October 1, 2025 • 47 mins
What do you look for when selecting a personal doctor? Years of experience? Hospital affiliation? Expertise and specialty? Martha's latest guest began her journey into medicine as a young student with a passion for science, biology, and the deep desire to impact the lives of others. With more than 40 years in practice and medical research, Dr. Caren Behar is changing the way women look at health and wellness. As a general internist and the medical director of the Joan Tisch Center for Women's Health, Dr. Behar treats a wide variety of conditions, with a focus on preventive care and health maintenance. She caters to the unique needs of women, consolidating annual medical and GYN exams, mammograms, bone density, medical subspecialties, women's orthopedics, dermatology, and cancer risk, all in one place. In this podcast, Dr. Behar talks to Martha about her approach to women's care, the latest advice on women's imaging and testing, the importance of mental health, and what she wishes all her female patients to know as they enter their later years. Be sure to listen.
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Episode Transcript
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Speaker 1 (00:03):
Doctor Karen Bahar is a general internist and the medical
director for the Joan H. Tish Center for Women's Health
at NYU Langone Health here in New York City. She
shares medical expertise on her weekly show Women's Health on
Serious XM's Doctor Radio. Welcome to my podcast, doctor Bayhart.
Speaker 2 (00:25):
Thank you for having me. I'm so thrilled and honored
to be here. Well that's the truth. Well, thank you well.
Speaker 1 (00:31):
I sat next to doctor Bayhart at at our mutual friend,
doctor Albert Knapp's house and doctor Ruth Oretz's house at
an outdoor summer party a few weeks ago, and we
got to talking and the conversation was really interesting, and
I thought, Wow, I would really like to interview doctor
Bayhart on my podcast.
Speaker 2 (00:53):
So here we are. It's very just a couple of
weeks later happen.
Speaker 1 (00:57):
I like to make things happen, but I also like
to talk to people who are doing interesting things and
changing the way we look at health. And you have
certainly made some very serious inroads in women's health, and
I think that the focus of this show should be
about that. What does an internist do versus a general practitioner.
Speaker 2 (01:21):
So the difference between an internist and a GP essentially
is that the old fashioned GP saw adults and children,
and an internist only sees adults. I see patients only
over eighteen years old, and a pediatrician would see the children.
So if you combine a pediatrician and an internist, you
get a GP. And gps actually used to also deliver babies.
(01:44):
They did a little bit of everything. They did a
little surgery. They were trained to do a little bit
of everything in medicine, and as we moved on in
medicine and for specialized and sub specialized, we separated out
seeing children from seeing adults, from doing obstetrics and gynecology.
And so I'm an internist. I see all patients over
(02:07):
the age of eighteen.
Speaker 1 (02:09):
The jooned Tish Women's Center at Langone, NYU sounds like
such a fascinating place. I have visited a couple doctors
at your center specialists in certain areas, but I didn't
really know about the jone Tish Center. And that you
are managing one hundred and thirty women doctors who are
(02:31):
seeing basically women patients is incredible.
Speaker 2 (02:34):
And how long have you been doing this? So it's
a little different we are now. We've combined many services
in our building. The Jone Tish Center for Women's Health
started in twenty eleven up on eighty fourth Street in
a smaller building and we were a small group of
about nine doctors, all women, medical subspecialists and guyna college logists,
(03:00):
a dermatologist, and we were wildly successful, outgrew our space.
It was a reasonably novel concept at the time. The
Tish family, in honor of their mother, Joan H. Tish,
donated money to get the center started. She had a
vision to have a women's health center. And for me,
(03:21):
you know, I started. We talked a little bit about this.
I started my career. I was the only woman in
the department of medicine at my first job in a
different medical school, and now I am one of all women.
I've come a long way. So we started with a
small group and we became full very quickly, and we
(03:42):
were landlocked. We really could not expand anymore. We were
at our capacity, and we looked for space to grow
and COVID hit we found a larger space in midtown.
And what we've done now, what NYU has done, is
they joined the Jontish Center, which is again mostly medical subspecialties, internists, cardiologists, endocrinologists,
(04:08):
GI We're on one floor and then on another floor
is all of obg YN. On another floor is reproductive
Endochronology or IVF. And on another floor yet is joint
programming between the Women's Center and the Department of OBGYN.
So we've started a fibroid center and a menopause center.
(04:29):
So it really is a building filled with women's services.
We have now been the building, all of us together
have now been renamed the Mignoni Women's Health Collaborative due
to a large generous donation from Alison and Roberto Mignoni
and a donation from Ken Griffin, and we're about to
(04:49):
launch a wellness center as well. That was a mouthful,
but that's all building.
Speaker 1 (04:54):
That is very extraordinary though, because and then just a
couple of blocks north just passed by the Men's Center
of NYU Langon. Yes they're a partner, so yeah, So
how many floors do they have?
Speaker 2 (05:10):
Don't know, they are growing. They have a number of
floors in an office building, they have maybe four or
five floors. Now, I don't want to speak, but they
have a lot of floors as well, and they're the
Preston Robert Tish, Joan Tish's husband. They similar donation for
the men's center there.
Speaker 1 (05:25):
Yeah, oh great, So I was laughing that, oh here
we are men's one on one, streets on another keeping segregated.
But I think you have to in a way if
you're studying the medicine of the female body is so
very different from the men.
Speaker 2 (05:41):
Well, you know, people ask me all the time about this,
and my feeling is we are a choice for people.
You can go anywhere in the country, in the city,
in the state and find male and female doctors together,
seeing male and female patients. I did that for much
of my career. There never was a choice really for
(06:01):
women to be able to go to a center that
focused specifically on them predominantly staffed by women. Our Jone
Tish Center is all female physicians on the OB floor
and on the IVF floor. There are some male physicians
in our building. We are all women, and it's an
unusual choice that women have. I spent a lot of
(06:24):
my career seeing patients women asking me when I refer
them to another doctor, is it a woman, And now
the answer is always yes.
