Spotlight Series

Guest Name: Dr. William Warner

Credentials:  MD, OB/GYN

All right, welcome Dr. Warner. Thank you so much for being on our spotlight series here for the Best in Utah Pelvic Health, and I’m going to read your bio here for our audience to learn all about who you are and what you do, and then we’ll jump into all the questions we have. Great, awesome.

Dr. Warner is a board-certified physician in obstetrics and gynecology and female pelvic medicine and reconstructive surgery with urogynecology. He earned his undergrad degree from the United States Naval Academy in 1996 and then attended medical school at the University of Utah, graduated in 2000. During his 21-year career as a Navy physician, he enjoyed tours as a Marine infantry medical officer, director of a surgical team supporting an amphibious assault squadron, and led the OBGYN department at the Marine Corp space in California.

He spent the last nine years stationed in San Diego practicing urogynecology. A urogynecologist is a surgeon who specializes in the care for women with pelvic floor disorders. Common problems arising from pelvic floor dysfunction include uterine and vaginal prolapse, urinary and bowel incontinence, overactive bladder, difficulty urinating or moving bowels, and pelvic or bladder pain.

Although your primary care provider, gynecologist, or urologist may have knowledge about these disorders, a urogynecologist can offer additional expertise and experience. The conditions that Dr. Warner treats are often hidden but deeply impacted in a woman’s life. He listens carefully to his patients, thoroughly explains their options, and helps them decide which treatment course is best for them.

He finds great satisfaction in helping his patients improve their quality of life by regaining function and confidence. Thank you so much, Dr. Warner, for being on our Spotlight series. I know that we personally at Reborn love working with you and your patients, and it’s a breath of fresh air to have such an amazing physician to collaborate with.

Tell us how you got into this field and how that all came to be. Sure. Most urogynecologists start as OBGYNs.

From the beginning of medical training, I was interested in women’s health. At one time, I enjoyed staying up all night and delivering babies. I initially became an OBGYN, and I did that for about three years.

I always really gravitated toward procedures and surgery. I wanted to expand my skills and be able to fix pelvic problems, so I decided to go back for a fellowship, which I did a few years later and got the advanced training that helps me do this today. Amazing.

Okay. Tell us about your practice and what makes it different compared to other practices that are out there. Yeah.

I think the biggest difference for me in the area of women’s health is just having more advanced training for problems of uterovaginal prolapse, urinary incontinence, and things like that, so more tools in the toolbox and things that I’m trained to do. I think the other thing is you’re just good at what you do a lot of, and treating those types of problems is all I do, so when you see the same things over and over and over, I think you hone your skills. You develop the ability to see things and have a better understanding than someone who does it less frequently.

Absolutely. We couldn’t agree more. Okay.

Tell us a little bit about who’s an ideal fit for you as a patient. What does that look like? Who are the types of women that are coming to see you, the conditions that you’re seeing, that on repeat of all those specialties that you do? Sure. The things that we’re primarily doing surgery for would be prolapse, which is descent of the pelvic organs, the uterus and vagina.

There’s an array of surgical procedures I can offer that can restore the normal anatomy and relieve symptoms that come from prolapse. Some of our patients aren’t good candidates for surgery or don’t desire to have a surgical procedure if they can avoid it. We can use a device called a pessary, which is placed in the vagina and can keep things in place.

Some types of urinary incontinence can be improved with surgical procedures, so I perform a lot of urethral or bladder slings, which can be very effectively if done properly. There has been a lot of talk about complications with slings and so forth. Some of them are founded, some of them aren’t.

I think many of the complications and problems can be avoided with proper technique and understanding of what you’re doing. Some of these procedures on the surface can appear fairly straightforward, and a lower volume physician may have good results most of the time, but there are some pitfalls that you can unknowingly fall into if you don’t have a proper breadth of experience. The other thing with prolapse and incontinence surgeries is knowing how to manage complications or problems.

