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Speaker 1: Pushkin.
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Speaker 2: This show is not a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes. Please consult your healthcare professional with any medical questions. Also in this show, we use women as shorthand for people with XX chromosomes. We understand sex and gender are more complex and acknowledge the experiences we describe reach beyond that word.
00:00:54
Speaker 1: We've talked to a lot of specialists on this show, but the doctors that people see most often are actually their primary care physicians. These doctors play a crucial role in preventive care, screening their patients for underlying and sometimes hidden health conscers. That's why I am thrilled to welcome to the show my colleague, doctor Jennifer mcguggin's hill. She's an internal medicine physician who's been practicing for over twenty years, and as you'll hear, her compassion for her patients and for fixing our healthcare system is evident in all she does.
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Speaker 3: This is a vital.
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Speaker 1: Conversation for anyone at any age interested in protecting their health and getting ahead of serious illness down the road. We'll discuss what to ask your doctor to check at your annual exam and how to advocate for what you need will also cover wide levels that may seem fine are still not optimal and worth paying attention to. So let's get into it. Why does she become an internist as opposed to a surgeon or dermatologist or gilian oncologist.
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Speaker 4: Yes, so I've always wanted to actually be an You know how when you were a little kid, everyone's like, oh, what do you want to do when you grow up? I knew I wanted to help people. I think seeing so many people in need of help and not necessarily getting the proper care early on is what drove me to wanting to be a doctor. And then as you start to get into the weeds of what that requires and schooling, it was very early on, I would say late college, and then once I got into medical school that I found it to be a challenge just focusing on one area of the body, to the point where it became comical as I rotated through clinical programs in medical school. For example, if it was surgery and someone was having challenges with either anxiety or their gut, I would constantly divert and want to address that, and I got scolded for that, and this became a repetitive.
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Speaker 3: Type of behavior pattern.
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Speaker 4: So then I realized that I wanted to treat the whole person. I could not ignore a particular question or concern just because it will didn't fit into the particular specialty that I was assigned to at the time. And I definitely made the right decision.
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Speaker 1: Excellent. So you deal with a lot with the preventive care and prevention of disease and illness. Most of our listeners have probably had a preventive care checkup at some point. What kind of questions should preventive care primary care physicians being asking of women in their thirties, forties, and fifties, what should they focus on?
00:03:59
Speaker 4: So focusing on a lot of kind of lifestyle behaviors, focusing on cancer prevention, focusing on cardiovascular care, and brain health. So if you look in by age, right, so in your thirties, you know what tends to be the focus. Family planning, reproductive health, things of that nature. But that segment that late twenties thirties, that's such a wonderful age group to reinforce lifestyle choices and how it really does impact your heart health and brain health from the standpoint of nutrition, So really focusing on treating your body properly from a nutritional standpoint, you know, minimizing alcohol use, avoiding smoking and vaping and toxic habits. That's really crucial starting as early as you can, you know, with women, as we approach forties, you know, we're in this perimenopausal menopausal my favorite tech life. You are the expert there, yes, yes, so really beginning it's never too early to talk about hormone, you know. And I think and I'm so grateful that that narrative is really changing and becoming more accepting because then we'll be less in that catch up mode. But the focus during that time period one along with breast cancer screening is you know, hormonal health and optimization and the same you know as we approach in the fifties. Other cancer screening that we start to really focus on around forty five is like colon cancer screening, you know. And all of these things are contingent upon obviously family history, because that could dictate, you know, whether or not screaming is to be sooner than later.
00:05:54
Speaker 1: So let's get into some some details. People have standard yearly laboratory values that they order. What do you order? What are you looking at when you what what lab should a woman have checked every year, every six months, et cetera.
00:06:10
Speaker 4: Sure, so so the standard you know there's there, what standard is defined by is is definitely evolved for me, I know, over the past few or five years, and really kind of focusing on understanding where is someone from a hematologic perspective, their organs, how they're working, where they are from a cardiovascular perspective, an inflammatory metabolic perspective, So you know, checking what we call a CBC or hemogram to look at their blood cell counts, looking at a comprehensive panel, to ensure that their liver and kidney functions fine, their electrolytes are okay, checking you know, hemoglobin A one c and insulin level, you know, our metabolic markers and target ranges in traditional medicine, I think need to be reevaluated because oftentimes when you are at safe, for example, hemoglobin A one C of five point seven, your body's already working hard. So really it's should be we're seeing it like five point three, five point four. And oftentimes when your insulin level you know, is above ten, even though it won't get flagged unless it's above twenty it's showing your body is working harder. So a lot of these quote unquote normals that are established, they're not optimal. It's similar to when someone says, I don't want to be good, I want to be great, and so those tests I really like to use thyroid vitamin levels like B twelve, iron, vitamin D, you know precursors for vitamin B twelve like methyl malonic acid and homocysteine. You know, a lot of times we can get tricked when we're doing blood work because we're being quote unquote good, We're eating well leading up until the blood work, we're taking our supplements leading up to the blood work, so those values are going to be normal, but are they really normal? So that's where a lot of the precursor labs like methylmalonic acid will show like okay, but they're normal in this space time on a Friday, but you're depleted in your body. So those tend to be kind of our go tos. And a full lippid panel as well.
00:08:20
Speaker 1: So let's talk about lipid panels actually, so you know, kind of a standard lipid panel is good cholesterol, bad cholesterol, and some triglyceroids and total cholesterol, right, but we're looking beyond that now and we look at lipid panels. Can you can you unpack that a little bit for us and let us know kind of like what women should be looking for in their lipid panel beyond my good cholesterol and my total cholesterol and my bad cholesterol.
00:08:46
Speaker 4: Yes, so traditional medicine, as you mentioned, you know, we get that snapshot that total the HDL the LDL, and I would have to say, there are a lot of people you know, in the past that I've seen that in hindsight, I probably would treat had we done more of an expanded validated test. And so there are the good cholesterol. HDL has honestly gotten too much credit, am I avent? We need to talk about that because that way, yes, it's gotten too much credit to the point where you know, an average person if their LDL is say like one thirty and you know, but their HDL is you know, over forty, maybe like sixty to seventy, then we're happy. We feel like they're quote unquote protected. But that's in the absence of knowing their true risk, and risk is defined by a couple of a different lab test that I'll mention along with the benefit of having ct calcium score. So when we do a full laboratory analysis, we're finding that there are certain proteins like APO liper protein B and the LDL particle size. So it's important. Yeah, so let's talk about that. So that's like a lot of people talking about ApoB. Now, so what is ApoB sure, So it's like it's it's like a relative as sister almost to the back clester. So APO B is is a liper protein, a protein that basically travels with the LDL bad cholesterol. And the reason I love it is because it corresponds more to risk for heart disease. And so oftentimes, like for example, we utilize the Boston Heart Platform, which checks this full lipid profile which includes APO B and LDL particle size, and you may have stellar cholesterol quote unquote standard cholesterol. You know your LDL, Oh, we're happy, and maybe like at one hundred and you know your or one thirty total cholesterol right at two hundred and HDL is phenomenally good. But your APO B may be in the red. So that's telling me in this moment in time, your cholesterol numbers by standard values may be good, but you are predisposed and your body's working hard, and you still are at risk based on that APO B and potentially particle size. Those markers fortunately are modifiable by nutrition and putting the work in, so it helps us to say, Okay, this person is at risk. We may not necessarily treat their cholesterol to an LDL goal of under one hundred, but we're going to intervene and have nutritional recommendations to say, Okay, this is what you're eating. You just seem to be more sensitive to it. Let's pull back on that one caveat to that is an additional test called lipoprotein A. And again I'm not a cardiologist, but we work with some amazing cardiologists present, and I've worked with many in the past, so you know, fortunate enough to continue to get their advice. But that lipe of protein A is another very important test that I would want everyone to at least have on file because that is a protein that is more we feel genetically linked to cardiovascular disease and risk for plaque.
00:12:12
Speaker 1: And you need to only do that once, right because or do you need to do it at midlife?
00:12:17
Speaker 4: That's a great question. You know, it's not something necessarily that we check quote unquote annually, but there's focus more on how actionable we are to treat that with medication. So I think that the frequency at which that test is going to be checked it's evolving and changing and will be determined based on treatment measures that are being looked at to target that. But at least at baseline, it's helpful to know if it exists for you, because that really paints a different That puts a different framework on how we look at your cholesterol and your cholesterol goal.
00:13:02
Speaker 1: Puts a different one to yes, maybe a threshold.
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Speaker 4: You're going to be more strict with someone that has a lipe of protein A to where their target ld and this is excluded. This isn't without even knowing what their karates look like, what their ct Calthum score is. The discussion will be a bit more strict. It will be different with someone that has lipoprotein A maybe a borderline APO B than someone who's in the green across the board.
00:13:30
Speaker 1: So this this, oh, your HDL is good, so your LDL we're not gonna worry about it. So your HDL is good. That's a little bit of a fallacy now, right, especially for midlife women. I think right the HDL is not as protective adversely, and.
00:13:46
Speaker 4: That's it's great for you, That's that's I'm happy. Yeah, but it's not the end of the story. Can't can't stop there. Let's talk a little bit about insulin resistance and hemoglobina W and C and what is typically drawn. You know, you see, typical panels will include a HMIC, glemin a W and C. Does everybody need a fasting insulin and fasting glue coast once a year?
00:14:06
Speaker 3: Everyone? I would I'm going to say yes.
00:14:11
Speaker 1: I love that. I'm going I like that answer.
00:14:13
Speaker 3: I'm going to say yes.
00:14:15
Speaker 4: And you know, I say yes because with with our with where we are from the standpoint of kind of our population, that the the degree of obesity, our nutrition, I feel as if we are constantly in a phase of a.
00:14:40
Speaker 3: Pattern of ketchup.
00:14:42
Speaker 4: We're constantly chasing better health as opposed to being on the other end and really proactively promoting great health. And there are certain measures that enable us to really be on that side of the fence. And so if I see someone that comes in for a routine checkup, and you know, maybe they're talking about having challenges with weight loss or they just feel like one common thing that I'll hear of people are aulate is it's just so easy to gain weight, like I feel. And this happens one as us women get older, the level of insulin resistance and it translating into physically one saying, I am, it's so easy for me to gain it's hard for me to lose. I've checked my thyroid twenty times and twenty times a month.
00:15:32
Speaker 3: That's not it.
00:15:33
Speaker 4: But their insulin level maybe hovering, you know, in the twelves thirteen's, and their body is working harder to really get ahead, and so really looking at that in the setting of the fast and glucose the A one c and paying attention to the trend.
