WEBVTT - Let's Talk About the Aftermath ...with Sara Sidner & Dr. Elizabeth Comen 0:00:02.480 --> 0:00:06.160 This is Let's Be Clear with Shannon Doherty. 0:00:07.760 --> 0:00:10.440 Welcome to Let's Be Clear. My name is Sarah Sidner. 0:00:10.880 --> 0:00:14.480 You probably don't know me unless you're up very early 0:00:14.560 --> 0:00:17.320 and watch CNN from seven am to ten am Eastern, 0:00:17.680 --> 0:00:19.639 where I do a new show with two of my 0:00:19.680 --> 0:00:24.520 buddies during the week. It was during that show that 0:00:24.720 --> 0:00:28.920 I revealed to the audience and to some of my 0:00:29.000 --> 0:00:32.120 distant relatives who did not know yet, that I had 0:00:32.240 --> 0:00:36.560 stage three breast cancer. I did it while choking back tears. 0:00:37.760 --> 0:00:40.080 But it has now been just over a year since 0:00:40.159 --> 0:00:44.920 my diagnosis, and while I was still recovering, I had 0:00:44.960 --> 0:00:49.400 just returned from my double mistectomy. I ended up reading 0:00:49.520 --> 0:00:53.840 this new story and this was the headline, and I'm 0:00:53.880 --> 0:00:58.040 going to read it to you now. Actress Shannon Doherty 0:00:58.560 --> 0:01:02.720 has died after a year battle with breast cancer. She 0:01:02.960 --> 0:01:08.280 was fifty three years old. I choked down those words, 0:01:08.920 --> 0:01:12.960 thinking in my head, how is this possible. She was 0:01:13.800 --> 0:01:18.160 the queen of the nineties. She was a part of 0:01:18.200 --> 0:01:21.200 our lives. Really all of us watched nine O two 0:01:21.240 --> 0:01:24.399 one zero, We watched all of the shows that she 0:01:24.560 --> 0:01:27.920 took part in. She was just sort of around and 0:01:28.040 --> 0:01:30.200 you sort of feel like you know somebody when they 0:01:30.280 --> 0:01:34.680 are on your television set. And I'm only a year 0:01:34.720 --> 0:01:38.039 younger than her. So with all her resources and with 0:01:38.120 --> 0:01:41.039 all her fame, and with all the people that she 0:01:41.120 --> 0:01:46.399 comes across, how is she gone? That really struck me. 0:01:47.360 --> 0:01:49.920 It turns out we both were diagnosed with the same 0:01:49.960 --> 0:01:54.280 type of cancer, so that sent me down a very 0:01:54.320 --> 0:01:59.200 depressing rabbit hole. But it really isn't important who I am. 0:01:59.520 --> 0:02:03.080 It is important that you get the information that you need. 0:02:03.480 --> 0:02:08.120 And we're going to be real, raw and real. There 0:02:08.200 --> 0:02:11.880 might be some cringe worthy things said during this podcast 0:02:12.040 --> 0:02:15.120 because I want you to know what the experience is 0:02:15.160 --> 0:02:18.040 actually like and some of the things that we never 0:02:18.160 --> 0:02:22.600 talk about, including sexual health and the problems that come 0:02:22.639 --> 0:02:27.919 along with cancer treatment. I will be as honest as 0:02:27.919 --> 0:02:34.080 I can, and embarrassingly so, so I hope that you 0:02:34.120 --> 0:02:38.560 will enjoy this because we have one of the most wonderful, 0:02:39.000 --> 0:02:42.880 knowledgeable guest that is with us today who can give 0:02:42.919 --> 0:02:46.919 you a lot of information. She is Harvard trained, She's 0:02:46.960 --> 0:02:51.080 an oncologist. She wrote this incredible book called All in 0:02:51.120 --> 0:02:54.440 Her Head, The Truth and Lies Early medicine taught us 0:02:54.480 --> 0:02:58.720 about women's bodies and why it matters today. She was 0:02:58.760 --> 0:03:04.919 also in a special with Oprah. So welcome and thank 0:03:04.960 --> 0:03:08.280 you for doing this with me. I am not Oprah Winfrey, 0:03:08.560 --> 0:03:10.440 but I am so happy to have you here to 0:03:10.480 --> 0:03:11.520 talk through this with us. 0:03:11.560 --> 0:03:13.880 And I'm honored truly to be here with you. 0:03:14.400 --> 0:03:19.400 Okay, So can we start with your pet Peeve? And 0:03:19.440 --> 0:03:22.720 I just did it when I announced Shannon Doherty had 0:03:22.800 --> 0:03:27.919 died of cancer. I said she lost her battle with cancer. 