Wednesday, September 24 Update:

Based on Governor Tony Evers’ statewide Executive Order, the Wisconsin Department of Health Services (DHS) issued a statewide standing medical order that allows those over 6 months old who want to receive the COVID-19 vaccine to get it at pharmacies across the state without a prescription. This means members can receive the vaccine at Hy-Vee and Costco, covered by GHC-SCW. The Moderna COVID vaccine is now available at all GHC-SCW clinics.* Please refrain from scheduling at the Madison College Clinic unless it is your Primary Clinic.

*The vaccine will be given while supplies last and is never guaranteed due to limited supply and demand.

Eligibility:

Anyone 6 months or older may receive the COVID-19 vaccine, per Gov. Evers Executive Order. (No one has to be over 65 years or older, or immunocompromised, to receive this vaccine, like in the past.)

If you are 65 or older, the CDC recommends you receive the COVID-19 vaccine as part of your routine care. You do not need to have a special conversation with your care team. If you are due for your COVID-19 vaccine, you can get it when supply is available!

If you are under 65, the CDC states that COVID-19 vaccination is based on “shared decision-making.” This means the vaccine is available to you, provided you have had a conversation with your primary care provider team to confirm the vaccine is correct for you.

Coverage: GHC-SCW will cover this year’s COVID-19 vaccine.

GHC-SCW Clinics:

• 6 months to 11 years old: We currently have VERY limited supply. This may change in the near future, but for now:
  • The COVID-19 vaccine can be scheduled at the GHC-SCW weekday flu clinics or added to your upcoming Primary Care Provider appointment notes.
  • This will NOT be available at Capitol Clinic weekend Flu Clinics.
• 12 years and older: The COVID-19 vaccine can be scheduled at the GHC-SCW weekday or weekend flu clinics or added to your upcoming Primary Care Provider appointment notes.
• 6 months to 17 years old who have BadgerCare Plus Coverage: At this time, GHC-SCW clinics cannot schedule or administer the COVID-19 vaccine. Please check with your local pharmacy.

Pharmacies: Pharmacies operate under different regulations than health systems, which has allowed some to begin receiving vaccine shipments earlier. For example, Walgreens has already started offering the COVID-19 vaccine; however, GHC-SCW does not contract with Walgreens for vaccine administration. Our contracted pharmacies (Hy-Vee and Costco) are now offering the vaccine; it will be covered under your GHC-SCW benefits and no prescription is needed.

Previous COVID-19 vaccine: Last year’s COVID-19 vaccine is no longer being offered at our GHC-SCW clinics or at our partner pharmacies. It does not match currently circulating virus strains and receiving it now could delay your eligibility for the updated vaccine.

We are committed to keeping you informed and will share updates on this page and in upcoming member communications as soon as new information is available.

Immunization and surveillance programs have continuously lowered the risk of widespread measles outbreaks in the US. However, measles cases continue to occur due to unvaccinated travelers who get measles while visiting other countries, and in the under-vaccinated populations in the United States. The best way to stay ahead and prevent measles is to get vaccinated.

CDC has put together a toolkit called Be Ready for Measles, full of educational graphics, videos and fact sheets for health departments around the Nation. Here at GHC-SCW, we understand how important it is to be prepared for outbreaks and to keep our community healthy, so we’ve put together helpful information from the toolkit below.

 

What is Measles?

Measles is a very contagious disease caused by a virus that spreads through the air when someone with the virus coughs or sneezes. After someone sick with measles leaves an area, the virus can remain airborne for two hours. About 9 out of 10 people who don’t have measles vaccines and come in contact with someone who is sick will also become infected. This disease is especially dangerous for babies and young children.

Do you think your child has Measles?

What to do if you think your child has Measles:

Measles symptoms typically show up 7-14 days after coming in contact with the virus. The most common symptoms include:

• High fever, spiking to over 104
• Cough
• Runny nose
• Red and/or watery eyes
• A rash on the face that breaks out 3-5 days after other symptoms begin

If you think someone in your family has measles, make sure you:

1. Keep them away from others who aren’t sick. Have the person who is sick stay in one room/section of the house.
2. Everyone who lives in the house should stay home to prevent the spread to those in the community.
3. Call a doctor or hospital right away and let them know someone in the home possibly has the measles. Please do not take them in right away; the doctor will give information/instructions on what to do next.