Speaker 1 (06:34):
Very very interesting. What are the advantages of a facility
like the Women's Center for your patient.
Speaker 2 (06:41):
So several advantages. I think obviously one we just touched on.
You know, there are many women who just want to
see women doctors. So not only do they have a
choice to see a women doctor, but the women are
incredibly talented, well trained. I've chosen almost every one of them. Elf.
(07:01):
We have an interest in women's health, all of us.
We've been working in women's health for years. So that's
number one. If you want to see women doctors, that's
a building. We're a building full of them. Number two
another important thing I think that's often overlooked. It's important
for the doctors. I never had the chance to work
(07:23):
with all women. Most of the time, I was the
only woman in the room. I'm sure you know what
that feels like. I was the only woman with lots
of men. So it's really gratifying for me at this
point in my career to work with all these talented women.
We're all friends, we get along, there's no drama, unlike
what people think when there's a building of women together.
(07:45):
That's number two, and number three is what we really
try to do. The whole point of the Women's center
is everything's available in one place. So women are busy.
They often don't take care of themselves. They take care
of their children, their spouses, their partners, everybody, their parents,
and they don't take care of themselves. So you come
to our building, You see your internists, do you have
(08:07):
your annual physical, you have your mammogram, your bone density,
see your gynecologist, and have whatever you need to have done. Shop.
Speaker 1 (08:14):
That's right, very best, that's right, and well we'll talk
about scheduling those kinds of examinations too, and how important
they are for every single woman. I've always liked going
to women doctors just because I think, well, they know
how I feel because they're a woman, I agree with you,
and they should know more about it than any male doctor.
(08:36):
Not and I have nothing against male doctors, but it's
so funny. I've just really appreciated a female gynecologist anything
because of the familiarity of the problems. At what stage
in life should a woman start looking at a center
like yours.
Speaker 2 (08:54):
Well, so I take care of women of all ages
starting at eighteen. And what something that's very gratifying for
all physicians I think is I take care of multi
generational families. I take care of grandparents, parents, children, and
that's good for research, isn't it. Oh, it's just great.
But also it's very gratifying to take care of multiple
generations in one family. So we start at eighteen. I
(09:17):
don't think women are too young at all, because you
want to The whole point now is to get women
and everyone, not just women. But I'm talking about the
Women's Center to have women enter later years in life
the healthiest.
Speaker 1 (09:34):
So well, yes, with longevity comes so many problems, and
to have the experience of first of all family, but
also I just have all those different practices in one place,
you can really help people. It's like, I just love
the idea of the Women's Center. So any age you
come at eighteen.
Speaker 2 (09:53):
Eighteen and older, yes, And you know, we do obviously
different things at different ages, and eighteen year old's needs
are different from an eighty year old's needs, but we
are trained to take care of patients of all ages
eighteen and over.
Speaker 1 (10:08):
What is the cancer risk program that I've read about?
Speaker 2 (10:11):
How does it work? So one of my personal passions.
I have a very close friend in NYU who is
the world expert on cancer genetics. Like the Broca gene
and other gene mutations that we know about. She is
the expert on these genetic mutations, and she happens to
be at her institution. She works at the cancer Center,
(10:31):
and I've spent a lot of time talking to her
about mutations and cancer risk. So her focus and the
cancer center focus, is on patients who've been diagnosed with cancer.
You're diagnosed, if you have a risk, you have genetic
testing for whatever reason. My focus is on the rest
of the population. So I see patients every day who
(10:55):
don't necessarily have cancer, but who have strong family histories
of cancer, a personal history of cancer, but have multiple
members in their family who had cancer, and they need
to have genetic testing to see if there's a mutation
in their family that puts them at risk for particular
types of cancer. You're finding. So we find in patients
(11:15):
who are sent for cancer genetics to a high risk program,
they're selected out and we're not sending average risk people.
Up to twenty five percent of those patients have a mutation,
and many patients don't. And for patients who have strong
family histories, we just may not have found those mutations yet.
(11:36):
So we retest our patients every five years. So the
reason I wanted to set up a risk program in
our building is my program is for keeping a close
eye on patients who have strong family histories. We surveil them.
So in other words, if you're at average risk, you're
in a screening program, you have a screening mammogram, But
(11:59):
if you're at high risk, you might need a breast MRI.
So for patients who are at higher risk because of
their family history, we follow them. Now in our cancer
risk program at a non cancer center, we are a
regular practice, so I think it's important for general practices
to incorporate cancer risk into their programs.
Speaker 1 (12:18):
So describe or explain for our listeners, what is the
Broca gene that we hear about.
Speaker 2 (12:24):
So, the Bronco gene, all of these mutication, it's an
accurate's b rca. Okay, it's the brcea. It's there are
many different genes where we have identified mutations on those
genes that confer an increased risk of certain types of cancers.
(12:46):
So most of these mutations are associated with risk for
more than one type of cancer. So for example, the Broca,
there's Broca one and Broco two, and there are many
other mutations that people may have heard about. Those were
the first that were described well widespread and are the
most well known. But we now know about probably four
(13:08):
or five hundred mutations, and so if we find a
mutation in a person, we know what cancer is they're
at risk for, so we watch them differently. So for example,
if you have a Bronco mutation, you're at risk for
breast cancer, you're at risk for ovarian cancer, you're at
risk for pancreatic cancer. Some question about colon, but let's
(13:30):
say breast, ovarian, and pancreatics. So every year these patients
have different testing than if you don't have this mutation.
So that's really why we one reason why we look
for these mutations. The other is if you have a mutation,
we test all your family members to see if they're
carrying the same mutation.
Speaker 1 (13:48):
Yeah, because those tests, two of my siblings died of embolisms.
Speaker 2 (13:53):
So then the doctor started to think, oh.
