashboards 48:42 - Final Thoughts --- More about this episode Given the lack of well-established blood glucose targets outside of type 1 diabetes, Dr. Canelo reviews commonly used ranges for individuals without diabetes, those with prediabetes, and pregnant patients with type 1 or 2 diabetes. He explains how to interpret CGM data, including the time in tight range, coefficient of variation, and the importance of focusing on overall trends rather than isolated glucose spikes. They also discuss the potential drawbacks associated with CGM use, including anxiety and eating-disorder risks. Practical considerations include sensor inaccuracies, false lows readings, and optimizing alarm settings. Dr. Canelo emphasizes the importance of having patients log meals and other events while wearing the sensor and scheduling follow-up after the initial 15-day wear period to ensure accurate interpretation and effective counseling. Finally, they compare OTC and prescription CGM options, including costs, clinician access to patient data, and insertion tips. --- Resources Stelo - Over the Counter CGM Option https://www.stelo.com/en-us --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • June 30 · 1 hr 2 min

    Ep. 123 Entrepreneurship in Medicine: Bridging Healthcare & Business with Dr. Nneka Una

    Are you building a business that can thrive without you, or just creating a job you can never leave? In this episode of BackTable Women’s Health, host Dr. Karen Toubi sits down with Dr. Nneka Una (Unachukwu), a board-certified pediatrician, founder of Ivy League Pediatrics, and creator of EntreMD, to discuss the mindset and skills needed to build a truly sustainable medical practice. The conversation explores why physician entrepreneurship is essential in today’s evolving healthcare landscape, the difference between building yourself a job and building a resilient business, and practical strategies for long-term growth. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:47 - From Employee to Owner 05:53 - Skills That Changed Everything 07:35 - The Wake Up Call 10:44 - Why Doctors Resist Business 15:06 - Profit as Patient Care 18:20 - Job vs. Business Entity 21:13 - CEO Hat and Team Systems 25:14 - Exit Value and Sellability 29:00 - More Profit: More Time Off 30:24 - Fear Before Breakthrough 35:32 - Choose Service Over Perfection 39:11 - Invest in Your Potential 46:26 - MEAT Week Priorities 48:40 - Three-Part Daily Rhythm 55:02 - Advice for Burned-Out Docs 59:29 - Wrap Up --- More about this episode Dr. Una shares how doctors can overcome resistance to “business,” why every practice needs a strong business engine, and how to balance profitability with ethical, people-centered care. She explains how to shift from employee to physician-CEO, tackle imposter syndrome, and develop systems that give your practice true staying power. The discussion provides actionable advice on hiring, team management, building exit value, and creating the freedom to take more time off without sacrificing patient care or financial stability. --- Resources EntreMD https://entremd.com/about-us/ The Profitable Private Practice Playbook https://entremd.com/method-book/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • June 23 · 42 min

    Ep. 122 Exploring the OB Hospitalist Model in Obstetrics with Dr. Maliha Sayla

    Lower C-section rates, faster deliveries, and less physician burnout: could the OB hospitalist model deliver all three? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Maliha Sayla, a board-certified OBGYN and medical director of labor and delivery at Northwestern Medicine Delnor Hospital, to explore how the OB hospitalist model is reshaping care for physicians, patients, and healthcare systems. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:27 - Why Hospitalists Matter 05:33 - How Their Model Works 07:15 - Managing Pushback 10:18 - Measuring Better Outcomes 15:58 - Drills and Emergencies 19:50 - Staffing and Transition 24:33 - ROI and OB-ED 26:33 - Residents and Teaching 30:52 - Future Flexible OB Careers 34:14 - Patient Acceptance of Model 36:47 - Collaboration and Lifestyle Balance 40:00 - Conclusion --- More about this episode Dr. Sayla shares her journey from traditional private practice to full-time OB hospitalist work, explaining how this model reduces physician burnout by making labor and delivery a dedicated role rather than one juggled alongside clinic visits, surgeries, and administrative responsibilities. She details her institution’s staffing structure, where hospitalists provide continuous labor and delivery coverage, allowing generalist OBGYNs to focus on outpatient care. Dr. Sayla highlights the benefits of having dedicated physicians available for bedside counseling, fetal monitoring, and real-time decision-making. The episode explores improvements in communication, collaboration, and patient outcomes, including lower NTSV (Nulliparous, Term, Singleton, Vertex) cesarean rates and shorter induction-to-delivery times after adopting the hospitalist model. Additionally, she discusses the hospitalist role in obstetric emergency preparedness and interdisciplinary collaboration, patient perspectives, and the potential of hospitalist programs to address OBGYN workforce shortages. --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • June 16 · 58 min