Remember, do not come into the clinics if you are sick. Stay home unless the sickness rapidly gets worse, or the following symptoms occur:

• Trouble breathing or breathing gets faster than normal
• Pain when breathing or coughing
• Dehydration, including a dry nose and mouth, using the bathroom less frequently and crying without tears coming out
• Fever or headache that won’t go away
• Confusion or severe weakness
• Low energy, difficulty feeding/eating or a blue color is seen around the mouth

If these symptoms occur, do not wait; take your child to the emergency room.

How do you protect your family against measles?

It is never too late to get vaccinated! The measles, mumps and rubella (MMR) vaccine is the best way to stay protected against the measles. Not only does it protect you and your family, but it also keeps the people around you and your community healthy.

Talk with your provider if you or your child has not been vaccinated.

 

Learn more – CDC Measles Information, Tip Sheets and videos:

About Measles | Measles (Rubeola) | CDC

Preventing Measles Before and After Travel

Measles: It Isn’t Just a Little Rash

Measles is very contagious

 

Why Are Girls 3x More Likely to Be Vaccinated Than Boys? Did you know HPV causes nearly 36,000 cases of cancer in the U.S. each year, and most of them could be prevented by a vaccine?

In 2006, the HPV vaccine was originally marketed to girls to prevent cervical cancer, but HPV causes cancer in all genders. Here at GHC-SCW, we want to spread awareness that the HPV vaccine isn’t just for girls. Boys need it too.

It’s safe. It’s effective. It could save a life.

 

What is HPV?

In the early 1980s, Human Papillomavirus (HPV) was found in cervical cancer cells, which sparked research and the eventual development of a vaccine. HPV is a sexually transmitted infection that spreads through skin-to-skin contact. There are about 40 different strains, or types, of HPV, and roughly 80% of sexually active people will come into contact with the virus at some point.

Most people with healthy immune systems can fight off the infection, but in some cases, it can become cancerous.

 

Vaccine History

The first HPV vaccine was patented in 1994, targeting four types of the virus. In 2006, the vaccine was approved by the FDA for girls ages 9 through 26. Today, we know that boys can also be affected by HPV, and they should be proactive in getting vaccinated too.

According to Cleveland Clinic, the HPV vaccine available today protects against 90% of the strains that cause cervical cancer, anal cancer and genital warts, as well as most strains that cause mouth and throat cancers.

 

Why Should Boys Get the HPV Vaccine Too?

While about 22,000 women are diagnosed with cancer caused by HPV each year, approximately 16,000 men are diagnosed with HPV-related cancers as well. The vaccine offers powerful protection before exposure and helps prevent cancers that can develop years later.
Protecting boys helps protect everyone.

 

Myths vs. Facts

Myth: HPV only affects girls, and girls only get cervical cancer, so boys don’t need the vaccine.

Fact: HPV affects everyone. While boys don’t get cervical cancer, HPV can still cause multiple cancers in males. Vaccinating them helps protect their health and reduces transmission to future partners.

Myth: The HPV vaccine is only for those who are sexually active.

Fact: The vaccine works best when given before any potential exposure to the virus. GHC-SCW recommends boys and girls as young as 9 receive the vaccine, well before most are sexually active. GHC-SCW encourages families and providers to have conversations early to make a plan.

Myth: The HPV Vaccine isn’t safe.

Fact: The HPV vaccine has been studied for over 15 years by the CDC, FDA and other organizations, and has a strong safety record. Like any vaccine, it may cause mild side effects like arm soreness, low-grade fever or feeling tired, but serious side effects are extremely rare.

 

Talk to your child’s Provider about getting them protected.

 

Learn more:

History of HPV Vaccine – National Vaccine Information Center (NVIC)

HPV Vaccination Recommendations | CDC

HPV Vaccine: Age, Schedule, Importance & Side Effects

When it comes to preventing serious illness, one simple step can make all the difference. The Pneumococcal Vaccine (PCV) offers strong, long-lasting protection against dangerous infections, all in a single dose for most adults.

What Is Pneumococcal Disease?