Usually, if patients come back after surgery and say, I’m noticing X, Y, or Z, the vast majority of the time, I could hone in pretty quickly, oh, that’s probably this, that’s probably that, helping them know what things are going to get better, what things might benefit from some physical therapy, for example, or what things might need another intervention to help take care of, so being able to keep all that in-house. Yeah, love that. Hey, what does the process look like to work with you or to get surgery with you, and how does a patient get to you for the right care at the right time? So I would say most of our patients are referred through either their primary care provider or another OBGYN.

Sometimes they have an established relationship with a gynecologist, so that’s who they initially go to, and if what they need is outside of their skill set, they may refer them on to us. Many come from their primary care doctors. Some women self-refer, which I think is okay.

Sometimes it can be helpful to see another women’s health provider first who might be able to offer them some more basic treatments or screen things, but sometimes that also just extends the time that it takes to get here to where they can get the final treatment they need, so we’re open to direct referrals or coming through another provider. Awesome, awesome. Okay, what’s something that most people, or actually I skipped this question here, what does recovery look like surgically for you, whether it’s prolapse, incontinence surgeries, those types of things that you’re doing, what does that timeline look like, what does recovery look like for the patient? Kind of walk us through that.

So certainly it depends on the procedure that’s done. Some procedures we do have a very quick recovery. You can be back to normal activity within a few days or a week or two.

The larger reconstructive surgeries we do, the timeline’s a little bit longer. For those, I find most patients are back to their basic day-to-day activities within about two weeks, so kind of a non-strenuous, you know, get out of the house, run basic errands, but still with taking it easy and resting a lot. Usually by six weeks you’re back pretty close to normal and healed to the point where we don’t have to have restrictions on your activity, and then a lot of our patients have what I call more functional issues, meaning surgery restores normal structure and anatomy, but a lot of the symptoms are more functional in nature, so things that are related to pain, urgency and overactivity in the bladder, irritable bowel function.

For many patients it can take six to twelve weeks for some of that to normalize. Wide variety there for sure, depending on what’s going on. So I kind of jokingly tell most patients anytime I make an incision it’s going to take six weeks for that to heal, so regardless of the surgery your incision’s going to take six weeks to heal.

What’s very hard to predict is how people’s bodies functionally respond to surgery. Some people bounce back and are normal very quickly, and some people it’s a much more protracted process, and usually I can give my patients a guess. You’re probably more likely to be on this side of the spectrum versus that, but you know sometimes I’m surprised, and people that I thought were just fine, you know, a lot of dysfunction gets unearthed when you do surgery, and then some people unfortunately do better than you expect.

Right, right. True clinical rationale, it depends, right? Okay, tell us a little nugget here of something that most people don’t know that you think that they should know about your services, about what you do, things like that. What’s a little nugget that you can share with us? Okay, my first one was kind of a joke, but it’s that I’m here.

Yeah, right. Well, I think bounce around among different providers who can help them to some degree, but don’t really feel like they get the ultimate answer or the ultimate treatment they need until they get to a urogynecologist, so I think that’s the first is just letting people know we exist. The other thing I spend the most time helping patients understand is the difference between, and I mentioned this before, what I call anatomic or structural problems, so those are things that I can fix with surgery often, and what I call functional problems, so if you have prolapse, meaning the uterus or the vagina is descending out and you’re seeing it, feeling it, that’s a structural anatomic problem I can fix with prolapse.

It often contributes to functional problems, meaning women with advanced prolapse will often have overactive bladder, issues with bowel function, and restoring normal structure or anatomy can lead to functional improvements, but a lot of functional problems are not related to abnormal anatomy, so pelvic floor dysfunction, which I find primarily stems from tension or tightness that we all tend to hold in our muscles to some degree, and then dysfunction, which is just a broad way of saying you’re not loading and using your muscles appropriately, so we all have pelvic floor muscles. Most of us don’t even know that we have them, let alone that we’re using them improperly. That can lead to a whole host of functional problems, anything from pelvic pain, bladder, vaginal pain, bladder dysfunction in the form of overactivity or difficulty emptying your bladder, bowel dysfunction, constipation, and these all occur in the absence of structural or anatomic abnormalities, so a large number of my patients have clear anatomic issues that would benefit from surgery.