00:15:51
Speaker 1: Right, that's the trend and optimal values. Right, we can't just look at our lab report and say green or red. It needs to be where are we in the green? Yes? Yeah, because a hemoglobin A one c of five point six is like maybe green, but it's kind of should.
00:16:06
Speaker 4: Be right, especially when you lived at five point two for the last ten twelve years. Like that matters, you know, that really does matter, And I think that's that's probably one of the most important helpful tips that I've tried to adhere to in primary preventative care. It's really walking that journey with the person to see what changes are taking place and not just taking for granted that one snapshot in time that all is well. It's what listening to them, listening to what their concerns are, what they've noticed because they're with themselves twenty four to seven in the context of what I may be seeing from a trend perspective over the course of a year or two.
00:16:58
Speaker 3: That's very, very, very important.
00:17:01
Speaker 1: That goes through medicine. That thread is through medicine everything we do, because I think when people come to sometimes I always tell people this is a snapshot in time. The whole story is what's important. Yes, and we have to look at that longitudinal trajectory. Yes, tell me a little bit about inflammatory markers and like see, reactive protein should be measured every year.
00:17:22
Speaker 4: I do like to measure it every year. You know, it gets very tricky because the sensitivity and specificity can be quite variable, especially in the setting of if someone comes in and you know they were just coming off of a cold, they don't know they're about to get a cold. It can definitely be offset by that and the challenge becomes you're now chasing this marker and you end up having to call them back in and repeat testing. You know, I do feel like it's helpful at least annually to check and or if someone is having specific symptoms like joint pain or something that's recurring and we're not sure why it's it's quite helpful.
00:18:08
Speaker 3: If it is elevated, it.
00:18:09
Speaker 4: Can prompt you to go down a rabbit hole, so you have to be very mindful it's and have shared decision making when you are doing the test.
00:18:18
Speaker 1: And the implemmatory markets are also important for cardiovascular tests right and brain health right because those systemic inflammation is not good for your cornarias or vessels.
00:18:28
Speaker 4: When we're talking about kind of preventative cardiology assessing kind of high sensitivity CRP, and it's you know, the reality is no one is theoretically sick or have a cold twenty four to seven. So if you're seeing that as you're checking these levels, they're consistently elevated, you have to ask yourself why things underlyth yes, yes, yes, Let's talk about some cardiovascular screening. How often should women have their blood pressure checked? So blood pressure check, you know, obviously as it stands right now, what we're doing is annually in the traditional medicine sense. If we're finding that your blood pressure is borderline, then you know repeating it. And now when I say borderline, that's different than high. So you know every three to six months to follow a trend. If you're in that gray zone like one thirty over eighty, if you're one sixty, you know over ninety, you need to have it repeated within a month.
00:19:28
Speaker 1: What's a normal blood pressure?
00:19:29
Speaker 4: So less than one thirty over eighty, okay, but if you're like one twenty to one thirty, I'm raising a brow. I'm raising a brow and following that up for sure.
00:19:41
Speaker 1: Do you recommend home blood pressure monitoring for people?
00:19:44
Speaker 3: I do?
00:19:45
Speaker 4: I do, but they it will get you in trouble that I g I do, but you you have to be counseled, because counseled on how to actually take the blood pressure, you know, being mindful of your kind of physical and mental state when you're checking the blood pressure, in logging your blood pressure one moment in time, blood pressure when you're trying to get the house settled, or you know, you just got off of a really bad phone call is not going to help. But really tracking that blood pressure, I tend to like AMRON. I mean, I don't you know, there are several out there, but it's more of a sense to establish, okay, what clearly is your baseline by having multiple values and checking an average.
00:20:37
Speaker 1: And you can get the AMRAN monitors on just on amazons. Its super easy. Absolutely. What is the best time of the day to check yourloo pressure? Morning before coffee or when should chill might check your blood pressure.
00:20:47
Speaker 4: So it depends on if you're monitoring for a spike. So I you know, I would say once you're wind down in the evening, it's fine. I tend to check mine in the morning and evening just to kind of you know, yeah, to see where I am. And then also, really the most important thing here is if we are concerned about potential elevation in blood pressure, whether or not we are going to establish you as having hypertension, really doing an ambulatory monitor is going to help. And you can get that from your doctor or if you're seeing a cardiologist and basically you wear the monitor so in its cycles to.
00:21:27
Speaker 3: Check your blood pressure.
00:21:28
Speaker 4: That's really the best way when we're trying to establish a diagnosis.
00:21:36
Speaker 1: We have to take a quick break, but when we return, we'll get into more testing like how often you should be getting an EKG and why it's important to know your calcium score. Plus we'll delve into a much talked about topic statins. Stay right there, let's talk about EKGs. Should everybody have an EKG or nobody have an EKG only with symptoms or no.
00:22:09
Speaker 4: I support a standard because there's you know, it's not as if we're necessarily doing an EKG because we think you're having a heart attack per se. But it can give so much information as far as the electrical conductivity of the heart, if there's a suggestion that the heart muscle could be too thick, if there is an issue with you know, abnormalities. There's certain intervals on an EKG that could either be too long or too short, and that can imply that there's if you're on a particular medication that can impact the intervals. That's a red flag. So it can give you quite a bit of information.
00:22:49
Speaker 1: So yearly EKG then yes, okay, let's talk my favorite cornary artery calcium yea and clearly so who should have what women should have a cornary artery calcium score? How often should they do them? Should everybody have a clearly done also to look at soft plaq? Can you walk us through that a little bit.
00:23:13
Speaker 4: Yeah, so I'm I'm definitely a fan of the calcium score. It's been I honestly would say a game changer as far as in the primary care setting, as far as who we treat, who we escalate for cardiovascular screening. Our cardiologists, you know, use it all the time. Theoretically, you know, essentially over forty. And the reason for that is even though we are doing baselines based on risk factor in some people in their thirties. But the reason for that is the validity of the test for people under forty is not as clear. So basically over forty as a rule of thumb, but certain risk enhancers, right, because everything is contingent upon risk. So a family history of you know, heart disease. You know someone that may have had a heart attack or stroke in their fifties or sixties. You know, if that particular person has very elevation a cholesterol. You know, if there's a familial hyperlipidemia syndrome that the person has. You know, inflammatory and established inflammatory condition can be associated with cardiovascular disease like autoimmun Yes to those, yes, folks that you know may have like lupus or rheumatoid arthritis, things of that nature. You know, someone with a history of sleep apnea, as someone with lipoprotein A kidney disease.
00:24:45
Speaker 3: Definitely.
00:24:46
Speaker 4: Uh And for for women, you know, I do feel as if premature menopause not having the opportunity to have that estrogenic benefit women that may have had pregnancy related.
00:25:03
Speaker 1: Complications like hypertension.
00:25:06
Speaker 4: Yes, yes, yes, I definitely recommend that as well for them.
00:25:11
Speaker 3: Yeah.
00:25:12
Speaker 1: So, and I think it's really important also that we impart that women's pregnancy history really impacts their future. Medical history is kind of a stress test, right it is. It is, even for cardiovascular disease, but also for insulin resistance.
00:25:25
Speaker 4: Yes, absolutely, and that is why obtaining a very detailed personal history, family history, obstetric history, gynecologic history, it's it's crucial.
00:25:38
Speaker 1: Yeah. And even like pre term labor and things like this and infertility actually a higher risk of cardiac disease, which I didn't really realize until I got to Atria and with you guys and the doctor pit and get to learn from you.
00:25:51
Speaker 4: Yes, absolutely, it's it's very important, and I think it I feel as if there is a shift fortunately with understanding how important it is with regards to women's health in general. A lot of the screening tests and what we should do and when we should do it really is being acknowledged based on the changes that women go through hormonally.
00:26:20
Speaker 1: Yeah, that's really putting that on the landscape now, which is really great. I want to go back to cornary art calcium scores. I'm forty five years old. My lipids are pretty good, my CEC is normal. I get lipids done once a year. When do I repeat my cornary artery calcium score? Again?
00:26:38
Speaker 3: Great questions.
00:26:39
Speaker 4: So, and I've asked our car team this as well, because you have to you know, it's radiation, you know, so do no harm. So if you know if your lipids are pristine, the you know your low risk from a you know from what we know from a genetic perspective, and your calcium score is zero, it is not negative unless a zero right, So one seems like, oh, it's just a smidgeon, but it's it's significant. And so your calcium score is zero, and let's say we have the benefit of checking krotids which are clear. You know, I think at five years, seven years it's reasonable unless there's been a change in your lipet profile or some other medical condition.
00:27:27
Speaker 1: Let's talk about karated imaging. So should every woman have her kartids checked? And what are we looking for when we when we look at karates, Like, what are we actually looking at?
00:27:36
Speaker 3: Sure?
00:27:36
Speaker 4: So when we do karate dopplers, we're looking for plaque, but we're all soft or harder both, yes, soft flats, but we're also looking at thickening. So when we see the it's called IMT, so the intermedia that the inner lining. Not all karated Doppler scans will measure IMT. So if there is opportunity during an assessment and you know it's recommended that you do a KARATEID, you know, be your own advocate and ask, well, what are the measurements are we measuring in IMT as well?
00:28:12
Speaker 1: So it's a marker and helps you, helps guide you because a CA only looks at a hard plaqu right, So that doppler am I correct in thinking that that doppler also gives you insight into psyche.
00:28:23
Speaker 4: It gives you it gives you insight into whether or not. And that's what I love about the body so amazing, because if how our body handles plaque is we have this calcified en casement, right, and so it's protective. But if you see that in the ct calcium score is based on calcification. So if you see that, that that implies that, okay, you have the ability to create plaque. So then let's look a little deeper and there'll be some people where we feel stopping at that calcium score, stopping at that caroateid, stopping at that lipor profile really isn't enough. You know, they've got like first degree, second three relatives that have cardiovascular disease. They may have had one blip of chess years ago and we thought, you know, it was provoked by stress. The calcium score maybe one. That's somebody that let's get a better picture. Let's be absolutely sure that we do not have any unstable plaque in your coronaries. That's somebody I may do a CTA on or the cardiology.
00:29:30
Speaker 1: Will recommend a little yes, And the CTA is where we start to see the soft plot correct with us.
00:29:36
Speaker 3: Yes.
00:29:37
Speaker 4: And you know the whole point of it is to again goes back to if we're going to focus on preventative care. It's only preventative in my opinion, if it's proactive. And you know that that result, that result from the CT calcium score, that next step from the CT andrew that could be the determinant and that convincing factor for that person to agree to take, say a statin to treat it, you know, because it's hard for me to you know, convince someone who's all right LDL maybe like one twenty or one hundred and it stopped there, but they're CC lit up like a Christmas tree. They've got plaque on their CTA. They're going to they're going to agree to treat.
