WEBVTT - Hormones and Women’s Health with Gynecologic Expert Dr. Elizabeth Poynor

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<v Speaker 1>Earlier this season, I spoke with several experts about cosmetic

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<v Speaker 1>dermatology and the science of skincare. The response was terrific

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<v Speaker 1>and thank you very much. Today we're going to continue

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<v Speaker 1>to explore medical topics, discussing the latest research, innovations and

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<v Speaker 1>health recommendations. Today I am at Newsstand Studios right in

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<v Speaker 1>Rockefeller Center speaking with doctor Elizabeth Poynter, a gynecologic oncologist,

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<v Speaker 1>an advanced pelvic surgeon, and an expert in midlife women's health.

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<v Speaker 1>I've known doctor Poynter for several years and I am

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<v Speaker 1>so impressed by her depth of knowledge about women's health.

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<v Speaker 1>And just to clarify the situation, she has also been

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<v Speaker 1>my gynecologist for several years and I have been extremely

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<v Speaker 1>happy with her treatment and with her consultations. So many

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<v Speaker 1>are very hesitant to talk about menopause. Many doctors, many

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<v Speaker 1>women are hesitanted to talk about a very natural occurrence

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<v Speaker 1>in every woman's life. But I firmly believe it's important

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<v Speaker 1>to learn as much as possible and to understand how

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<v Speaker 1>the changes associated with menopause can affect physical, emotional, mental,

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<v Speaker 1>and social well being. Doctor Pointer, welcome to our podcast.

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<v Speaker 2>Thank you so much for having me today and allowing

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<v Speaker 2>me to talk about to speak with you about.

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<v Speaker 3>One of my favorite subjects, women's health.

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<v Speaker 1>Well, it's so much more than about women's ability to reproduce. Elizabeth,

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<v Speaker 1>I've heard you say that we need to go beyond

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<v Speaker 1>bikini medicine. Can you tell me what you mean by that?

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<v Speaker 2>So women have distinct physiologies from men, largely dictated by

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<v Speaker 2>fluctuating hormone levels throughout the month and throughout our lifespans.

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<v Speaker 2>So we know, and we've known for quite some time

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<v Speaker 2>that women are not small men. However, there hasn't been

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<v Speaker 2>a lot of work devoted to this or a lot

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<v Speaker 2>of research relating to this, And now we're just at

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<v Speaker 2>a pivotal moment where we're beginning to realize the importance

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<v Speaker 2>of specific female physiology and it needs to be studied

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<v Speaker 2>and entreated and looked at very differently through a different lens,

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<v Speaker 2>a hormonal lens.

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<v Speaker 1>And you, as an expert, know a lot more than

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<v Speaker 1>most of us, because for the record, I've been on

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<v Speaker 1>hormone replacement since I was like forty years old. That's great,

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<v Speaker 1>and you want to know something, I think it is great.

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<v Speaker 1>I think it has kept me more vital, more healthy,

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<v Speaker 1>more my bones stronger. If that's true, I'm not sure

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<v Speaker 1>if that's just genetics or if it really has been

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<v Speaker 1>helped by my hormone replacement.

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<v Speaker 2>Definitely for women, when hormone replacement, usually consisting of estrogen

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<v Speaker 2>or estrogen plus progesterone, started within a few years of

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<v Speaker 2>menopause or in that perimenopausal transition or before the age

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<v Speaker 2>of sixty, you're really going to get great benefits from it.

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<v Speaker 2>You're going to get cardiac benefits, cardiac protection, bone health protection,

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<v Speaker 2>of course, maybe even brain protection.

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<v Speaker 1>That data I certainly hope. Yes.

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<v Speaker 2>So it's great that you started early and had physicians

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<v Speaker 2>who were engaged and who actually did that foil years.

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<v Speaker 1>It was because I had a lower abdominal hysterectomy after

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<v Speaker 1>the birth of my daughter, I developed fibroids or something

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<v Speaker 1>like that. I don't know, I can't you know. That

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<v Speaker 1>was a long time ago, and the doctor said, oh,

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<v Speaker 1>it'd be best if you just had this procedure and

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<v Speaker 1>then but he started me immediately on hormone replacement. It

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<v Speaker 1>was primarily progesterone and a little bit of justeosterone. I think, so.

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<v Speaker 2>Before the Women's Health Initiative study that was very standard.

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<v Speaker 2>Kind of the advantage of being an older physician is

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<v Speaker 2>you get to see the history of medicine and the

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<v Speaker 2>history of trajectories and how we treat people. And when

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<v Speaker 2>I first started in surgical oncology, when we would remove

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<v Speaker 2>ovary's or do a hysterectomy with ovaries, we would always

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<v Speaker 2>recommend hormone support to protect the heart. The Women's Health

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<v Speaker 2>Initiative Study was published and came out in two thousand

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<v Speaker 2>and two and really took that off the table for

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<v Speaker 2>a lot of people, and a lot of doctors then

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<v Speaker 2>became very scared to provide hormone support for their patients

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<v Speaker 2>before well the study was the interpretations of the study

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<v Speaker 2>were prematurely released, right.

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<v Speaker 3>We looked at the Women's.

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<v Speaker 2>Health Initiative Study included one hundred and fifty thousand women

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<v Speaker 2>who were as young as in their forties and as

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<v Speaker 2>old as seventy nine, and they were randomized to either

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<v Speaker 2>be on hormone support or no hormone support. And what

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<v Speaker 2>we found is the risk of cardiac disease and breast

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<v Speaker 2>cancer was higher. But remember we were starting women far

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<v Speaker 2>after the transition of menopause. These were women who were

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<v Speaker 2>in their sixties and seventies, who were more than twenty

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<v Speaker 2>years for some of them probably after menopause. But when

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<v Speaker 2>we did a subset analysis, meaning we took and we

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<v Speaker 2>looked at specific populations or groups of women within that study,

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<v Speaker 2>we found that if hormones were started early in that

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<v Speaker 2>perimenopausal or menopausal transition, that you actually did gain significant

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<v Speaker 2>cardiac benefit from paramant support and decreased our death from

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<v Speaker 2>all causes actually other than breast cancer, which was slightly

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<v Speaker 2>elevated in this study.

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<v Speaker 1>And not all surveys are the surveys that we need.

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<v Speaker 2>We need to interpret studies the appropriate way just because

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<v Speaker 2>something is published and we need to look at how

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<v Speaker 2>to interpret it, and we have to be intelligent about

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<v Speaker 2>how we interpret it.

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<v Speaker 1>Now I'm looking I had a very beautiful, slender, chic,

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<v Speaker 1>short skirted, long leggage, high heel wearing Guya colleges.

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<v Speaker 3>Kay, I'm coming back here more often.

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<v Speaker 1>When I first met doctor Porter, I thought she was

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<v Speaker 1>maybe the office assistant on a summer break from college

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<v Speaker 1>or but here here I am sitting next to a

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<v Speaker 1>very beautiful female doctor with long black hair. How do

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<v Speaker 1>you keep in shape like this with your horobably difficult schedule.

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<v Speaker 2>Well, I practiced what I counsel my patients. I started

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<v Speaker 2>on hormones when I was forty three. I had some

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<v Speaker 2>new mood issues actually around the age of forty three,

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<v Speaker 2>and I was doing very large surgical oncology cases and

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<v Speaker 2>kind of hand ringing a little bit and developed some anxiety.

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<v Speaker 1>Was your son born then?

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<v Speaker 2>Note he was born. He was about a year or

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<v Speaker 2>two after he was born. And it was my mom

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<v Speaker 2>who said, oh, I think it might be your estrogen.

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<v Speaker 2>And so I actually started on hormone support due to

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<v Speaker 2>some anxiety, which was I'm now in retrospect, was definitely

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<v Speaker 2>the perimenopausal transition. And this is before anybody really reconnized

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<v Speaker 2>that anxiety or depression was actually linked to perimenopause or

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<v Speaker 2>menopausal transitions. So I started early on hormone support, and

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<v Speaker 2>I think it's kept my metabolism good. And I practice

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<v Speaker 2>what I speak about in terms of nutrition, exercise, lifestyle,

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<v Speaker 2>healthy sleep, good outlook, all those things that helped to

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<v Speaker 2>keep us young. So I try my hardest.

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<v Speaker 1>There are men who will say, oh, she's in a

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<v Speaker 1>bad mood today, she's in menopause. Probably men are telling

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<v Speaker 1>me this and I mean, what do they know about menopause?

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<v Speaker 2>Well, we need to educate them more. And I think

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<v Speaker 2>you're aware. My husband is a breast surgeon, and so

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<v Speaker 2>when I was starting on hormones, my husband is very

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<v Speaker 2>knowledgeable obviously about breast cancers. Like, no wife of mine

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<v Speaker 2>is going to start on hormones because of the breast

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<v Speaker 2>cancer risk.

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<v Speaker 3>And we can talk more about that, and I hope

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<v Speaker 3>we do.

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<v Speaker 2>But he went to all the best medical schools, had

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<v Speaker 2>all the best training, knew nothing about menopause, knew nothing

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<v Speaker 2>about hormonal transitions, and was like, this.

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<v Speaker 3>Is no joke.

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<v Speaker 2>And I'm like, yeah, no, it's not a joke in

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<v Speaker 2>terms of the changes that we go through. But I

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<v Speaker 2>think there's more conversation now. There's more out on social

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<v Speaker 2>media about menopause. There's certainly more in the popular press

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<v Speaker 2>about menopause, and so now individuals are men and women

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<v Speaker 2>are realizing that anxiety or depression or mood issues are

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<v Speaker 2>tightly linked to hormonal fluctuations.

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<v Speaker 1>Now once on hormones, now I've been on hormones for

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<v Speaker 1>a long time. I started like right in my early

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<v Speaker 1>forties too. Does your treatment have to change? How do

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<v Speaker 1>you test for hormonal balance and everything.

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<v Speaker 2>So this is the tricky part about hormonal management. Naturally,

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<v Speaker 2>we will need to change hormone dosing over an individual's lifetime.

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<v Speaker 2>If you still have your ovaries and you're transitioning through

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<v Speaker 2>perimenopause or into menopause, the ovaries don't just decide one

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<v Speaker 2>day they're going to turn off. They naturally decline, and

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<v Speaker 2>so we may start on lower doses of estrogen, we

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<v Speaker 2>may start on doses of progesterone with odd estrogen or

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<v Speaker 2>and then naturally anticipate that they will need to be

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<v Speaker 2>escalated over a woman's lifetime and then maybe drop down

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<v Speaker 2>a little bit when we get a little bit older. Actually,

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<v Speaker 2>so that this is a conversation and dialogue that every

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<v Speaker 2>woman should have with her physician or the person who's

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<v Speaker 2>helping her manage her hormones, because it's really a communication

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<v Speaker 2>because what works for one person doesn't work for everybody.

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<v Speaker 2>So it's very highly personalized medicine.

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<v Speaker 1>I don't usually talk to people about their treatments or

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<v Speaker 1>medical treatments, but a couple of my very close friends

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<v Speaker 1>have spoken to me like, oh, why do you have

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<v Speaker 1>such a nice skin? And I say, I think it's

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<v Speaker 1>because of the hormones I taken, and of course genes,

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<v Speaker 1>but and I said, do you take hormones? And most

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<v Speaker 1>of them, most of my friends, have never been on

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<v Speaker 1>hormone replacement.

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<v Speaker 2>So about that period of the Women's Health Initiative Study

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<v Speaker 2>when it came out, and I remember this, I mean,

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<v Speaker 2>we sent letters to our patients. At the time, I

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<v Speaker 2>was at Slung Cattering as a surgeon, and we sent

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<v Speaker 2>letters to our patients, you know, stop your hormones immediately.