0:03:28.520 --> 0:03:34.640 Why do you hate it when people say lost her battle? Yeah? 0:03:34.800 --> 0:03:38.480 I mean the word in and itself in that context 0:03:38.600 --> 0:03:41.400 just makes my heart race and honestly my blood boil, 0:03:41.560 --> 0:03:46.840 because there are no winners and losers in cancer, and 0:03:47.000 --> 0:03:50.960 language is so critical to how we experience illness, the 0:03:51.040 --> 0:03:54.080 stories that are told ourselves, that we tell ourselves, and 0:03:54.120 --> 0:03:58.000 when it comes to cancer, nobody wants to lose that battle. 0:03:58.040 --> 0:04:01.240 And I think about all the patients that will interpret 0:04:01.320 --> 0:04:04.280 and have interpreted that is somehow they're not fighting hard enough, 0:04:04.840 --> 0:04:08.360 when in fact they are truly fighting. And so I 0:04:08.360 --> 0:04:11.040 would wish and hope that the media and the lay 0:04:11.040 --> 0:04:15.440 public would remove that metaphor from a cancer diagnosis. In 0:04:15.480 --> 0:04:18.839 cancer treatment, it's also very violent imagery, as in the 0:04:18.920 --> 0:04:20.760 drugs that we're giving and the treatment that we're doing, 0:04:20.839 --> 0:04:23.599 which we're trying to do to ease suffering and to 0:04:24.400 --> 0:04:29.080 have compassionate care, are really these violent weapons, and it 0:04:29.120 --> 0:04:32.719 perpetuates a narrative that I think is really more harmful 0:04:32.720 --> 0:04:33.480 than beneficial. 0:04:34.160 --> 0:04:36.160 That's such a good point, and I do it all 0:04:36.200 --> 0:04:38.920 the time. I'm like, yeah, I'm battling cancer or I'm 0:04:38.960 --> 0:04:43.040 fighting cancer. And it does put you in a place 0:04:43.080 --> 0:04:49.080 where if you don't win, then you didn't try hard enough. Yeah, 0:04:49.120 --> 0:04:51.960 And what a thing to put on a cancer patient. 0:04:52.120 --> 0:04:54.039 It's like, course, you didn't fight hard enough. I guess 0:04:54.040 --> 0:04:57.880 that's why somebody died. And it's not fair nor true. 0:04:58.000 --> 0:04:58.560 It's not true. 0:04:58.560 --> 0:05:01.919 And it also lends itself to a tremendous amount of 0:05:01.920 --> 0:05:03.880 guilt that I see day in and day out, where 0:05:03.880 --> 0:05:05.960 people will say I was so stressed out that's why 0:05:05.960 --> 0:05:08.240 I got cancer, or I didn't do X, Y and Z, 0:05:08.480 --> 0:05:12.120 or I'm not an e rate or I'm not visualizing 0:05:12.200 --> 0:05:14.760 it away. I would love love to be out of 0:05:14.760 --> 0:05:17.960 a job if we could pray, visualize, and eat our 0:05:18.000 --> 0:05:19.880 way out of cancer. It's not to say that those 0:05:19.920 --> 0:05:22.839 things are not important for how we experience disease and 0:05:22.880 --> 0:05:24.760 a whole host of other things that we can get into, 0:05:25.040 --> 0:05:28.880 but they're not unilaterally causing or curing cancer. And the 0:05:29.080 --> 0:05:31.840 guilt that it saddles patients with. I would love to 0:05:32.560 --> 0:05:35.320 unburden them from that. And what goes along with that 0:05:35.440 --> 0:05:37.239 is this language of battle and fighting. 0:05:38.560 --> 0:05:43.200 Why do we, as women, and not all women, but many, 0:05:43.240 --> 0:05:47.279 many women, because you see them coming in a daily basis, 0:05:48.240 --> 0:05:53.360 Why do we have this need to please our doctors? 0:05:53.920 --> 0:05:57.000 Why do we have such a hard time advocating for ourselves. 