00:30:30
Speaker 1: Let's talk a little bit about statins and women and midlife women, right because you know, you hear a lot about well, statins are not as well proven to decrease mortality as they are and men. But I believe my interpretation is is the power the studies have been underpowered yet, yes, and so can you speak to that just a little bit. I mean, statins are protective for a while satins are protective. Statins are protective. You know, there's even in a research to show, you know, potential plaque stabilization and regression. There's anti inflammatory benefit. The benefit of treating your risk far outweighs.
00:31:06
Speaker 3: The risk of the medicine.
00:31:07
Speaker 1: And you can always follow your insulin resistance. Right. So let's talk a little bit about perimenopause and what that does for our risk, cardiac risk, metabolic risk, and midlife and bone health. Also, as women transition through midlife, blood pressure I believe tends to go up, certainly, lipids change, cardiac risk changes, metabolic risk changes. Can you impact that a little bit for us about how you approach a midlife woman?
00:31:35
Speaker 3: Sure?
00:31:36
Speaker 4: Sure, So when I have my midlife ladies, A huge part of that relationship and that assessment truly comes from what they're telling me, what their symptoms are, what they've been experiencing, you know, whether it's brain fog, you know, or weight changes, fatigue, things of that nature.
00:32:02
Speaker 3: You know.
00:32:02
Speaker 1: I obviously engage you in your expertise with the hormonal piece, and I start doing on my incessant laboratory testing of hormonesy.
00:32:11
Speaker 4: Yes, but it you know it really I try to highlight to them truly how in this stage the decline in bone, the potential decline in bone health. You know, the lower threshold for insulin resistance that occurs during this time, the less estrogen that you have from a cardioprotective standpoint, So really being kind of a sounding board for encouraging them to address this with hormone support. If it involves you know, statin therapy, and it involves metformin for insulin resistance, so be it. But the awareness is very, very key as far as what can happen during that time.
00:32:55
Speaker 1: Yeah, it's funny. I always women would say to me, well, the laboratory test must be wrong. You know, my cholesterol has always been perfect, you know. And then so it's to be anticipatory, right to these body composition changes and lipid profile changes.
00:33:11
Speaker 4: We may see, you know, a transition of you know, body fat in different ways. Everybody you know has metabolic changes, you know, it's very individualized. But we may see more of a shift in the subcutaneous fat. We may see if there's more metabolic impact from perimenopause and menopause, we may see that shift in that fat more to visceral fat. And these changes can occur year to year. I do find in that perimenopausem menopause period the changes occur a lot more rapidly, and with each decade. Obviously there's there's significant changes, but that forty to fifty and then fifty to sixty window, it changes.
00:33:53
Speaker 1: Rapidly, right, that's the Yeah, that's big metabolic changes and bone health changes. So let's talk bone health. So the guidelines recommend checking bone densities at age sixty five or maybe sooner if you have an elevated risk, and probably every woman's at elevated risk, right because she's losing estrogen. When do you recommend that a woman have her first bone density and why bone density?
00:34:16
Speaker 4: I generally recommend based on menopause, but sixty five I find to.
00:34:22
Speaker 3: Be far too late.
00:34:26
Speaker 4: So at the least fifty, there are some of my ladies in their forties that I will check it, especially if they had premature menopause so they don't have that estrogen benefit. To be honest with you, the majority of my patients that historically I've diagnosed with osteopeni or osteoporosis are in their mid to late forties and fifties. So had we waited to sixty five, we would be chasing our tail behind. And this probably would have been after a fracture so you know a lot of you know, premature menopause, history of eating disorder, history of prolonged steroid use for some reason, autoimmune conditions which could have warranted you know, steroid use as well. Those are factors that have to come into play when considering your bone health and screening with DEXA.
00:35:20
Speaker 1: And also family history, family.
00:35:22
Speaker 3: History, my family history absolutely, so how do you.
00:35:25
Speaker 1: How can a woman advocate for herself in terms of she wants a bone density? She has you know, wants a bone density. So she points out to her physician, look, I do have some respectors here, please order it in terms of can cover it because I have these respectors and just be proactive about it.
00:35:40
Speaker 4: And it's a partnership I do, you know. I tell patients all the time like we learn from patients more than they learn from us in many respects, and so I try to encourage patients to be your own advocate by educating you know yourself. There's there are there's a lot more information out now for our public record than before. When you dig deeper into what particular risk would be, that oftentimes prompts people to ask questions in their family. It is always surprising to me how much a patient doesn't necessarily know about their family history, whether or not it's because you know, don't ask, don't tell. But then there's also a stigma behind, you know, older generations not necessarily conveying their family history to the younger generations.
00:36:33
Speaker 1: So when somebody's looking and to get into their family history, what do they need to look for? Dementia, family history, cancer, family history, cardiovascular family history, clotting right.
00:36:43
Speaker 4: Yes, yes, you know, when we go through a family history, I usually will ask, okay, is there a family history of breast colon ovarian, lung cancer, melanoma. Those are like the big ease I'll usually ask for. You know, if there's a family history of thyroy cancer. That's becoming more and more important because we're in the world of gops and things of that. So it helps to have that ahead of time. Heart disease, but hear and cerebral vascular disease, anyone with heart attacks or strokes in their fifties or sixties, anyone with sudden cardiac death, like just.
00:37:20
Speaker 1: That's super important.
00:37:21
Speaker 4: Yeah, because a lot of times we don't know, you know, people have signent heart attacks. The don't necessarily dobt but someone just to have complete sudden cardiac death. Unclear why you know the specifics, because that could be plaque that ruptured, it could be an aneurysm, it could have been a fatal arrhythmia. But regardless of that, you know you don't necessarily need to know the autopsy results. But that's going to prompt you to have the recommend to recommend them seeing a cardiologist or do a higher level cardiology testing.
00:37:53
Speaker 1: And that family history of aneurysm is really important, right, because you should have some aneurysm screening if you have a family history.
00:37:59
Speaker 4: Yes, absolutely, absolutely, so it's very important to get that information as well.
00:38:07
Speaker 1: Still to come, we'll discuss key strategies for cancer screening, like colonoscopies and whether you should ask your doctor to screen for lung cancer. Plus we'll cover the warning signs you should never ignore. Let's talk a little bit about cancer screening. Let's talk about colon cancer, what age, what type of screening? Do I have to have a colonoscopy or can I do like a colar guard or whether these other fancy or tests.
00:38:47
Speaker 4: I will let you have a coligard only if you absolutely refuse the colonoscophy, So colonoscopy, I mean this This probably is one area outside of maybe heart disease, where the family history is so important. I was really glad that this screening age moved to forty five. I think knowing knowing the family history if anyone in your families have colon cancer, or if there are colon polyp syndromes, like and you know someone that you see, they may not know if there's a colon colon pollp syndrome in their family, but you can there's a way you could phrase the question to kind of extract whether or not there's suspicion. Do you have a relative that's going for colonoscopies every year?
00:39:33
Speaker 1: Right? Something's going on.
00:39:35
Speaker 4: Something's going on, So a lot of time shaping the question really matters. But forty five to start, if there's a family history of colon cancer, you begin at age forty or ten years younger than the youngest affected member. So you know, there are some of my patients that are on a protocol at thirty. You know, if there is an existing history of inflammatory bow disease like crohnes or servati colitis, they're on a totally different screening regimen earlier and more frequently.
00:40:07
Speaker 1: So colonoscopy is still the gold standard.
00:40:09
Speaker 3: It is it is now.
00:40:10
Speaker 4: You know, there's there's col of Guard, there's you know guardian that she old blood tests. Those are recommended for low risk average every three years. The problem is the sensitivity of those tests are it's low for pre cancerous lesions. So you know, it makes everyone uncomfortable, but look, it's better than not doing anything at all. So there are a fair amount of folks that I'll have on a col of Guard regimen and they do it every three years, knowing again sher decision making, knowing that if any of this is positive, it's going to be recommended that you have a colonoscopy anyway. So but I encourage the colonoscopy.
00:40:55
Speaker 1: Lung cancer screening not really spoken about very much, and the guidelines are missed I find by a lot of people out there.
00:41:02
Speaker 3: Yes, yes they are.
00:41:03
Speaker 4: So currently you know, age graded than fifty with twenty pack at least twenty pack year history.
00:41:09
Speaker 1: So what does that mean?
00:41:11
Speaker 4: So a pack a day for twenty years, which you know we're because we're doing so much screening, you know at age your Fortunately, the people that we're picking up they're younger than fifty. You know, the guidelines don't necessarily factor in. Yes, it factors in the smoking history, but secondhand smoker exposure.
00:41:32
Speaker 1: The environment just rapidly change.
00:41:35
Speaker 4: Absolutely, So these guidelines really have to be reshaped and revisited for the current environment. The exposures, rad on exposure, you know, occupational exposures, through you know, through work, all of these all of these things really make a difference. It has to be very individualized. That's why creating that partnership with your PCP, having full disclosure as far as you know what your lifestyle is, where you live, where you've traveled, all of those things become extremely extremely important.
00:42:12
Speaker 1: I love that concept of the partnership with your people. So it has to be I think that's what we're losing in modern medicine. And let's talk a little bit just about breast cancer. When when should we start screening for breast cancer?
00:42:24
Speaker 4: So I traditionally will recommend mimography at forty mammogram and ultrasound.
00:42:30
Speaker 1: As you know better than anyone else, you.
00:42:32
Speaker 4: Know, the degree of fibercistic breast disease is incredibly high. And so if we're finding that the challenge in traditional medicine is always approval, insurance approval, right, and you know the clinical indication when someone has fibercistic breast disease, potentially a family history whether not to do breast MRIs, that's something that's on the table for discussion as well. But I typically will start at forty, at.
00:43:00
Speaker 1: Forty and then younger if you have a family history. And let's talk about vaccines midlife women. What vaccines should we have?
00:43:08
Speaker 4: So typical vaccines, you know ted obviously every ten years, I like to check MMR immune status just because you know, it's very common that it's checked in that peripartum you know period or preconception period. But sometimes immunity WANs and we have had outbreaks, so I check immune status. If they're not immune, I offer boosters hepatitis B. I will check immune status. Hepatitis B can yes with travel blood transfusions, but it can be transmitted sexually, and so I definitely recommend checking that status so that we can booster you if needed. Shingles over fifty, numavacs over sixty five. Unless there are risk factors like established pulmonary disease, diabetes can be a consideration but typically at sixty five RSV vaccine I'm going to recommend as well, and then HPV vaccine that shared decision making after twenty six, twenty six to forty five.