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<v Speaker 2>We were very couscormed about it. Stop them immediately. Well,

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<v Speaker 2>about fifty percent of people went back on hormone support. Actually,

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<v Speaker 2>so fifty percent has significant symptoms off of hormone support.

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<v Speaker 2>So everything with the Women's Health Initiative Study came from

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<v Speaker 2>a screeching halt because it was just a knee jerk

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<v Speaker 2>reaction because there was an elevated relative risk of breast

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<v Speaker 2>cancer with this type of hormone support that was prescribed

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<v Speaker 2>in this study, everybody to stop their hormones. And instead

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<v Speaker 2>of throwing out the drugs and saying, okay, these drugs

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<v Speaker 2>might not be the safest that we could use, we

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<v Speaker 2>actually throughout the issue. We threw out menopause and said, well,

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<v Speaker 2>there's nothing we can do for you because this Women's

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<v Speaker 2>Health Initiative study came out. You can't take hormones, they're

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<v Speaker 2>not safe. But we have newer preparations now that the

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<v Speaker 2>French have had for a number of years, longer than us,

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<v Speaker 2>that are actually safer than our older preparations, and this

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<v Speaker 2>is now being brought to the forefront, so we have

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<v Speaker 2>instead of saying we can't do anything, we now have

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<v Speaker 2>safer preparations to treat with well.

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<v Speaker 1>Most discussions around hormone therapy is about relieving symptoms of menopause,

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<v Speaker 1>but they must affect so many other parts of our health.

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<v Speaker 1>I mean, they must help so much more in bone

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<v Speaker 1>strength and good hair.

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<v Speaker 3>Is that true? Absolutely?

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<v Speaker 2>There's estrogen receptors all throughout the body. I mean we

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<v Speaker 2>could talk from the tip of your head down to

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<v Speaker 2>your toes, to the muscle, bones and joints basically. So

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<v Speaker 2>there's estrogen receptors in the brain that are increasingly being

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<v Speaker 2>identified as being important actually and maintaining cognitive function for women.

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<v Speaker 3>In terms of estrogen support.

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<v Speaker 2>It was recently published that around the time of perimenopause,

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<v Speaker 2>estrogen receptors are those hearts of our cells that hold

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<v Speaker 2>on to estrogen actually increase at the time of perimenopause,

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<v Speaker 2>and there's some data out that really suggests that women

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<v Speaker 2>who are on early hormone support within three years of

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<v Speaker 2>menopause actually have improved cognitive function and may have a

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<v Speaker 2>decreased risk of dementia. Overall, that's the brain, cardiac health.

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<v Speaker 2>We know that there's a thirty percent reduction in all

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<v Speaker 2>cause of mortality other than breast cancer with hormone support,

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<v Speaker 2>and that's thought to be largely through cardiac risk. Skin

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<v Speaker 2>definitely increases, collagen production, decreases fine lines and wrinkles. There's

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<v Speaker 2>data in the literature that few people review and discuss

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<v Speaker 2>that even with topical estrogen we can improve skin muscles. Well,

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<v Speaker 2>of course we are muscle mass changes when our estrogen drops.

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<v Speaker 2>It can also drop and decline as estra levels decline.

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<v Speaker 2>Bone health has been recognized for many years that as

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<v Speaker 2>estrogen declines, bone health deteriorates, and we can help bone

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<v Speaker 2>health by adding back estrogen. So really and metabolism also, right,

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<v Speaker 2>So when estrogen levels start to decline, we begin to

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<v Speaker 2>develop metabolic disruptions. So you can look at every organ

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<v Speaker 2>system in the body basically and have some link to

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<v Speaker 2>hormone fluctuations in terms of the health of that organ system.

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<v Speaker 1>So what happens to the woman who has a brisk

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<v Speaker 1>cancer history in the family, what do you tell her

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<v Speaker 1>about taking hormones.

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<v Speaker 2>So a family history of breast cancer without a personal

0:11:33.200 --> 0:11:35.679
<v Speaker 2>history of breast cancer is not an absolute contra indication

0:11:35.720 --> 0:11:39.520
<v Speaker 2>to hormones. Even with our highest risk individuals in terms

0:11:39.520 --> 0:11:42.040
<v Speaker 2>of genetic mutations, we will many times speak with them

0:11:42.040 --> 0:11:45.640
<v Speaker 2>about hormone support after ovaries are removed and recommended. Actually,

0:11:46.120 --> 0:11:49.200
<v Speaker 2>so I think every individual in every situation is to

0:11:49.240 --> 0:11:52.079
<v Speaker 2>be personalized, but a family history of breast cancer is

0:11:52.120 --> 0:11:54.440
<v Speaker 2>not a contraindication to hormone support.

0:11:54.720 --> 0:11:56.000
<v Speaker 1>Are you writing about this too?

0:11:56.720 --> 0:12:00.000
<v Speaker 2>Oh yeah, oh yes, yes, So we're working in a book. Definitely,

0:12:00.040 --> 0:12:00.959
<v Speaker 2>we're writing about this.

0:12:01.120 --> 0:12:03.839
<v Speaker 1>When is that book available, Probably.

0:12:03.559 --> 0:12:05.440
<v Speaker 2>Within the next eight or nine months. We want to

0:12:05.440 --> 0:12:09.120
<v Speaker 2>offer you solutions and how you can age beautifully and

0:12:09.280 --> 0:12:10.920
<v Speaker 2>be vibrant just as you're doing.

0:12:11.240 --> 0:12:13.760
<v Speaker 1>I have so many friends who need this book, so

0:12:13.960 --> 0:12:15.679
<v Speaker 1>good luck with it. I can't wait. I can't wait.

0:12:15.679 --> 0:12:18.120
<v Speaker 1>Thank you. You'll have to come back on the podcast

0:12:18.160 --> 0:12:30.440
<v Speaker 1>to talk about the book. So what innovations are you

0:12:30.520 --> 0:12:33.360
<v Speaker 1>seeing about when it comes to the science of managing

0:12:33.360 --> 0:12:36.960
<v Speaker 1>and treating the symptoms of MENOPAUSEA when do you know

0:12:37.000 --> 0:12:39.200
<v Speaker 1>that you're in menopause? When? How do you know?

0:12:39.480 --> 0:12:42.720
<v Speaker 2>So menopause is really defined as being postmenopausal as you

0:12:42.800 --> 0:12:44.840
<v Speaker 2>don't have I haven't had a period for a year.

0:12:44.920 --> 0:12:48.160
<v Speaker 2>But that's an antiquated kind of definition, right, because that

0:12:48.280 --> 0:12:50.840
<v Speaker 2>definition was before we had laboratory testing. Everybody kind of

0:12:50.840 --> 0:12:53.080
<v Speaker 2>forgets you know, one hundred years ago we weren't able

0:12:53.120 --> 0:12:55.920
<v Speaker 2>to check for these levels of bollicle stimulating hormones and

0:12:55.960 --> 0:12:58.520
<v Speaker 2>asterrodial level. So menopausemeaus you haven't had a period. And

0:12:58.520 --> 0:13:00.280
<v Speaker 2>when your post menoposamis you haven't had a peer in

0:13:00.280 --> 0:13:04.480
<v Speaker 2>one year. Perimenopause is that time leading up to menopause.

0:13:04.880 --> 0:13:08.640
<v Speaker 2>And then perimenopause really can start anywhere between eight and

0:13:08.679 --> 0:13:11.080
<v Speaker 2>ten years prior to your final menstrual period.

0:13:11.480 --> 0:13:16.520
<v Speaker 1>So women, that's an elongated right in a bad mood? Well,

0:13:16.559 --> 0:13:18.600
<v Speaker 1>I mean that's what you hear. Everybody is in a

0:13:18.640 --> 0:13:19.200
<v Speaker 1>bad mood.

0:13:19.320 --> 0:13:22.400
<v Speaker 2>Think everybody reacts differently, right, I mean, I think everybody

0:13:22.400 --> 0:13:25.480
<v Speaker 2>has their own different types of issues as their hormone

0:13:25.520 --> 0:13:27.880
<v Speaker 2>levels fluctuate. And that's actually an interesting question is in itself.

0:13:27.920 --> 0:13:30.600
<v Speaker 2>Why are some individual symptomatic and others not right?

0:13:30.840 --> 0:13:33.640
<v Speaker 1>And could that be also because if they were taking

0:13:33.720 --> 0:13:37.200
<v Speaker 1>hormones maybe that would prolong good health or of course,

0:13:37.280 --> 0:13:40.080
<v Speaker 1>and that's when I phone the actual menopause.

0:13:39.640 --> 0:13:41.320
<v Speaker 2>Right, that is one of the big questions that I

0:13:41.400 --> 0:13:44.640
<v Speaker 2>have actually just as a practitioner. If we start hormones earlier,

0:13:44.800 --> 0:13:47.160
<v Speaker 2>can we stave off some of these cognitive changes that

0:13:47.160 --> 0:13:50.679
<v Speaker 2>we see because right at the time of perimenopause and menopause,

0:13:50.760 --> 0:13:53.240
<v Speaker 2>we see real changes in the brain. The brain size changes,

0:13:53.320 --> 0:13:55.560
<v Speaker 2>the blood flow changes, the metabolism change them. You can

0:13:55.600 --> 0:13:58.679
<v Speaker 2>see it on scans. So if we start hormones earlier,

0:13:58.760 --> 0:14:02.160
<v Speaker 2>especially at women who maybe elevated risk of cognitive issues

0:14:02.160 --> 0:14:04.720
<v Speaker 2>and that type of thing, if we start earlier before

0:14:04.760 --> 0:14:07.880
<v Speaker 2>fluctuations really set in, can we actually stave off these

0:14:08.040 --> 0:14:11.000
<v Speaker 2>issues even better? And those are big questions right now

0:14:11.000 --> 0:14:13.280
<v Speaker 2>that are not just now being asked and beginning to

0:14:13.320 --> 0:14:15.560
<v Speaker 2>be answered based at a basic science level and at

0:14:15.559 --> 0:14:17.000
<v Speaker 2>a clinical level also.

0:14:16.960 --> 0:14:19.880
<v Speaker 1>So are you giving brain scans to women now on

0:14:19.920 --> 0:14:20.880
<v Speaker 1>a regular basis?

0:14:21.000 --> 0:14:24.760
<v Speaker 2>There are research protocols where people are beginning to do that,

0:14:24.920 --> 0:14:27.720
<v Speaker 2>looking at MRIs of the brains, looking at brain size,

0:14:27.760 --> 0:14:30.360
<v Speaker 2>brain processing, this type of thing, and that's very kind

0:14:30.360 --> 0:14:31.400
<v Speaker 2>of elevated testing.

0:14:32.120 --> 0:14:34.840
<v Speaker 1>What about physical tests physical.

0:14:34.480 --> 0:14:37.480
<v Speaker 2>Test Well, certainly in terms of cognitive testing, there are

0:14:37.520 --> 0:14:40.880
<v Speaker 2>definitely physical testing. But by the time you have manifested

0:14:40.920 --> 0:14:43.040
<v Speaker 2>any of these physical symptoms, and I'm just talking about

0:14:43.040 --> 0:14:45.040
<v Speaker 2>brain health as an example, we could talk about every

0:14:45.120 --> 0:14:48.000
<v Speaker 2>organ system. But the time you've manifested, you are transitioned

0:14:48.040 --> 0:14:49.920
<v Speaker 2>into a disease state. So we want to keep you

0:14:49.960 --> 0:14:52.920
<v Speaker 2>from transitioning into a disease state. We want to cut

0:14:52.960 --> 0:14:54.040
<v Speaker 2>we want to prevent anything.