    Ep. 121 Urogynecology Surgical Trends and Training Insights with Dr. John Occhino

    Get an inside look at prolapse surgery, from technique to training to team-based care. In this episode of BackTable Women’s Health, Dr. Amy Park talks with Mayo Clinic urogynecologist and pelvic reconstructive surgeon Dr. John Occhino about the art and strategy behind prolapse repair. They explore why Dr. Occhino favors vaginal approaches, when robotics come into play, and how he frames staged treatment strategies, particularly for younger patients at risk of recurrence. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:09 - Choosing Vaginal vs. Robotic Approach 10:24 - Why Vaginal Skills Declined 13:20 - OR Setup and Positioning 16:32 - Anterior Entry Technique 20:05 - Ureter Safety and Suspension 28:14 - Robotic Hysteropexy Considerations 31:47 - Collaborative Training Culture 35:41 - Beyond See One Do One 46:13 - Anatomy Keeps You Safe 49:46 - Leadership Authenticity 53:45 - Team Support and Wrap Up --- More about this episode The conversation covers how to counsel patients about prolapse as a dynamic condition, the trade-offs between durability and mesh aversion, and the importance of prioritizing symptoms and quality of life in decision-making. They share practical tips on vaginal hysterectomy technique and ergonomics, discuss why vaginal surgery skills are declining, and highlight best practices in surgical education, including apprenticeship-style training, promoting psychological safety, setting targeted goals, fostering collaboration among program directors, and grounding surgical judgment in anatomy and authenticity in leadership. --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • June 9 · 44 min

    Ep. 120 Understanding Vulvar Disorders in Gynecology with Dr. Chailee Moss

    Can a “normal” pelvic exam mask life-altering pain? On this episode of BackTable Women’s Health, host Dr. Karen Toubi interviews board-certified OBGYN Dr. Chailee Moss about why common vulvovaginal pain and skin conditions are frequently missed or dismissed as “normal” exams. Dr. Moss explores how gaps between gynecology and dermatology, limited training, and the under-recognition of non-life-threatening but highly morbid pain contribute to these diagnostic challenges, including mental health impact and even suicidality in some cases. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:56 - Why Pain Gets Missed 08:58 - Building Trust With Time 10:51 - Vulvodynia Workup Basics 16:02 - Hormonal Vestibulodynia Clues 21:21 - New Treatments On Horizon 23:07 - Lichen Steroid Maintenance 26:25 - Biopsy Decisions And Mimics 30:30 - Multimodal Treatment Planning 33:00 - Pelvic Floor PT Done Right 35:55 - When To Consider Surgery 37:33 - Clinical Trials Ketotifen Botox 40:40 - Conclusion and Resources --- More about this episode They discuss rebuilding trust through time, attentive listening, and clear communication, along with a detailed evaluation process that includes medication review, targeted symptom questions, Q-tip mapping, vulvoscopy, cultures, and selective biopsy. The approach informs an individualized, multimodal treatment plan. Additional topics include lichen steroid counseling,differentiating mimickers like yeast and irritant dermatitis, and connecting patients to resources such as ISSWSH, ISSVD, and support groups. --- Resources Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711 ISSWSH https://www.isswsh.org/ Pudendal Hope https://www.pudendalhope.info/ Tight Lipped https://www.tightlipped.org/ The National Vulvodynia Association https://www.nva.org/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • June 2 · 42 min