00:44:16
Speaker 1: Yeah, and I think we will never have that data in older women. So if you're a sexually active older woman, older meaning like over forty five, yeah, we're still very young, yeh. You know, review with your provider getting an HPV vaccine. So what are the signs and symptoms that every woman should bring immediately or at some point to their healthcare provider? For me and the gynecology world, is abnormal vaginal bleeding or discharge? What is it for you? What do you want to hear about immediately or you want evaluated and worked up?
00:44:49
Speaker 4: Sure, So I would say headaches, worsening, migraine, things like vision loss, chest pain, in general, symptoms that recur, abdominal pain out of proportion to what you would expect for your cycle. If you no longer are having your cycle and you're having bleeding vaginal bleeding, that as well UTI symptoms, you know, recurring joint pain unprovoked by physical activity, I'd want to know about to those tend to be the.
00:45:20
Speaker 1: Biggies, what about fatigue? Fatigue? Fatigue, Yeah, it's a tough one.
00:45:25
Speaker 3: It can be really so multi factorial.
00:45:30
Speaker 4: However, fatigue in the setting of any of those other symptoms like fatigue, hair loss, weight changes, I'm going to want to definitely know about it. Listening to your body is probably the best. I love that thing that any woman can do, and really really listening to your body because you feel it is important because we get very much caught up into the day to day the grind as I call it. You know, work, family, you know, travel obligations, and we very much are We have a low threshold for bringing symptoms to the table because they can always be explained. Fatigue can always be explained. I mean, chess ban can always be explained by something that we do. But you have to listen to your body and be able to have someone to partner with to discuss these symptoms.
00:46:29
Speaker 1: I love the listening to your body.
00:46:31
Speaker 4: You know.
00:46:31
Speaker 1: I actually found my cancer because I didn't feel right and I knew something was off, and so I actually went on a hunt.
00:46:38
Speaker 3: Wow.
00:46:39
Speaker 1: And so I always ask patients like, how do you feel? You know, if someone says I don't feel just right, you know, that's a very serious thing that you've got to delve into a little.
00:46:48
Speaker 3: It's it's it's very serious.
00:46:50
Speaker 1: Okay, But because I'm taken down the rabbit hole too, it can.
00:46:53
Speaker 4: It can, But I think that what could potentially have We cannot listen to our body if we do not silence the noise around it. And you can't silence the noise around it if you're not pausing to hear were body, and so certain kind of actual things to you know, do In order to do that, you have to pause, meditate, prey, sit in a quiet place. We don't do that anymore because we're running, we're you know, taking care of obligations, or even if we're not necessarily running and taking care of obligations, we're on our phone, we're scrolling on every social platform, we're on the computer. You there is there's such value in just being still and making that a regular exercise. That's the only way you're going to, I think, get into the rhythm of hearing your body.
00:47:59
Speaker 3: So you talk a lot.
00:48:00
Speaker 1: About the partnership with the patient, and which is just beautiful. Actually we've taken that out of modern So how do we help women, How do we counsel women to find somebody that you can partner with longitudinally to help you and guide you through your health journey.
00:48:23
Speaker 4: Yeah, yeah, that is That's a question I asked myself every single day. I mean, I think this, I know, I think that medicine in general, the traditional medicine has become the priority has become checking boxes and not necessarily sitting and looking at the patient and listening to what they're saying. And the unfortunate thing is a lot of that's dictated by you know, insurance companies and whatever you know, health system you may be in. So figuring out how within that those walls to really change the narrative. Oftentimes, in my previous practices, I would just create pauses in the day. You just have to be creative and create pauses in the day which would essentially allow me to have the quality time and listen. I would create phone call follow ups. You know, whatever we didn't discussed during the visit, I'm going to call you and you know, just to allow you to expand on it.
00:49:28
Speaker 3: When patients see.
00:49:30
Speaker 4: That you are willing and able to give the time, they're going to be more amenable to talking. Yeah, And it's that nothing will replace that. Nothing nothing can replace.
00:49:45
Speaker 1: That also highlights the importance right of health when you engage and re engage. Yes, what are some of the exciting advances that you see and prevention medicine or preventive care.
00:50:00
Speaker 4: It's interesting so with you know, with certain platforms wearables, the ability for patients to kind of monitor their own body changes I think has been It's been good. It can be a bit confusing, but you know, like apple watches or rings, things of that nature, you know, it can get you into trouble because you know it'll be you may have a rhythm that's just because the person was jumping up and down and moving and then they're calling you in a panic saying they have a fib That's not necessarily the case, but it really it empowers someone to actually care about their health care. And I think that's one of the benefits of some of the technology that's out the wearables.
00:50:46
Speaker 1: What wearables do you recommend? Do you do you recommend sleep tracking, heart rate monitorings? Even I do like sleep tracking. I think that it can offer a lot of information as far as or or at least trigger additional you know, testing as far as you know, looking at what someone's quartersol level is what their you know, heart rate tends to be things of that nature. So I do like that the whoop I've used and that, you know, I do like the information that that offers. I'm not endorsing anyone, but it can be quite helpful. But it also can be helpful when the patient brings that data to the physician and you look at it together, right, because I learned from it, and you know, it gives me insight into what's going on with them at home. Right, So what do you do for your own health? If you mind? Do you mind sharing? Yeah? What's your exercise regimen? What's your nutrition regimen? Stress mindset regimen?
00:51:50
Speaker 4: I you know, I try to stay even keeled, and you are are so soothing. I like, and now I can face my day after speaking with you. I'm having a therapeutic episode here.
00:52:02
Speaker 1: Actually this has been very beneficial because Jennifer is so soothing and so introspective. So how do you there? How do you manage your home? So I pray a lot. I'm not gonna lie.
00:52:17
Speaker 3: I pray a lot.
00:52:18
Speaker 4: I mean, you know, my family keeps me incredibly grounded.
00:52:24
Speaker 3: You know.
00:52:25
Speaker 4: I try to get quality sleep but I am in the menopause boade for sure, so I engage hormone support, which definitely you know, has helped nutrition wise, I try to I'm a big protein eater.
00:52:44
Speaker 1: How many a day?
00:52:45
Speaker 4: Right, so I'm really bad, but I try to get to sixty at least. It's a challenge because with my schedule, I literally just kind of pick up and go. But meal prep has it's key, it's everything so and it could be fun. You can get creative with it. So I rely on protein shakes and meat.
00:53:09
Speaker 1: Read just good for.
00:53:10
Speaker 3: Creative yeah, yes, yes, yes, so I you know.
00:53:15
Speaker 4: And it's also because you know, to be honest, nutrition, I will feel it when I am not good with nutrition. So it's not because I'm you know, that disciplined. It's because I don't want to feel bad. So that is what you know, That's why I.
00:53:35
Speaker 3: Tend it here to it.
00:53:36
Speaker 4: Physical activity. I love being physically active. My motivation for being physically active is because it keeps me at peace, not because I want to lose this pound or look this way. It literally that's just the added benefit. But it keeps me at peace, keeps me regulated. Those endorphins going helps manage my insulin resistance, so that is crucial. Fortunately, my commute is very physical. I used to do kind of higher level CrossFit, but I had a few injuries, so I had to pull back. The hardest part was accepting pull back. Oh yeah, that's hard. That and not that's very hard. But but I found that resisting the acceptance actually kept me from doing anything. Yeah, so you know, instead of my runs, I do walking. I love weights. I need to do more of them, kettlebells. I just bought a big set of those. So all of those things make you feel so good. And no matter how advanced science gets, no matter how many wearables come out, no matter how many supplements come out, nothing will replace the benefit of physical exercise.
00:54:52
Speaker 1: Everybody knows. I'm a huge advocate of that.
00:54:54
Speaker 4: I mean, you have to talk about your workout after this because I eat those arms.
00:54:59
Speaker 1: I but yeah, it really I mean for a cognitive function, for a mindset, for physicality, for metabolic health, just across the board.
00:55:11
Speaker 4: And if you can't move in the sense of walking, you can use things in your home. You know, lift weights with you know, a jug of water, or if you know you're doing laundry and say your laundry is on another floor. Only carry up the amount that you can carry in your hands. That's at least two to three trips if you have a family.
00:55:33
Speaker 1: Always amazes me because I have my Apple Watch on when I and my Aura ring on. When I do housework and laundry, I get in like ten thousand steps.
00:55:44
Speaker 3: Very invigorating. Yes, yes, as yes.
00:55:47
Speaker 1: It's one or two things that you wish all of our listeners knew, Like what do what knowledge do you want to impart to us? What should we all know other than move right?
00:55:59
Speaker 4: Other than move I would say, I would say, give yourself permission to prioritize yourself and be your own advocate for your health.
00:56:12
Speaker 1: That is so beyond important. If we want to have women advocate for themselves right now in terms of getting the proper care, where should they look any resources that you want to share with us?
00:56:24
Speaker 4: Sure, so there are certain groups Facebook, you know they'll have certain groups and you know women's health societies online, even your local town or you know there are certain township sites and resources that are actually gathering collectively creating social groups. So I would definitely, you know, look online for that as well. And to be honest with you don't. Don't be afraid to start your own social group.
00:57:01
Speaker 1: I love that.
00:57:02
Speaker 4: Don't be afraid to start it. You could like minded people, Yeah, don't and just I mean, and it can just literally start with just having a group of three or four women over meet at a park, meet at a coffee bar, and it can just explode into But you have to start somewhere.
00:57:22
Speaker 3: Yeah, you have to start.
00:57:23
Speaker 1: So be afraid to start your own I love that. I was really moved by this conversation with doctor Jennifer mcguggins hill about being in partnership with your PCP. Ask for the testing that you need to keep your health on track. That means a comprehensive blood panel that includes a really thorough lipid panel including LP, little A and ApoB, checking your CBC to look at your blood cell counts, checking your hemoglob and a NC and your insulin level. Wearables can help here to provide a baseline and to catch any abnormalities. Share that data with your physician and listen to your body. Tell your doctor when things are feeling off, they're not complaints, they're actually information, and sometimes those symptoms are trying to tell you something really important. All patients, but also all practitioners can take something away from this conversation, especially creating space for pauses for listening, engaging and re engaging. Decoding Women's Health is a production of Pushkin Industries and the Atria Health and Research Institute. This episode was produced by Kalalah and Amy Gaines McQuaid. It was edited by Karen Schakerjee mastering by Sarah Bugare. Our executive producer is Alexander Garreton. Our theme song was composed by HANNS. Brown. Concept and creative development by Shavan O'Connor. Special thanks to Vicky Merrick, Alan Tish, David Saltzman, doctor David Dodick, Sarah Nix, Jacob Goldstein, Leah Rose, Jordan McMillan, Morgan Ratner, Owen Miller, Eric Sandler, and Greta Cone. I'm doctor Elizabeth Pointer. Thanks for listening and until next time,
Speaker 1: Pushkin.