0:14:54.120 --> 0:14:56.880
<v Speaker 1>Early detection, early examination is best.

0:14:57.000 --> 0:14:58.080
<v Speaker 3>Yeah, and early prevention.

0:14:58.160 --> 0:15:00.080
<v Speaker 1>So like what age would you say a woman and

0:15:00.080 --> 0:15:01.800
<v Speaker 1>should start really considering this?

0:15:02.000 --> 0:15:04.160
<v Speaker 2>So I think you know, women between the ages of

0:15:04.160 --> 0:15:06.720
<v Speaker 2>thirty five and forty can begin to see significant hormonal

0:15:06.720 --> 0:15:09.480
<v Speaker 2>fluctuations and really need to pay attention to their symptoms.

0:15:09.600 --> 0:15:12.880
<v Speaker 2>Right now, we don't have great laboratory testing. Again, this

0:15:12.920 --> 0:15:15.080
<v Speaker 2>is an area that I'm super interested in, is can

0:15:15.160 --> 0:15:17.600
<v Speaker 2>we really begin to define when estrogen levels start to

0:15:17.640 --> 0:15:21.000
<v Speaker 2>fluctuate or progesterone levels start to decline with our current

0:15:21.120 --> 0:15:24.800
<v Speaker 2>testing that's really well accepted. We're not really there yet,

0:15:24.800 --> 0:15:26.400
<v Speaker 2>and we have to listen to narratives, And this is

0:15:26.400 --> 0:15:30.000
<v Speaker 2>why doctors need and physicians and healthcare providers really need

0:15:30.040 --> 0:15:32.520
<v Speaker 2>to listen to the patients that they're caring for about.

0:15:32.560 --> 0:15:35.040
<v Speaker 2>You know, may have a little more anxiety, like some

0:15:35.080 --> 0:15:37.920
<v Speaker 2>of the earliest symptoms of actually hormone changes, a little

0:15:37.920 --> 0:15:39.840
<v Speaker 2>bit of anxiety, maybe a little shape shifting. You don't

0:15:39.840 --> 0:15:41.120
<v Speaker 2>even have to gain weight, you just get a little

0:15:41.160 --> 0:15:44.960
<v Speaker 2>thicker in the waste. That may represent an accumulation of

0:15:44.960 --> 0:15:47.560
<v Speaker 2>what we call visceral fat, which happens as estrogen levels

0:15:47.560 --> 0:15:50.600
<v Speaker 2>start to decline. May have a little new anxiety, libido

0:15:50.680 --> 0:15:55.440
<v Speaker 2>issues actually or early worn early symptoms of estrogen fluctuations,

0:15:55.800 --> 0:15:58.920
<v Speaker 2>vaginal dryness at certain time points of the month, actually

0:15:58.920 --> 0:16:02.040
<v Speaker 2>a cycle maybe, So we need to listen to our

0:16:02.120 --> 0:16:04.840
<v Speaker 2>narratives of our patients to really kind of determine where

0:16:04.880 --> 0:16:07.960
<v Speaker 2>they are in this transition. And then it'd be great

0:16:07.960 --> 0:16:09.280
<v Speaker 2>to have some laboratory testing too.

0:16:09.440 --> 0:16:11.360
<v Speaker 1>And women should be a little bit more open with

0:16:11.400 --> 0:16:14.840
<v Speaker 1>their doctors. I would say, are women are still a

0:16:14.880 --> 0:16:18.320
<v Speaker 1>little shy? I think sometimes I think so physical being.

0:16:18.480 --> 0:16:19.720
<v Speaker 3>I think some that's changing.

0:16:19.840 --> 0:16:22.480
<v Speaker 2>I think thanks to social media and the internet and

0:16:22.480 --> 0:16:25.120
<v Speaker 2>more conversations. You know, I realized during COVID actually that

0:16:25.160 --> 0:16:27.640
<v Speaker 2>when we were having these kind of anonymized zoom meetings

0:16:27.640 --> 0:16:31.160
<v Speaker 2>and things like this with patients and speaking groups, that

0:16:31.240 --> 0:16:33.600
<v Speaker 2>women talked a little bit more freely. And now they

0:16:33.600 --> 0:16:36.280
<v Speaker 2>can get information a little bit more easily, so they

0:16:36.360 --> 0:16:38.480
<v Speaker 2>might become a little bit more open. And this generation

0:16:38.600 --> 0:16:41.000
<v Speaker 2>of women now who are transitioning through menopause are very

0:16:41.000 --> 0:16:43.880
<v Speaker 2>open about it. And that's great because that's bringing all

0:16:43.920 --> 0:16:47.440
<v Speaker 2>of this conversation to the forefront and helping women to

0:16:47.480 --> 0:16:49.440
<v Speaker 2>open up about it. But still you still have to

0:16:49.680 --> 0:16:52.160
<v Speaker 2>elicit and ask questions, do you have pain with intercourse?

0:16:52.200 --> 0:16:56.440
<v Speaker 2>Do you have vaginal dryness? People don't always volunteer that information.

0:16:56.560 --> 0:16:59.000
<v Speaker 2>We have specific questions that we ask our patients.

0:16:58.640 --> 0:17:00.600
<v Speaker 1>So it's up to the doctors as well as the

0:17:00.600 --> 0:17:04.400
<v Speaker 1>patient's Absolutely we have overt and uh open about all this.

0:17:04.960 --> 0:17:08.720
<v Speaker 1>There's so many other questions to ask a guidecologist of

0:17:08.840 --> 0:17:12.919
<v Speaker 1>your stature. What is the current guidance on frequency of mamograms?

0:17:12.960 --> 0:17:17.679
<v Speaker 2>For example, most professional societies actually recommend a yearly mammogram.

0:17:17.800 --> 0:17:20.760
<v Speaker 2>Still AI is going to help that, I hope actually

0:17:20.760 --> 0:17:23.520
<v Speaker 2>in terms of in terms of looking for pattern recognition,

0:17:23.600 --> 0:17:26.320
<v Speaker 2>I mean, AI is like so great looking at pattern recognition, Like,

0:17:26.640 --> 0:17:28.040
<v Speaker 2>we're at a point now where we can look at

0:17:28.040 --> 0:17:30.240
<v Speaker 2>an EKG and this was just brought to my attention,

0:17:30.440 --> 0:17:32.560
<v Speaker 2>and that AI group can look and that the machine

0:17:32.640 --> 0:17:34.720
<v Speaker 2>learning can look and say it's a male or female EKG.

0:17:34.880 --> 0:17:37.280
<v Speaker 2>There's no physician who can do that. So now we

0:17:37.400 --> 0:17:39.800
<v Speaker 2>have all this great pattern recognition. So this is really

0:17:39.800 --> 0:17:42.160
<v Speaker 2>going to contribute to our screening. But most people still

0:17:42.200 --> 0:17:45.040
<v Speaker 2>recommend a yearly mammogram and of course a breast ultrasound

0:17:45.040 --> 0:17:47.160
<v Speaker 2>if you have dense breast and if you're at elevated risk,

0:17:47.200 --> 0:17:48.120
<v Speaker 2>consider a breast MRI.

0:17:48.880 --> 0:17:50.160
<v Speaker 1>And what about pap smears.

0:17:50.760 --> 0:17:52.760
<v Speaker 2>Pap smear is a little bit less on the guidance

0:17:52.760 --> 0:17:55.560
<v Speaker 2>in terms of the frequency is recommended now every two

0:17:55.640 --> 0:17:57.840
<v Speaker 2>to three years if you haven't had an abnormal pap

0:17:57.880 --> 0:18:01.200
<v Speaker 2>smere or HPV negative testing every five years if you're

0:18:01.280 --> 0:18:03.560
<v Speaker 2>over the age of thirty and HPV negatives.

0:18:03.840 --> 0:18:06.760
<v Speaker 1>So I used to be every visit right.

0:18:06.520 --> 0:18:10.280
<v Speaker 2>But there's guidelines are for population health, right, and so

0:18:10.320 --> 0:18:12.880
<v Speaker 2>it's always like I always, I think it's a conversation

0:18:13.000 --> 0:18:16.560
<v Speaker 2>between the individual and the person who's taking care of them.

0:18:16.680 --> 0:18:22.240
<v Speaker 1>Of course, copies seems like everybody is prepping for a kolonoscopy.

0:18:22.359 --> 0:18:23.520
<v Speaker 3>Well, so colonoscopy.

0:18:23.560 --> 0:18:26.080
<v Speaker 2>We've decreased the age of recommendation of kolonoscopy down to

0:18:26.160 --> 0:18:30.320
<v Speaker 2>forty five. That's because we're seeing aggressive colon cancers and

0:18:30.400 --> 0:18:34.080
<v Speaker 2>younger people. We're not quite sure why, but definitely colonoscopy

0:18:34.119 --> 0:18:36.800
<v Speaker 2>has remained the gold standard. But there's also there's liquid

0:18:37.200 --> 0:18:41.520
<v Speaker 2>tumor biopsies looking for fragments of tumor DNA in stool

0:18:41.560 --> 0:18:43.639
<v Speaker 2>samples and such, and also in the blood. And so

0:18:43.720 --> 0:18:47.440
<v Speaker 2>these screening modalities are also poised to contribute.

0:18:47.080 --> 0:18:51.119
<v Speaker 1>To mail order stool samplings. That right, I mean you

0:18:51.160 --> 0:18:53.040
<v Speaker 1>could just you can just put some poop in a

0:18:53.160 --> 0:18:54.960
<v Speaker 1>in a tube and send it off in the mail.

0:18:55.160 --> 0:18:55.440
<v Speaker 3>Right.

0:18:55.520 --> 0:18:56.480
<v Speaker 1>Are those accurate?

0:18:56.840 --> 0:18:58.160
<v Speaker 3>They are very accurate.

0:18:58.320 --> 0:19:02.119
<v Speaker 2>They are not well accepted for an individual who is

0:19:02.160 --> 0:19:04.040
<v Speaker 2>known to be at elevated risk, such as.

0:19:03.920 --> 0:19:07.879
<v Speaker 3>A family history or a pre do that, you know,

0:19:07.960 --> 0:19:08.959
<v Speaker 3>they're extremely accurate.

0:19:09.080 --> 0:19:10.359
<v Speaker 1>They're a little scary to me.

0:19:11.119 --> 0:19:13.520
<v Speaker 2>The easier that we can make a screening test for

0:19:13.600 --> 0:19:16.160
<v Speaker 2>somebody and the less invasive that it will be, the

0:19:16.160 --> 0:19:19.280
<v Speaker 2>more acceptable that it will be. Overall, and so, and

0:19:19.320 --> 0:19:21.720
<v Speaker 2>I think again we're moving as we get as we

0:19:21.800 --> 0:19:23.680
<v Speaker 2>have more molecular diagnostics.

0:19:24.119 --> 0:19:26.600
<v Speaker 1>And I always worry about the temperature, and if it's

0:19:26.600 --> 0:19:29.960
<v Speaker 1>one hundred degrees outside, well, any symptoms disappear, you know,

0:19:30.280 --> 0:19:32.040
<v Speaker 1>That's what I think about if it's in the mail.

0:19:32.119 --> 0:19:34.119
<v Speaker 1>For us, ever, are sitting in a hot truck for

0:19:34.200 --> 0:19:35.040
<v Speaker 1>four days, right.

0:19:34.880 --> 0:19:37.159
<v Speaker 2>We're looking at fragments of DNA and such, and so

0:19:37.200 --> 0:19:38.040
<v Speaker 2>that's pretty stable.