0:05:57.360 --> 0:05:59.400 Oh, I think it's so complicated, but I think so 0:05:59.480 --> 0:06:01.960 much about the experience of medicine and what happens in 0:06:02.000 --> 0:06:05.880 the doctor patient exam room reflects history and culture and 0:06:05.960 --> 0:06:08.520 society and in general, you have a lot of women 0:06:08.640 --> 0:06:12.120 that have inherited this sense of needing to please and 0:06:12.200 --> 0:06:15.719 take care of others. And when that is overlaid with 0:06:15.760 --> 0:06:19.200 the power dynamic of the doctor in the exam room, 0:06:19.440 --> 0:06:21.880 you don't want to feel like you're bothering them, burdening them, 0:06:22.960 --> 0:06:25.839 you know, hysterical with them, and it becomes a lot 0:06:25.920 --> 0:06:28.920 harder to advocate for yourself in that context. And I 0:06:29.440 --> 0:06:32.520 have been in that situation myself many many times. I 0:06:32.520 --> 0:06:34.679 think what makes it even harder. And what I've seen 0:06:35.000 --> 0:06:38.560 is when you have strong, powerful women who are on 0:06:38.680 --> 0:06:42.600 TV or her lawyers are advocating for other people or 0:06:42.800 --> 0:06:45.080 who are you know, mothers, whatever it may be, they're 0:06:45.120 --> 0:06:47.599 taking care of everybody else and advocating for everybody else. 0:06:47.640 --> 0:06:50.039 And so when they know in their soul I'm not 0:06:50.160 --> 0:06:52.680 following my intuition or I'm not asking the questions I 0:06:52.720 --> 0:06:56.880 need to, it feels very devaluing of yourself. And you 0:06:56.880 --> 0:06:58.640 don't kind of know how to crawl out of that 0:06:58.920 --> 0:07:01.520 because you think I'm supposed to be this strong person 0:07:01.960 --> 0:07:04.560 and yet I could not ask this basic question that 0:07:04.600 --> 0:07:06.719 I've always wanted to know about myself. 0:07:07.560 --> 0:07:09.160 I want to ask you about some of the things 0:07:09.160 --> 0:07:11.360 that I hear all the time, and you sort of 0:07:11.400 --> 0:07:17.880 alluded to it. Probably once a week I hear someone 0:07:17.920 --> 0:07:22.239 say to me, you know, sugar feeds cancer, you really 0:07:22.240 --> 0:07:25.040 shouldn't eat that. Is that true? 0:07:25.840 --> 0:07:28.800 So there's a lot to unpact there. Sugar is not 0:07:28.960 --> 0:07:32.320 like you remember going into the cancer and feeding it right. 0:07:32.400 --> 0:07:34.840 It's not this like one way train with that eminem 0:07:34.880 --> 0:07:37.200 that you put in your mouth. And that also puts 0:07:37.200 --> 0:07:40.680 a lot of blame on the patient. That being said, 0:07:41.360 --> 0:07:44.360 Excessive sugar can lead to excessive weight, it can change 0:07:44.360 --> 0:07:47.440 your metabolic function, and we know that that is not 0:07:47.520 --> 0:07:50.800 good overall. As but being what's called a host to cancer. 0:07:50.920 --> 0:07:53.120 So cancer cells are living in your body, and we 0:07:53.160 --> 0:07:55.760 want to make them inhospitable. We want to make your 0:07:55.800 --> 0:07:59.280 body and the environment around it less hospitable to cancer. 0:07:59.360 --> 0:08:01.760 So I think about you know, if I have a 0:08:01.840 --> 0:08:04.720 rose seed and I'm trying to grow it in Antarctica, 0:08:04.760 --> 0:08:06.480 it's not going to grow as well because it's frigid, 0:08:06.520 --> 0:08:09.040 it's cold, it's snowy. If I put it in Florida 0:08:09.120 --> 0:08:11.320 with sunshine and great soil, it's going to grow more. 0:08:11.680 --> 0:08:14.840 So to some degree, the habitat that the cancer can 0:08:14.920 --> 0:08:18.160 live in matters. So trying to maintain a healthy diet, 0:08:18.520 --> 0:08:21.840 trying to exercise, is trying to have an overall healthy 0:08:21.960 --> 0:08:25.080 body is important. But it's not some runaway train. If 0:08:25.120 --> 0:08:26.960 you have a bite of cake or you have a cookie. 0:08:27.400 --> 0:08:29.000 We just want to do everything in moderation. 