Bacteria called Streptococcus pneumoniae cause pneumococcal disease and can lead to several serious, sometimes life-threatening, illnesses. These bacteria can invade different parts of the body, causing infections such as pneumonia in the lungs, meningitis in the brain and spinal cord, and bacteremia in the bloodstream. Even more common infections, like ear and sinus infections, can become severe in vulnerable individuals. The disease spreads through coughing, sneezing or close contact, making it especially concerning in community settings and among people with weakened immune systems.

Why Choose the PCV?

The latest Pneumococcal Vaccine is a significant advancement in protection. It offers broader defense against more strains of pneumonia-causing bacteria than earlier versions. With just one dose for most adults, the vaccine is both convenient and practical. It’s also FDA-approved and recommended by the CDC, offering long-lasting immunity and peace of mind.

Who Should Get the PCV?

Adults aged 50 and older are strongly encouraged to get the PCV. Additionally, adults between the ages of 18 and 49 may benefit if they have certain health conditions. These include heart or lung disease, diabetes, chronic kidney or liver issues or a weakened immune system. Adults with a history of smoking are also encouraged to consider vaccination. If you’re unsure whether this applies to you, your health care provider can help you decide.

The Benefits of PCV

Benefit	Why It Matters
Multi-strain protection	Covers more types of pneumonia-causing bacteria
One-time dose	Simple, convenient and easy to schedule
Reduced risk	Lowers chances of hospitalization and severe complications
Community protection	Helps prevent disease from spreading to others

Side Effects

The PCV is thoroughly tested and proven safe for adults. Like many vaccines, it may cause mild side effects such as soreness at the injection site, general fatigue or a low-grade fever. These symptoms are typically short-lived and resolve within one to two days.

Scheduling Your Vaccination

Don’t wait to protect your health or the health of those around you. A single shot can defend against a serious illness.

Talk to your primary care provider to see if the pneumococcal vaccine (PCV) is right for you.

Stay healthy. Stay protected. Get vaccinated with PCV.

 

Learn more here. 

May is Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD) Awareness Month, a time dedicated to increasing understanding and awareness of a group of complex, often misunderstood connective tissue disorders. These medical conditions affect the body’s connective tissue, which holds your skin, joints and other organs together. People with EDS or HSD may look healthy on the outside, but they often deal with pain, injuries and fatigue every day. 

 

What is Ehlers-Danlos Syndrome (EDS)? 

EDS is a group of genetic disorders that affect how the body makes connective tissue. Connective tissue is found throughout the body, providing support, protection and structure to other body parts. The Ehlers-Danlos syndromes are caused by genetic changes that prevent connective tissue from functioning correctly. There are 13 different types of EDS, but the most common is hypermobile EDS (hEDS). 

Each type of EDS has its own set of features and distinct diagnostic criteria. Some symptoms are common across all types of EDS. 

Common symptoms include: 

• Very flexible joints (also called hypermobility) 

• Frequent joint dislocations and sprains 

• Chronic pain and tiredness 

• Fragile or stretchy skin 

 

What Are Hypermobility Spectrum Disorders (HSD)? 

HSD is similar to hypermobile EDS (hEDS). It also causes joint pain and hypermobility, but it doesn’t meet all the medical rules for EDS. People with HSD often have the same symptoms and struggles as those with EDS. Joint hypermobility is seen in all types of HSD.  

Joint hypermobility alone is not always a problem. The problem occurs when hypermobile joints are unstable or place too much strain on other parts of the body. Joint instability occurs when a joint’s bones aren’t held securely, leading to joint subluxations, dislocations, sprains and other injuries.  Hypermobility also affects a person’s muscles because the muscles are required to “hold on” to the joints, which puts extra strain on them and causes muscle fatigue more quickly. 

How are EDS and HSD managed? 

There are no disease-specific treatments for any type of EDS or HSD, so they are managed by addressing each person’s symptoms. There are lifestyle modifications that can be made that will help, such as pacing your activity. Each person’s care plan should address their individual needs.  There are many conditions associated with hEDS and HDS. These comorbidities can include autonomic dysfunction, digestive issues, chronic pain, mental health conditions and many more. 

 

Why Awareness is Important 

Many people with EDS or HSD wait years for a correct diagnosis. Their symptoms are often overlooked or misdiagnosed as anxiety, poor posture or growing pains. Without proper care and understanding, these conditions can get worse and impact both physical and mental health.  