00:00:24
Speaker 2: This show is not a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes. Please consult your healthcare professional with any medical questions. Also in this show, we use women as shorthand for people with XX chromosomes. We understand sex and gender are more complex and acknowledge the experiences we describe reach beyond that word.
00:00:54
Speaker 1: We've talked to a lot of specialists on this show, but the doctors that people see most often are actually their primary care physicians. These doctors play a crucial role in preventive care, screening their patients for underlying and sometimes hidden health conscers. That's why I am thrilled to welcome to the show my colleague, doctor Jennifer mcguggin's hill. She's an internal medicine physician who's been practicing for over twenty years, and as you'll hear, her compassion for her patients and for fixing our healthcare system is evident in all she does.
00:01:31
Speaker 3: This is a vital.
00:01:32
Speaker 1: Conversation for anyone at any age interested in protecting their health and getting ahead of serious illness down the road. We'll discuss what to ask your doctor to check at your annual exam and how to advocate for what you need will also cover wide levels that may seem fine are still not optimal and worth paying attention to. So let's get into it. Why does she become an internist as opposed to a surgeon or dermatologist or gilian oncologist.
00:02:05
Speaker 4: Yes, so I've always wanted to actually be an You know how when you were a little kid, everyone's like, oh, what do you want to do when you grow up? I knew I wanted to help people. I think seeing so many people in need of help and not necessarily getting the proper care early on is what drove me to wanting to be a doctor. And then as you start to get into the weeds of what that requires and schooling, it was very early on, I would say late college, and then once I got into medical school that I found it to be a challenge just focusing on one area of the body, to the point where it became comical as I rotated through clinical programs in medical school. For example, if it was surgery and someone was having challenges with either anxiety or their gut, I would constantly divert and want to address that, and I got scolded for that, and this became a repetitive.
00:03:13
Speaker 3: Type of behavior pattern.
00:03:15
Speaker 4: So then I realized that I wanted to treat the whole person. I could not ignore a particular question or concern just because it will didn't fit into the particular specialty that I was assigned to at the time. And I definitely made the right decision.
00:03:34
Speaker 1: Excellent. So you deal with a lot with the preventive care and prevention of disease and illness. Most of our listeners have probably had a preventive care checkup at some point. What kind of questions should preventive care primary care physicians being asking of women in their thirties, forties, and fifties, what should they focus on?
00:03:59
Speaker 4: So focusing on a lot of kind of lifestyle behaviors, focusing on cancer prevention, focusing on cardiovascular care, and brain health. So if you look in by age, right, so in your thirties, you know what tends to be the focus. Family planning, reproductive health, things of that nature. But that segment that late twenties thirties, that's such a wonderful age group to reinforce lifestyle choices and how it really does impact your heart health and brain health from the standpoint of nutrition, So really focusing on treating your body properly from a nutritional standpoint, you know, minimizing alcohol use, avoiding smoking and vaping and toxic habits. That's really crucial starting as early as you can, you know, with women, as we approach forties, you know, we're in this perimenopausal menopausal my favorite tech life. You are the expert there, yes, yes, so really beginning it's never too early to talk about hormone, you know. And I think and I'm so grateful that that narrative is really changing and becoming more accepting because then we'll be less in that catch up mode. But the focus during that time period one along with breast cancer screening is you know, hormonal health and optimization and the same you know as we approach in the fifties. Other cancer screening that we start to really focus on around forty five is like colon cancer screening, you know. And all of these things are contingent upon obviously family history, because that could dictate, you know, whether or not screaming is to be sooner than later.
00:05:54
Speaker 1: So let's get into some some details. People have standard yearly laboratory values that they order. What do you order? What are you looking at when you what what lab should a woman have checked every year, every six months, et cetera.
00:06:10
Speaker 4: Sure, so so the standard you know there's there, what standard is defined by is is definitely evolved for me, I know, over the past few or five years, and really kind of focusing on understanding where is someone from a hematologic perspective, their organs, how they're working, where they are from a cardiovascular perspective, an inflammatory metabolic perspective, So you know, checking what we call a CBC or hemogram to look at their blood cell counts, looking at a comprehensive panel, to ensure that their liver and kidney functions fine, their electrolytes are okay, checking you know, hemoglobin A one c and insulin level, you know, our metabolic markers and target ranges in traditional medicine, I think need to be reevaluated because oftentimes when you are at safe, for example, hemoglobin A one C of five point seven, your body's already working hard. So really it's should be we're seeing it like five point three, five point four. And oftentimes when your insulin level you know, is above ten, even though it won't get flagged unless it's above twenty it's showing your body is working harder. So a lot of these quote unquote normals that are established, they're not optimal. It's similar to when someone says, I don't want to be good, I want to be great, and so those tests I really like to use thyroid vitamin levels like B twelve, iron, vitamin D, you know precursors for vitamin B twelve like methyl malonic acid and homocysteine. You know, a lot of times we can get tricked when we're doing blood work because we're being quote unquote good, We're eating well leading up until the blood work, we're taking our supplements leading up to the blood work, so those values are going to be normal, but are they really normal? So that's where a lot of the precursor labs like methylmalonic acid will show like okay, but they're normal in this space time on a Friday, but you're depleted in your body. So those tend to be kind of our go tos. And a full lippid panel as well.
00:08:20
Speaker 1: So let's talk about lipid panels actually, so you know, kind of a standard lipid panel is good cholesterol, bad cholesterol, and some triglyceroids and total cholesterol, right, but we're looking beyond that now and we look at lipid panels. Can you can you unpack that a little bit for us and let us know kind of like what women should be looking for in their lipid panel beyond my good cholesterol and my total cholesterol and my bad cholesterol.
00:08:46
Speaker 4: Yes, so traditional medicine, as you mentioned, you know, we get that snapshot that total the HDL the LDL, and I would have to say, there are a lot of people you know, in the past that I've seen that in hindsight, I probably would treat had we done more of an expanded validated test. And so there are the good cholesterol. HDL has honestly gotten too much credit, am I avent? We need to talk about that because that way, yes, it's gotten too much credit to the point where you know, an average person if their LDL is say like one thirty and you know, but their HDL is you know, over forty, maybe like sixty to seventy, then we're happy. We feel like they're quote unquote protected. But that's in the absence of knowing their true risk, and risk is defined by a couple of a different lab test that I'll mention along with the benefit of having ct calcium score. So when we do a full laboratory analysis, we're finding that there are certain proteins like APO liper protein B and the LDL particle size. So it's important. Yeah, so let's talk about that. So that's like a lot of people talking about ApoB. Now, so what is ApoB sure, So it's like it's it's like a relative as sister almost to the back clester. So APO B is is a liper protein, a protein that basically travels with the LDL bad cholesterol. And the reason I love it is because it corresponds more to risk for heart disease. And so oftentimes, like for example, we utilize the Boston Heart Platform, which checks this full lipid profile which includes APO B and LDL particle size, and you may have stellar cholesterol quote unquote standard cholesterol. You know your LDL, Oh, we're happy, and maybe like at one hundred and you know your or one thirty total cholesterol right at two hundred and HDL is phenomenally good. But your APO B may be in the red. So that's telling me in this moment in time, your cholesterol numbers by standard values may be good, but you are predisposed and your body's working hard, and you still are at risk based on that APO B and potentially particle size. Those markers fortunately are modifiable by nutrition and putting the work in, so it helps us to say, Okay, this person is at risk. We may not necessarily treat their cholesterol to an LDL goal of under one hundred, but we're going to intervene and have nutritional recommendations to say, Okay, this is what you're eating. You just seem to be more sensitive to it. Let's pull back on that one caveat to that is an additional test called lipoprotein A. And again I'm not a cardiologist, but we work with some amazing cardiologists present, and I've worked with many in the past, so you know, fortunate enough to continue to get their advice. But that lipe of protein A is another very important test that I would want everyone to at least have on file because that is a protein that is more we feel genetically linked to cardiovascular disease and risk for plaque.
00:12:12
Speaker 1: And you need to only do that once, right because or do you need to do it at midlife?
00:12:17
Speaker 4: That's a great question. You know, it's not something necessarily that we check quote unquote annually, but there's focus more on how actionable we are to treat that with medication. So I think that the frequency at which that test is going to be checked it's evolving and changing and will be determined based on treatment measures that are being looked at to target that. But at least at baseline, it's helpful to know if it exists for you, because that really paints a different That puts a different framework on how we look at your cholesterol and your cholesterol goal.
00:13:02
Speaker 1: Puts a different one to yes, maybe a threshold.
00:13:05
Speaker 4: You're going to be more strict with someone that has a lipe of protein A to where their target ld and this is excluded. This isn't without even knowing what their karates look like, what their ct Calthum score is. The discussion will be a bit more strict. It will be different with someone that has lipoprotein A maybe a borderline APO B than someone who's in the green across the board.
00:13:30
Speaker 1: So this this, oh, your HDL is good, so your LDL we're not gonna worry about it. So your HDL is good. That's a little bit of a fallacy now, right, especially for midlife women. I think right the HDL is not as protective adversely, and.
00:13:46
Speaker 4: That's it's great for you, That's that's I'm happy. Yeah, but it's not the end of the story. Can't can't stop there. Let's talk a little bit about insulin resistance and hemoglobina W and C and what is typically drawn. You know, you see, typical panels will include a HMIC, glemin a W and C. Does everybody need a fasting insulin and fasting glue coast once a year?
00:14:06
Speaker 3: Everyone? I would I'm going to say yes.
00:14:11
Speaker 1: I love that. I'm going I like that answer.
00:14:13
Speaker 3: I'm going to say yes.
00:14:15
Speaker 4: And you know, I say yes because with with our with where we are from the standpoint of kind of our population, that the the degree of obesity, our nutrition, I feel as if we are constantly in a phase of a.
00:14:40
Speaker 3: Pattern of ketchup.
00:14:42
Speaker 4: We're constantly chasing better health as opposed to being on the other end and really proactively promoting great health. And there are certain measures that enable us to really be on that side of the fence. And so if I see someone that comes in for a routine checkup, and you know, maybe they're talking about having challenges with weight loss or they just feel like one common thing that I'll hear of people are aulate is it's just so easy to gain weight, like I feel. And this happens one as us women get older, the level of insulin resistance and it translating into physically one saying, I am, it's so easy for me to gain it's hard for me to lose. I've checked my thyroid twenty times and twenty times a month.
00:15:32
Speaker 3: That's not it.
00:15:33
Speaker 4: But their insulin level maybe hovering, you know, in the twelves thirteen's, and their body is working harder to really get ahead, and so really looking at that in the setting of the fast and glucose the A one c and paying attention to the trend.