Speaker 1 (13:55):
Gosh, maybe we should all be tested for propensity for
such a writing.
Speaker 2 (14:00):
That's right now.
Speaker 1 (14:00):
We were all tested and no one else had that propensity,
which is we're so lucky, right, But so it was
really more and I think habitual or environmental. How spontaneous
the spontaneous okay, that's the right word, spontaneous than hereditary.
But my daughter who's half Jewish, had to have a
test for the brocogene.
Speaker 2 (14:21):
Right, So in Israel they test everyone. They do. In
this country we don't. But in Israel they test everyone
for brocogene. There are some other countries where the broca
carriage or the prevalence of brocogene is very high, for
example Ethiopia, it's very high. Yes, So it's very interesting.
And this is Julia Smith, who's our expert, is also
(14:42):
interested in history and will tell you exactly where in
the world you came from based on your mutation.
Speaker 1 (14:47):
And that's all reading the genome, the human genome.
Speaker 2 (14:50):
It's knowing about the mutations and where people migrated. Yes, absolutely,
I find that very fascinating. And I love the idea
of having your own geno rid by appropriate doctors to
see what your history is and what it could be.
I had it done in Iceland, And do you ever
(15:10):
send people to Iceland to have it done. I have
not sent them there to have it done. What did
you learn?
Speaker 1 (15:14):
I learned that I had no propensity for any life
threatening disease? Which seemed to be kind of accurate because
no one in our families had cancer and no one
had really heart disease. But that I was prone to obesity.
Speaker 2 (15:31):
Isn't that weird? Interesting? You're not not at all obese?
Speaker 1 (15:35):
No, no, but I mean if I guess, if I
ate a lot, I could get fat. But that was
the only bad thing that came out of my first
test there.
Speaker 2 (15:44):
Well, it makes sense. You're not sixty and you're in
great health, so it makes sense. It was very interesting.
Speaker 1 (15:51):
So what do you wish that all of your patients
would do for their preventative health?
Speaker 2 (15:57):
Oh boy, So first of all, currently on all my
patients having a blood pressure machine at home. That's my
new kick. We all have a scale at home. Every
one knows how much they weigh, and you basically know
how much you weigh without getting on the scale. If
you have a reference point, mine is right, mine is
my genes, right, that's my point. You know how much
(16:19):
you weigh. You don't have to get on the scale,
But you have no idea what your blood pressure is, right, Nope.
So I think it's an important vital sign. It's an
important risk factor. And coming to the doctor once a
year and checking your blood pressure once a year is
not adequate. So I have a blood pressure machine on
my desk now, and every patient that comes in, I say,
you should have one of these. So that's one thing
(16:41):
I think people should. Which do you like the best,
any of the digital ones? I mean, I have an
omron on my desk, but any of the digital machines
that you have to put on your upper arm not
a risk one. The risk ones are not accurate. People
do that, or finger ones not accurate. That's one. Two
is people should start exercising you and make it a habit,
(17:01):
because we know when you get to for women in particular,
when you get to menopause, you're going to gain weight.
So start your habits young. Start exercising young. And in
New York it seems to be much more common that
people exercise regularly rather than leaving you know, the further wing.
Speaker 1 (17:20):
The games around and your friends do it, so you
do it. I think I think you're right. And also
people will buy machines at home. They can they keep
the treadmill in their home now that they build little
gyms for themselves. Many apartment buildings have gyms, right, that's right,
which I think are so terribly important.
Speaker 2 (17:37):
And so different from when we grew up. It wasn't
like that, not at all. You know, there were not
a lot of people exercising. Jack o'laane was exercising and
that was it. And so exercise, check your blood pressure,
Eat healthfully, obviously, start with good eating habits when you're young.
Get your age appropriate immunizations. Have your see your guy ecologists,
(18:01):
have your PAP smears, have your HPV testing. And when
I talk about vaccines, get your HPV vaccine. Cervical cancer
is preventable by getting the HPV vaccine is So those
are some of the things for preventative care.
Speaker 1 (18:25):
What's the latest guidance on mammograms for how many years
do we have to get them?
Speaker 2 (18:29):
That's a great question. At least we start at forty
The guidance will say every one to two years. Most
doctors believe every one year. So I am of the
camp that every one year is the right way to go.
And the guidance, the guidelines or the United States Preventive
Services Task Force guidelines stop at seventy five. We continue
(18:54):
in most patients beyond seventy five, and most doctors, I
think will agree with me for all the screening tests
for colonoscopy, for mammograms, there are upper age limits, but
we don't abide by them. If someone's coming in to
see me at ninety and they're well and still seeing me,
I'm still doing a mammogram and a colonoscopy. I have
(19:15):
a ninety year old woman who works full time as
a lawyer. I have plenty of ninety year old women
who are still working full time.
Speaker 1 (19:22):
Why when I stop doing that? I know several of them.
Speaker 2 (19:24):
Right, right, So why would we stop testing them? Exactly?
Speaker 1 (19:27):
What are the conditions women should pay attention to at
each age. Let's start at forty. Okay, so forty.