 

Resources to Learn More About EDS & HSD

• The Ehlers-Danlos Society – What is EDS?
• The Ehlers-Danlos Society – What is HSD?
• Video: Ehlers-Danlos Syndromes (EDS) Explained: What You Need to Know

In our fast-paced world, it’s easy to get caught up in the hustle and bustle of daily life. But often, this comes at the expense of neglecting our emotional well-being. Caring for your mental health is as crucial as looking after your physical health. We’ll explore the importance of nurturing your emotional well-being and provide tips to help prioritize your mental health.

 

The Importance of Emotional Well-Being

Emotional well-being refers to your ability to understand, manage and express your emotions constructively. It is vital to your overall health and affects various aspects of your life, including relationships, work and physical health. Here’s why nurturing your emotional well-being is essential:

 

• Reducing Stress: Effective emotional management helps you cope with stress better, reducing its negative impact on your body and mind.

 

• Enhancing Relationships: When you’re emotionally healthy, you can form and maintain positive relationships with others.

 

• Improving Decision-Making: Emotional well-being allows for clearer thinking, aiding in better decision-making and problem-solving.

 

• Boosting Resilience: Resilience, the ability to bounce back from adversity, is closely tied to emotional well-being. It helps you navigate life’s challenges more effectively.

 

• Increasing Overall Happiness: Emotional well-being contributes significantly to happiness and life satisfaction.

 

Tips for Nurturing Your Emotional Well-Being

Now that we understand the importance of emotional well-being let’s explore some practical steps to nurture it:

Prioritize Self-Care

Self-care doesn’t necessarily mean bubble baths and expensive trips to the spa. (They are nice if they do help you though!) Dedicate time to self-care activities that make you happy, whether it’s reading, practicing mindfulness or pursuing a hobby.

Stay Connected

Maintain social connections with friends and loved ones. A strong support system can provide comfort during tough times. Schedule a coffee date with a friend or visit a relative you haven’t seen.

Exercise Regularly

Physical activity releases endorphins, boosting your mood and reducing stress. Aim for at least 30 minutes of exercise most days. You don’t necessarily need to do a grueling fitness class every day. Consistency is key in physical activity, so opt for activities you enjoy, whether it’s riding a bike, swimming or playing pickleball.

Seek Professional Help

If you’re struggling with your mental health, don’t hesitate to seek help from a behavioral health professional. They can provide valuable guidance and support. They can also refer you to helpful resources and programs, like our Foundations Intensive Outpatient Program. Substance use disorders can also hurt mental health. GHC-SCW Primary Care Providers offer compassionate care for substance use disorders, including specialized medication management and a supportive path to recovery.

There are several ways that GHC-SCW members can connect to outpatient behavioral health, psychiatry and therapy at GHC-SCW.  Visit our Behavioral Health page for more information.

Practice Mindfulness

Mindfulness techniques, such as meditation and deep breathing, can help you stay present and manage stress. Looking for some simple exercises to get started? Check out the Spinal Breathing Exercise on our YouTube channel. 

Set Realistic Goals

While it’s tempting to do everything, tackling your entire to-do list all at once can be overwhelming. Break your goals into smaller, achievable steps. Make sure to celebrate your successes along the way, too!

Limit Screen Time

Screen time is unavoidable in many careers. For many, computers and smartphones have become essential tools for their jobs. However, excessive screen time, especially on social media, can negatively impact mental health. During your downtime, make sure to set boundaries for healthy device use. It can be as simple as turning off notifications, setting a timer to limit usage and keeping your phone or laptop out of the bedroom.

Get Quality Sleep

Prioritize sleep, aiming for seven to nine hours per night. Quality rest is essential for emotional well-being and vital to your physical health. To create a sleep-friendly space, keep your bedroom cool, dark and quiet with comfortable bedding.

Express Gratitude

Regularly express gratitude for the positive aspects of your life. This practice can foster a more positive outlook. One way to do this is to keep a daily gratitude journal. You could start your day positively by writing down the things for which you are grateful. Another way to express gratitude is by taking time before bed to note events that brightened your day. Some events you could note in your journal may include witnessing a random act of kindness or seeing your favorite flowers on your daily walk.

Educate Yourself

Learning about mental health can be powerful in understanding these conditions. You can also be part of the movement to reduce stigma and support others who are struggling with these conditions. Our online health conditions pages provide helpful information and resources on common mental health challenges, such as anxiety and depression.