A number of my patients have both, but quite a few, I saw four patients this morning, and none of them had issues that really needed surgery. They all had functional problems coming from pelvic floor dysfunction, whether it was pain, constipation, overactive bladder, and so there are some medications and sometimes procedural type things we do, but physical therapy was at the top of the list I wrote out for every patient I saw this morning, so four patients in a morning in a surgeon’s office, and all four of them, the number one thing I recommended was pelvic floor physical therapy. Yeah, and that’s one of the things we love about you is you’re an advocate for us and for getting the patients where they need to go to help with what they have going on, and vice versa.

We know that we can rely on you for that good surgical outcome, and we can refer patients back to you just the like, so thank you so much for that. Did you have more that you wanted to say on those? Did you have a whole list of things? I think that was it for that one. For that one, okay, and then is there anything special that you want to promote to the audience about either your services or things that around health and wellness and medicine that you think would be really important for our listeners to know? I think I said most of what I wanted to say on that.

I think just knowing that I’m here and that you’re there. Yeah, absolutely. I live in an area where there’s an abundance of physical therapists trained in pelvic floor.

That’s not everywhere, but the trick isn’t so much finding a pelvic physical therapist. It’s finding the good ones, which we certainly have with you and your practice there, but just knowing that you’re out there. Yeah, absolutely.

I couldn’t agree more. I think everyone’s number one problem is people just don’t know that they exist even to begin with. Awesome.

Is there anything specifically that you as a physician want to be known for in the community? Yeah, I think the number one thing is I just strive for good quality and efficiency in our practice, really drilling down to what the problems are, giving patients good advice, and taking the time to educate them what their problems are, what they need. Then if they need surgery, just doing it right the first time. I see quite a few patients who have had surgeries and procedures done in the past, and there’s a natural failure rate with most surgeries.

I’m not saying any time a surgery fails or doesn’t last for a long period of time that it was done improperly, but I see many things that were done that could have been done better or could have been done more durably or could have more fully addressed the patient’s problem. I think just making sure that we provide the best care that will fix things as much as we can. Then also, I’m fairly honest with my patients.

When they don’t have surgical problems, I tell them, this is not a surgical problem. A lot of people don’t like to hear that because it’s a lot easier if I can just fix their problem. Trust me, it would have been easier if the four patients I saw this morning just needed a surgery.

I would have just scheduled them for surgery and fixed it. It takes more time to help people understand when their problems are more functional in nature. It’s about rehabilitation and long-term management.

If you walk out of my office being told you don’t need surgery, I like to think that you’ve gotten a pretty solid answer. Then we have a great team of staff in our office. They’ve been amazing.

When I walked into your office, I was like, wow, these people are great. Just right from the front door to my handmaid and my nurse, you’re going to get good care. Your phone calls will be returned.

You’re going to get answers. I can’t promise I’m always on time. If I’m behind, just know that the time I’m spending with somebody else, you’re going to get your turn.

We have a great staff here. Very kind humans that are doing good work and doing the right kind of work and high-quality care throughout all of it. My last question for you then is, where can we find you? Where are your clinics at? Where do you do surgery at? Website, contact information, all things like that.

Our website would be graingermedical.com. You can search under urogynecology or my name, William Warner. Our office number is 801-302-1780. We are primarily just in Riverton.

It’s right around the intersection of Bangor and 126 South. Then I do surgeries at Riverton Hospital, which is right across the highway here, and also at Lone Peak Hospital, which is in Draper, just off of I-15, next to Shields. Awesome.

Awesome. Thank you so much, Dr. Warner, for being on our spotlight. Thank you for all that you do in our community and continue to keep fighting the good fight for all of us here.

Okay. Thank you. Enjoyed the discussion.