Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person, because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Hello, and thank you for listening to Meet the Doctor. I'm Eva Sheie, and my guest today is Dr. Leslie Bender-Ralph, and she is a board certified obstetrician and gynecologist in Tarpon Springs, Florida, which is Tampa. Do I have it right?

Dr. Bender-Ralph (00:45):
Yeah, I'm in Tampa.

Eva Sheie (00:45):
Yeah, Tampa. But you're closer to the water than you're not like downtown Tampa, right?

Dr. Bender-Ralph (00:51):
I'm really close to the airport. Yeah. Yeah.

Eva Sheie (00:55):
Does that come in handy?

Dr. Bender-Ralph (00:57):
I wish it did. I wish I was able to fly out more often, but unfortunately I'm not. But yeah.

Eva Sheie (01:03):
No, it just sits there telling you you can't leave.

Dr. Bender-Ralph (01:05):
Exactly. And I just look from a distance.

Eva Sheie (01:10):
So you're just at the beginning of having your own practice. So kind of tell us a little bit about what your days look like right now and your nights sometimes.

Dr. Bender-Ralph (01:19):
Usually my day starts at 9:00 AM except for those days, and you kind of gave a little bit of hint about that. I'm still doing obstetrics at night, so when I have a night call, I'll usually come into the office probably a little bit later around noontime and see patients until 5:00 PM. But yeah, that's pretty much my day, how it goes.

Eva Sheie (01:43):
And so your patients are probably all women, is that accurate?

Dr. Bender-Ralph (01:47):
Well, for the most part, yes. But since I started doing hormone pellets, I've taken on some men, the partners of some of my female patients.

Eva Sheie (01:58):
Interesting.

Dr. Bender-Ralph (01:59):
Yeah. Who would've thunk it, right?

Eva Sheie (02:01):
How does that happen? The women are so happy that they drag their husbands in, or do they not have to be dragged?

Dr. Bender-Ralph (02:07):
Oh my goodness, Eva, you're so smart. You just said it, literally. My women patients, they are so excited and happy that they're pretty much back to themselves again and how they remember things and now the partner has to catch up. And so that's pretty much what brings the male in, their spouse.

Eva Sheie (02:27):
Do you think that we forget how we used to feel, or is it sort of just back there? I don't know that I remember feeling great. I'm just trying to call this up.

Dr. Bender-Ralph (02:39):
Yeah, it's like you don't realize what you have until you no longer have it, and then you realize what's missing. And that's what I see. Patients come in and they'll say, I'm just so tired. I just feel exhausted. Or I'm at work and all of a sudden I forget what I'm going to say. I have this brain fog and it's so aggravating. What's going on with me. And all of these little things will add up. Whether it's a connection with my partner, it's different now. I no longer have the desire or something's changed. And when you put all those symptoms together, they're like, it has to be something wrong. I just don't know what, and then they'll go and do their due diligence and say, wait, maybe it's a hormonal imbalance. And most of them are correct for the most part. I mean, you really can see it at all ages.

Eva Sheie (03:35):
How do they bring it up with you?

Dr. Bender-Ralph (03:37):
Well, the most common reason they come in or complaint would be the intimacy between them and their partner. My husband says he's ready to go, he's ready to connect, and I'm just kind of exhausted and tired and lack that desire, and I want to have that desire and I want to have the energy. I want to be back the way I was before, but I'm noticing that I am slowly kind of changing.

Eva Sheie (04:10):
How long have you been in your own office by yourself now?

Dr. Bender-Ralph (04:14):
Oh, since May. So this is all,

Eva Sheie (04:17):
Oh, not that long.

Dr. Bender-Ralph (04:17):
Yeah, yeah. Since May. I've beforre been hospital employed where I was in practice, but this'll be the first time with private practice, ground up startup practice of my own.

Eva Sheie (04:30):
So what pushed you over the cliff?

Dr. Bender-Ralph (04:34):
I think I got to the point of where I just wanted to have my own autonomy, make my own hours of course, and just really treat patients in a setting where I didn't feel rushed. We would see a concierge type setting where I could spend my time with patients. My schedule wasn't over flooded with patients to where I felt like they were being rushed and they felt like they were being rushed and dissatisfied. This allows me to have time with them, to speak with them, to listen so they can be heard, their concerns. And it's a world of difference. I mean, they leave feeling like, okay, this is how it should be. I'm heard someone actually cares to stop to listen, and I don't feel like I'm on the clock, like I'm being rushed. So I think it's the way medicine should be.

Eva Sheie (05:27):
In your old world, how long was a typical appointment, and then how long is it now in your own world?

Dr. Bender-Ralph (05:33):
So before, I remember the time, Eva, when I would have 35 to 40 patients on my schedule.

Eva Sheie (05:38):
In one day?