Speaker 2 (19:34):
You know already the average age of menopause in this
country is fifty two. It's dropping. The average age that
women go through menopause around fifty two. Is that lower
than it used to be? I don't know that we
knew the average age before, you know when when I
first went into practice. So at around forty, a woman
should be starting to have her mammogram, she should be
(19:55):
seeing her gynecologist at once a year, having a pap
smere at that point. So the pap smear guidelines have
changed and we have a lot of trouble convincing patients
about this. So the PAP smear guidelines starting at thirty
or you do a PAP with an HPV and if
the HPV is negative, you can do a PAP every
(20:15):
five years. From under thirty, the paps are the are
every three years, but once you hit thirty, if your
HPV is negative, you do it every five years. And
patients in our day were used to having paps every year,
but we now know that the cause of cervical cancer
almost overwhelmingly is the HPV virus. So if your HPV
(20:38):
virus is negative, you do not need a PAP every year,
So start having your regular paps, your regular mammograms. A
regular physical. Blood drawing is very controversial. You know, we
do all this blood every year. It is, in many
people's opinion, overkill. If somebody doesn't have any complaints, the
chances of finding something abnormal on the blood are limited,
(21:00):
similar to finding something abnormal on the physical if you
have no complaints. But we do a physical every year,
we do some basic blood work. I do some blood
testing every year. We definitely need baseline lipids. You need
to know what your cholesterol is. I think all women
need to know what their thyroid function is because thyroid
disease is so common in women. And I think all
women need to know what the hemoglobin A one C is,
(21:20):
which is their blood sugar. And so I do those
tests plus others every year. Get your routine immunizations. The
pneumonia vaccine age. Up until October of twenty twenty four,
we gave a pneumonia vaccine at sixty five the age.
In October of twenty four, the CDC dropped the age
down to fifty. Shingles vaccine the Shinrik starts at fifty
(21:42):
two doses. COVID vaccines. You know, we can talk about
that a bit because I'm a big proponent of the
COVID vaccine. It was a game changer for COVID, and
those are.
Speaker 1 (21:54):
Some I believe it kept me healthy. Yes, despite contracting.
I think I probably contracted COVID twice, but the vaccine
saved me from any serious illness.
Speaker 2 (22:03):
There you go. I was sick for a day or two,
and that's the point of the vaccine. That's right.
Speaker 1 (22:08):
You said that the most discussed topic amongst your patients
is perimenopausal weight gain.
Speaker 2 (22:14):
Isn't that weird. Well, so I have so many stories
about this. If you think about women walking down the street,
and you think about postmenopausal women, kind of the postmenopausal
woman outfit is a tunic top and black leggings right
to cover that mid right mid body weight gain right.
(22:35):
So we know this is why when you ask about
preventative health and what do we tell women to do,
we know that when you enter menopause, if you make
no changes, if you eat the same way, if you
exercise the same way, if you make zero changes, you
will gain weight. You will not maintain your weight. Your
metabolism changes in menopause, your insulin resistance changes in menopause,
(22:58):
your estrogen levels change, pause, you will gain weight. Some
women will gain five pounds, some women will gain thirty
five pounds. But every woman will gain weight. Many of
those women also become pre diabetic. Oh, and that is
associated with the weight gain. So and bad diet and
bad diet, that's correct. So what the conversation I have
(23:21):
most frequently is, as women are approaching menopause and their
sugars starting to creep up and their weights starting to
creep up, is what to do about it? So it
is we are recognizing it more and more now, which
is why I say have these start these good habits earlier. Start.
You must exercise, you must do aerobic exercise. You must
reduce your carbs. You must pay attention to your diet
(23:44):
or you'll gain weight. Good advice, Very good. I'm thinking
back to my own history.
Speaker 1 (23:52):
I because when I got married, I was nineteen and
I was like one hundred and I don't know, nineteen pounds.
There you go, and I'm nowhere near one hundred and
night and never have been since. That's right, But I did.
I did put on weight after pregnancy and my but
now I'm wearing clothes that I wore thirty years ago.
Speaker 2 (24:13):
Which is good. And you're taking care of yourself and.
Speaker 1 (24:15):
Not exercising you know a lot, right, and lifting weights
and doing pilates and horseback riding, doing all the things
at my age that here's before probably weren't done. But
now everybody my age is doing all of this stuff.
Speaker 2 (24:30):
Well not everybody, you're an exception. I mean many people
are exercising more, but what you just described you're doing
a lot longer than many people. But that's why you're
keeping the weight off.
Speaker 1 (24:39):
This. I am keeping the weight off and keeping agile.
Speaker 2 (24:42):
And the other thing I want to say about exercise
is you needed for your bones. Right, we didn't even
talk about osteoporosis in your bones. When you go through menopause.
You need to do both weight bearing exercise anaerobic exercise
for your bones. You didn't mention hormone replacement, right, we
didn't talk about that either. Hormone replacement is another topic
we can talk about for a long time. You know,
(25:05):
years ago, when hormone replacement first became a thing, we
were giving higher doses of hormones. There were some articles
that were published talking about the downsides of hormone replacement
therapy and the risk of heart disease. A lot of
the original studies have been debunked, especially using lower doses
of hormones, so more and more women now are using
(25:26):
hormone replacement therapy. It's best to use it within ten
years of going through menopause. Beyond ten years, there's some
increased risk of cancer if you start later on. Oh really, yes,
So it's best to use it within the to begin
it within the first ten years of going through menopause.
Speaker 1 (25:44):
So we hear a lot of buzz around mental health.
M hm, Why is there so much attention paid to
this subject? Are you seeing an influence?
Speaker 2 (25:55):
Well, I'll tell you my personal my personal experience. And
then because I'm not a I'm not a psychiatrist, But
in my experience in practice, I'm seeing much more anxiety
now in younger girls, much more depression, many more people
on medication now than when I first went into practice.
(26:15):
And it's kind of staggering how many people now are
on anxiolytic medications like benzodiazepines, xanax, drugs like that, klonipin,
and antidepressants. And I may be wrong, it's just what
I'm observing in my practice. Oh, I think you're I
think you're right.
Speaker 1 (26:33):
I mean, I have never taken any of those things,
but I know everybody around me is taking those.
Speaker 2 (26:39):
Right add meds and and sleeping pills. It's a habit.
I agree, it's a habit. Well, the sleeping pills definitely
are a habit, and we can we can easily get
people to to taper off the sleeping pills, but people
don't refuse to do it. You know the best method
now to go to sleep. They're recommended by the Sleep
Associations Sleep organizations is cognitive behavioral therapy, but it's not
(27:05):
a pill. It's not a quick fix, and there's lots
of over the counter things people can try. We've been
touch on sleep either, but sleep is a huge issue,
especially after women go through menopause. Women have interrupted sleep,
poor sleep, wake up to go to the bathroom, have
difficulty sleeping, and a lot of people have trouble falling
asleep and rely on medication. And it's a difficult situation
(27:29):
both for the patient and the doctor.