 

Nurturing your emotional well-being is valuable to your overall health and happiness. Incorporate these tips into your daily life to prioritize your mental health and contribute to a more emotionally fulfilling existence. Remember, seeking help when needed is a sign of strength, and there’s support available for everyone. Your mental health matters, so make it a priority.

The Dangers of High Blood Pressure 

Doctors call high blood pressure “the silent killer” because it can cause serious health problems without showing any symptoms.

 

What is Blood Pressure? 

Blood pressure is the force of blood pushing against the walls of our blood vessels as it travels through our body. It’s like the pressure of water flowing through a garden hose. When doctors measure blood pressure, they look at two numbers: the systolic (when the heart beats) and the diastolic (when the heart rests between beats). 

 

Why is High Blood Pressure Dangerous? 

High blood pressure, also known as hypertension, means the pressure in your blood vessels is too high. This high pressure can damage your blood vessels and make your heart work harder than it should. Over time, high blood pressure can lead to health problems, such as: 

• Heart Disease: High blood pressure can cause your heart to become larger and weaker, leading to heart attacks or heart failure. 
• Stroke: It can damage the blood vessels in your brain, increasing the risk of a stroke, which happens when part of the brain doesn’t get enough blood. 
• Kidney Damage: Your kidneys help filter waste from your blood. High blood pressure can damage the blood vessels in your kidneys, making it harder for them to do their job. 
• Eye Problems: It can also damage the blood vessels in your eyes, leading to vision problems or even blindness. 
• Sexual dysfunction: Healthy blood pressure is essential for sexual function. When you have hypertension, you may experience reduced blood flow to your pelvic area, leading to a loss of libido. Males with hypertension might also develop erectile dysfunction due to blood flow problems. Females may experience vaginal dryness and fatigue. 

 

How Can We Keep Our Blood Pressure Healthy? 

There are several ways to help keep our blood pressure at a healthy level: 

• Eat a Balanced Diet: Eating plenty of fruits, vegetables, whole grains, and lean proteins can help keep your blood pressure in check. 
• Exercise Regularly: Physical activity helps your heart stay strong and healthy. 
• Limit Salt and Sugar: Too much salt and sugar can raise your blood pressure, so eating them in moderation is essential. 
• Avoid Smoking and Alcohol: These can increase your blood pressure and harm your overall health. 
• Manage Stress: Finding ways to relax and manage stress can help keep your blood pressure normal. 
• Take your medications as prescribed: If a healthcare provider prescribes medication for your blood pressure, you should take your medicine as prescribed, even if you feel fine and your blood pressure is controlled. If you experience side effects from your medication, let your provider or pharmacist know.
• Enter Your Home Blood Pressures in MyChart: This is a good way to share your home blood pressure readings with your provider and care team. Please call the clinic at 608-257-9700 if you have more than one home blood pressure over 180/110. Please send a MyChart to your provider if you have more than one home blood pressure over 160/100. 

How to enter your blood pressure in MyChart: 

1. Log into GHC MyChart. 
2. Click on the “Menu” button in the upper left corner. 
3. Select “Track My Health” found under “My Record” 
4. Under active flowsheets, click “MyChart Fitness Tracking” or “Patient-Entered Blood Pressure.” 
5. Click “Add New Data.” 
6. Fill out the date, time, systolic and diastolic blood pressure readings, pulse, and save.

 

Resources 

• GHC-SCW has Clinical Pharmacists who can help you with blood pressure management.  
• Home blood pressure monitors are available for purchase at GHC-SCW pharmacies for $49.99. 
• Additional information about blood pressure resources at GHC can be found here.
• High Blood Pressure Basics and Treating High Blood Pressure are both brief informative videos about high blood pressure from the Center for Disease Control (CDC) 
• Let’s Talk about Blood Pressure is a free online course about high blood pressure from the American Heart Association (AHA). 
• How To Monitor Your Blood Pressure at Home is a video by the AHA that explains how to check your blood pressure at home. 

Breast cancer remains one of the most pressing health challenges for women worldwide, but awareness is a powerful tool in the fight against it. Each year, October brings a surge of pink ribbons and educational campaigns, reminding us of the importance of early detection, ongoing research and compassionate support for those affected.