    Ep. 119 Single-Gene NIPT Explained: Clinical Applications & Benefits with Dr. Andrei Rebarber

    How do you decide which noninvasive prenatal testing option is best for your patient, and when should you reach for single-gene NIPT? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews maternal-fetal medicine specialist Dr. Andrei Rebarber to break down the evolving world of prenatal genetic testing. They discuss the importance of pan-ethnic carrier screening, the clinical scenarios where single-gene NIPT is most useful, and how to navigate counseling and follow-up for a wide range of patients. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Natera https://www.natera.com/info/fetal-focus --- Timestamps 00:00 - Introduction 04:43 - Prenatal Genetic Testing Basics 07:10 - Larger Panel Screening Benefits 10:49 - Defining Single-Gene NIPT 14:51 - Counseling and Invasive Options 18:26 - Accuracy Data and No Call Rate 22:03 - Patient Acceptance of Test 24:18 - When to Test and Screen 26:13 - Counseling Carrier Results 30:12 - In Utero Treatment 32:36 - Workflow for Generalists 35:33 - How to Interpret Literature 40:08 - Closing Remarks --- More about this episode Dr. Rebarber shares how witnessing in-utero transfusions for severe Rh disease inspired his career in OBGYN and maternal-fetal medicine, highlighting the importance of treating the fetus as a patient and the rapid growth of fetal therapy. The episode reviews ACOG-guided carrier screening for conditions like cystic fibrosis and hemoglobinopathies, the trend toward larger, pan-ethnic screening panels, and why carrier findings are common but true “double-carrier” couples are relatively rare. Dr. Rebarber also discusses the clinical utility of single-gene NIPT—a cell-free placental DNA test for select recessive conditions—especially when partner testing isn’t possible or when patients wish to avoid invasive procedures. The conversation compares screening and diagnostic strategies, including CVS and amniocentesis, and provides practical insight into interpreting test performance and emerging research. --- Resources EXpanding Prenatal Cell Free DNA Screening Across moNogenic Disorders (EXPAND) https://clinicaltrials.gov/study/NCT06808880?tab=study --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • May 26 · 48 min

    Ep. 118 Comprehensive Bone Health: Diet, Hormones, & Preventative Care with Dr. Pooja Luthra

    Osteoporosis may present after menopause, but prevention starts decades earlier. In this episode of BackTable Women’s Health, Dr. Carla Gunn, guest host and OBGYN, interviews Dr. Pooja Luthra, an endocrinologist at UConn Health, about osteopenia, osteoporosis, and practical strategies for lifelong bone health. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:28 - Why Bone Health Matters Early 05:23 - Bone as a Vital Sign 08:02 - Amenorrhea and Early Screening 09:51 - Calcium, Vitamin D, and Protein 15:11 - Menopause Bone Biology Explained 21:58 - Metabolic Diseases and Bone Risk 25:58 - Early Screening Red Flags 27:53 - Hormone Therapy Bone Benefits 30:59 - Reading DEXA Scores 33:42 - FRAX Scores 35:09 - Modern Treatment Sequencing 38:02 - Bisphosphonates Mechanism and Concerns 41:16 - Secondary Labs and Referrals 44:23 - Closing Thoughts --- More about this episode Dr. Luthra explains how peak bone mass is largely established by early adulthood, followed by accelerated loss during the perimenopausal/menopausal transition due to estrogen decline, inflammatory cytokines, altered calcium absorption, and increased bone resorption. She reviews prevention strategies, including adequate calcium, vitamin D, and protein intake, resistance training, and avoiding smoking and excess alcohol use. The discussion also covers high-risk conditions that can negatively impact bone health, including amenorrhea, premature ovarian insufficiency, hyperthyroidism, diabetes, and chronic kidney disease, along with considerations for earlier screening in these patients. Dr. Luthra walks through DEXA interpretation, including T-scores, Z-scores, trabecular bone score (TBS), and FRAX assessment. She closes the conversation by outlining treatment sequencing with anabolic agents before antiresorptives, bisphosphonate safety, alternative therapies, and secondary osteoporosis workup labs. --- Resources FRAX Tool: https://www.fraxplus.org/calculation-tool --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • May 19 · 52 min