Speaker 1 (27:30):
So if you're taking if you're having trouble sleeping and
the doctor is telling you you have to get more
sleep right and you don't take a sleeping pill, is
that better than taking a sleeping pill.
Speaker 2 (27:44):
So sleep is the most important, But an induced sleep
is better than less well from in my opinion, not
with sleeping pills, not with prescription, not with benzos. But
there are some simple things you can do, like try magnesium,
try melatonin, controversial base but tribenadrill benadryl isn't over the
counter safe medication that sedates people. It's a sedating antihistamine.
(28:09):
So we take advantage of the sedating.
Speaker 1 (28:10):
Properties by the non sleeping type drowsy.
Speaker 2 (28:15):
By the drowsy type to go to sleep. You're right,
and you know some of this doesn't that dry you out,
But it's better than taking ambient.
Speaker 1 (28:22):
Oh it is.
Speaker 2 (28:23):
It's better to sleep, and it's better than taking ambient
in my estimation, gummis or another option. People swear by gummies,
but those are non prescription things that you can try
to get to sleep. And cognitive behavioral therapy. There are
online services that offer online CBT for sleep that may help.
And you're right. I mean, we tell people you must sleep,
(28:45):
and then what do we do for them. It's a
bit of a quandary. I wanted to say one more thing.
I was thinking about the postmenopausal weight gain that we
didn't talk about, and that's alcohol.
Speaker 1 (28:54):
Oh the workohol is a.
Speaker 2 (28:55):
Big culprit in particular for women poor postmenopausal. If you
remember during COD, how many women were having these zoom
meetings and drinking on their zooms, you know, the line
zooms and they were home right, and it created a
lot of alcoholics and a lot of weight gain from
the alcohol. People forget that alcohol is a corb. I know.
Speaker 1 (29:12):
I saw that with many of my friends. I saw
a big weight.
Speaker 2 (29:15):
Gain right, that's right, and it was a lot of
it was from Alcolman. Some people during COVID they were
home and they ate healthier, and the other you know,
it was it was two groups of people. There were
people who used to go out to restaurants all the time,
and during COVID they were home and they were healthier now.
And then there were the people who ate better when
they were out and ate junk when they were home
(29:35):
and gained weight. But the alcohol was a big issue
during COVID and after COVID alcohol has to be limited.
Do you find that.
Speaker 1 (29:43):
I mean, I had one doctor who told me that
smoking was better than alcohol.
Speaker 2 (29:47):
No, I don't agree with that doctor smoking alcoholic I
don't agree with that. I'm sorry, Well what.
Speaker 1 (29:54):
About And then I met another I met another doctor
or researcher who showed me his lit of the most
dangerous substances that you can put in your body.
Speaker 2 (30:03):
Right Number one? Alcohol, Well, alcohol is not I'm not. Yeah.
I think smoking cigarettes.
Speaker 1 (30:13):
After that was heroin, after that was cocaine, then tobacco.
Speaker 2 (30:19):
Well, I think probably because more people drink, there's more
morbidity and mortality from alcohol because it's except it's legal.
Unlike heroin, it's legal. So people drink frequently, so I
think by sheer numbers, there's more.
Speaker 1 (30:35):
So I drink so very little because of that. That
scared me.
Speaker 2 (30:40):
One of the other reasons why you're healthy, right, I mean,
you have very I don't have to have this conversation
for you.
Speaker 1 (30:49):
So so mental mental health, I mean after nine I
think nine to eleven started, it started at all for
New Yorkers. It was a terrible time, yes, that, and
I think mental health started on a decline after that. Fearfulness,
all kinds of stuff.
Speaker 2 (31:07):
And then COVID just right, COVID was horrible. It was
we were I mean I worked every day during COVID,
and you know, for the first three months of COVID.
In March of twenty twenty, I went to work at
the hospital because the hospitals asked for outpatient doctors to
come work in the hospital, so I volunteered for a
couple of months. And the streets it was frightening. There
(31:29):
were days that I was on the train by myself,
I was on the subway by myself, I was on
the commuter train by myself. I never knew who if
somebody was going to get on at the next step.
I would walk for blocks in Manhattan and nobody was there.
And people what COVID did was people who had some
social anxieties and social phobias. It made it normalized it
(31:49):
for them because then that's right, and they continued afterwards.
So I saw that with children a lot, right, children,
that's right. Yeah, COVID was a very bad time for
mental health. And I would just comment on mental health also,
not only do I think there's more medication, but accessibility
to mental health care providers is terrible now. It's very
(32:10):
hard to find mental health care providers. They're overworked for
many of them don't take insurance. The access to mental
health care is very difficult these days.
Speaker 1 (32:23):
What about life coaching and those kinds of things.
Speaker 2 (32:25):
I mean to me, that's not really mental health care,
you know, I don't consider that a mental health provider.
But also, when we trained, and when you and I
were younger, you would go to a psychiatrist both for
your therapy and your medication. No more now psychiatrists basically
for the most part, just you medication and a therapist.
A psychologist, a social work or a therapist does the therapy.
(32:49):
So no more, one person you need two people.
Speaker 1 (33:01):
What simple advice would help any patient manage their stress
and their well being?
Speaker 2 (33:06):
Any simple guys, I think, find an exercise that you like,
because exercise with the endorphins clearly helps you manage stress.
That's number one. Socialize. I ask my patients three questions.
Are you mentally active, are you physically active? And are
you socially active? Because I learned in COVID that people
were not socially active anymore, and we know there have
(33:28):
been all these studies published in the New York Times
and medical journals that socialization really helps people with longevity.