0:08:29.440 --> 0:08:35.480 That is really interesting that you say that, because I 0:08:35.520 --> 0:08:40.400 asked a couple of different oncologists. I was in one 0:08:40.400 --> 0:08:44.360 place and then I came to New York and got 0:08:44.360 --> 0:08:46.920 my treatment here. Because this is where I was working, 0:08:46.920 --> 0:08:49.040 and I wanted to try to work throughout this. I 0:08:49.040 --> 0:08:50.760 don't know that was smart or not, but I did, 0:08:52.480 --> 0:08:56.360 and I asked, is there a cancer diet? Is there 0:08:56.440 --> 0:09:00.840 something I should be doing or changing and that actually 0:09:01.280 --> 0:09:06.280 helps to either shrink cancer or to stop cancer? And 0:09:06.360 --> 0:09:10.560 I was told no twice except when it came to 0:09:10.640 --> 0:09:18.560 drinking alcohol. Three oncologists said, do not drink alcohol. I'm confused, 0:09:19.040 --> 0:09:21.679 is there a cancer diet or not? If there's not 0:09:21.720 --> 0:09:23.640 supposed to drink alcohol, it seems to me that there's 0:09:23.679 --> 0:09:26.240 got to be something to do with nutrition. It's a great, 0:09:26.280 --> 0:09:26.920 great question. 0:09:27.040 --> 0:09:29.000 I'll tell you what I think we know, and then 0:09:29.040 --> 0:09:31.880 we'll hit the alcohol point as well. So we do 0:09:32.040 --> 0:09:35.160 know that maintaining more of a plant forward diet with 0:09:35.320 --> 0:09:37.960 less processed foods. And what is processed foods? I mean, 0:09:38.160 --> 0:09:40.360 there are all these quizzes online about is it process 0:09:40.440 --> 0:09:44.320 is it not processed? In general, if it's got artificial 0:09:44.360 --> 0:09:46.200 dies in it, so it's more likely to be processed. 0:09:46.240 --> 0:09:49.160 If you can't pronounce a laundry list of ingredients there, 0:09:49.160 --> 0:09:51.040 it's more likely to be processed than nuts. 0:09:51.480 --> 0:09:52.440 Not. You want to think. 0:09:52.280 --> 0:09:58.280 About whole foods, whole grains, real foods and limiting especially 0:09:58.360 --> 0:10:03.120 processed red meats, process deli meats, the process salami, the pepperoni, 0:10:03.200 --> 0:10:06.679 things like that, and processed red meats, and doing your 0:10:06.720 --> 0:10:09.360 best to have again a plant four diet that has 0:10:09.360 --> 0:10:12.200 fruits and vegetables in it, and a colorful diet. That's 0:10:12.240 --> 0:10:14.760 the first thing that we know is really important, and 0:10:14.840 --> 0:10:18.120 again trying to avoid the ultra processed foods. The other 0:10:18.200 --> 0:10:21.280 piece that we know that can be helpful is alcohol. 0:10:21.720 --> 0:10:25.000 So in this country especially, we use alcohol to celebrate, 0:10:25.040 --> 0:10:27.360 we use alcohol to numb feelings. 0:10:27.360 --> 0:10:29.120 There's also from the good to the bad. 0:10:29.280 --> 0:10:33.600 Alcohol runs the spectrum of when you see it infiltrating 0:10:33.640 --> 0:10:35.480 as a main character in someone's life. 0:10:35.679 --> 0:10:37.640 My mother is British, so we want to talk about 0:10:37.640 --> 0:10:40.079 alcohol being a main character, like the pub is, like 0:10:40.120 --> 0:10:44.440 where my grandfather lived. Yes, that was the social event. 0:10:44.520 --> 0:10:48.560 So alcohol is just part of the way we live 0:10:48.600 --> 0:10:49.400 and celebrate and. 0:10:50.280 --> 0:10:54.199 Talk exactly exactly, But it's a no for me. It's well, 0:10:54.320 --> 0:10:56.520 let's think about it. So it's we know that it's 0:10:56.559 --> 0:10:59.800 a carcinogen. We know that there's an association the more 0:10:59.800 --> 0:11:02.240 you drink, the higher your risk. However, this is not 0:11:02.360 --> 0:11:06.800 the same risk as having a genetic mutation that leads to, 0:11:06.840 --> 0:11:09.120 you know, an eighty five percent increase risk of cancer 0:11:09.160 --> 0:11:11.280 over your lifetime. But people ask me all the time, 0:11:11.360 --> 0:11:13.840 what can I do that's within my control. You can't 0:11:13.920 --> 0:11:16.720 control what your family history is. You can control what 0:11:16.840 --> 0:11:19.200 you put in your mouth and how you exercise and 0:11:19.240 --> 0:11:22.400 what you drink. And so we do know that there 0:11:22.440 --> 0:11:25.240 is an increase association not only with breast cancer, but 0:11:25.320 --> 0:11:29.200 other types of cancers from alcohol consumption because it is 0:11:29.200 --> 0:11:32.040 a direct carcinogen. So for my patients that ask me 0:11:32.400 --> 0:11:35.320 if they can limit it to you know, limited celebrations 0:11:35.400 --> 0:11:37.560 or think about why are you reaching for that glass? 