0:19:38.080 --> 0:19:41.840
<v Speaker 1>Actually that's stable. Yay? Stable? So can you break down

0:19:41.920 --> 0:19:43.960
<v Speaker 1>by decade? This is a this is a kind of

0:19:44.000 --> 0:19:47.560
<v Speaker 1>a hard question. How should women adjust their medical routines

0:19:47.600 --> 0:19:51.520
<v Speaker 1>and health habits. Let's just say in their late thirties forties.

0:19:52.160 --> 0:19:53.520
<v Speaker 1>What do you do then?

0:19:53.720 --> 0:19:57.280
<v Speaker 2>So, for for many women in their late thirties, they're

0:19:57.600 --> 0:20:00.080
<v Speaker 2>completing child bearing if they've chosen to have children, and

0:20:00.440 --> 0:20:04.680
<v Speaker 2>are focused less on reproduction and more on now focusing

0:20:04.760 --> 0:20:06.800
<v Speaker 2>attention a little bit to their own health. And some

0:20:06.840 --> 0:20:09.040
<v Speaker 2>of us need attention, need to do that, and because

0:20:09.040 --> 0:20:11.639
<v Speaker 2>we all have busy lives or we're taking care of children,

0:20:11.720 --> 0:20:13.800
<v Speaker 2>or we're taking care of our families, or we're working.

0:20:14.280 --> 0:20:17.359
<v Speaker 2>But this is a time after child bearing, right to

0:20:17.480 --> 0:20:21.200
<v Speaker 2>really begin to focus and focus on health. And that

0:20:21.400 --> 0:20:24.400
<v Speaker 2>is healthy exercise, making sure that you move every day,

0:20:24.560 --> 0:20:29.439
<v Speaker 2>healthy nutrition, staying socially engaged, stress management, paying attention to

0:20:29.480 --> 0:20:31.920
<v Speaker 2>sleep for a lot of people, which is also very difficult.

0:20:32.000 --> 0:20:34.840
<v Speaker 2>But you know, late thirties early forties time to just

0:20:35.000 --> 0:20:37.800
<v Speaker 2>establish your patterns and patterns of good health and also

0:20:37.880 --> 0:20:40.080
<v Speaker 2>listen to your body. What's your body telling you? You know,

0:20:40.359 --> 0:20:42.679
<v Speaker 2>we don't talk as physicians about this enough. Like your

0:20:42.720 --> 0:20:45.479
<v Speaker 2>body will speak with to you a little bit. Sometimes

0:20:45.480 --> 0:20:47.200
<v Speaker 2>it whispers, but it'll tell you when things are a

0:20:47.200 --> 0:20:49.240
<v Speaker 2>little bit of wry or not wrong. So I always

0:20:49.280 --> 0:20:50.960
<v Speaker 2>try to tell women, you know, if you feel like

0:20:51.000 --> 0:20:53.600
<v Speaker 2>something's not right, bring it to the attention of your physician.

0:20:54.000 --> 0:20:56.040
<v Speaker 2>So thirties and forties are where you're started to listen

0:20:56.080 --> 0:20:59.280
<v Speaker 2>to your body and establish good health habits and get

0:20:59.280 --> 0:21:01.520
<v Speaker 2>into the to the routine of making sure that you

0:21:01.560 --> 0:21:04.360
<v Speaker 2>get a yearly exam. See you see your physician once

0:21:04.400 --> 0:21:07.119
<v Speaker 2>a year, have your lipids checked, have your hemoglobin A

0:21:07.200 --> 0:21:09.560
<v Speaker 2>one seed checked, find out what your baseline is and

0:21:09.600 --> 0:21:12.160
<v Speaker 2>where you're starting from, and then grab onto some good

0:21:12.200 --> 0:21:15.920
<v Speaker 2>health habits to age with strong and what you do.

0:21:16.200 --> 0:21:19.480
<v Speaker 2>So fifties are a time where really estrogen levels are

0:21:19.480 --> 0:21:22.600
<v Speaker 2>really declining, and so thirty five to forty to to

0:21:22.640 --> 0:21:25.960
<v Speaker 2>the late forties, right, we're starting to we see estrogen fluctuations,

0:21:25.960 --> 0:21:28.280
<v Speaker 2>but we really see estrogen levels start to decline in

0:21:28.320 --> 0:21:31.879
<v Speaker 2>the early to mid fifties. And so again that's paying

0:21:31.920 --> 0:21:34.600
<v Speaker 2>really close attention to your symptoms. Knowing your family history,

0:21:34.680 --> 0:21:36.800
<v Speaker 2>know your family history of cardiac disease, know your family

0:21:36.880 --> 0:21:39.800
<v Speaker 2>history of dementia, speak to your health care provider's hormone

0:21:39.800 --> 0:21:43.639
<v Speaker 2>support right for you. Paying attention to maybe not feeling yourself.

0:21:43.680 --> 0:21:45.919
<v Speaker 2>I always as my patients, you know, do you have

0:21:46.000 --> 0:21:48.000
<v Speaker 2>you lost your JOI de v You know, you might

0:21:48.000 --> 0:21:50.200
<v Speaker 2>say I'm not, I don't have anxietyor depression.

0:21:49.720 --> 0:21:51.720
<v Speaker 3>But you might say, you know, I don't feel like myself.

0:21:51.760 --> 0:21:52.040
<v Speaker 3>I don't.

0:21:52.119 --> 0:21:54.119
<v Speaker 2>I don't have the same confidence when you while I

0:21:54.160 --> 0:21:57.800
<v Speaker 2>walk into the boardroom, Am I having any word finding difficulty?

0:21:57.920 --> 0:22:00.439
<v Speaker 2>It's really about how am I enjoying my life?

0:22:00.600 --> 0:22:00.800
<v Speaker 3>You know?

0:22:00.840 --> 0:22:02.879
<v Speaker 2>These are all just very subtle things that we as

0:22:02.880 --> 0:22:05.399
<v Speaker 2>physicians don't always ask, but these are important things to

0:22:05.440 --> 0:22:08.920
<v Speaker 2>ask yourself. And then if you have any of these

0:22:08.960 --> 0:22:11.359
<v Speaker 2>issues and they're new for you, something that's new or

0:22:11.400 --> 0:22:16.240
<v Speaker 2>different from you needs to be addressed. Actually, sixties sixties

0:22:16.359 --> 0:22:20.200
<v Speaker 2>that's a time to really double down. I think on nutrition, exercise, mindset,

0:22:20.240 --> 0:22:22.760
<v Speaker 2>stained socially engaged, making sure you have a great sense

0:22:22.800 --> 0:22:23.280
<v Speaker 2>of purpose.

0:22:23.800 --> 0:22:25.679
<v Speaker 3>Of course, having all of your testing that.

0:22:25.640 --> 0:22:27.720
<v Speaker 2>You would normally have with blood test, I failed to

0:22:27.720 --> 0:22:30.120
<v Speaker 2>mention a coordinary calcium score. But know your family history

0:22:30.119 --> 0:22:33.840
<v Speaker 2>of cardiac disease super important. But consider advanced testing in

0:22:33.920 --> 0:22:36.359
<v Speaker 2>terms of more advanced cardiac testing in the fifties and

0:22:36.480 --> 0:22:39.119
<v Speaker 2>early sixties, pay attention to that, of course. Also the

0:22:39.160 --> 0:22:41.040
<v Speaker 2>sixties are where we have to, I think, make a

0:22:41.080 --> 0:22:43.800
<v Speaker 2>real concerted effort, Like I am going to exercise every day.

0:22:43.880 --> 0:22:45.280
<v Speaker 2>I'm going to do one hundred and fifty minutes of

0:22:45.359 --> 0:22:47.560
<v Speaker 2>zone two cardiac. I'm going to do strength training three

0:22:47.640 --> 0:22:49.440
<v Speaker 2>days a week. I'm going to make sure that I'm

0:22:49.720 --> 0:22:52.399
<v Speaker 2>eating enough protein because we tend to lose muscle masses

0:22:52.440 --> 0:22:54.320
<v Speaker 2>we age, so we want to make sure we ramp

0:22:54.400 --> 0:22:57.240
<v Speaker 2>up the protein, decrease the carbohydrates. Maybe a little bit

0:22:57.240 --> 0:23:02.000
<v Speaker 2>in nutrition a little controversial with that, yeah, but definitely

0:23:02.040 --> 0:23:03.840
<v Speaker 2>ramp up the proteins. And how you adjust that with

0:23:03.880 --> 0:23:05.800
<v Speaker 2>your carbohydrates, that's your choice, but.

0:23:06.080 --> 0:23:07.240
<v Speaker 3>Definitely ramp up on protein.

0:23:07.560 --> 0:23:09.280
<v Speaker 2>And then I think it's really like I said, sleep

0:23:09.320 --> 0:23:11.240
<v Speaker 2>is really important, becomes a little bit more difficult to

0:23:11.240 --> 0:23:13.120
<v Speaker 2>sleep as we age, and so what.

0:23:13.080 --> 0:23:14.960
<v Speaker 1>Should one do about that? I mean, this is so

0:23:15.040 --> 0:23:18.040
<v Speaker 1>many people are talking about, Oh I can't really sleep.

0:23:18.080 --> 0:23:18.440
<v Speaker 1>I can't.

0:23:18.800 --> 0:23:21.040
<v Speaker 2>One thing that's really important is realize that sleep is

0:23:21.040 --> 0:23:24.000
<v Speaker 2>an active process. Realize that it's something that's really important.

0:23:24.040 --> 0:23:25.520
<v Speaker 2>It's not like you just go to sleep and your

0:23:25.520 --> 0:23:28.000
<v Speaker 2>body's not doing stuff. It's doing really important stuff, right,

0:23:28.280 --> 0:23:31.320
<v Speaker 2>So scheduling sleep, making sure and we all know sleep hygiene,

0:23:31.359 --> 0:23:34.080
<v Speaker 2>you know, turning screens off, giving yourself an hour of

0:23:34.119 --> 0:23:36.800
<v Speaker 2>wind down, you know these things. But also I think

0:23:36.840 --> 0:23:38.760
<v Speaker 2>it's really important just to get in that mindset of

0:23:39.400 --> 0:23:42.080
<v Speaker 2>training your body to realize that sleep is important. And

0:23:42.240 --> 0:23:46.800
<v Speaker 2>also I just recently got an aura ring. You're supposed

0:23:46.800 --> 0:23:48.199
<v Speaker 2>to wearing a four PingER. I get data on my

0:23:48.240 --> 0:23:51.359
<v Speaker 2>ring finger. But what that showed me which was really interesting.

0:23:51.400 --> 0:23:53.080
<v Speaker 2>I mean I have a million degrees from all these

0:23:53.119 --> 0:23:56.439
<v Speaker 2>Ivy League educations, and I didn't realize that being in

0:23:56.480 --> 0:23:58.240
<v Speaker 2>bed does not mean that you are asleep, that you

0:23:58.280 --> 0:24:01.320
<v Speaker 2>are sleeping exactly, or a ring gives you or any

0:24:01.320 --> 0:24:04.000
<v Speaker 2>of these wearables whoop or any of these give you

0:24:04.520 --> 0:24:07.000
<v Speaker 2>insight into if your sleep is disrupted.

0:24:06.680 --> 0:24:09.959
<v Speaker 1>Or by the way is, Oh, you are a and

0:24:10.040 --> 0:24:12.560
<v Speaker 1>I just got one. It was too small for me.

0:24:12.720 --> 0:24:15.520
<v Speaker 1>So I'm waiting for my new one to come because

0:24:15.560 --> 0:24:17.639
<v Speaker 1>i want to wear it on my forefinger. It is,

0:24:17.680 --> 0:24:19.919
<v Speaker 1>and I want to I'm dying to see what my

0:24:20.280 --> 0:24:21.320
<v Speaker 1>horrible sleep habits.