Dr. Bender-Ralph (05:39):
In one day. Now half of those would be OB patients, which usually tend to be quicker visits, with the GYN patients taken a little bit longer. But just the way our medical system is made up, I mean, there's such demand and you want to help everyone, but then when you try to help everyone, you realize the time that you have to spend to actually help them keeps decreasing because you want to get them in, you want to see them, and you don't want them to have long waits until they get an appointment. But here now, I feel like I'm able to see a patient, one patient 30 minutes to an hour, and yes, and it feels good to me. I don't feel rushed. It feels great to the patient. We talk about their concerns, we discuss their family. I feel like I really get to know them and they get to know me.

Eva Sheie (06:34):
Do they start looking at their watch? Don't you have to be somewhere, Dr. Bender?

Dr. Bender-Ralph (06:38):
No, they don't.

Eva Sheie (06:39):
What are you doing here? This is not.

Dr. Bender-Ralph (06:42):
They don't. They feel so relaxed, and I feel like they think it could go on even longer. It's just amazing what you can hear from patients and their experiences with previous offices and how now they just kind of feel like they have that time.

Eva Sheie (06:58):
Did you ever do, or do you still do high risk pregnancy?

Dr. Bender-Ralph (07:03):
Yeah, when I do my labor shifts, they're all high risk. So pretty much everything that gets funneled through the Tampa Bay area comes to our hospital in Tampa. So it gets extremely, extremely high risk. Yes.

Eva Sheie (07:17):
I was really old when I had mine, so I know what that channel looks like. There's only one, and you're all there together. Oh, hey, old lady, how are you doing? Yeah, I always thought that was so funny. I'd look around, does she look older than me?

Dr. Bender-Ralph (07:34):
Oh, no. Well, the age when women are having children now, it is getting up there more and more now. I'm noticing 44 year olds, 45 year olds, and we always said advanced maternal age started at 35, but there's even been discussions of pushing it even a little bit further back because more

Eva Sheie (07:53):
45 is the new 35.

Dr. Bender-Ralph (07:55):
Yeah, it's getting more common now, for sure.

Eva Sheie (07:57):
Yeah. Yep. I did my second one at 44 and everything was fine.

Dr. Bender-Ralph (08:05):
Well, thank God.

Eva Sheie (08:06):
Yeah, yeah. Praise the Lord. How did you end up in women's health in the first place?

Dr. Bender-Ralph (08:14):
I felt comfortable. When I rotated through the other specialties and other fields of medicine, once I landed on OB, it just made sense to me. Being able to empower women and help bring life into the world, it's just a feeling like none other just feels really good.

Eva Sheie (08:39):
Do you think you'll keep delivering babies indefinitely? Is there a world where you're like, I don't want to do that anymore, or just during the day?

Dr. Bender-Ralph (08:49):
Right. I dunno. My mom, she's so funny. She asked me the same question when I kind of ventured off to really focus on gynecology and cosmetics. And she goes, I hope you're going to still bring babies into the world, right? Because that's what you trained for, right? And I told her, I said, I think so. But Eva, I'm out of my reproductive years and now I feel like I'm kind of following my patients now to the next stage of life, whether it's hormones and trying to get into anti-aging and age reversal techniques, procedures. So I feel like I'm just kind of growing along with my patients.

Eva Sheie (09:30):
Makes sense.

Dr. Bender-Ralph (09:31):
Yeah. This is the next stage.

Eva Sheie (09:34):
We all, I think, want to benefit from your experience. I say this as a person who always chooses old doctors because they know

Dr. Bender-Ralph (09:42):
They've been around.

Eva Sheie (09:44):
They know stuff.

Dr. Bender-Ralph (09:46):
Right, right. No, that's true.

Eva Sheie (09:50):
So in the future, I mean there's a ton of advancements happening both in hormones and in weight loss. How are you thinking about that and what does that look like for your patients?

Dr. Bender-Ralph (10:05):
I think that weight loss is such a big factor when it comes to, especially with hormonal imbalances, that's also a coming complaint. Women will come in and state, not only am I feeling the anxiety or fatigue or lack a focus, I also feel I just can't lose weight. And I feel like it's really a blessing that the GLP-1's have became so popular. I mean, every medication has risk, and you have to really weigh the benefits versus the risk and how take into account the patient's medical history and whether or not they're a good candidate. But it is really made weight loss achievable for a lot of patients. And we're taught now to really see obesity and as more of a condition versus the individual just doesn't have the willpower to stop our control with they eat. And when we see it more as a disease or a disorder like we see hypertension, then we tend to be more aggressive with the treatment. Because we know it can lead to cardiovascular disease and other issues down the road for the patient.

Eva Sheie (11:28):
Why is it so hard to lose weight at that sort of middle age? What is going on in the body that makes it so difficult?