0:11:37.600 --> 0:11:39.400 Is there something else we could do in its place? 0:11:39.720 --> 0:11:42.400 And with respect to the social component of it, I 0:11:42.480 --> 0:11:44.679 like to invite my patients to think about talking to 0:11:44.720 --> 0:11:47.360 their family members, talking to their friends instead of saying 0:11:47.360 --> 0:11:49.319 you had a bad day, have a beer, or we're 0:11:49.320 --> 0:11:51.480 going to take a toast to you know, with this 0:11:51.600 --> 0:11:53.520 glass of wine. Is there something else we could do 0:11:53.840 --> 0:11:56.079 together as a community. 0:11:56.360 --> 0:12:01.480 That's really poignant because it's such an easy thing. What 0:12:01.520 --> 0:12:04.080 do people always say when you first meet them, Like 0:12:04.320 --> 0:12:07.760 with girlfriends, it's like, hey, we should grab a drink, yeah, right, 0:12:07.880 --> 0:12:10.120 and so I have changed that to, hey, let's go 0:12:10.120 --> 0:12:13.040 grab coffee even if it's four o'clock, you know what 0:12:13.080 --> 0:12:17.480 I mean, just something else that's still sort of social. 0:12:17.600 --> 0:12:19.280 But I want to grab a cob of coffee with 0:12:19.320 --> 0:12:20.760 you girl. You know you even grab a cop of 0:12:20.800 --> 0:12:21.959 coffee any time with me, and. 0:12:21.920 --> 0:12:23.160 Then we can go with for a walk at the 0:12:23.200 --> 0:12:25.560 same time and really knock them down. 0:12:26.040 --> 0:12:29.520 Yeah, but that is one of the things. It's like 0:12:29.559 --> 0:12:31.000 you don't want to say no, and then you get 0:12:31.000 --> 0:12:34.600 the pressure to drink. I have never been. This is 0:12:34.640 --> 0:12:38.320 a miracle because my family on both sides, loves a 0:12:38.360 --> 0:12:42.640 good glass of whatever, usually hard stuff. But I've never 0:12:42.640 --> 0:12:44.160 been a drinker because I just don't like the taste. 0:12:44.160 --> 0:12:47.600 And I finally realized in my thirties that I was 0:12:47.640 --> 0:12:50.680 just drinking socially just because everybody else was and I 0:12:50.679 --> 0:12:53.560 wanted to fit in. And then I grew up and said, like, 0:12:53.640 --> 0:12:56.320 I don't even like this. So I get, for example, 0:12:56.360 --> 0:13:01.520 I'm like seltzer with some cranberry juice and like a 0:13:01.559 --> 0:13:04.320 pretty flower or throw something in there, like a twist 0:13:04.520 --> 0:13:06.760 that makes it seem like I'm drinking, so I don't 0:13:06.760 --> 0:13:08.480 have to hear the amoryam or yam or why aren't 0:13:08.480 --> 0:13:11.000 you drinking? What are you doing? Yeah? Perfect? Now I'm like, 0:13:11.360 --> 0:13:13.280 I have cancer, so I can't really drink that and 0:13:13.280 --> 0:13:16.040 people shut the hell out. That tends to help when 0:13:16.040 --> 0:13:19.599 they're like, oh, okay, yeah, yeah, but you don't have 0:13:19.640 --> 0:13:21.440 to use that excuse. You can just make it look 0:13:21.440 --> 0:13:23.840 like you're drinking and you're just having a Seltzer water 0:13:23.880 --> 0:13:26.679 with you know, lemon in it. I think that's great. 0:13:27.320 --> 0:13:29.679 It tends to work for me. Everybody has their way 0:13:29.720 --> 0:13:32.920 of doing things now too, because you touched on this 0:13:33.080 --> 0:13:37.160 as you always do, because you're the expert being overweight. 