Kerry: 0:29

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Camille Imbo. Welcome to the podcast.

Camille: 0:37

Thank you. I'm very excited to be here. Hi everyone.

Kerry: 0:41

Always lovely to network with another local Tampa Bay area provider. So thank you for joining us and why don't you just start off with telling us a little about who you are and what you do.

Camille: 0:52

Sure. So as you mentioned, my name is Camille Imbo. I am a pediatric and adolescent gynecologist, which I know probably immediately raises a lot of eyebrows as to what that is, and I'll go into that in a bit. But I am originally from California, but did my med school and residency here. Popped out to Phoenix, Arizona for two years for my peds and adolescent GYN fellowship, and then came back here to open my practice.

Kerry: 1:20

Very nice. Where did you train here at USF

Camille: 1:23

Yep. Yeah, I went to med school at USF and then residency right next door in Brandon.

Kerry: 1:28

Nice. All right, welcome back. I know you've been back a little while, but that's exciting. I also looked and saw that you've lived many different places and trained many places in the world. How do you think that's shaped how you care for patients today?

Camille: 1:40

Oh, absolutely. I think being able to understand different cultures and backgrounds I am lucky that I grew up. Speaking many languages. So that also works sometimes, especially, we have a large Latino population. I got to learn Spanish back in college and do a lot of volunteering in Mexico and Costa Rica. But then also my own family's background. There are West African from Cameroon. So I understand different ways of approaching medicine and taking recommendations or how I should give recommendations to different cultures.

Kerry: 2:15

Absolutely. You mentioned, pediatric gynecology, definitely not well known. Honestly, I didn't even know there was a fellowship for it. So as I love about my podcast, I learn something new every day. So how do you explain this sub subspecialty to parents and patients?

Camille: 2:32

Yeah, the big overarching is, pediatricians are often not comfortable with GYN related issues. And gynecologists are not really trained or comfortable with younger patients less than like 16, 18-year-old, yet the average woman gets her period around 12. And as I very blatantly say girls are born with all their parts and things can go wrong from the very beginning. So from birth until they reach 16 to 18, they are experiencing issues and they fall in the middle not really getting appropriate care. So that is where we come in. It's a subspecialty where we work in collaboration with a lot of people. So whether that's with OB-GYNs and pediatricians, but also with a lot of other subs specialties, like endocrinologists, hematologists, we're a little bit of all of those things. So any hormonal abnormalities is the most common things we see. But then also like infections physical changes, anything like that can be happening to young girls from birth all the way up until right before adulthood is where we come in.

Kerry: 3:42

That makes sense. Sometimes we think of like gynecology as a surgical specialty as well, so perhaps that's not seen as much in this age group that you see.

Camille: 3:52

It is actually good. Like I know

Kerry: 3:54

See so many myths to

Camille: 3:56

of what we do. Yeah. And it's just really one of those things until you experience it or your child experiences it, people don't really think about a little girl in her ovaries and having cysts. But we do a lot of cystectomies on young girls. There are a lot of disorders or sexual differences. So being born with half a uterus that's not fully connected, a hymen that's not fully open any kind of, just not fully developed basically, and we help open that up in whatever way necessary or removing anything that's not supposed to be there. So those would be the biggest ones. Cystectomies, ovarian torsions, ectomies, I'd say are the three biggest surgeries that we perform.

Kerry: 4:39

Interesting. Okay. I think, sometimes as like from primary care standpoint, I'm like, oh you don't need to see A GYN yet'cause you don't need a pap until you're 21 or sexually active and things like that. And that's mostly'cause you can clear HPV or anything on, but why do you think it's important that children and see someone specifically trained in your area?