0:24:21.640 --> 0:24:23.400
<v Speaker 2>It will give you a lot of insight and then

0:24:23.440 --> 0:24:25.919
<v Speaker 2>you can see, like, you know, does a little bit

0:24:25.920 --> 0:24:28.520
<v Speaker 2>of wine the night before does it disrupt my sleep?

0:24:28.520 --> 0:24:31.359
<v Speaker 2>And you'll be amazed that like two ounces of wine

0:24:31.400 --> 0:24:34.919
<v Speaker 2>will actually lead to some sleep disruption or you know,

0:24:34.960 --> 0:24:38.480
<v Speaker 2>I'm always amazed at the heart rate variability actually correlates

0:24:38.480 --> 0:24:39.280
<v Speaker 2>with my stress.

0:24:39.440 --> 0:24:42.560
<v Speaker 3>Actually, it's really so. It gives you good insight into

0:24:42.840 --> 0:24:45.399
<v Speaker 3>when you sleep better? What did I do the day before?

0:24:46.040 --> 0:24:50.200
<v Speaker 1>What to do correct exactly? That's what I'm looking forward

0:24:50.280 --> 0:24:53.679
<v Speaker 1>to to really determining with mine. So what should we

0:24:53.720 --> 0:24:55.119
<v Speaker 1>do in our seventies.

0:24:54.720 --> 0:24:57.040
<v Speaker 2>I think similar to the sixties. I mean, you just

0:24:57.119 --> 0:24:59.440
<v Speaker 2>you really want to make sure that you are really

0:24:59.520 --> 0:25:04.399
<v Speaker 2>focusing non nutrition, exercise, sleep. I think even more so

0:25:05.160 --> 0:25:08.560
<v Speaker 2>sense of purpose and social engagement becomes really important in

0:25:08.600 --> 0:25:11.919
<v Speaker 2>the seventies. I think that we need to you know,

0:25:11.960 --> 0:25:14.360
<v Speaker 2>we live in I always say it's a great time

0:25:14.359 --> 0:25:16.720
<v Speaker 2>to get being getting older in our society right now,

0:25:16.760 --> 0:25:20.160
<v Speaker 2>because I love all the older Instagram accounts, I love

0:25:20.280 --> 0:25:23.600
<v Speaker 2>the older the magazines that are for individuals post fifty.

0:25:23.640 --> 0:25:25.280
<v Speaker 2>I think it's really great. In the past, we wouldn't

0:25:25.280 --> 0:25:25.760
<v Speaker 2>have seen these.

0:25:25.640 --> 0:25:27.359
<v Speaker 1>Public AA and what else.

0:25:27.560 --> 0:25:29.880
<v Speaker 2>Yeah, oh, there's there's a few others actually that don't

0:25:29.880 --> 0:25:30.960
<v Speaker 2>have retired in the.

0:25:30.840 --> 0:25:34.480
<v Speaker 1>Title because AARP is like that retired shouldn't be there,

0:25:34.520 --> 0:25:37.280
<v Speaker 1>because yeah, I encourage people never to retire.

0:25:37.359 --> 0:25:40.400
<v Speaker 3>I'm not retiring. No, yeah, don't Yeah, I'm not retired never.

0:25:40.920 --> 0:25:43.080
<v Speaker 2>But I think that's why that sense of engagement and

0:25:43.119 --> 0:25:45.359
<v Speaker 2>purpose becomes really important, because a lot of us will

0:25:45.359 --> 0:25:48.959
<v Speaker 2>exit the working fields, and I think that we have

0:25:49.040 --> 0:25:52.600
<v Speaker 2>to really focus on community, sense of engagement, sense of purpose.

0:25:52.640 --> 0:25:55.480
<v Speaker 2>These are all if you look at the common denominators

0:25:55.560 --> 0:25:59.000
<v Speaker 2>of individuals are centurions, and they are people who have

0:25:59.040 --> 0:26:01.280
<v Speaker 2>a great sense of purpose, a great sense of optimism.

0:26:01.359 --> 0:26:04.000
<v Speaker 2>They remain socially engaged. So got to do all the

0:26:04.000 --> 0:26:07.440
<v Speaker 2>other good stuff with nutrition exercise. Protein exercise becomes even

0:26:07.520 --> 0:26:10.040
<v Speaker 2>more important because you want to really maintain muscle mass

0:26:10.040 --> 0:26:12.679
<v Speaker 2>and don't want to become frail, and because that has

0:26:12.760 --> 0:26:15.560
<v Speaker 2>its own set of issues. But that maintaining of that

0:26:16.000 --> 0:26:18.960
<v Speaker 2>social structure is so important and sense of purpose is

0:26:19.000 --> 0:26:23.240
<v Speaker 2>so important, and then eighties, same thing, really the same thing,

0:26:23.400 --> 0:26:26.879
<v Speaker 2>and I think, you know, just really maintaining that all

0:26:26.920 --> 0:26:29.080
<v Speaker 2>those great health abb is that you established.

0:26:29.200 --> 0:26:31.800
<v Speaker 1>It's harder and harder to find doctors to take care

0:26:31.880 --> 0:26:34.720
<v Speaker 1>of you as you get older. Being involved with the

0:26:34.720 --> 0:26:38.160
<v Speaker 1>Center for Living at Mount Sinai, I learned that geriatric

0:26:38.320 --> 0:26:42.320
<v Speaker 1>medicine is a medicine that for a while fill out

0:26:42.320 --> 0:26:46.159
<v Speaker 1>of favor because doctors didn't want to deal with elderly people.

0:26:46.680 --> 0:26:50.119
<v Speaker 1>But now with the aging population, it's starting to become

0:26:50.160 --> 0:26:53.879
<v Speaker 1>a more interesting field of endeavor for doctors. So I

0:26:53.920 --> 0:26:56.879
<v Speaker 1>hope more and more go into geriatric medicine because we

0:26:57.000 --> 0:26:58.879
<v Speaker 1>need to really deal with all of those as we

0:26:58.920 --> 0:27:02.800
<v Speaker 1>get older and not feel bad about getting older.

0:27:03.240 --> 0:27:05.320
<v Speaker 2>It's great to get older. You want to age strong.

0:27:05.480 --> 0:27:07.320
<v Speaker 2>You want to be you want to age with strength.

0:27:07.400 --> 0:27:09.800
<v Speaker 2>That's the title age strong. You want to be strong

0:27:09.880 --> 0:27:12.320
<v Speaker 2>as we because you're getting older. The opposite is no good, right.

0:27:12.400 --> 0:27:15.040
<v Speaker 2>You want to get older. You want to be chronologically

0:27:15.320 --> 0:27:18.840
<v Speaker 2>older and biologically fit and a little bit younger. And

0:27:19.840 --> 0:27:21.760
<v Speaker 2>I think that this is a great time. I'll always

0:27:21.760 --> 0:27:24.600
<v Speaker 2>say it. I think we're aging with more optimism now,

0:27:24.880 --> 0:27:28.280
<v Speaker 2>and I think we're on the cusp of really changing

0:27:28.760 --> 0:27:32.080
<v Speaker 2>that whole approach to medicine for older individuals.

0:27:31.680 --> 0:27:35.760
<v Speaker 1>When it comes to longevity medicine. Are there specific considerations

0:27:35.760 --> 0:27:37.760
<v Speaker 1>for women that would be different from men.

0:27:38.200 --> 0:27:41.160
<v Speaker 2>Totally in terms of longevity. You know, we're just now

0:27:41.200 --> 0:27:46.240
<v Speaker 2>realizing the importance of estrogen to basic issues such as dementia,

0:27:46.280 --> 0:27:48.800
<v Speaker 2>cardiac disease, and cancer. Right, these are the three things,

0:27:48.840 --> 0:27:52.760
<v Speaker 2>the three issues they associated with aging. Mitochondrial support and

0:27:52.880 --> 0:27:56.359
<v Speaker 2>inflammation are issues as we age, right, or mitochondria aren't

0:27:56.359 --> 0:27:58.440
<v Speaker 2>as strong. Those are the little powerhouses that make energy

0:27:58.440 --> 0:28:00.800
<v Speaker 2>in ourselves, and we have more inflam so we really

0:28:00.880 --> 0:28:02.800
<v Speaker 2>need to pay attention to ways to mitigate that.

0:28:02.880 --> 0:28:05.720
<v Speaker 1>Well, how do you because inflammation, I think is a

0:28:05.760 --> 0:28:06.960
<v Speaker 1>big problem. I feel it.

0:28:07.280 --> 0:28:12.640
<v Speaker 2>Yeah, that is a strong foundation in nutrition, exercise, good mindset,

0:28:12.720 --> 0:28:16.320
<v Speaker 2>keeping your cortisol levels lower, so managing stress super important.

0:28:16.760 --> 0:28:17.879
<v Speaker 3>And then I'm going to say.

0:28:17.720 --> 0:28:21.199
<v Speaker 2>It estrogen, right, because estrogen is an anti inflammatory, it's

0:28:21.240 --> 0:28:23.919
<v Speaker 2>an antioxidant, so that will definitely help. There's some evidence

0:28:23.920 --> 0:28:27.440
<v Speaker 2>that actually estrogen directly impacts on the mitochondria. So what's

0:28:27.560 --> 0:28:30.400
<v Speaker 2>new in longevity medicine is that we're we.

0:28:30.359 --> 0:28:32.760
<v Speaker 1>Are remembering that word everyone medachondria.

0:28:33.560 --> 0:28:34.960
<v Speaker 3>Yeah, that's really important.

0:28:35.520 --> 0:28:38.160
<v Speaker 2>They're what we're realizing is that women and men are

0:28:38.200 --> 0:28:41.000
<v Speaker 2>different and and that will translate over at the cellular

0:28:41.080 --> 0:28:43.760
<v Speaker 2>level also in terms of how we respond.

0:28:43.480 --> 0:28:49.479
<v Speaker 1>Tot Oh, of course, that's what I want to know.

0:28:50.520 --> 0:28:53.160
<v Speaker 2>I think, you know, women, so women live tend to

0:28:53.200 --> 0:28:56.320
<v Speaker 2>live longer than men, but we live currently we still

0:28:56.360 --> 0:28:59.560
<v Speaker 2>live in more years of being unhealthy. We have fewer

0:28:59.600 --> 0:29:01.000
<v Speaker 2>years of active health than men.

0:29:01.040 --> 0:29:01.120
<v Speaker 1>Do.

0:29:01.640 --> 0:29:03.200
<v Speaker 2>We really have to get to the bottom of that

0:29:03.280 --> 0:29:05.080
<v Speaker 2>and why that occurs. And that's you know, because we

0:29:05.080 --> 0:29:07.360
<v Speaker 2>didn't have women in research until nineteen ninety three and

0:29:07.920 --> 0:29:10.760
<v Speaker 2>I AGE did it and mandate at female animals until

0:29:10.760 --> 0:29:14.480
<v Speaker 2>twenty sixteen. So we live more years in poorer health

0:29:14.520 --> 0:29:16.280
<v Speaker 2>than men, but we tend to live longer. But the

0:29:16.400 --> 0:29:19.080
<v Speaker 2>idea is to get us to get to better health.

0:29:19.120 --> 0:29:20.680
<v Speaker 2>Actually for those all of those years.

0:29:30.720 --> 0:29:34.360
<v Speaker 1>Let's get real about midlife metabolism and women. What happens

0:29:34.360 --> 0:29:36.160
<v Speaker 1>to our metabolism as we age?