    Ep. 117 Radiation Therapy Advances for Gynecologic Cancers with Dr. Andrew Lim

    "The treatment of cervical cancer is definitely a team sport." Hear how recent radiation advancements are impacting gynecologic cancer care, and how to partner with your radiation oncologist to tailor therapy. This BackTable Women’s Health / Tumor Board episode features hosts Dr. Mona Guo and Dr. Marcia Ciccone joined by USC radiation oncologist and brachytherapy director Dr. Andrew Lim discussing modern radiation techniques, indications for definitive/adjuvant therapy, and toxicity management in gynecologic cancers. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:39 - Modern External Beam IMRT 05:47 - Planning With CT And AI 08:14 - Daily Setup Imaging Workflow 13:30 - Dose and Fractionation Basics 18:50 - HDR Image Guided Brachy 21:50 - Brachy Vs External Boost Evidence 24:54 - Managing Side Effects and Menopause 28:49 - Hormone Therapy Benefits 30:37 - Dilators and Pelvic Rehab 33:12 - Long Term Radiation Effects 38:14 - Spacers and Prolapse Planning 41:42 - Reirradiation and Plan Review 44:05 - Palliative Radiation Choices 46:50 - Gamma Knife Explained 50:16 - Conclusion --- More about this episode Dr. Lim contrasts historical four-field box radiation with contemporary IMRT, CT-based planning, daily cone-beam verification, and AI-assisted contouring with dosimetrist support. They review pelvic radiation treatment timelines, emerging hypofractionation data, and the essential role of image-guided brachytherapy for cervical cancer, including outpatient workflows and improved tumor coverage with reduced bladder/rectum dose. The group covers patient counseling on expected side effects, radiation-induced menopause, fertility, sexual health, vaginal stenosis prevention with dilators/pelvic floor therapy, late effects, re-irradiation considerations, spacers, palliative regimens, and stereotactic radiosurgery/Gamma Knife for brain metastases. --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

  • May 12 · 36 min

    Ep. 116 Understanding the Birth Crisis: A Structural Collapse Perspective with Dr. Yamicia Connor

    What happens when maternity care deserts stop being just a “rural problem” and start impacting your own labor and delivery unit? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Yamicia Connor about the evolving “birth worker crisis.” Dr. Connor reframes the issue as a long-standing structural collapse accelerated by deliberate policy decisions, not simply sudden burnout. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:30 - Structural Collapse Explained 05:41 - What Providers Can Do 09:40 - Data On Care Deserts 14:24 - COVID Like System Failure 19:50 - Limits Of Telehealth 20:57 - Think Systemwide Care 23:52 - Insurance Access Shifts 25:04 - Support Midlevel Workforce 27:06 - Build Future Infrastructure 29:39 - Burnout Is System Failure 31:02 - Defunding Surveillance Risks 32:51 - Stop Calling It Burnout 34:35 - Conclusion --- More about this episode Dr. Connor describes how the systematic decoupling of clinical science from federal and state infrastructure has shifted legal and operational risk onto individual physicians, leading to illogical practice patterns and confusion about the standard of care, especially in settings like emergency departments. A review of the 2024 March of Dimes data showing over 35% of U.S. counties are now maternity care deserts, and JAMA-tracked data in states like Idaho, where nearly a third of OBs left between 2022 and 2024. She warns that as more rural units close, regional and academic hospitals will absorb sicker and less managed patients, straining L&D units, NICUs, staffing, and training pipelines. To address this crisis, Dr. Connor calls for system-level coordination, stronger leadership from professional societies, improved care navigation, expanded mid-level support, and enhanced telehealth infrastructure to extend obstetric expertise. --- Resources Maternity Care Deserts Across the US https://www.marchofdimes.org/maternity-care-deserts-report Change in Number of OB/GYN Physicians Practicing Obstetrics After the Dobbs Decision https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837058 --- BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

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