Camille: 5:01

Yes. That's such a great question. So it's actually recommended to start seeing a gynecologist at age 13, partially because of that average age of periods being around 12, but then also because back when I practiced just generalized O-B-G-Y-N with adults a lot of women come in and say, I've been suffering of this for the past 10 years. 20 years, right? And so once puberty hits even before, but usually once puberty hits is when a lot of women start experiencing certain issues. Start noticing changes in their bodies that they don't know how to talk about. And it's a good time to start to learn how to advocate for yourself, how to advocate for your body. Unfortunately women's health is taboo in a lot of ways. There's words even on my social media that I have to edit how I say it, and I'm like, this is just the body part. Why can't I say that? But so if we can have girls be comfortable with these issues. Things like endometriosis and P-C-O-S-I diagnose in the early teens and sometimes even younger. So if they wait until they're seeing an ob, GYN at 20 plus, they've been suffering for years and years. The other reason that they should see a pediatric gynecologist specifically is that part of our training is knowing how to talk to them, right? So whenever you talk to a pediatrician, they'll say children are not just little adults, right? So it's not just you don't approach things in the same way, the way you do an exam, the way you make them comfortable, confidential conversations, talking to a child and their parent, right? I am someone who loves teenagers, which most people don't, but I just understand their approach to life and how they need to hear recommendations. So that's as simple as it may seem of just expressing things differently. It makes a huge difference to how they approach their body and their health, so that when they do see an OB GYN later on in life, they're better equipped.

Kerry: 6:57

What do you think happens when, like any issues that they have maybe ignored or dismissed or said that it's normal and maybe something that they'd grow out of?

Camille: 7:06

Yeah, the kind of, humorous answer is they become the parent of a young girl who then tells her to ignore those issues as well. So often I see a patient and the mom is sitting there, she goes, oh. I think I may have endometriosis too, but no one told me. I assumed it was normal. I think I may have PCOS too. And because again, if you're told for years and years to ignore it or not told anything about it, then at some point you just never bring it up and these issues aren't quote, unquote, just pain even though pain and quality of life is extremely important, but they can lead to bigger things later on in life. There's higher risk of cancers with PCOS and endometriosis. Infertility issues can come from that. If your hormones are abnormal, you can have osteoporosis. So there's true, health issues that can come of it later on in life, but I think it creates a huge distrust in the medical community if for so much of their life, something that they experience once a month is horrible and they're just told to, to live with it.

Kerry: 8:10

So I think many teens and kids are nervous to talk about everything. Like this, you already alluded to this, maybe they're scared too about a GYN visit, right? How do you create that safe and respectful environment?

Camille: 8:24

Yeah, a big part of my visits is the beginning of laying out what's going to happen partially because it's a specialty most haven't heard about, so when parents come in, they'll be like, Ooh, pap smears in the speculum. And so they're terrifying, their poor little girls and so good amount of times my first visit, I'm not even laying hands on the patient like maybe, listening to her heart, lungs, things like that. But it's really a lot of talking and really dissecting everything going on and them letting them talk about themselves and doing a lot of education. I say I'm almost more of a teacher than a doctor sometimes, because it's explaining why are you having periods, what is a uterus? What are ovaries? What does everything do so that when it does come to, okay, there's certain labs or exams that we need to do, there's more understanding of why we're even doing them. And then the second part is giving them ownership of their body. That there's nothing that they have to do. They don't have to struggle through and be in pain and just sit there and take it kind of thing. I use mirrors sometimes to show them what I'm doing, give them breathing techniques, tell them they're allowed to tell me to stop at any point in time. In pediatric GYN, way more often than generalists we'll do things under anesthesia that are simple. I've done pap smears under anesthesia.'Cause I take a lot of care of a lot of patients with special needs.'Cause it really comes down to we're that first exposure for a lot of these kids to the GYN world or kind of intrusive exams. And if I can have someone be like, oh, this was a lot better than I thought, then I can lay out their medical path to be a lot more positive rather than shut them down right there and then. Because medical trauma is so real and I've seen so many adults terrified of, speculums and all those things because it, it was a horrible experience. I'm one of'em myself that my first pap smear was horrifying, and so I'm like, okay, I don't want that to happen to a future patient.

Kerry: 10:24

Yeah, you already answered my question on what do you do with patients who have had medical trauma or have special needs. So that's a, very important, subset of the population to, appropriately handle. How about involving PA parents? Like how do you balance involving them and still empowering the patient?

Camille: 10:40

Yeah, it's a delicate balance because there have been times where I stand firmly with the patient, whether it is they really want something. Of course, as long as it's safe. If they really want something done the parent really wants something done and the patient's just not comfortable with it yet. Let's see, something like birth control, and I'm like, okay, if they're not sexually active, there's no reason for it right now I'm not gonna force a medication on a patient. And same with the other way around, things like that. But again, it comes back down to education. Making them see this young girl as a young woman and a human of themselves, and explaining why maybe the parent's belief is misguided. And just trying to meet in the middle. I think of it in the same way as. Just a one-on-one, even with an adult who's, wants to do something different. There's just that added layer of, it's not for them, it's for a different patient. So at the end of the day, I am like, I care about your daughter's health and safety. So our final decision here is to make everyone feel comfortable and be safe.