0:13:38.120 --> 0:13:42.520 Does being overweight or being obese make you more susceptible 0:13:42.640 --> 0:13:44.760 to cancer? It does, It does. 0:13:45.320 --> 0:13:50.800 So we know that obesity, like tobacco consumption or alcohol consumption, 0:13:50.960 --> 0:13:55.120 is one modifiable risk factor for cancer, but we know 0:13:55.200 --> 0:13:58.520 that it can also be a tremendous battle to fight right, 0:13:58.640 --> 0:14:01.760 and so it's something that we really want patients to 0:14:01.840 --> 0:14:05.080 talk openly with their doctors about about what are their options, 0:14:05.080 --> 0:14:07.440 what are their lifestyle options, what are the medication options 0:14:07.480 --> 0:14:09.400 that they might be able to have so that they 0:14:09.440 --> 0:14:12.400 can start to decrease their risk from that access weight 0:14:12.520 --> 0:14:14.040 and this is my fault. 0:14:13.800 --> 0:14:16.199 Like that's the first thing that stuff jump into my head. 0:14:16.200 --> 0:14:18.400 And there is so much shame around that that I 0:14:18.400 --> 0:14:21.600 think we have to really dismantle and compassionately give patients 0:14:21.640 --> 0:14:22.280 their options. 0:14:35.080 --> 0:14:37.960 Speaking of shame, this is a hard one for me 0:14:38.040 --> 0:14:41.880 to discuss. Uh. And this might be a little cringe worthy, guys, 0:14:41.880 --> 0:14:45.480 So just you know, if you're listening with your younger kids, 0:14:45.560 --> 0:14:49.960 or you're listening with a daughter or a son, you 0:14:50.040 --> 0:14:51.720 may not want to go down this road. But I'm 0:14:51.720 --> 0:14:54.640 going to talk about sex. Where the hell did my 0:14:54.680 --> 0:14:57.320 libido go? Love that you asked that? 0:14:57.440 --> 0:14:59.200 Can we make sex less cringe worthy? 0:14:59.280 --> 0:15:03.320 It's so be fine, I know, but talking to you're 0:15:03.360 --> 0:15:08.960 not a stranger, but you all are like, yeah, literally 0:15:09.320 --> 0:15:13.880 just vanished. Yeah, and I'm married and it's a problem 0:15:13.960 --> 0:15:15.760 and we can pretend that it is and it's like, oh, 0:15:15.840 --> 0:15:18.160 you know, it's fine, we'll work it out. It's like 0:15:19.160 --> 0:15:21.720 you have to talk about it and it's so uncomfortable. 0:15:21.760 --> 0:15:24.080 So what happened? Where does it go when you're in 0:15:24.120 --> 0:15:24.880 cancer treatment? 0:15:25.160 --> 0:15:28.000 I think it's so multifactorial. And again I champion you, 0:15:28.240 --> 0:15:32.040 celebrate you for going there and really authentically talking and 0:15:32.120 --> 0:15:34.640 vulnerably talking about such an important topic and one that 0:15:34.680 --> 0:15:36.720 I bang my head against the wall all the time 0:15:37.120 --> 0:15:39.400 so that we can really honor this, particularly for women. 0:15:39.760 --> 0:15:42.560 We know as a society we are far more likely 0:15:42.600 --> 0:15:45.200 to address sexual needs of men than we are about women, 0:15:45.240 --> 0:15:48.040 and it is a huge bleeping problem. I know we're 0:15:48.040 --> 0:15:51.200 on a recorded line right now, so I can't insert 0:15:51.200 --> 0:15:53.840 all the profanity, but I really I really mean all 0:15:53.840 --> 0:15:55.720 of it, and it's a real that in and of 0:15:55.760 --> 0:15:58.840 itself is a shame. Historically and to the present, we 0:15:58.880 --> 0:16:01.280 are two times more likely to ask men about sexual 0:16:01.280 --> 0:16:03.880 side effects from cancer targeted therapies than we are women. 0:16:04.200 --> 0:16:06.720 And I see this shameplay out day in and day out. 0:16:07.040 --> 0:16:09.800 So when it comes to cancer and breast cancer specifically 0:16:09.800 --> 0:16:12.400 in libido, lots of different things. First of all, the 0:16:12.520 --> 0:16:16.760 stress and trauma of going through a cancer diagnosis is huge. 0:16:16.920 --> 0:16:17.960 That's all you can think about all. 0:16:18.040 --> 0:16:21.560 It's all yes, And our sexual beings and our sexual 0:16:21.600 --> 0:16:24.400 self is so related to how we feel in our 0:16:24.440 --> 0:16:28.440 bodies physically, how we approach things mentally, the ways that 0:16:28.480 --> 0:16:31.480 we access joy, and the