So find an exercise, find friends and family, and find
a hobby.
Speaker 1 (33:42):
It's very good advice. I mean I say that too,
but I see struggles. I see struggles in young people.
I see struggles even in my own family, where withdrawal,
they look lonely, but they say they're not lonely, but
they are lonely.
Speaker 2 (33:59):
All phone addictions, the phone and computer addictions.
Speaker 1 (34:02):
But not speaking on the phone right, texting, no, never talking,
no human interaction. I like talking on the phone. I
like getting twenty five phone calls a day because I
feel like I'm connecting right. And yet children are not talking.
Speaker 2 (34:18):
People are having entire relationships on it through text. They
meet through a text, they break up through a text,
and they don't talk to each other. I hate it also, okay,
I remember the day texting started.
Speaker 1 (34:31):
Yes, tell us, Well, first it was phones, then it
was emails and phones, right then texting in silence, silence
in the office.
Speaker 2 (34:42):
People are texting from desk to desk. People on the
train when I commute, no one looks. I used to talk.
I used to talk to the person sitting next to me.
They're texting on a plane. Everybody's texting. People at a restaurant.
Couple are out together, sitting at a table together with
(35:02):
their children, and they're all voices. Yes, there's no The
human interaction is really suffering. No, I totally agree, and
I think that's contributing to mental illness also of course,
to this isolation. Absolutely, I don't like it at all.
I'm big on talking, as you can see. Yes, well
that's what I liked about you.
Speaker 1 (35:21):
I like that when we sat down at a lunch table,
not knowing each other, you started to.
Speaker 2 (35:25):
Talk and I loved it because you were talking. Uh huh.
Speaker 1 (35:29):
Heart disease is the leading killer of women. I keep
reading what do women need to do to prevent and
monitor heart disease?
Speaker 2 (35:39):
That's a brilliant question. It's very complicated. So women's cardiac
profiles change when they go through menopause. That's one thing
that we know. Cholesterol starts to go up, the good
cholesterol goes down, the bad cholesterol goes up. That's one
thing that happens. So the main risk factors for heart
(35:59):
to disease that you have a control over. One is
don't smoke. Smoking is a huge risk factor for heart disease.
So don't smoke, don't start smoking, and if you smoke,
stop smoking. I don't see many smokers anymore. That's also
changed in my career.
Speaker 1 (36:13):
Oh but there's hidden smokers.
Speaker 2 (36:16):
Yeah, but not like there was. We didn't see. We
saw so much smoking when I first went into practice,
and a lot of smoking related disease. I don't see
as much anymore. Maybe it's because I practice in the
middle of New York City now and the message has
gotten out, but don't smoke. Monitor your blood pressure. High
blood untreated high blood pressure is a huge risk factor
for heart disease. So that's why I say get a
(36:37):
blood pressure machine at home check your blood sugar. Diabetes
is a risk factor for heart disease. Family history is
a risk factor for heart disease. And when you go
through menopause. I believe that women should be evaluated differently
once they go through menopause. We have to keep on
top of their lipids, we have to keep on top
of their coronary arteries after they go through menopause because
(36:58):
our profiles change. So an exercise, exercise, exercise, I say again,
I can't say it enough.
Speaker 1 (37:05):
Well, one thing that I've noticed on Instagram, which we
all are slightly addiction to, is that there are lots
and lots and lots of variations of very good exercises
appearing Chinese taichi, you know. And I think that's a
good I think that's a good sign because people are
starting to pay attention to more and more to a
(37:26):
good exercise. I hope, I hope. What do you think
about supplements? This is another big question. Everybody wants to
have a supplement. They want to be selling supplements that
they think are going to help and save the world. Right,
So what do you think?
Speaker 2 (37:42):
So the important take home point about supplements is that
the supplement vitamin industry is completely unregulated. You have no
idea what you're getting. Please know that could be just
sugar pear. It could be that's correct. What I tell
my patients about supplements is two things. One, if you
eat a healthy diet over the course of a week,
(38:04):
If you get all your food groups in the course
of a week, chances are you're fine. Number one. But
number two, I check for important vitamins. I check every
year a vitamin D level, a B twelve level, your
iron studies, your blood counts which reflect your iron studies,
And if there's anything that you're missing of those specific vitamins,
I will let you know. Beyond that, you really don't
(38:27):
need to take anything else if you want to. You're
generally making expensive urine because you're just peeing it all out.
Speaker 1 (38:34):
What about ann and your urine as yellow?
Speaker 2 (38:38):
You're as brownie, you're dehydrated. Drink more waters, I should
drink more. About collagen? What about it?
Speaker 1 (38:46):
Are any of these collagen supplements any good at all?
Speaker 2 (38:49):
Are they going to help us?
Speaker 1 (38:51):
I don't get in osteoporosis.
Speaker 2 (38:53):
No, no, I don't think we know the answer to that.
But my guess is no. Again, another supple, and that's unregulated.
Speaker 1 (39:00):
We're eating up ground or bones of something.
Speaker 2 (39:02):
Well, that's differently eating sardines. Eating fish with bones is
a good source of calcium. We do recommend that women
take twelve hundred milligrams of calcium every day. Best way
to get it is dietary calcium. So dairy and you
can have fat low fat dairy of skim milk, fat
free dairy sardines with bones. That is a good thing.
Speaker 1 (39:21):
Sardines I buy the most beautiful. You got to eat
a can like every other day.
Speaker 2 (39:27):
Okay, those are good, right, excellent, Those are great for
your calcium and vitamin D. Okay.
Speaker 1 (39:31):
Now, the other big thing that's happening in the city.
Not every every block, but many blocks have body scan
operations going on. You can go in and have a
body scan and they're going to tell you if you
have signs of anything.
Speaker 2 (39:45):
I can an what do you think? So I asked
our expert, our cancer risk cancer genetics person, and the
answer to that is no, no need to do that.