0:29:36.640 --> 0:29:40.320
<v Speaker 2>So as estrogen levels go down, we do this shape shifting, right,

0:29:40.360 --> 0:29:44.320
<v Speaker 2>so we begin to deposit fat in the visceral areas

0:29:44.400 --> 0:29:47.200
<v Speaker 2>or the abdominal areas, so around your liver, around your heart,

0:29:47.320 --> 0:29:52.120
<v Speaker 2>and your stomach. Basically, so the fat are adipocites that

0:29:52.240 --> 0:29:55.160
<v Speaker 2>live in the hip region and buttock region actually begin

0:29:55.360 --> 0:29:59.320
<v Speaker 2>to not migrate, but shifts into to the visceral area.

0:29:59.360 --> 0:30:02.320
<v Speaker 2>That becomes an flammatory and then that leads to what

0:30:02.360 --> 0:30:05.960
<v Speaker 2>we call insulin resistance, so we have metabolic disruption, so

0:30:06.200 --> 0:30:09.080
<v Speaker 2>and that also leads to more inflammation. So it becomes

0:30:09.080 --> 0:30:13.080
<v Speaker 2>a vicious cycle of low estrogen levels, visceral fat deposition, inflammation,

0:30:13.240 --> 0:30:14.760
<v Speaker 2>more visceral fat deposition.

0:30:14.920 --> 0:30:16.560
<v Speaker 1>Meno pot.

0:30:16.680 --> 0:30:20.640
<v Speaker 2>I wouldn't use that term because I am a professional,

0:30:20.680 --> 0:30:24.200
<v Speaker 2>but there is that term that is definitely circulating. Yeah,

0:30:24.240 --> 0:30:26.880
<v Speaker 2>I wouldn't use that, but that is definitely circulating around

0:30:26.880 --> 0:30:30.200
<v Speaker 2>and that does refer to our waste to hip circumference

0:30:30.320 --> 0:30:33.320
<v Speaker 2>ratio increases, and that's actually a better measure of what's

0:30:33.320 --> 0:30:34.920
<v Speaker 2>going on in our body because one term that we

0:30:34.960 --> 0:30:36.160
<v Speaker 2>do use is called skinny fat.

0:30:36.480 --> 0:30:38.800
<v Speaker 3>You can be abnormal weight.

0:30:38.720 --> 0:30:41.280
<v Speaker 2>Or of normal BMI, but all of that fat can

0:30:41.320 --> 0:30:45.040
<v Speaker 2>be in your abdominal area and that's unhealthy and that

0:30:45.120 --> 0:30:48.080
<v Speaker 2>leads to this what's called insulin resistance and weight gain.

0:30:48.000 --> 0:30:52.040
<v Speaker 1>And eat of watermelon a day. I just read that's

0:30:52.040 --> 0:30:54.880
<v Speaker 1>a new hack. Just eat a watermelon a day and

0:30:54.920 --> 0:30:57.600
<v Speaker 1>you will not ever get fat in your stomach. Well,

0:30:58.200 --> 0:31:01.160
<v Speaker 1>that just came over the you know, that was on

0:31:01.200 --> 0:31:02.800
<v Speaker 1>the Instagram the other day.

0:31:03.000 --> 0:31:05.360
<v Speaker 2>But that reminds me of the old pineapple diet for

0:31:05.520 --> 0:31:07.800
<v Speaker 2>the nineteen seventies, of which I ate so much pineapple

0:31:07.840 --> 0:31:09.680
<v Speaker 2>that my mouth was about to fall off. So yeah,

0:31:09.680 --> 0:31:11.280
<v Speaker 2>I don't think eating a watermelon a day.

0:31:11.400 --> 0:31:17.040
<v Speaker 1>I don't either. But sleep habits are of ultimate importance.

0:31:17.560 --> 0:31:20.400
<v Speaker 2>Sleep is really important. Sleep is really important to cognitive function.

0:31:20.680 --> 0:31:24.000
<v Speaker 2>Less sleep equals worse cognitive function, it equals higher when

0:31:24.040 --> 0:31:26.200
<v Speaker 2>people who don't sleep have a higher risk of dementia.

0:31:26.760 --> 0:31:28.840
<v Speaker 2>It is, like I said, it is an active process.

0:31:28.840 --> 0:31:33.080
<v Speaker 2>We're clearing our brain waste products. There's a whole system

0:31:33.160 --> 0:31:37.080
<v Speaker 2>where the way lymphatic fluid circulates around the body at night.

0:31:37.000 --> 0:31:39.600
<v Speaker 1>So you think that when you're sleeping, all that is

0:31:39.640 --> 0:31:40.440
<v Speaker 1>going away.

0:31:40.720 --> 0:31:43.400
<v Speaker 2>There is, there's active So it's an active process. It's

0:31:43.480 --> 0:31:45.040
<v Speaker 2>like it's an active process.

0:31:45.480 --> 0:31:47.920
<v Speaker 1>It's not bunk, as my grandfather would say.

0:31:48.000 --> 0:31:50.760
<v Speaker 2>No, And it's really really, really important. And I actually

0:31:50.880 --> 0:31:53.480
<v Speaker 2>did a course for a malpractice carrier recently, and it

0:31:53.520 --> 0:31:56.080
<v Speaker 2>was all about sleep and cognition and cognitive function. And

0:31:56.120 --> 0:31:57.840
<v Speaker 2>there's been a lot of studies and physicians that we

0:31:57.880 --> 0:32:01.880
<v Speaker 2>make poor diagnostic when we have less sleep, and it's

0:32:01.920 --> 0:32:05.200
<v Speaker 2>really so there is an activity that is going on

0:32:05.320 --> 0:32:06.560
<v Speaker 2>in our brain as we sleep.

0:32:07.040 --> 0:32:11.200
<v Speaker 1>Is there a connection to cardiovascular health? How lipids and

0:32:11.280 --> 0:32:13.680
<v Speaker 1>cholesterols start to change at this age and beyond.

0:32:14.040 --> 0:32:16.160
<v Speaker 2>Certainly in terms of there's a link to sleep in

0:32:16.200 --> 0:32:19.000
<v Speaker 2>cardiovascular health because when we don't sleep, where we live

0:32:19.000 --> 0:32:22.160
<v Speaker 2>in an inflame state, and that's actually bad for cardiac health.

0:32:22.200 --> 0:32:25.440
<v Speaker 2>And in terms of cardiac health and lipid metabolism are

0:32:25.480 --> 0:32:28.120
<v Speaker 2>extremely linked. And at midlife our lipids change in our

0:32:28.120 --> 0:32:29.200
<v Speaker 2>cardiac health changes.

0:32:29.480 --> 0:32:32.400
<v Speaker 1>So what are some no nos in terms of diet

0:32:32.600 --> 0:32:34.200
<v Speaker 1>for anti inflammatory?

0:32:35.080 --> 0:32:36.280
<v Speaker 3>Get rid of processed food.

0:32:36.360 --> 0:32:39.200
<v Speaker 2>So anything that has more than three ingredients on it

0:32:39.240 --> 0:32:43.080
<v Speaker 2>is probably a processed food. Shop the periphery of the supermarkets.

0:32:43.120 --> 0:32:46.400
<v Speaker 2>Eat freshole food and don't use added sugars. Sugars are

0:32:46.400 --> 0:32:48.720
<v Speaker 2>super super inflammatory. The sugars that you get in fruits

0:32:48.760 --> 0:32:51.360
<v Speaker 2>and berries actually are fine because they come with fiber,

0:32:51.720 --> 0:32:53.800
<v Speaker 2>but the sugar that's just added into something is not

0:32:53.880 --> 0:32:55.440
<v Speaker 2>good at super inflammatory.

0:32:56.200 --> 0:32:57.600
<v Speaker 1>So you don't eat any sugar.

0:32:57.960 --> 0:33:01.920
<v Speaker 2>I really minimize it, really pay attention to that chocolate,

0:33:02.520 --> 0:33:05.320
<v Speaker 2>dark chocolate. Dark chocolate's great for your brain, good antioxidants.

0:33:05.320 --> 0:33:06.760
<v Speaker 2>So no, no sugar.

0:33:06.920 --> 0:33:07.440
<v Speaker 1>Coffee.

0:33:08.360 --> 0:33:11.080
<v Speaker 2>So there's one hundred studies trying to prove that coffee

0:33:11.120 --> 0:33:13.080
<v Speaker 2>is bad for you, but no studies have shown that

0:33:13.080 --> 0:33:15.240
<v Speaker 2>it's really bad for you. They tried to link it

0:33:15.240 --> 0:33:17.920
<v Speaker 2>to pancreatic cancer at one point that was not successful.

0:33:17.960 --> 0:33:20.160
<v Speaker 2>So I can't find anything bad about coffee, and coffee

0:33:20.160 --> 0:33:21.520
<v Speaker 2>has antioxidant's good for your brain.

0:33:21.640 --> 0:33:24.520
<v Speaker 3>Especially teas are okay. Also same thing.

0:33:24.560 --> 0:33:26.280
<v Speaker 2>You just have to watch out for your caffeine content,

0:33:26.880 --> 0:33:29.840
<v Speaker 2>especially with teas. Also, you just want to drink a

0:33:29.880 --> 0:33:32.720
<v Speaker 2>tea that's caffeinated too close to sleep because that can

0:33:32.760 --> 0:33:34.160
<v Speaker 2>really be a disruptor for your sleep.

0:33:34.360 --> 0:33:38.000
<v Speaker 1>Diet coke, oh.

0:33:37.200 --> 0:33:39.200
<v Speaker 3>So yeah, that would be a processed food.

0:33:39.840 --> 0:33:43.520
<v Speaker 1>More than three ingredients. Those are the things that people forget.

0:33:43.640 --> 0:33:45.040
<v Speaker 1>They think that that's just water.

0:33:45.680 --> 0:33:48.320
<v Speaker 2>Yeah, and you have to look at artificial sweeteners and

0:33:48.360 --> 0:33:51.440
<v Speaker 2>the impact that they have. A lot of physicians, especially surgeons,

0:33:51.440 --> 0:33:54.320
<v Speaker 2>have big diet coke habits. And I stopped diet coke

0:33:54.360 --> 0:33:57.160
<v Speaker 2>a while ago, and when I was actually stopping drinking it.

0:33:57.200 --> 0:33:59.640
<v Speaker 2>I actually had like some mood issues and I was like,

0:33:59.720 --> 0:34:02.120
<v Speaker 2>this is so weird. I'm like, everything's great. I shouldn't

0:34:02.120 --> 0:34:04.080
<v Speaker 2>have any mood issues. And then I start reading about

0:34:04.080 --> 0:34:07.160
<v Speaker 2>I was like, oh, I'm withdrawing from all the aspartame.

0:34:06.760 --> 0:34:10.319
<v Speaker 1>When I read about artificial sweeteners or actually, my daughter

0:34:10.360 --> 0:34:12.920
<v Speaker 1>pointed it out to me. She had listened to an

0:34:12.920 --> 0:34:17.839
<v Speaker 1>interview with the man who invented an artificial sweeteners, the

0:34:17.840 --> 0:34:20.359
<v Speaker 1>most popular one, and he said that if he could

0:34:20.400 --> 0:34:23.040
<v Speaker 1>do it all over again, he would never invent it. It's

0:34:22.880 --> 0:34:26.759
<v Speaker 1>interesting because it's so dangerous for the human health. But

0:34:27.000 --> 0:34:28.880
<v Speaker 1>I don't use a lot of sugar, but I do

0:34:29.120 --> 0:34:29.760
<v Speaker 1>like dessert.

0:34:30.239 --> 0:34:33.200
<v Speaker 2>So there's a ninety percent rule, right that we have

0:34:33.400 --> 0:34:35.480
<v Speaker 2>got to enjoy life, right, you know, just don't need

0:34:35.520 --> 0:34:36.680
<v Speaker 2>a lot of chocolate cake or eat a lot of

0:34:36.719 --> 0:34:37.439
<v Speaker 2>cake all the time.