things that might inspire us 0:16:31.520 --> 0:16:35.200 throughout the day, especially if we're thinking about a cancer 0:16:35.240 --> 0:16:38.240 diagnosis or cancer treatment, or even just scheduling treatment can 0:16:38.280 --> 0:16:41.120 be exhausting and overwhelming for patients. And then there's the 0:16:41.200 --> 0:16:44.400 biological and physical issues that can go on from cancer treatment, 0:16:44.440 --> 0:16:48.320 and particularly with breast cancer treatment, it can affect hormone levels, 0:16:49.200 --> 0:16:49.800 which can. 0:16:49.680 --> 0:16:50.640 We about to talk about that. 0:16:50.800 --> 0:16:52.640 Let's do it. You want me to just bring it, 0:16:52.720 --> 0:16:54.640 I mean, and we can just go there. But you know, 0:16:55.200 --> 0:16:58.760 particularly with intercourse women, it can feel like I have 0:16:58.800 --> 0:17:00.280 heard so many patients say. 0:17:00.040 --> 0:17:01.360 It's painful, painful. 0:17:01.400 --> 0:17:04.000 They tell me it feels like having knives, yes, right, 0:17:04.080 --> 0:17:07.480 like shards of glass inside your vagina. And we should 0:17:07.480 --> 0:17:09.560 be able to use that language and talk about it 0:17:09.880 --> 0:17:11.600 and de shame it and figure out what we're going 0:17:11.640 --> 0:17:15.520 to do about it. So for breast cancer patients, there 0:17:15.520 --> 0:17:18.720 are lots of things that we can do, including treatments 0:17:18.720 --> 0:17:21.600 that we give directly locally that can improve the hormonal 0:17:21.640 --> 0:17:24.880 function of that area. And we have to not only 0:17:24.960 --> 0:17:27.679 bring more research into this, but more clinical expertise. 0:17:27.960 --> 0:17:29.720 I think that, Okay, you just said something I hadn't heard, 0:17:29.720 --> 0:17:31.480 so I need to yeah, because you know, I know 0:17:31.520 --> 0:17:33.600 down rabbit holes, and you know, I'm one of those 0:17:33.600 --> 0:17:36.359 googling people, which I was warned not to, and you 0:17:36.480 --> 0:17:38.920 can't stop me because it literally is part of my job. 0:17:39.000 --> 0:17:41.360 So I can't help it. But you just said there 0:17:41.400 --> 0:17:47.159 are things that you can use, Yes, estrogen even if 0:17:47.200 --> 0:17:48.480 you have an estrogen. 0:17:48.160 --> 0:17:50.760 Recept Yes, yes, so if you have an estrogen receptor 0:17:50.760 --> 0:17:51.800 positive breast cancer. 0:17:51.880 --> 0:17:54.240 Okay, so we're blowing my mind right out. 0:17:54.480 --> 0:17:57.440 Yes, yes, so even if you have a cancer that 0:17:57.480 --> 0:18:01.800 we're trying to block estrogen with throughout your whole body, right, 0:18:01.880 --> 0:18:05.399 you can use intravaginal forms of estrogen that are not 0:18:05.920 --> 0:18:09.160 systemically absorbed in any appreciable way that we know from 0:18:09.200 --> 0:18:11.600 research is not going to increase your risk of breast cancer, 0:18:11.880 --> 0:18:16.199 but can locally change the tissue and make that what 0:18:16.320 --> 0:18:17.399 it more used to be. 0:18:17.600 --> 0:18:19.440 Like, right, how come I'm just hearing this right now? 0:18:19.440 --> 0:18:22.360 I'm a year. Get in there, girl, I'm a year 0:18:22.400 --> 0:18:24.800 in treatment. Yeah, how come I'm just hearing this? You 0:18:24.840 --> 0:18:26.560 know why? Because I don't bring it up to my 0:18:26.600 --> 0:18:29.680 doctor either. I don't. Now, you can just play the recording. 0:18:31.680 --> 0:18:33.840 I don't want to talk about it. I especially don't 0:18:33.920 --> 0:18:36.639 want to talk I am a grown ass woman and 0:18:36.720 --> 0:18:38.880 I don't want to talk about this with a male 0:18:38.920 --> 0:18:41.120 on cologist. I don't I don't even want to talk 0:18:41.119 --> 0:18:44.680 about it with the female colleges to be perfectly like honest, 0:18:44.760 --> 0:18:49.960 like it gives me all kinds of nervous energy, Like 0:18:50.160 --> 0:18:51.159 even right now. 0:18:51.080 --> 0:18:53.160 Yeah, well, I wish I could come give you a hug, 0:18:53.160 --> 0:18:55.399 but I'm not going to crawl over the microphone. But 0:18:55.640 --> 0:18:58.720 know that every woman that I speak to in some 0:18:58.800 --> 0:19:02.280 measure has struggled with this, particularly going through a cancer diagnosis, 0:19:02.560 --> 0:19:04.440 whether it's something that they want to be doing more 0:19:04.440 --> 0:19:07.800 of or they're afraid of, or it's painful, and it's complex. 