So I want to try to explain this so it
makes some sense. So we screen. We do screening tests
again like a mammogram, a colonoscopy, and in order for
(40:06):
a test to be recommended as a screening test, it
has to fulfill for criteria, the disease has to be common. So,
for example, breast cancer occurs in one in seven to
eight women in this country randomly, so very common, and
if you have a family history, it can be as
much as one and two so extremely common, as opposed
to something like pancreatic or ovarian cancer, where they're not common,
(40:30):
so we don't screen for those in the whole population.
So disease has to be common. The test we use
for screening has to have be sensitive and specific, low
false positive, low false negative rate. Right, we can't have
a test where all the values are way off. It's
got to be a relatively reliable test. Third criteria is
the doing the test has to have an impact on
(40:53):
your longevity. So for example, if we tested everyone for
pancreatic cancer, we're probably not going to make a d
in significant in longevity by testing the entire population. And
the fourth criteria is it has to be relatively inexpensive,
So you can't do a screening test that costs ten
thousand dollars on everybody every year. Mammograms are cheap, disease
(41:16):
is common, we have clearly an impact on outcome and
low false positives and negatives. So with the body scans,
they don't fulfill those criteria, so we most of what
they do is they send people down rabbit holes because
they find incidental things that are meaningless. Anyway, if you
have a symptom, if you have an abnormal blood test,
(41:38):
that's different, I'll get the cat scan on you, or
I'll get whatever scan is appropriate. But for asymptomatic people,
you should not be doing these total body scans. Okay,
that's good news.
Speaker 1 (41:49):
Do we still need to worry about COVID a reoccurrence
of COVID?
Speaker 2 (41:53):
Yes, so there's still COVID around. There's still a fair
amount of COVID around. And again I'm going to say
something that's my own personal opinion from my practice. It's anecdotal.
You know, we're still recommending people get COVID vaccines. They're
change they change the code the strains like a flu vaccine.
Definitely get your COVID vaccines. The COVID vaccine was the
(42:15):
game changer in this country, undoubtedly in terms of keeping
people from dying out of the hospital less sick. It
was because of the vaccine. I witnessed that. I through
all my COVID work and after I worked in the hospital,
I was one of the co directors of the long
COVID program at NYU, so I had a lot of
COVID experience and the vaccine made a huge difference. We're
(42:35):
still seeing COVID most we're not seeing the sickness that
we saw in twenty twenty because of the vaccine largely,
and we have heard immunity and people have immunity from
getting the disease. You have some natural immunity. Also, the
point I wanted to make is because we're vaccinated, a
lot of people who are getting COVID have mild disease.
(42:56):
It presents as almost a cold. I have a running nose,
I have a sore throat. The home COVID tests, when
they're positive, are reliable, but when they're negative, I don't
trust them. I've had a lot of negative home COVID
tests where I've sent people for swabs, for a respiratory
swab and they come back positive. So if you do
a COVID test and it's positive, fine, But if it's negative,
(43:16):
it doesn't mean you don't have COVID. That was the
point I wanted to make here go get a swab.
Speaker 1 (43:21):
So, okay, we're gonna still worry about COVID.
Speaker 2 (43:24):
It is still present epidemic, it's not and it's also
not as deadly as it was in twenty twenty. We've
learned a lot about COVID and how to manage it.
So don't be frightened of COVID. Get vaccinated, but it
should still be on people's radar. And the difference between COVID.
One difference between COVID and influenza is influenza tends to
be a seasonal virus in cold weather. COVID seems to
(43:45):
be occurring all year round. It doesn't pick a season.
So I have patients with COVID right now. I've seen
patients with COVID. The last couple of weeks. I've had
a couple of patients with COVID.
Speaker 1 (43:56):
On your weekly radio show, you have featured moments of kindness?
Can you share moments of kindness? Which what does that mean?
So that started in COVID? I did, Yes, it started
in COVID, and people were so down that I wanted
to just point out some random moment of kindness that
I saw on the street anywhere I wanted people to
(44:17):
call in with moments of kindness, and I tried for
a long time every week to mention a moment of
kindness that I saw, that I witnessed, that somebody told
me about, and I had a lot of them, just
to kind of cheer people up, you know, because we
were so down, and it.
Speaker 2 (44:33):
Was a very poignant one that you heard. We did
a show on random acts of kindness. I did a
whole radio show about it, and somebody called in to
thank a kindergarten teacher that they had, which blew my
mind because I actually found my middle school biology teacher
after I graduated medical school to thank her for inspiring
(44:55):
me to go to medical school. That's nice, that was great.
I will say. I told my husband I would do
this about the moments of kindness that my husband retired
last week after almost fifty years in medicine, when my
daughter had a baby, and when my husband retired. The
kindness of our patients is mind boggling. I will one
(45:17):
of my patients came in one day who I don't
know very well. I see her once a year, and
she saw that I had a grandchild, and she's an artist,
and during COVID. She taught herself how to sew. She
was at the party, I believe, and I saw her
at nine o'clock in the morning, told her I had
a grandchild. At noon that day, her husband showed up
(45:37):
in my office with a little dress that she had
made and a hat and booties for my granddaughter. It
was so kind. And my husband has had patients who
people don't have. You know, they work at they work
very hard, don't have a lot of expendable cash. And
one particular group of sisters, the Carter Sisters that my
(45:58):
husband takes care of, got my granddaughter basically an entire wardrobe.
The kindness of people, when when you have events in
your life that you don't think touch them, is remarkable.
Speaker 1 (46:11):
That is a very nice thing to have. How does
the format of a live radio show help you with
your goals as a doctor?
Speaker 2 (46:19):
Oh, another good question. There's a lot of misinformation out there,
even in our country where we have the absolute best
medical care available in the world. It's a call in show.