Kerry: 11:46

Absolutely. I was gonna ask what do you think about, I think over the last, I don't know, 10, 15 years, maybe more? Girls are having puberty earlier than they were in the past. Can you comment on that? Maybe that's also a greater reason why they might need to see a gynecologist earlier.

Camille: 12:03

Absolutely. Yeah, there's a lot of research about it and different conclusions that have been reached. One of the biggest one is stress factors. There's actually an article, and I don't remember the name off the top of my head, but that showed that there was an Increase of precocious puberty after COVID because of just the stress factors that were happening. And then of course higher rates of obesity and the foods we eat, decreased exercise, all of those types of things definitely affect puberty these days. So yes, the earlier that a patient can talk to a gynecologist or at least be aware of these types of things so that they know. I've had patients who had went through precocious puberty and the parent didn't realize that it was abnormal that their daughter started her period at six years old until many years later. And I was like, oh, there were so many things we could have done about that. So yeah, the earlier we can educate, even if that first visit is there's nothing wrong. I'm just letting you know of all the things that are going to happen and what to expect, and what to know of what's going to be normal and what's abnormal, and then maybe I'll see you again in two, three years, but at least you have that set up for you.

Kerry: 13:12

So can you walk us through some of the most common, like pediatric and ad adolescent conditions that you see?

Camille: 13:18

Sure. The super most common one is abnormal periods whether it's heavy periods, painful periods, irregular not having them ever being 16, 17 and not having one or having it, and then it disappears for a year for a variety of reasons. This is one where I see girls often misled because it sounds very similar to something an adult would go through. And so they get an adult workup. But there are slight variations to look out for in young girls, like how we diagnose PCOS, it's a little bit different. Which birth controls work better in a teenage population is gonna be slightly different than in an adult. And then again, going back to educating I'll have someone, a young girl either say, oh, my period is normal, but when you really ask all of the questions, they're leading through every hour and a half, so because we're not used to in the adult world digging through that as much as sometimes these things can be missed. So I'd say abnormal periods is right up there as the most common thing that I see. Then after that it diversifies a lot. You either have the surgical issues, so like ovarian cysts, whether they're normal ones or ones that require cystectomies, or more in the range of hormonal abnormalities. Whether it is things they were born with like turners congenital adrenal hyperplasia all these types of things that require either hormonal changes or working together with like plastic surgery, all those types of things. So there's like the most common, and then everything else is right there in the middle.

Kerry: 14:59

Do you do a lot of like lifestyle management to help regulate periods or you, yes.

Camille: 15:04

Absolutely. Yeah. Yeah. The number one is having them track their periods in some shape or form. It's always funny, someone comes in and they're like, my period's abnormal, but then can't tell me when it's came, when it was there. Yeah. It's so knowing those kinds of things and then diet and exercise, which I know is. The answer to just about everything. A healthy body is going to have healthy outcomes. Not saying that solves everything, but, trying aim for like anti-inflammatory foods can help decrease the pain related to periods for those who have lighter abnormalities related to their periods. And then movement, heat, yoga, those types of things can help calm the body during those more stressful times. But it's also equally okay to need, medication or anything like that. Sometimes people are like, oh, I want a natural outcome, and they're bedridden during their period for a week, and I'm like we've passed the, natural needs. If you're already Someone who eats well and you move your body and you are unfortunately cursed with terrible periods. You don't have to power through them or blame yourself of, oh, I'm not doing enough. Sometimes they do need straight up treatment.

Kerry: 16:18

You mentioned that diagnosing PCOS is a little bit different in adolescents. Can you tell us more about that?

Camille: 16:24

Yeah. So the

Kerry: 16:25

And what PCOS is maybe, in

Camille: 16:27

yes. Yeah, let's back up.

Kerry: 16:29

in a while,

Camille: 16:30

Yeah so PCOS stands for polycystic ovarian syndrome, which I always get a little bit annoyed that's what it's called, because people then think it has to do with ovarian cysts, which really is just a symptom of it, but really it's the disease of hormonal imbalance. So. aren't they

Kerry: 16:46

going to change the name of it?