Detecting Breast Cancer Early

Early detection saves lives, and it begins with regular screenings! The National Breast Cancer Foundation has determined that when breast cancer is found in its earliest, localized stages, the five-year relative survival rate is 99%. There are over 3.8 million breast cancer survivors in the United States who have gotten tested, diagnosed and have fought the intense battle against cancer. The U.S. Preventative Services Task Force now recommends all women get screened for breast cancer every other year starting at the age of 40 instead of the previously recommended age of 50. This change aims to detect breast cancer earlier, saving more lives and improving outcomes. The American College of Radiology (ACR) recommends that high-risk women, including Black and Ashkenazi Jewish women, undergo a risk assessment by age 25 to determine if earlier screening is needed. High-risk women may need more intensive screening, including MRI surveillance, mammograms or breast ultrasounds, starting at ages 25 to 30.

 

New Screening Recommendations

If you fit into the new recommended age of 40 and haven’t already, schedule your breast cancer screening today by logging into your GHCMyChart account. All mammograms take place at our Hatchery Hill Clinic in Fitchburg, Wisconsin. If you receive your care at a clinic outside of GHC-SCW, your GHCMyChart account will prompt you to call to schedule your appointment.

Along with getting tested by a professional, the National Breast Cancer Foundation encourages women of all ages to do monthly breast self-exams and to be aware of their bodies to detect any abnormalities. In these self-exams, look for bumps, abnormal skin color and texture and note any sore spots.

 

Breast Cancer in Men

Breast cancer begins as a growth of either malignant or cancerous cells in breast tissue. This tissue is found in everyone, male and female. While it is most common for women, men can also be diagnosed with breast cancer, with 1 in every 100 breast cancers diagnosed in the U.S. being found in a man. Men can get tested if they feel a lump or see changes to the color or thickness of skin on their chest.

Male Breast Cancer Awareness Week is marked every October 17-23. For more information about male breast cancer, including statistics, symptoms and stories from men who have survived breast cancer, please visit this page on the Center for Disease Control (CDC) website.

 

Cancer Screenings

The recent guidelines and recommendations for breast cancer screenings have been updated, and we’ve made it easy to make an appointment to receive this potentially life-changing checkup. If you are eligible for a screening and receive care at a GHC-SCW primary care clinic, follow the simple steps below:

Step 1: Log into your GHCMyChart account

Step 2: Select “Schedule an Appointment”

Step 3: Select “Mammogram Screening”

Step 4: Answer a few questions and select the time that works best for you

 

For More Information and Resources:

• Breast Cancer | Breast Cancer Information & Overview | American Cancer Society
• Breast Cancer Information, Support & Donations – National Breast Cancer Foundation
• Male Breast Cancer: What Men Need to Know eBook – National Breast Cancer Foundation

Urinary incontinence refers to the leakage of urine. This condition affects millions of people. Although urine leakage affects both men and women, women are two times more likely to have this problem.  Though this is common, it is not normal. People are encouraged to seek help from health care professionals.

Types of Urinary Incontinence

There are 5 types of urinary incontinence

• Stress incontinence is when you leak urine when performing a task. This includes coughing, laughing, sneezing, or lifting heavy objects.
• Urge incontinence is when you have the sudden urge to urinate but can’t hold it in long enough to make it to the bathroom.
• Mixed incontinence is a combination of stress and urge incontinence.
• Overflow incontinence is the involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and/or bladder outlet obstruction. As a result, small and frequent amounts of urine leak out later. This happens because the bladder gets too full.
• Functional incontinence is when your bladder and muscles work properly but you have other challenges. For example, you cannot access a bathroom, do not realize you have to use the bathroom, or have trouble removing your clothes.

 

Treatment Options

A visit with your health care provider can help you figure out what’s causing urinary incontinence. A combination of treatments may work best. The proper course of treatment depends on a few different factors. Some options include:

• Pelvic floor therapy
• Bladder retraining
• Behavioral and lifestyle changes
• Medical treatments

 

If you have questions about urinary incontinence, speak with your health care provider.

Physical Therapy can address pelvic and abdominal muscle coordination, strength and endurance through a therapy program that teaches you bladder control and home exercises. You will need a referral from your primary care provider to be seen by one of our pelvic floor providers.