Dr. Bender-Ralph (11:36):
It's estrogen. It's estrogen is supposed to be our fat burner, and we see that start to decline. I mean, it doesn't happen abruptly because the ovaries are still able to produce, but at the same, there's a slow decline. And we see that because that's such a common symptom for perimenopausal women or women who have hormonal imbalances. It's very common. I can just think of our polycystic ovarian syndrome patients who have those hormonal imbalances and obesity usually accompanies it. And so hormones play a big part of this.

Eva Sheie (12:19):
I assume when you see somebody for the first time, the very first thing you do is labs, right?

Dr. Bender-Ralph (12:25):
So Right, exactly. You want to have a baseline for sure. When you're dealing with weight loss and even hormones, you want to see where their baseline is. And when it comes to, of course, the GLP's, I'm looking at the liver, the pancreas, all of those labs just to get a baseline of where they are and to see if they are a candidate. And on the hormone replacement side of it, I'm getting labs to see where their testosterone, where's their estradiol, what is their sex hormone binding level? Where is their, just so many different things we look for to determine is this patient deficient of one of those or do they have an imbalance?

Eva Sheie (13:06):
So how often do you have your patients doing both hormone replacement and a GLP-1? Is that pretty common now?

Dr. Bender-Ralph (13:13):
It is. It really is. But I'll usually let a patient try their hormone replacement therapy first. Sometimes they feel like, and they couldn't be right some of the time, that if they replace their hormones and they get them optimized, then they will have the energy to go to the gym. They will have the energy to do those things that can help facilitate in their weight loss. And sometimes they'll get their hormones optimized and they'll have the energy and they'll say, I'm going to the gym, but nothing's happening. And that's really when your GLPs kind of kick in and can help facilitate and help them reach their goals.

Eva Sheie (13:51):
So how often do they come back and check in with you? Are they there every month, every three months? What does that look like?

Dr. Bender-Ralph (13:57):
So after the hormones when they come in, I'll usually have them come back after two weeks to just review the labs and go over their options. And then after that, just depending on which route of hormones they would like to proceed with, whether it's the pellets, the injections, the pills, the creams. Usually they come back in a month and then we see what needs to be tweaked. But they're always welcome to come back prior to that time if they're having any issues or feel like, I just can't wait till a month. This is just not it. This is not working until we get it right.

Eva Sheie (14:32):
Is there a favorite that you have in there? Is the pellet better than the injection, or does it just depend on the person?

Dr. Bender-Ralph (14:39):
It depends on the person, but I have to say my favorite is pellets.

Eva Sheie (14:44):
Pellets.

Dr. Bender-Ralph (14:44):
Yeah. I would have to say my favorite is a pellets just because it's so convenient, and I think patients like that too. And with the pellets tends to mimic their hormones and the way their body would actually produce 'em. So it's just a better route.

Eva Sheie (15:02):
Now, can men handle the pellets as well as women or women tougher in this scenario here?

Dr. Bender-Ralph (15:08):
I think you know the answer.

Eva Sheie (15:09):
You know I do, that's why I'm asking. So about 10 years ago, we used to hang out with it, we had a strong friend group, and one of the guys in this group showed up at trivia and he was like, I had a procedure today. And I was like, okay, whatever, dude. And half an hour later, he brought it up again, he was like, I'm in a little bit of pain. I said, what did you do? And he said, I had a testosterone pellet placed. Are you serious? Right. You're giving me this much drama over a pellet?

Dr. Bender-Ralph (15:44):
Right. Yeah. It's like a major surgery.

Eva Sheie (15:47):
For a man.

Dr. Bender-Ralph (15:53):
It's funny. But yeah, women tend to be able to handle pretty much anything I feel like. Like a walk in the park.

Eva Sheie (16:00):
Yes, we can. And you see it every day.

Dr. Bender-Ralph (16:03):
Right?

Eva Sheie (16:04):
Yeah. Sometimes you look back on the stuff you handled and wonder, how did you do that?

Dr. Bender-Ralph (16:09):
Yeah. Yeah, for sure.

Eva Sheie (16:11):
That's one of the great things about getting older, I think is looking backward on the things you did.

Dr. Bender-Ralph (16:18):
Yeah, just reflecting.

Eva Sheie (16:21):
You're going to look back on starting your own practice and you're not going to remember how hard it was someday.

Dr. Bender-Ralph (16:28):
I hope not, cuz now it's so much work, but I enjoy it. I enjoy coming to work every day and I enjoy seeing my patients, and that in itself is rewarding.

Eva Sheie (16:42):
How are patients finding you?

Dr. Bender-Ralph (16:45):
So I have marketing, a marketing team that's really great. I have ads, Google, Facebook, Instagram. I think the biggest is word of mouth. That's been really great. See someone, a patient, they're satisfied and they want to go tell their friends. So that one really is straight to my heart, goes straight to my heart.