0:34:37.560 --> 0:34:40.440
<v Speaker 3>You know, but what do you use? It's nice to enjoy.

0:34:40.719 --> 0:34:45.040
<v Speaker 1>Every now and then. So how do we deal with

0:34:45.320 --> 0:34:48.040
<v Speaker 1>mental health and mood and women's health.

0:34:48.480 --> 0:34:51.960
<v Speaker 2>I think that we need to be really attuned to it.

0:34:52.040 --> 0:34:56.000
<v Speaker 2>And this is where as health providers and specialists in

0:34:56.040 --> 0:34:58.200
<v Speaker 2>women's health, we really need to key in on that

0:34:58.360 --> 0:35:00.560
<v Speaker 2>that so just can be a simple question about how

0:35:00.600 --> 0:35:02.440
<v Speaker 2>are you feeling? Are you feeling any different? How are

0:35:02.440 --> 0:35:05.160
<v Speaker 2>you feeling? That goes back to those JOI de v questions,

0:35:05.840 --> 0:35:08.000
<v Speaker 2>And I do think that we need more mental health

0:35:08.000 --> 0:35:11.360
<v Speaker 2>providers that are keyed into midlife women's health and really

0:35:11.480 --> 0:35:15.239
<v Speaker 2>understand these changes that occur because estrogen and progesterone really

0:35:15.239 --> 0:35:18.360
<v Speaker 2>do affect the neurotransmitters. I mean, there are real issues

0:35:18.400 --> 0:35:21.520
<v Speaker 2>that are medically happening in the brain as estrogen levels

0:35:21.520 --> 0:35:24.520
<v Speaker 2>are fluctuating. We see that also in women before midlife

0:35:24.560 --> 0:35:29.760
<v Speaker 2>with PMS and PMDD and postpartum depression, and the treatments

0:35:29.800 --> 0:35:33.000
<v Speaker 2>of these issues and recognition of these issues definitely warrant

0:35:33.040 --> 0:35:36.160
<v Speaker 2>further study and for their higher numbers of individuals involved

0:35:36.200 --> 0:35:37.000
<v Speaker 2>in these specialties.

0:35:37.680 --> 0:35:40.480
<v Speaker 1>Is it true that women are at higher risk for dementia?

0:35:40.800 --> 0:35:42.680
<v Speaker 3>Yes? Two thirds of Yes, totally.

0:35:42.719 --> 0:35:45.560
<v Speaker 2>And this is one area that I'm super interested in

0:35:45.680 --> 0:35:48.520
<v Speaker 2>actually and is gaining in popularity in terms of interest,

0:35:48.640 --> 0:35:51.279
<v Speaker 2>And because why is that? Is it hormone fluctuations? Is

0:35:51.360 --> 0:35:55.319
<v Speaker 2>our lifestyle what makes us more susceptible intimasions? A lot

0:35:55.360 --> 0:35:58.239
<v Speaker 2>of individuals are looking at the role of hormones on

0:35:59.000 --> 0:36:01.920
<v Speaker 2>the female brain, and we are moving in that direction.

0:36:02.440 --> 0:36:05.280
<v Speaker 2>Lifestyle factors are also being looked at, but that research

0:36:05.320 --> 0:36:08.560
<v Speaker 2>is really accelerating and it's super exciting. And this leads

0:36:08.640 --> 0:36:11.200
<v Speaker 2>us back to, you know, can we identify women who

0:36:11.239 --> 0:36:14.360
<v Speaker 2>are at high risk and then get hormone support or

0:36:14.360 --> 0:36:16.120
<v Speaker 2>lifestyle support initiated earlier?

0:36:16.640 --> 0:36:19.919
<v Speaker 1>Are there lifestylent interventions that one a woman can take?

0:36:20.200 --> 0:36:24.400
<v Speaker 2>Absolutely anti inflammatory nutrition, making sure that you have your

0:36:24.400 --> 0:36:27.799
<v Speaker 2>homoicystine levels checked, which is inflammatory for the brain and

0:36:27.840 --> 0:36:28.240
<v Speaker 2>the heart.

0:36:28.719 --> 0:36:30.480
<v Speaker 1>Good stress who does that? Who?

0:36:31.239 --> 0:36:33.480
<v Speaker 3>Generalists can do that? Check? You can add what is

0:36:33.600 --> 0:36:34.319
<v Speaker 3>it's a blood test?

0:36:34.400 --> 0:36:34.640
<v Speaker 2>There?

0:36:34.719 --> 0:36:37.680
<v Speaker 3>These are blood tests and is what do you ask for?

0:36:37.840 --> 0:36:40.239
<v Speaker 2>I would ask for just a general metabolic panel. I

0:36:40.239 --> 0:36:43.840
<v Speaker 2>would ask for homoicysteine levels and that's not all generalists

0:36:43.840 --> 0:36:47.239
<v Speaker 2>will do a homicistine level but super important, super and

0:36:47.280 --> 0:36:49.880
<v Speaker 2>I think that we are at elevated risk for dementia

0:36:49.880 --> 0:36:51.879
<v Speaker 2>and cognitive issues, so we need to be a little

0:36:51.880 --> 0:36:55.959
<v Speaker 2>bit more aggressive in our female population. But definitely early

0:36:56.000 --> 0:36:59.080
<v Speaker 2>identification of individuals who may be at elevated risk and

0:36:59.160 --> 0:37:03.520
<v Speaker 2>warrant more intensive interventions. And then for individuals who are

0:37:03.520 --> 0:37:05.040
<v Speaker 2>not deemed to be at risk. We are all at

0:37:05.080 --> 0:37:07.440
<v Speaker 2>risks because we're all women, you know, so, but just

0:37:07.480 --> 0:37:10.280
<v Speaker 2>paying attention close attention to lifestyle factors and those subtle

0:37:10.320 --> 0:37:13.480
<v Speaker 2>hormonal issues that you know. And one of the first

0:37:13.560 --> 0:37:16.600
<v Speaker 2>signs of perimenopause is like word finding difficulty. Sometimes I'll

0:37:16.600 --> 0:37:19.279
<v Speaker 2>ask people, you know, is your memory off, and they'll say, no,

0:37:19.320 --> 0:37:21.040
<v Speaker 2>it's not really often. So are you having any word

0:37:21.040 --> 0:37:21.880
<v Speaker 2>finding difficulty?

0:37:21.880 --> 0:37:22.000
<v Speaker 1>Oh?

0:37:22.080 --> 0:37:24.840
<v Speaker 2>Yeah, I can't remember names the same way. So what

0:37:24.520 --> 0:37:28.640
<v Speaker 2>we what we call associative memory or coordinating like like

0:37:28.719 --> 0:37:31.400
<v Speaker 2>things or faces and names and such starts to go

0:37:31.480 --> 0:37:33.520
<v Speaker 2>off a little bit and word finding goes off a

0:37:33.520 --> 0:37:36.319
<v Speaker 2>little bit, and that can be correlated actually with real

0:37:36.400 --> 0:37:39.640
<v Speaker 2>changes in the brain structure. So these are active areas

0:37:39.680 --> 0:37:41.120
<v Speaker 2>of research and are just.

0:37:41.280 --> 0:37:42.400
<v Speaker 1>What can one do about that?

0:37:43.239 --> 0:37:46.640
<v Speaker 2>Again, review it with your position. Maybe are your healthcare providers.

0:37:46.640 --> 0:37:49.680
<v Speaker 2>Speak to your provider about maybe starting on hormone support

0:37:49.719 --> 0:37:51.600
<v Speaker 2>earlier if you're considering it. And I think this is

0:37:51.640 --> 0:37:54.359
<v Speaker 2>one one thing that I'd recommend to people. Also kind

0:37:54.360 --> 0:37:56.080
<v Speaker 2>of get your opinion on hormon support. Are you going

0:37:56.120 --> 0:37:56.800
<v Speaker 2>to go in that direction?

0:37:56.880 --> 0:37:59.600
<v Speaker 3>Yes or no? Right? And then you know, educate.

0:37:59.320 --> 0:38:02.960
<v Speaker 2>Yourself early, be reactive to it, be proactive actually and then,

0:38:03.000 --> 0:38:05.759
<v Speaker 2>of course, lifestyle interventions. We know that lifestyle interventions in

0:38:05.840 --> 0:38:10.080
<v Speaker 2>terms of stress management, nutrition support, supplement, targeted supplement support,

0:38:10.840 --> 0:38:13.920
<v Speaker 2>and exercise can help with brain health. Interestingly, when we

0:38:14.000 --> 0:38:17.120
<v Speaker 2>move skeleton muscle, we release a hormone called a risin.

0:38:17.360 --> 0:38:18.680
<v Speaker 3>Actually, so when we just move.

0:38:18.560 --> 0:38:21.879
<v Speaker 1>Skeletal muscles, I don't even know, so.

0:38:21.840 --> 0:38:23.759
<v Speaker 3>It's a myokine. Of course, it's a myokine.

0:38:23.840 --> 0:38:26.400
<v Speaker 2>So it's a substance that's produced by the muscle that

0:38:26.440 --> 0:38:29.600
<v Speaker 2>when you just move muscle, it's a substance, a chemical substance.

0:38:29.600 --> 0:38:32.880
<v Speaker 2>It travels throughout the body into the brain and increases

0:38:32.920 --> 0:38:34.680
<v Speaker 2>your brain function and structure.

0:38:34.760 --> 0:38:37.799
<v Speaker 1>Actually, I did my pilates today. Why did I move some.

0:38:37.960 --> 0:38:39.240
<v Speaker 3>Yeah, that's piloates.

0:38:39.280 --> 0:38:42.759
<v Speaker 2>Great, Just moving skeleton muscle will help your brain. And

0:38:42.920 --> 0:38:46.040
<v Speaker 2>we're getting the scientific so to provide context to it.

0:38:46.320 --> 0:38:48.799
<v Speaker 2>We can always tell people like what to do, but

0:38:49.000 --> 0:38:51.160
<v Speaker 2>why to do it? Actually will help people.

0:38:51.280 --> 0:38:53.600
<v Speaker 1>I like that. I like that. I mean, we're reasoning.

0:38:53.680 --> 0:38:56.279
<v Speaker 1>My trainer did not tell me about that, but I'm

0:38:56.320 --> 0:39:00.400
<v Speaker 1>going to tell her about it because there is a

0:39:00.400 --> 0:39:03.839
<v Speaker 1>a reason for doing the six thirty am pilates. As

0:39:03.840 --> 0:39:06.839
<v Speaker 1>an oncologist, do you have any insight into why we're

0:39:06.880 --> 0:39:10.080
<v Speaker 1>seeing a rise in cancer in younger people.

0:39:10.600 --> 0:39:12.640
<v Speaker 2>Why, you know, I don't think we understand that now.

0:39:12.640 --> 0:39:17.480
<v Speaker 2>I mean obvious targets are nutrition, social stressures, social structure

0:39:17.840 --> 0:39:22.160
<v Speaker 2>leading to increased stress, nutrition, environmental exposures. A lot of

0:39:22.200 --> 0:39:24.600
<v Speaker 2>people will point to nutrition right now, but I have

0:39:24.719 --> 0:39:27.400
<v Speaker 2>a lot of patients in my practice who practice excellent

0:39:27.480 --> 0:39:32.239
<v Speaker 2>nutrition who have had early young colon cancers and are

0:39:32.280 --> 0:39:32.880
<v Speaker 2>not a lot.