00:15:51
Speaker 1: Right, that's the trend and optimal values. Right, we can't just look at our lab report and say green or red. It needs to be where are we in the green? Yes? Yeah, because a hemoglobin A one c of five point six is like maybe green, but it's kind of should.
00:16:06
Speaker 4: Be right, especially when you lived at five point two for the last ten twelve years. Like that matters, you know, that really does matter, And I think that's that's probably one of the most important helpful tips that I've tried to adhere to in primary preventative care. It's really walking that journey with the person to see what changes are taking place and not just taking for granted that one snapshot in time that all is well. It's what listening to them, listening to what their concerns are, what they've noticed because they're with themselves twenty four to seven in the context of what I may be seeing from a trend perspective over the course of a year or two.
00:16:58
Speaker 3: That's very, very, very important.
00:17:01
Speaker 1: That goes through medicine. That thread is through medicine everything we do, because I think when people come to sometimes I always tell people this is a snapshot in time. The whole story is what's important. Yes, and we have to look at that longitudinal trajectory. Yes, tell me a little bit about inflammatory markers and like see, reactive protein should be measured every year.
00:17:22
Speaker 4: I do like to measure it every year. You know, it gets very tricky because the sensitivity and specificity can be quite variable, especially in the setting of if someone comes in and you know they were just coming off of a cold, they don't know they're about to get a cold. It can definitely be offset by that and the challenge becomes you're now chasing this marker and you end up having to call them back in and repeat testing. You know, I do feel like it's helpful at least annually to check and or if someone is having specific symptoms like joint pain or something that's recurring and we're not sure why it's it's quite helpful.
00:18:08
Speaker 3: If it is elevated, it.
00:18:09
Speaker 4: Can prompt you to go down a rabbit hole, so you have to be very mindful it's and have shared decision making when you are doing the test.
00:18:18
Speaker 1: And the implemmatory markets are also important for cardiovascular tests right and brain health right because those systemic inflammation is not good for your cornarias or vessels.
00:18:28
Speaker 4: When we're talking about kind of preventative cardiology assessing kind of high sensitivity CRP, and it's you know, the reality is no one is theoretically sick or have a cold twenty four to seven. So if you're seeing that as you're checking these levels, they're consistently elevated, you have to ask yourself why things underlyth yes, yes, yes, Let's talk about some cardiovascular screening. How often should women have their blood pressure checked? So blood pressure check, you know, obviously as it stands right now, what we're doing is annually in the traditional medicine sense. If we're finding that your blood pressure is borderline, then you know repeating it. And now when I say borderline, that's different than high. So you know every three to six months to follow a trend. If you're in that gray zone like one thirty over eighty, if you're one sixty, you know over ninety, you need to have it repeated within a month.
00:19:28
Speaker 1: What's a normal blood pressure?
00:19:29
Speaker 4: So less than one thirty over eighty, okay, but if you're like one twenty to one thirty, I'm raising a brow. I'm raising a brow and following that up for sure.
00:19:41
Speaker 1: Do you recommend home blood pressure monitoring for people?
00:19:44
Speaker 3: I do?
00:19:45
Speaker 4: I do, but they it will get you in trouble that I g I do, but you you have to be counseled, because counseled on how to actually take the blood pressure, you know, being mindful of your kind of physical and mental state when you're checking the blood pressure, in logging your blood pressure one moment in time, blood pressure when you're trying to get the house settled, or you know, you just got off of a really bad phone call is not going to help. But really tracking that blood pressure, I tend to like AMRON. I mean, I don't you know, there are several out there, but it's more of a sense to establish, okay, what clearly is your baseline by having multiple values and checking an average.
00:20:37
Speaker 1: And you can get the AMRAN monitors on just on amazons. Its super easy. Absolutely. What is the best time of the day to check yourloo pressure? Morning before coffee or when should chill might check your blood pressure.
00:20:47
Speaker 4: So it depends on if you're monitoring for a spike. So I you know, I would say once you're wind down in the evening, it's fine. I tend to check mine in the morning and evening just to kind of you know, yeah, to see where I am. And then also, really the most important thing here is if we are concerned about potential elevation in blood pressure, whether or not we are going to establish you as having hypertension, really doing an ambulatory monitor is going to help. And you can get that from your doctor or if you're seeing a cardiologist and basically you wear the monitor so in its cycles to.
00:21:27
Speaker 3: Check your blood pressure.
00:21:28
Speaker 4: That's really the best way when we're trying to establish a diagnosis.
00:21:36
Speaker 1: We have to take a quick break, but when we return, we'll get into more testing like how often you should be getting an EKG and why it's important to know your calcium score. Plus we'll delve into a much talked about topic statins. Stay right there, let's talk about EKGs. Should everybody have an EKG or nobody have an EKG only with symptoms or no.
00:22:09
Speaker 4: I support a standard because there's you know, it's not as if we're necessarily doing an EKG because we think you're having a heart attack per se. But it can give so much information as far as the electrical conductivity of the heart, if there's a suggestion that the heart muscle could be too thick, if there is an issue with you know, abnormalities. There's certain intervals on an EKG that could either be too long or too short, and that can imply that there's if you're on a particular medication that can impact the intervals. That's a red flag. So it can give you quite a bit of information.
00:22:49
Speaker 1: So yearly EKG then yes, okay, let's talk my favorite cornary artery calcium yea and clearly so who should have what women should have a cornary artery calcium score? How often should they do them? Should everybody have a clearly done also to look at soft plaq? Can you walk us through that a little bit.
00:23:13
Speaker 4: Yeah, so I'm I'm definitely a fan of the calcium score. It's been I honestly would say a game changer as far as in the primary care setting, as far as who we treat, who we escalate for cardiovascular screening. Our cardiologists, you know, use it all the time. Theoretically, you know, essentially over forty. And the reason for that is even though we are doing baselines based on risk factor in some people in their thirties. But the reason for that is the validity of the test for people under forty is not as clear. So basically over forty as a rule of thumb, but certain risk enhancers, right, because everything is contingent upon risk. So a family history of you know, heart disease. You know someone that may have had a heart attack or stroke in their fifties or sixties. You know, if that particular person has very elevation a cholesterol. You know, if there's a familial hyperlipidemia syndrome that the person has. You know, inflammatory and established inflammatory condition can be associated with cardiovascular disease like autoimmun Yes to those, yes, folks that you know may have like lupus or rheumatoid arthritis, things of that nature. You know, someone with a history of sleep apnea, as someone with lipoprotein A kidney disease.
00:24:45
Speaker 3: Definitely.
00:24:46
Speaker 4: Uh And for for women, you know, I do feel as if premature menopause not having the opportunity to have that estrogenic benefit women that may have had pregnancy related.
00:25:03
Speaker 1: Complications like hypertension.
00:25:06
Speaker 4: Yes, yes, yes, I definitely recommend that as well for them.
00:25:11
Speaker 3: Yeah.
00:25:12
Speaker 1: So, and I think it's really important also that we impart that women's pregnancy history really impacts their future. Medical history is kind of a stress test, right it is. It is, even for cardiovascular disease, but also for insulin resistance.
00:25:25
Speaker 4: Yes, absolutely, and that is why obtaining a very detailed personal history, family history, obstetric history, gynecologic history, it's it's crucial.
00:25:38
Speaker 1: Yeah. And even like pre term labor and things like this and infertility actually a higher risk of cardiac disease, which I didn't really realize until I got to Atria and with you guys and the doctor pit and get to learn from you.
00:25:51
Speaker 4: Yes, absolutely, it's it's very important, and I think it I feel as if there is a shift fortunately with understanding how important it is with regards to women's health in general. A lot of the screening tests and what we should do and when we should do it really is being acknowledged based on the changes that women go through hormonally.
00:26:20
Speaker 1: Yeah, that's really putting that on the landscape now, which is really great. I want to go back to cornary art calcium scores. I'm forty five years old. My lipids are pretty good, my CEC is normal. I get lipids done once a year. When do I repeat my cornary artery calcium score? Again?
00:26:38
Speaker 3: Great questions.
00:26:39
Speaker 4: So, and I've asked our car team this as well, because you have to you know, it's radiation, you know, so do no harm. So if you know if your lipids are pristine, the you know your low risk from a you know from what we know from a genetic perspective, and your calcium score is zero, it is not negative unless a zero right, So one seems like, oh, it's just a smidgeon, but it's it's significant. And so your calcium score is zero, and let's say we have the benefit of checking krotids which are clear. You know, I think at five years, seven years it's reasonable unless there's been a change in your lipet profile or some other medical condition.
00:27:27
Speaker 1: Let's talk about karated imaging. So should every woman have her kartids checked? And what are we looking for when we when we look at karates, Like, what are we actually looking at?
00:27:36
Speaker 3: Sure?
00:27:36
Speaker 4: So when we do karate dopplers, we're looking for plaque, but we're all soft or harder both, yes, soft flats, but we're also looking at thickening. So when we see the it's called IMT, so the intermedia that the inner lining. Not all karated Doppler scans will measure IMT. So if there is opportunity during an assessment and you know it's recommended that you do a KARATEID, you know, be your own advocate and ask, well, what are the measurements are we measuring in IMT as well?
00:28:12
Speaker 1: So it's a marker and helps you, helps guide you because a CA only looks at a hard plaqu right, So that doppler am I correct in thinking that that doppler also gives you insight into psyche.
00:28:23
Speaker 4: It gives you it gives you insight into whether or not. And that's what I love about the body so amazing, because if how our body handles plaque is we have this calcified en casement, right, and so it's protective. But if you see that in the ct calcium score is based on calcification. So if you see that, that that implies that, okay, you have the ability to create plaque. So then let's look a little deeper and there'll be some people where we feel stopping at that calcium score, stopping at that caroateid, stopping at that lipor profile really isn't enough. You know, they've got like first degree, second three relatives that have cardiovascular disease. They may have had one blip of chess years ago and we thought, you know, it was provoked by stress. The calcium score maybe one. That's somebody that let's get a better picture. Let's be absolutely sure that we do not have any unstable plaque in your coronaries. That's somebody I may do a CTA on or the cardiology.
00:29:30
Speaker 1: Will recommend a little yes, And the CTA is where we start to see the soft plot correct with us.
00:29:36
Speaker 3: Yes.
00:29:37
Speaker 4: And you know the whole point of it is to again goes back to if we're going to focus on preventative care. It's only preventative in my opinion, if it's proactive. And you know that that result, that result from the CT calcium score, that next step from the CT andrew that could be the determinant and that convincing factor for that person to agree to take, say a statin to treat it, you know, because it's hard for me to you know, convince someone who's all right LDL maybe like one twenty or one hundred and it stopped there, but they're CC lit up like a Christmas tree. They've got plaque on their CTA. They're going to they're going to agree to treat.