0:19:07.960 --> 0:19:10.280 And part of the issue is it shouldn't just be 0:19:10.320 --> 0:19:13.040 for the oncologists. We should have sex therapists that work 0:19:13.040 --> 0:19:17.160 at hospitals. We should have gynecologists that are particularly aware 0:19:17.200 --> 0:19:20.520 of these issues how they relate to cancer patients. Pelvic 0:19:20.560 --> 0:19:24.880 floor physical therapy can be hugely helpful for patients, and 0:19:25.080 --> 0:19:28.040 you know, a lot of hospitals don't have this integrated 0:19:28.040 --> 0:19:30.280 into their care teams, and we really need to push 0:19:30.280 --> 0:19:32.120 for that and make that more a part of our 0:19:32.320 --> 0:19:35.200 society and cultural narrative, so that just like we ask 0:19:35.280 --> 0:19:39.480 about chess pain or exercise tolerance, we ask patients about 0:19:39.520 --> 0:19:42.600 their sexual function and what they want for themselves. 0:19:43.080 --> 0:19:47.840 It's really trying to help the whole body. And I 0:19:47.920 --> 0:19:50.960 know you know where I am right now. That is 0:19:51.000 --> 0:19:53.600 the mentality is like, we are not just treating you 0:19:53.720 --> 0:19:56.440 as a cancer patient. We are treating you as a 0:19:56.520 --> 0:19:58.879 human being. So we want to look at the whole thing. 0:19:58.920 --> 0:20:03.600 And to be fair a nerve, a female nurse asked me, like, 0:20:03.600 --> 0:20:07.080 are you dryness? And I in my in my head, 0:20:07.119 --> 0:20:09.600 I was like, it feels like knives when I'm having sex. 0:20:09.680 --> 0:20:14.240 And honestly, I worried about my marriage, even though my 0:20:14.320 --> 0:20:21.480 husband has been unbelievable, like unbelievably strong and unbelievably supportive. 0:20:21.800 --> 0:20:23.680 And it's like, look at this hurts. We're not doing 0:20:23.760 --> 0:20:27.320 we will just figure something out. And I feel so guilty, 0:20:28.280 --> 0:20:31.280 Like I feel so terrible because I know it's not sustainable. 0:20:32.200 --> 0:20:34.520 And so to hear from you that there's something that 0:20:34.560 --> 0:20:36.840 I can do about it that's different than okay, the 0:20:36.880 --> 0:20:40.080 cream and to try this and the it's a revelation 0:20:40.200 --> 0:20:41.399 to me and I think it will be to a 0:20:41.440 --> 0:20:46.080 lot of women. Yes, we should mention that hormone receptor 0:20:46.320 --> 0:20:51.040 HR two HR hormone receptor positive positive and then her 0:20:51.200 --> 0:20:55.640 too negative is the most common type of cancer, breast cancers. 0:20:55.680 --> 0:20:58.159 When you hear that, I mean that is you have 0:20:58.240 --> 0:21:00.639 to strip yourself of hormones because it feeds off basically 0:21:00.680 --> 0:21:02.560 the hormones. Is that kind of what the cancer is 0:21:02.720 --> 0:21:03.120 right to. 0:21:03.080 --> 0:21:05.720 Some degree, and especially now if you look at social media, 0:21:05.760 --> 0:21:08.560 everyone's talking about menopause and giving everyone hormone yes and 0:21:08.560 --> 0:21:11.480 giving everyone hormone replacement therapy. But we don't have that 0:21:11.600 --> 0:21:14.360 knowledge about what we can really do for patients who 0:21:14.440 --> 0:21:17.639 are going through or have survived breast cancer. That is 0:21:17.640 --> 0:21:20.439 a huge unmet need in terms of breast cancer research. 0:21:20.760 --> 0:21:23.199 Thinking about for patients who've had breast cancer, can we 0:21:23.240 --> 0:21:26.360