0:39:32.760 --> 0:39:36.359
<v Speaker 1>But a few. Why is it something else in our food,

0:39:36.800 --> 0:39:38.239
<v Speaker 1>in our environment, in our water.

0:39:38.440 --> 0:39:40.360
<v Speaker 2>Well, we also have to look to our microbiome. Is

0:39:40.400 --> 0:39:43.000
<v Speaker 2>our microbiome putting us at risk? Which is intimately linked?

0:39:43.040 --> 0:39:44.640
<v Speaker 2>So that's all The bugs that live in the gut

0:39:44.680 --> 0:39:48.440
<v Speaker 2>are really important, you know, is our microbiome at risk

0:39:48.480 --> 0:39:50.719
<v Speaker 2>from our modern lifestyle. I don't think we have those

0:39:50.760 --> 0:39:52.680
<v Speaker 2>answers yet, but those are kind of the targets of

0:39:52.719 --> 0:39:54.200
<v Speaker 2>where people are looking right now.

0:39:54.360 --> 0:39:55.560
<v Speaker 1>Good research going on.

0:39:55.800 --> 0:39:57.680
<v Speaker 3>Definitely lots of good research going on.

0:39:58.520 --> 0:40:01.320
<v Speaker 1>So now this is a new project for doctor Poynter.

0:40:01.520 --> 0:40:07.040
<v Speaker 1>She has recently left her beautiful gynecological practice in a

0:40:07.080 --> 0:40:10.919
<v Speaker 1>private office with lovely help. By the way, your your

0:40:11.040 --> 0:40:14.760
<v Speaker 1>ultrasound woman was so amazing, you would go to doctor

0:40:14.800 --> 0:40:16.800
<v Speaker 1>Poynter's office and you would lie down on the table

0:40:16.840 --> 0:40:21.160
<v Speaker 1>and you would have your all your organs ultrasounded right,

0:40:21.280 --> 0:40:23.680
<v Speaker 1>and it was I really liked that because it was

0:40:23.719 --> 0:40:26.440
<v Speaker 1>such a nice way to start an examination, knowing that

0:40:26.480 --> 0:40:28.319
<v Speaker 1>there was nothing to look for.

0:40:28.480 --> 0:40:30.680
<v Speaker 3>Empowering, right, It's very empowering.

0:40:31.640 --> 0:40:35.400
<v Speaker 1>And doctor Poynter has left to join Atria. It's a

0:40:35.480 --> 0:40:38.440
<v Speaker 1>it's an organization started here in New York City. So

0:40:38.560 --> 0:40:39.480
<v Speaker 1>describe Atria.

0:40:39.560 --> 0:40:42.600
<v Speaker 2>So Atria is super unique and poise to I think

0:40:42.680 --> 0:40:45.480
<v Speaker 2>make some really big contributions. Leaving my practice was like

0:40:45.560 --> 0:40:48.640
<v Speaker 2>literally ripping my heart out of my chest voluntarily.

0:40:48.719 --> 0:40:52.120
<v Speaker 1>It was such a personal practice and your offices were

0:40:52.160 --> 0:40:54.840
<v Speaker 1>so personal. It was a unique place.

0:40:55.560 --> 0:40:58.640
<v Speaker 2>Thank you for the compliments of the office. So Atria

0:40:59.120 --> 0:41:04.200
<v Speaker 2>is a multi specialty group. So I work next to

0:41:04.400 --> 0:41:09.800
<v Speaker 2>the smartest brain health people, the smartest endocrinologist, the smartest cardiologist.

0:41:10.440 --> 0:41:14.759
<v Speaker 2>We have nutrition experts, we have exercise experts. We even

0:41:14.800 --> 0:41:18.040
<v Speaker 2>have a naturopathic physician who has involved in integrative care.

0:41:18.640 --> 0:41:21.560
<v Speaker 2>We all work together and it's a real cross fertilization

0:41:22.040 --> 0:41:26.760
<v Speaker 2>of ideas and how to approach clinical issues, further research,

0:41:26.840 --> 0:41:30.480
<v Speaker 2>and also we are involved in patient care, and it

0:41:30.560 --> 0:41:33.000
<v Speaker 2>is the way that the world of what we call

0:41:33.040 --> 0:41:35.120
<v Speaker 2>primary prevention is going to move forward.

0:41:35.360 --> 0:41:37.439
<v Speaker 3>It is a private organization, so.

0:41:37.560 --> 0:41:41.600
<v Speaker 2>It's not bound by many of the constraints that will

0:41:41.600 --> 0:41:45.920
<v Speaker 2>happen in an academic setting. However, every physician who is

0:41:45.960 --> 0:41:50.279
<v Speaker 2>there has a very strong academic and research background. We

0:41:50.400 --> 0:41:55.200
<v Speaker 2>have strategy specialists all working together to help formulate and

0:41:55.280 --> 0:41:58.360
<v Speaker 2>develop a new model for how to deliver care and

0:41:58.400 --> 0:42:02.080
<v Speaker 2>how to deliver primary prevention because we want to be proactive,

0:42:02.320 --> 0:42:04.680
<v Speaker 2>we want to be predictive. We want to get things

0:42:04.680 --> 0:42:07.800
<v Speaker 2>before disease happens and before disease transitions, or pick it

0:42:07.880 --> 0:42:09.160
<v Speaker 2>up at its earliest point.

0:42:09.440 --> 0:42:12.040
<v Speaker 1>How does one find out about ATRIA?

0:42:12.080 --> 0:42:16.960
<v Speaker 2>So we're online of course, and a R I A.

0:42:17.360 --> 0:42:20.520
<v Speaker 2>We have two locations currently New York and Florida. I

0:42:20.560 --> 0:42:22.360
<v Speaker 2>have to pinch myself a little bit that I'm there

0:42:22.560 --> 0:42:25.640
<v Speaker 2>because I work with the smart, very smart people, the

0:42:25.680 --> 0:42:28.640
<v Speaker 2>smartest people I've worked with, and it was a lot

0:42:28.640 --> 0:42:29.920
<v Speaker 2>of the work that I was trying to do on

0:42:29.960 --> 0:42:32.640
<v Speaker 2>my own in my private practice, and I realize that

0:42:32.800 --> 0:42:35.000
<v Speaker 2>I can't do it all by myself, and I need

0:42:35.320 --> 0:42:37.759
<v Speaker 2>help to further the cause. Right, And so we're all

0:42:37.800 --> 0:42:41.279
<v Speaker 2>working together to further the cause of primary prevention medicine.

0:42:41.320 --> 0:42:43.319
<v Speaker 2>I think you'll see more in the future. Atre is

0:42:43.360 --> 0:42:46.399
<v Speaker 2>just getting started. It is just in its infancy, and

0:42:46.920 --> 0:42:48.120
<v Speaker 2>we are still in it two or.

0:42:48.120 --> 0:42:51.279
<v Speaker 1>Three years old. It sounds like such a good way

0:42:51.360 --> 0:42:55.680
<v Speaker 1>to learn about oneself and know about oneself for the future.

0:42:55.719 --> 0:42:58.480
<v Speaker 1>I mean, you know, at my age, I really need

0:42:58.520 --> 0:43:00.080
<v Speaker 1>to know a lot.

0:43:00.680 --> 0:43:04.239
<v Speaker 2>Right, and I think we're we're collecting the information on

0:43:04.320 --> 0:43:07.480
<v Speaker 2>how to get that to everybody in the future. And

0:43:07.600 --> 0:43:09.680
<v Speaker 2>how what do we need to know, how do we

0:43:09.760 --> 0:43:10.239
<v Speaker 2>need to know?

0:43:10.800 --> 0:43:11.800
<v Speaker 3>How do we intervene?

0:43:12.200 --> 0:43:15.640
<v Speaker 2>And this can only happen with a multi specialty group

0:43:15.680 --> 0:43:19.280
<v Speaker 2>that is nimble and can ask questions quickly and adjust

0:43:19.800 --> 0:43:21.160
<v Speaker 2>and readjust as needed.

0:43:21.600 --> 0:43:25.520
<v Speaker 1>I got very interested in blood in the last five years,

0:43:25.840 --> 0:43:28.520
<v Speaker 1>so I will have a blood tist of complete you

0:43:28.600 --> 0:43:29.600
<v Speaker 1>call it what do you call it? Big?

0:43:29.680 --> 0:43:30.960
<v Speaker 3>You say chemistry profile?

0:43:31.600 --> 0:43:35.000
<v Speaker 1>And I get a choice a year and I look

0:43:35.040 --> 0:43:37.560
<v Speaker 1>at it and it's so funny how some things go

0:43:37.680 --> 0:43:40.120
<v Speaker 1>up and some things go down. Accounts go down. Is

0:43:40.160 --> 0:43:43.000
<v Speaker 1>that because the testing is different or is it because

0:43:43.040 --> 0:43:44.440
<v Speaker 1>the laboratory is different?

0:43:45.600 --> 0:43:45.799
<v Speaker 3>OK?

0:43:46.000 --> 0:43:47.759
<v Speaker 1>I'm not an expert in any way, but I just

0:43:47.840 --> 0:43:50.319
<v Speaker 1>like to see that I'm pretty stable and within the

0:43:50.360 --> 0:43:52.040
<v Speaker 1>parameters of good.

0:43:51.840 --> 0:43:55.359
<v Speaker 2>Health, there's variability. There's variability in the human body. We

0:43:55.440 --> 0:43:59.839
<v Speaker 2>react to our environment, right. Our body is constantly reacting, readjusting, right,

0:44:00.080 --> 0:44:01.480
<v Speaker 2>So if you.

0:44:01.440 --> 0:44:04.200
<v Speaker 1>Take an iron supplement, it's going to change your iron

0:44:04.239 --> 0:44:05.200
<v Speaker 1>and your blood.

0:44:05.200 --> 0:44:08.160
<v Speaker 2>Correct and it's the human body is dynamic, so you know,

0:44:08.200 --> 0:44:09.960
<v Speaker 2>and you have to look at trends over time. We

0:44:10.000 --> 0:44:12.239
<v Speaker 2>look at trends over time. We look at not just

0:44:12.360 --> 0:44:15.440
<v Speaker 2>individual components of the blood, but how they're interacting together.

0:44:15.480 --> 0:44:17.160
<v Speaker 3>And this our AI is really going to help us

0:44:17.160 --> 0:44:18.200
<v Speaker 3>in exciting.

0:44:17.840 --> 0:44:21.719
<v Speaker 1>Wages to see that. Yeah, yeah, well, this is so fascinating.

0:44:21.760 --> 0:44:26.279
<v Speaker 1>Your practice has expanded exponentially with this new adventure that

0:44:26.320 --> 0:44:30.160
<v Speaker 1>you've joined. Very interesting to learn more about the challenges

0:44:30.200 --> 0:44:33.120
<v Speaker 1>facing women in each of their decades. We have to

0:44:33.160 --> 0:44:36.440
<v Speaker 1>pay be very aware of women listening about this, and

0:44:36.480 --> 0:44:39.880
<v Speaker 1>so to men. It's a very interesting time in medicine,

0:44:40.239 --> 0:44:42.960
<v Speaker 1>and I applaud your efforts. It's really great and I

0:44:42.960 --> 0:44:44.000
<v Speaker 1>look forward to your book.

0:44:44.520 --> 0:44:46.520
<v Speaker 2>Thank you so much for having me and allowing me

0:44:46.560 --> 0:44:48.640
<v Speaker 2>to speak today. I think we're at a great time in medicine.

0:44:48.680 --> 0:44:50.400
<v Speaker 2>We're about to crack through some issues.

0:44:50.480 --> 0:44:53.160
<v Speaker 1>Well, that is excellent to know. Thank you, doctor Pointer.