00:30:30
Speaker 1: Let's talk a little bit about statins and women and midlife women, right because you know, you hear a lot about well, statins are not as well proven to decrease mortality as they are and men. But I believe my interpretation is is the power the studies have been underpowered yet, yes, and so can you speak to that just a little bit. I mean, statins are protective for a while satins are protective. Statins are protective. You know, there's even in a research to show, you know, potential plaque stabilization and regression. There's anti inflammatory benefit. The benefit of treating your risk far outweighs.
00:31:06
Speaker 3: The risk of the medicine.
00:31:07
Speaker 1: And you can always follow your insulin resistance. Right. So let's talk a little bit about perimenopause and what that does for our risk, cardiac risk, metabolic risk, and midlife and bone health. Also, as women transition through midlife, blood pressure I believe tends to go up, certainly, lipids change, cardiac risk changes, metabolic risk changes. Can you impact that a little bit for us about how you approach a midlife woman?
00:31:35
Speaker 3: Sure?
00:31:36
Speaker 4: Sure, So when I have my midlife ladies, A huge part of that relationship and that assessment truly comes from what they're telling me, what their symptoms are, what they've been experiencing, you know, whether it's brain fog, you know, or weight changes, fatigue, things of that nature.
00:32:02
Speaker 3: You know.
00:32:02
Speaker 1: I obviously engage you in your expertise with the hormonal piece, and I start doing on my incessant laboratory testing of hormonesy.
00:32:11
Speaker 4: Yes, but it you know it really I try to highlight to them truly how in this stage the decline in bone, the potential decline in bone health. You know, the lower threshold for insulin resistance that occurs during this time, the less estrogen that you have from a cardioprotective standpoint, So really being kind of a sounding board for encouraging them to address this with hormone support. If it involves you know, statin therapy, and it involves metformin for insulin resistance, so be it. But the awareness is very, very key as far as what can happen during that time.
00:32:55
Speaker 1: Yeah, it's funny. I always women would say to me, well, the laboratory test must be wrong. You know, my cholesterol has always been perfect, you know. And then so it's to be anticipatory, right to these body composition changes and lipid profile changes.
00:33:11
Speaker 4: We may see, you know, a transition of you know, body fat in different ways. Everybody you know has metabolic changes, you know, it's very individualized. But we may see more of a shift in the subcutaneous fat. We may see if there's more metabolic impact from perimenopause and menopause, we may see that shift in that fat more to visceral fat. And these changes can occur year to year. I do find in that perimenopausem menopause period the changes occur a lot more rapidly, and with each decade. Obviously there's there's significant changes, but that forty to fifty and then fifty to sixty window, it changes.
00:33:53
Speaker 1: Rapidly, right, that's the Yeah, that's big metabolic changes and bone health changes. So let's talk bone health. So the guidelines recommend checking bone densities at age sixty five or maybe sooner if you have an elevated risk, and probably every woman's at elevated risk, right because she's losing estrogen. When do you recommend that a woman have her first bone density and why bone density?
00:34:16
Speaker 4: I generally recommend based on menopause, but sixty five I find to.
00:34:22
Speaker 3: Be far too late.
00:34:26
Speaker 4: So at the least fifty, there are some of my ladies in their forties that I will check it, especially if they had premature menopause so they don't have that estrogen benefit. To be honest with you, the majority of my patients that historically I've diagnosed with osteopeni or osteoporosis are in their mid to late forties and fifties. So had we waited to sixty five, we would be chasing our tail behind. And this probably would have been after a fracture so you know a lot of you know, premature menopause, history of eating disorder, history of prolonged steroid use for some reason, autoimmune conditions which could have warranted you know, steroid use as well. Those are factors that have to come into play when considering your bone health and screening with DEXA.
00:35:20
Speaker 1: And also family history, family.
00:35:22
Speaker 3: History, my family history absolutely, so how do you.
00:35:25
Speaker 1: How can a woman advocate for herself in terms of she wants a bone density? She has you know, wants a bone density. So she points out to her physician, look, I do have some respectors here, please order it in terms of can cover it because I have these respectors and just be proactive about it.
00:35:40
Speaker 4: And it's a partnership I do, you know. I tell patients all the time like we learn from patients more than they learn from us in many respects, and so I try to encourage patients to be your own advocate by educating you know yourself. There's there are there's a lot more information out now for our public record than before. When you dig deeper into what particular risk would be, that oftentimes prompts people to ask questions in their family. It is always surprising to me how much a patient doesn't necessarily know about their family history, whether or not it's because you know, don't ask, don't tell. But then there's also a stigma behind, you know, older generations not necessarily conveying their family history to the younger generations.
00:36:33
Speaker 1: So when somebody's looking and to get into their family history, what do they need to look for? Dementia, family history, cancer, family history, cardiovascular family history, clotting right.
00:36:43
Speaker 4: Yes, yes, you know, when we go through a family history, I usually will ask, okay, is there a family history of breast colon ovarian, lung cancer, melanoma. Those are like the big ease I'll usually ask for. You know, if there's a family history of thyroy cancer. That's becoming more and more important because we're in the world of gops and things of that. So it helps to have that ahead of time. Heart disease, but hear and cerebral vascular disease, anyone with heart attacks or strokes in their fifties or sixties, anyone with sudden cardiac death, like just.
00:37:20
Speaker 1: That's super important.
00:37:21
Speaker 4: Yeah, because a lot of times we don't know, you know, people have signent heart attacks. The don't necessarily dobt but someone just to have complete sudden cardiac death. Unclear why you know the specifics, because that could be plaque that ruptured, it could be an aneurysm, it could have been a fatal arrhythmia. But regardless of that, you know you don't necessarily need to know the autopsy results. But that's going to prompt you to have the recommend to recommend them seeing a cardiologist or do a higher level cardiology testing.
00:37:53
Speaker 1: And that family history of aneurysm is really important, right, because you should have some aneurysm screening if you have a family history.
00:37:59
Speaker 4: Yes, absolutely, absolutely, so it's very important to get that information as well.
00:38:07
Speaker 1: Still to come, we'll discuss key strategies for cancer screening, like colonoscopies and whether you should ask your doctor to screen for lung cancer. Plus we'll cover the warning signs you should never ignore. Let's talk a little bit about cancer screening. Let's talk about colon cancer, what age, what type of screening? Do I have to have a colonoscopy or can I do like a colar guard or whether these other fancy or tests.
00:38:47
Speaker 4: I will let you have a coligard only if you absolutely refuse the colonoscophy, So colonoscopy, I mean this This probably is one area outside of maybe heart disease, where the family history is so important. I was really glad that this screening age moved to forty five. I think knowing knowing the family history if anyone in your families have colon cancer, or if there are colon polyp syndromes, like and you know someone that you see, they may not know if there's a colon colon pollp syndrome in their family, but you can there's a way you could phrase the question to kind of extract whether or not there's suspicion. Do you have a relative that's going for colonoscopies every year?
00:39:33
Speaker 1: Right? Something's going on.
00:39:35
Speaker 4: Something's going on, So a lot of time shaping the question really matters. But forty five to start, if there's a family history of colon cancer, you begin at age forty or ten years younger than the youngest affected member. So you know, there are some of my patients that are on a protocol at thirty. You know, if there is an existing history of inflammatory bow disease like crohnes or servati colitis, they're on a totally different screening regimen earlier and more frequently.
00:40:07
Speaker 1: So colonoscopy is still the gold standard.
00:40:09
Speaker 3: It is it is now.
00:40:10
Speaker 4: You know, there's there's col of Guard, there's you know guardian that she old blood tests. Those are recommended for low risk average every three years. The problem is the sensitivity of those tests are it's low for pre cancerous lesions. So you know, it makes everyone uncomfortable, but look, it's better than not doing anything at all. So there are a fair amount of folks that I'll have on a col of Guard regimen and they do it every three years, knowing again sher decision making, knowing that if any of this is positive, it's going to be recommended that you have a colonoscopy anyway. So but I encourage the colonoscopy.
00:40:55
Speaker 1: Lung cancer screening not really spoken about very much, and the guidelines are missed I find by a lot of people out there.
00:41:02
Speaker 3: Yes, yes they are.
00:41:03
Speaker 4: So currently you know, age graded than fifty with twenty pack at least twenty pack year history.
00:41:09
Speaker 1: So what does that mean?
00:41:11
Speaker 4: So a pack a day for twenty years, which you know we're because we're doing so much screening, you know at age your Fortunately, the people that we're picking up they're younger than fifty. You know, the guidelines don't necessarily factor in. Yes, it factors in the smoking history, but secondhand smoker exposure.
00:41:32
Speaker 1: The environment just rapidly change.
00:41:35
Speaker 4: Absolutely, So these guidelines really have to be reshaped and revisited for the current environment. The exposures, rad on exposure, you know, occupational exposures, through you know, through work, all of these all of these things really make a difference. It has to be very individualized. That's why creating that partnership with your PCP, having full disclosure as far as you know what your lifestyle is, where you live, where you've traveled, all of those things become extremely extremely important.
00:42:12
Speaker 1: I love that concept of the partnership with your people. So it has to be I think that's what we're losing in modern medicine. And let's talk a little bit just about breast cancer. When when should we start screening for breast cancer?
00:42:24
Speaker 4: So I traditionally will recommend mimography at forty mammogram and ultrasound.
00:42:30
Speaker 1: As you know better than anyone else, you.
00:42:32
Speaker 4: Know, the degree of fibercistic breast disease is incredibly high. And so if we're finding that the challenge in traditional medicine is always approval, insurance approval, right, and you know the clinical indication when someone has fibercistic breast disease, potentially a family history whether not to do breast MRIs, that's something that's on the table for discussion as well. But I typically will start at forty, at.
00:43:00
Speaker 1: Forty and then younger if you have a family history. And let's talk about vaccines midlife women. What vaccines should we have?
00:43:08
Speaker 4: So typical vaccines, you know ted obviously every ten years, I like to check MMR immune status just because you know, it's very common that it's checked in that peripartum you know period or preconception period. But sometimes immunity WANs and we have had outbreaks, so I check immune status. If they're not immune, I offer boosters hepatitis B. I will check immune status. Hepatitis B can yes with travel blood transfusions, but it can be transmitted sexually, and so I definitely recommend checking that status so that we can booster you if needed. Shingles over fifty, numavacs over sixty five. Unless there are risk factors like established pulmonary disease, diabetes can be a consideration but typically at sixty five RSV vaccine I'm going to recommend as well, and then HPV vaccine that shared decision making after twenty six, twenty six to forty five.