Camille: 16:48

There are some societies, endocrinology and reproductive endocrinologists have talked about it. I'm very patiently waiting for that to happen. The amount of girls that I see who are like, oh, I went to the emergency room. They saw a couple cysts, they told me I have PCOS. No, because it's terrifying. Then they Google and they see, oh, you might be infertile and all of these things, and I'm like, no, it was just a cyst. That's not what it is. But to go back to the three diagnostic points with PCOS, and you have to have at least two of the three of them is hyperandrogenism, which means high testosterone levels, so high levels of the quote unquote male hormones, which women have. Some testosterone, but having higher levels that can lead to things like hair growth on your face and other, and a lot of acne issues like that. The other one is, irregular periods. So skipping periods more than three months apart is one of the syndromes, and that's usually due to abnormal ovulation. So normally you should be ovulating about two weeks before your periods every month. And girls with PCOS. Aren't ovulating regularly, which is where that fertility issue comes in'cause if you don't ovulate, you can't get pregnant. But doesn't mean that it doesn't happen at all. It's just very random. And then the third one is where the name comes from of polycystic ovaries. What it is, it's that not ovulating, they're actually making those eggs. They're just not releasing them. So when you look at the ovary under an ultrasound, there's a bunch of eggs sitting there and not just two or three, but like 10, 11, 12 eggs sitting there and they're not being released. So that's the like general definition for adults and everything. And the definition isn't changed for teens. It's just used differently. One of the issues is picture a teenager, they probably have acne. Their first year of periods are probably irregular, and ironically enough, teenagers are the most fertile, so they are the ones with most eggs. So that would mean we would be passing around the diagnosis of PCOS to every 12-year-old because that's what they all look like. So that's where the difference comes in of we don't diagnose it within the first two years of having a period because it's very common actually only 60% of girls have a normal, regular period in their first two years post menarchy. And then we're very careful about, the hyperandrogenism. So the high testosterone levels of just oh, a little bit of acne. You have PCOS we're more likely to use laboratory levels of having high testosterone levels. And then the polycystic part is actually not diagnostic whatsoever. So I actually don't even do an ultrasound on teenagers'cause they're more than likely to have it or not, and that doesn't mean anything either way. So really the irregular period aspect after two years and high testosterone levels on labs.

Kerry: 19:47

Very interesting. Yeah, that makes a lot of sense and I'm glad you mentioned about, the abnormality of the first one to two years of periods, because that's definitely something important to know that you're still probably normal, but I don't know, wanna say anything is normal'cause then they wouldn't find somebody like you. But it is very common, like you

Camille: 20:05

Yeah. and irregular periods is the big one because it actually takes, for that 99th percentile of girls to have regular periods, it can take up to six years. So that's where it gets a little bit difficult. The first two years is very common, but then past that is where I do all of the workup. And if everything comes back normal, I just keep a close eye on them.'cause it's oh, you just may be someone who's a later bloomer and how long it takes things to normalize.

Kerry: 20:31

Yeah. Interesting. So tell us about SPARC Gynocology. Tell us about your practice

Camille: 20:36

Yeah, so when I graduated fellowship, there's always the what are you going to do next, and pediatric gynecology is with it being so small is often an academic practice. And as I mentioned, we work with a lot of other subspecialties, my passion is very into accessibility and I know that with academic practices, that often means that it can take six months to see a doctor and there's a lot of bureaucracy in it. And to be honest, medicine. It got difficult for me. I was like, the only way I can keep practicing is if I can do it my way. Which unfortunately means the hard way of doing, of starting from the beginning. But in my research of how to open a practice and what to do, I landed on direct care or DPC, which is where care is provided outside of insurance. And the benefit of that is, we don't have to worry about prior authorizations. Or Oh, you're vis, seeing 20 people every 10 minutes because insurance only pays this amount. Or I'm gonna see you for this and I bill you for that. So I have to see you again, so I can bill you for that other issue. We can just really have a conversation between doctor and patient, and especially when it comes to young patients. I think it's. So important to not be rushed and have that full time. So that's where Spark comes from. So it's a direct care pediatric and adolescent gynecology practice where I see patients from 25 and under. And so it's cash pay, meaning there's very transparent costs, and there's also membership options, which I think is really exciting because it means patients can text me, call me, anytime they want, they can come in for a visit. As often as they want. There's not that barrier of, oh, I just saw my doctor and now I have a question and I have to wait. God knows how long to see them again. Or I send a message that goes to their nurse, then goes to this other person before it makes it to my physician. My goal was just to really give patients direct access to me. And yeah, so it's exciting. It's scary. It's a lot. I just opened about now, two weeks ago. It's definitely a new world. We don't learn the business side of things in medical school, but it, that's been something I dove in deeply. And luckily the direct care community is very helpful and there's other people who do it and gynecology in the area. So diving into the pediatric gynecology wasn't as scary.