Eva Sheie (17:07):
That is the best way.

Dr. Bender-Ralph (17:08):
Yeah.

Eva Sheie (17:10):
Okay. So give us an overview of all the services that you have on the aesthetic side.

Dr. Bender-Ralph (17:17):
On the aesthetic side, I offer liposuction. Body Tite, which is one of the devices by InMode really does well in conjunction with the liposuction for skin tightening. I also do PDO threads or thread lifts. I do Botox, PRP, microneedling.

Eva Sheie (17:43):
Is there anything where you're combining your gynecological background with aesthetics? Do you do feminine rejuvenation down there?

Dr. Bender-Ralph (17:51):
Yes. That is in the making. Yes, with vaginal rejuvenation. I also do labiaplasty. I think that's only natural. Instead, I've repaired so many different after deliveries where there's the vagina, the labia just comes as, the next natural thing I should be doing is labiaplasty.

Eva Sheie (18:12):
Okay. So still delivering babies, helping women with hormones, weight loss, some aesthetics, probably growing on the aesthetic side as you get going. Who's on your team? Who might we meet when we come to see you before we get in the room with you?

Dr. Bender-Ralph (18:31):
So I have an excellent surgical tech that I have borrowed from a hospital who is excellent. And she comes and gives me a helping hand when needed. And so far just her and I.

Eva Sheie (18:49):
That's good. You have to have the right people too. You can't just put anybody in there, when you're trying to take good care of people, that's just as important.

Dr. Bender-Ralph (18:59):
Oh, for sure. We've worked together for many years and she knows my flow. I know her flow, and so it just works.

Eva Sheie (19:09):
The best surgical techs are like third arms, third and fourth arms, aren't they?

Dr. Bender-Ralph (19:14):
Oh yeah. I mean, before I call it instrument, she already knows what I'm going to call. It's natural.

Eva Sheie (19:20):
Give us a little flavor of what you like to do outside of work now that you're not, well, maybe you're working more than you were before, I don't know.

Dr. Bender-Ralph (19:28):
Yeah, eventually, hopefully it'll be more time, more free time. But I enjoy my husband and my three kids. Laya, Liam and Jordan. They keep me pretty busy, but since school has started, I feel like I come from the office to straight home to doing homework, taking a shower, and going to sleep.

Eva Sheie (19:52):
Isn't it annoying that they all have to eat every single day? It's like so much work.

Dr. Bender-Ralph (19:56):
Oh, don't remind me of that, yeah.

Eva Sheie (19:58):
Like you just ate yesterday.

Dr. Bender-Ralph (20:00):
I'm like, how can we not have leftovers? I just don't get it. Do I have to cook every day?

Eva Sheie (20:08):
It is the one thing that everyone in the world has in common that no one has solved for, and you just can't eat out every day. I guess you can. I know one doctor who finally hired a chef.

Dr. Bender-Ralph (20:20):
Oh, nice. Fancy. Nice. No, for now, I just have Chick-fil-A and my kids do not get tired of it.

Eva Sheie (20:26):
What about Sunday?

Dr. Bender-Ralph (20:28):
Yeah. No, Sunday, Sunday is not so bad. So usually on Saturdays I'm able to prep something, usually season a baked chicken and get it ready so that way on Sunday after church, just come home, pop it in the oven, and have a nice meal. They'll last for Sunday and maybe Monday. But yeah, the rest of the week is just so hard.

Eva Sheie (20:43):
You still do Sunday dinner with the whole family and sit down?

Dr. Bender-Ralph (20:48):
Oh yeah. Yeah, for sure. We look forward to that.

Eva Sheie (20:49):
It's the best. We like to go for barbecue because we live in Austin and there's a lot of meat around.

Dr. Bender-Ralph (20:59):
Oh my goodness. And I'm sure since that's Texas, it's really legit barbecue.

Eva Sheie (21:03):
Most of the time. Yeah. Even the bad barbecue is pretty good.

Dr. Bender-Ralph (21:06):
It's still, bad barbecue is good garbecue to me.

Eva Sheie (21:12):
If someone is listening or watching today and they want to find out more about you, where should they go look for more information?

Dr. Bender-Ralph (21:20):
My website is www.gsatampa.com.

Eva Sheie (21:27):
I'll make sure we put it in the show notes.

Dr. Bender-Ralph (21:29):
Thank you.

Eva Sheie (21:30):
Thank you so much for telling your story to us today. I am so glad to meet you.

Dr. Bender-Ralph (21:35):
Oh, it's so nice meeting you too. Thank you for having me. I really appreciate it.

Eva Sheie (21:41):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links, including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at MeettheDoctorpodcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, theaxis.io.