00:44:16
Speaker 1: Yeah, and I think we will never have that data in older women. So if you're a sexually active older woman, older meaning like over forty five, yeah, we're still very young, yeh. You know, review with your provider getting an HPV vaccine. So what are the signs and symptoms that every woman should bring immediately or at some point to their healthcare provider? For me and the gynecology world, is abnormal vaginal bleeding or discharge? What is it for you? What do you want to hear about immediately or you want evaluated and worked up?
00:44:49
Speaker 4: Sure, So I would say headaches, worsening, migraine, things like vision loss, chest pain, in general, symptoms that recur, abdominal pain out of proportion to what you would expect for your cycle. If you no longer are having your cycle and you're having bleeding vaginal bleeding, that as well UTI symptoms, you know, recurring joint pain unprovoked by physical activity, I'd want to know about to those tend to be the.
00:45:20
Speaker 1: Biggies, what about fatigue? Fatigue? Fatigue, Yeah, it's a tough one.
00:45:25
Speaker 3: It can be really so multi factorial.
00:45:30
Speaker 4: However, fatigue in the setting of any of those other symptoms like fatigue, hair loss, weight changes, I'm going to want to definitely know about it. Listening to your body is probably the best. I love that thing that any woman can do, and really really listening to your body because you feel it is important because we get very much caught up into the day to day the grind as I call it. You know, work, family, you know, travel obligations, and we very much are We have a low threshold for bringing symptoms to the table because they can always be explained. Fatigue can always be explained. I mean, chess ban can always be explained by something that we do. But you have to listen to your body and be able to have someone to partner with to discuss these symptoms.
00:46:29
Speaker 1: I love the listening to your body.
00:46:31
Speaker 4: You know.
00:46:31
Speaker 1: I actually found my cancer because I didn't feel right and I knew something was off, and so I actually went on a hunt.
00:46:38
Speaker 3: Wow.
00:46:39
Speaker 1: And so I always ask patients like, how do you feel? You know, if someone says I don't feel just right, you know, that's a very serious thing that you've got to delve into a little.
00:46:48
Speaker 3: It's it's it's very serious.
00:46:50
Speaker 1: Okay, But because I'm taken down the rabbit hole too, it can.
00:46:53
Speaker 4: It can, But I think that what could potentially have We cannot listen to our body if we do not silence the noise around it. And you can't silence the noise around it if you're not pausing to hear were body, and so certain kind of actual things to you know, do In order to do that, you have to pause, meditate, prey, sit in a quiet place. We don't do that anymore because we're running, we're you know, taking care of obligations, or even if we're not necessarily running and taking care of obligations, we're on our phone, we're scrolling on every social platform, we're on the computer. You there is there's such value in just being still and making that a regular exercise. That's the only way you're going to, I think, get into the rhythm of hearing your body.
00:47:59
Speaker 3: So you talk a lot.
00:48:00
Speaker 1: About the partnership with the patient, and which is just beautiful. Actually we've taken that out of modern So how do we help women, How do we counsel women to find somebody that you can partner with longitudinally to help you and guide you through your health journey.
00:48:23
Speaker 4: Yeah, yeah, that is That's a question I asked myself every single day. I mean, I think this, I know, I think that medicine in general, the traditional medicine has become the priority has become checking boxes and not necessarily sitting and looking at the patient and listening to what they're saying. And the unfortunate thing is a lot of that's dictated by you know, insurance companies and whatever you know, health system you may be in. So figuring out how within that those walls to really change the narrative. Oftentimes, in my previous practices, I would just create pauses in the day. You just have to be creative and create pauses in the day which would essentially allow me to have the quality time and listen. I would create phone call follow ups. You know, whatever we didn't discussed during the visit, I'm going to call you and you know, just to allow you to expand on it.
00:49:28
Speaker 3: When patients see.
00:49:30
Speaker 4: That you are willing and able to give the time, they're going to be more amenable to talking. Yeah, And it's that nothing will replace that. Nothing nothing can replace.
00:49:45
Speaker 1: That also highlights the importance right of health when you engage and re engage. Yes, what are some of the exciting advances that you see and prevention medicine or preventive care.
00:50:00
Speaker 4: It's interesting so with you know, with certain platforms wearables, the ability for patients to kind of monitor their own body changes I think has been It's been good. It can be a bit confusing, but you know, like apple watches or rings, things of that nature, you know, it can get you into trouble because you know it'll be you may have a rhythm that's just because the person was jumping up and down and moving and then they're calling you in a panic saying they have a fib That's not necessarily the case, but it really it empowers someone to actually care about their health care. And I think that's one of the benefits of some of the technology that's out the wearables.
00:50:46
Speaker 1: What wearables do you recommend? Do you do you recommend sleep tracking, heart rate monitorings? Even I do like sleep tracking. I think that it can offer a lot of information as far as or or at least trigger additional you know, testing as far as you know, looking at what someone's quartersol level is what their you know, heart rate tends to be things of that nature. So I do like that the whoop I've used and that, you know, I do like the information that that offers. I'm not endorsing anyone, but it can be quite helpful. But it also can be helpful when the patient brings that data to the physician and you look at it together, right, because I learned from it, and you know, it gives me insight into what's going on with them at home. Right, So what do you do for your own health? If you mind? Do you mind sharing? Yeah? What's your exercise regimen? What's your nutrition regimen? Stress mindset regimen?
00:51:50
Speaker 4: I you know, I try to stay even keeled, and you are are so soothing. I like, and now I can face my day after speaking with you. I'm having a therapeutic episode here.
00:52:02
Speaker 1: Actually this has been very beneficial because Jennifer is so soothing and so introspective. So how do you there? How do you manage your home? So I pray a lot. I'm not gonna lie.
00:52:17
Speaker 3: I pray a lot.
00:52:18
Speaker 4: I mean, you know, my family keeps me incredibly grounded.
00:52:24
Speaker 3: You know.
00:52:25
Speaker 4: I try to get quality sleep but I am in the menopause boade for sure, so I engage hormone support, which definitely you know, has helped nutrition wise, I try to I'm a big protein eater.
00:52:44
Speaker 1: How many a day?
00:52:45
Speaker 4: Right, so I'm really bad, but I try to get to sixty at least. It's a challenge because with my schedule, I literally just kind of pick up and go. But meal prep has it's key, it's everything so and it could be fun. You can get creative with it. So I rely on protein shakes and meat.
00:53:09
Speaker 1: Read just good for.
00:53:10
Speaker 3: Creative yeah, yes, yes, yes, so I you know.
00:53:15
Speaker 4: And it's also because you know, to be honest, nutrition, I will feel it when I am not good with nutrition. So it's not because I'm you know, that disciplined. It's because I don't want to feel bad. So that is what you know, That's why I.
00:53:35
Speaker 3: Tend it here to it.
00:53:36
Speaker 4: Physical activity. I love being physically active. My motivation for being physically active is because it keeps me at peace, not because I want to lose this pound or look this way. It literally that's just the added benefit. But it keeps me at peace, keeps me regulated. Those endorphins going helps manage my insulin resistance, so that is crucial. Fortunately, my commute is very physical. I used to do kind of higher level CrossFit, but I had a few injuries, so I had to pull back. The hardest part was accepting pull back. Oh yeah, that's hard. That and not that's very hard. But but I found that resisting the acceptance actually kept me from doing anything. Yeah, so you know, instead of my runs, I do walking. I love weights. I need to do more of them, kettlebells. I just bought a big set of those. So all of those things make you feel so good. And no matter how advanced science gets, no matter how many wearables come out, no matter how many supplements come out, nothing will replace the benefit of physical exercise.
00:54:52
Speaker 1: Everybody knows. I'm a huge advocate of that.
00:54:54
Speaker 4: I mean, you have to talk about your workout after this because I eat those arms.
00:54:59
Speaker 1: I but yeah, it really I mean for a cognitive function, for a mindset, for physicality, for metabolic health, just across the board.
00:55:11
Speaker 4: And if you can't move in the sense of walking, you can use things in your home. You know, lift weights with you know, a jug of water, or if you know you're doing laundry and say your laundry is on another floor. Only carry up the amount that you can carry in your hands. That's at least two to three trips if you have a family.
00:55:33
Speaker 1: Always amazes me because I have my Apple Watch on when I and my Aura ring on. When I do housework and laundry, I get in like ten thousand steps.
00:55:44
Speaker 3: Very invigorating. Yes, yes, as yes.
00:55:47
Speaker 1: It's one or two things that you wish all of our listeners knew, Like what do what knowledge do you want to impart to us? What should we all know other than move right?
00:55:59
Speaker 4: Other than move I would say, I would say, give yourself permission to prioritize yourself and be your own advocate for your health.
00:56:12
Speaker 1: That is so beyond important. If we want to have women advocate for themselves right now in terms of getting the proper care, where should they look any resources that you want to share with us?
00:56:24
Speaker 4: Sure, so there are certain groups Facebook, you know they'll have certain groups and you know women's health societies online, even your local town or you know there are certain township sites and resources that are actually gathering collectively creating social groups. So I would definitely, you know, look online for that as well. And to be honest with you don't. Don't be afraid to start your own social group.
00:57:01
Speaker 1: I love that.
00:57:02
Speaker 4: Don't be afraid to start it. You could like minded people, Yeah, don't and just I mean, and it can just literally start with just having a group of three or four women over meet at a park, meet at a coffee bar, and it can just explode into But you have to start somewhere.
00:57:22
Speaker 3: Yeah, you have to start.
00:57:23
Speaker 1: So be afraid to start your own I love that. I was really moved by this conversation with doctor Jennifer mcguggins hill about being in partnership with your PCP. Ask for the testing that you need to keep your health on track. That means a comprehensive blood panel that includes a really thorough lipid panel including LP, little A and ApoB, checking your CBC to look at your blood cell counts, checking your hemoglob and a NC and your insulin level. Wearables can help here to provide a baseline and to catch any abnormalities. Share that data with your physician and listen to your body. Tell your doctor when things are feeling off, they're not complaints, they're actually information, and sometimes those symptoms are trying to tell you something really important. All patients, but also all practitioners can take something away from this conversation, especially creating space for pauses for listening, engaging and re engaging. Decoding Women's Health is a production of Pushkin Industries and the Atria Health and Research Institute. This episode was produced by Kalalah and Amy Gaines McQuaid. It was edited by Karen Schakerjee mastering by Sarah Bugare. Our executive producer is Alexander Garreton. Our theme song was composed by HANNS. Brown. Concept and creative development by Shavan O'Connor. Special thanks to Vicky Merrick, Alan Tish, David Saltzman, doctor David Dodick, Sarah Nix, Jacob Goldstein, Leah Rose, Jordan McMillan, Morgan Ratner, Owen Miller, Eric Sandler, and Greta Cone. I'm doctor Elizabeth Pointer. Thanks for listening and until next time,