Kerry: 23:13

Yeah. We are seeing, different medical models these days and as much as insurance gives us headaches, it's nice to be able to just not have to use it if we don't have to do you do like super bills or anything? If they wanted to use it, yeah.

Camille: 23:26

No, I can. I always say I can't guarantee what your insurance will cover or not. Because the issue with that is if I dive too deep into it, then I'm rejoining the headache of insurance all over again. And that's the part that's obviously hard to convince people, and I understand it, right? You pay hundreds of dollars for your insurance every month. So why would you wanna pay more for something else? And the example I give is, you're paying for your insurance, but then you show up a, you have to wait, God knows how long for your appointment. And then you get there and you might have a copay, and then you may have labs or medications that you need to pay some certain amount for, and then let's say you need an MRI, your insurance will be like, no, you need an ultrasound first, or you need to try these three medications first. So something that could have been like, oh, for a hundred dollars, you get all of those things versus your insurance amount plus all these other extras. So I think just the transparency of it and the ease of it is what that, that cost is for. So I fully understand when people are a little bit scared of the idea, but once people understand it and are within it makes a lot of sense.

Kerry: 24:39

Yeah. It's very exciting to have your practice all new and tell us about your podcast. What's the

Camille: 24:44

Yeah, so it's called PAG Over Pastries. It's inspired by, there's another OB GYN podcast called Over Coffee, and it's an educational podcast about pag or pediatric and adolescent gynecology. And we cover all different types of, to topics. We invite different guests. Pediatric and adolescent gynecology guests to talk about, all of these different packed topics for about 20 to 30 minutes. It is catered towards other medical folks that take care of this population, whether they're pediatric and adolescent gynecologists, or pediatricians family medicine, OBGYNs, because so many my own residency had no pediatric gynecologist. When I said that's what I wanted to go into my own attendings didn't know what I was talking about. So that's our way of, okay, you may not have access to it. Here's a way to learn about it. And funny enough, the most popular episode is what is PAG

Kerry: 25:40

yeah.

Camille: 25:41

but it's been out for a year now and doing pretty well. Yeah, we get i'd say about 200 views per episode, and it's available on Spotify, apple, all of the different places, and it's been a really fun thing to do.

Kerry: 25:56

Great. Yeah, we'll link that up in our show notes. I do wanna ask you what you know, one last fun question, what your favorite health tip is for parents and teens to remember.

Camille: 26:05

Ooh, so many.

Kerry: 26:08

So many

Camille: 26:08

I know. The one.

Kerry: 26:10

Yeah.

Camille: 26:10

I'd say actually the general one is everything in moderation. I see too often people try to go all in either on eating healthy or on exercising. And when you go all in, you are very quick to quit because it was too much. Or quitting things. Cold Turkey. And I always tell patients, I'm never gonna tell you not to eat pizza'cause I'm never gonna. Stop eating pizza, but maybe don't eat it every day or don't eat the entire pizza right next to your pizza have a salad as well. Or you don't have to go lift a bunch of weights, just walk around the block after dinner. Little things like that. Consistency is better than extremes.

Kerry: 26:48

I definitely agree. Consistency is definitely better. So I like that tip. Very nice. Why don't you, so we mentioned your name of your practice and the podcast, but where can people find you if they wanna work with you, where are you located and all

Camille: 26:59

Absolutely. So I'm in St. Petersburg. I'm actually subleasing from another DPC practice called ReMed. So I'm in her office in downtown St. Petersburg. The name of the practice is SPARC, which is S-P-A-R-C. Stands for specialized pediatric and affirming reproductive Care. So SPARCgynecology, and Instagram, Facebook, website. It's all SPARC gynecology.

Kerry: 27:26

Perfect. Thank you so much. Thank you so much for being on the podcast today, and thank you everybody for listening to our wonderful conversation. And please tune in next week for next week's episode.

Camille: 27:36

Thank you so much for having me.

Kerry: 27:38

Yes.