We talk about two topics every week, and we do
two medical topics and people call in and I have
an expert on and ask us questions, and I have
(46:39):
learned that there's a lot of bad information, so we
correct a lot of bad information very important, which is
really important.
Speaker 1 (46:45):
Yes, yes, well, thank you so much. We have we
have over we have talked for longer than aloud. Well
and we can go on for you. Oh gosh, yes,
I have so many more questions.
Speaker 2 (46:59):
Come back again next time.
Speaker 1 (47:01):
Thank you for sharing all this great, great information, Doctor Bahar.
And for those of you at home, tune into doctor
Bayhart's show Women's Health Thursdays at ten am Eastern Time
on Doctor Radio Serious XM for lots of great medical expertise.
Thank you so much, thank you. This was a pleasure.
Doctor Karen Bahar is a general internist and the medical
director for the Joan H. Tish Center for Women's Health
at NYU Langone Health here in New York City. She
shares medical expertise on her weekly show Women's Health on
Serious XM's Doctor Radio. Welcome to my podcast, doctor Bayhart.
Speaker 2 (00:25):
Thank you for having me. I'm so thrilled and honored
to be here. Well that's the truth. Well, thank you well.
Speaker 1 (00:31):
I sat next to doctor Bayhart at at our mutual friend,
doctor Albert Knapp's house and doctor Ruth Oretz's house at
an outdoor summer party a few weeks ago, and we
got to talking and the conversation was really interesting, and
I thought, Wow, I would really like to interview doctor
Bayhart on my podcast.
Speaker 2 (00:53):
So here we are. It's very just a couple of
weeks later happen.
Speaker 1 (00:57):
I like to make things happen, but I also like
to talk to people who are doing interesting things and
changing the way we look at health. And you have
certainly made some very serious inroads in women's health, and
I think that the focus of this show should be
about that. What does an internist do versus a general practitioner.
Speaker 2 (01:21):
So the difference between an internist and a GP essentially
is that the old fashioned GP saw adults and children,
and an internist only sees adults. I see patients only
over eighteen years old, and a pediatrician would see the children.
So if you combine a pediatrician and an internist, you
get a GP. And gps actually used to also deliver babies.
(01:44):
They did a little bit of everything. They did a
little surgery. They were trained to do a little bit
of everything in medicine, and as we moved on in
medicine and for specialized and sub specialized, we separated out
seeing children from seeing adults, from doing obstetrics and gynecology.
And so I'm an internist. I see all patients over
(02:07):
the age of eighteen.
Speaker 1 (02:09):
The jooned Tish Women's Center at Langone, NYU sounds like
such a fascinating place. I have visited a couple doctors
at your center specialists in certain areas, but I didn't
really know about the jone Tish Center. And that you
are managing one hundred and thirty women doctors who are
(02:31):
seeing basically women patients is incredible.
Speaker 2 (02:34):
And how long have you been doing this? So it's
a little different we are now. We've combined many services
in our building. The Jone Tish Center for Women's Health
started in twenty eleven up on eighty fourth Street in
a smaller building and we were a small group of
about nine doctors, all women, medical subspecialists and guyna college logists,
(03:00):
a dermatologist, and we were wildly successful, outgrew our space.
It was a reasonably novel concept at the time. The
Tish family, in honor of their mother, Joan H. Tish,
donated money to get the center started. She had a
vision to have a women's health center. And for me,
(03:21):
you know, I started. We talked a little bit about this.
I started my career. I was the only woman in
the department of medicine at my first job in a
different medical school, and now I am one of all women.
I've come a long way. So we started with a
small group and we became full very quickly, and we
(03:42):
were landlocked. We really could not expand anymore. We were
at our capacity, and we looked for space to grow
and COVID hit we found a larger space in midtown.
And what we've done now, what NYU has done, is
they joined the Jontish Center, which is again mostly medical subspecialties, internists, cardiologists, endocrinologists,
(04:08):
GI We're on one floor and then on another floor
is all of obg YN. On another floor is reproductive
Endochronology or IVF. And on another floor yet is joint
programming between the Women's Center and the Department of OBGYN.
So we've started a fibroid center and a menopause center.
(04:29):
So it really is a building filled with women's services.
We have now been the building, all of us together
have now been renamed the Mignoni Women's Health Collaborative due
to a large generous donation from Alison and Roberto Mignoni
and a donation from Ken Griffin, and we're about to
(04:49):
launch a wellness center as well. That was a mouthful,
but that's all building.
Speaker 1 (04:54):
That is very extraordinary though, because and then just a
couple of blocks north just passed by the Men's Center
of NYU Langon. Yes they're a partner, so yeah, So
how many floors do they have?
Speaker 2 (05:10):
Don't know, they are growing. They have a number of
floors in an office building, they have maybe four or
five floors. Now, I don't want to speak, but they
have a lot of floors as well, and they're the
Preston Robert Tish, Joan Tish's husband. They similar donation for
the men's center there.
Speaker 1 (05:25):
Yeah, oh great, So I was laughing that, oh here
we are men's one on one, streets on another keeping segregated.
But I think you have to in a way if
you're studying the medicine of the female body is so
very different from the men.
Speaker 2 (05:41):
Well, you know, people ask me all the time about this,
and my feeling is we are a choice for people.
You can go anywhere in the country, in the city,
in the state and find male and female doctors together,
seeing male and female patients. I did that for much
of my career. There never was a choice really for
(06:01):
women to be able to go to a center that
focused specifically on them predominantly staffed by women. Our Jone
Tish Center is all female physicians on the OB floor
and on the IVF floor. There are some male physicians
in our building. We are all women, and it's an
unusual choice that women have. I spent a lot of
(06:24):
my career seeing patients women asking me when I refer
them to another doctor, is it a woman, And now
the answer is always yes.
Speaker 1 (06:34):
Very very interesting. What are the advantages of a facility
like the Women's Center for your patient.
Speaker 2 (06:41):
So several advantages. I think obviously one we just touched on.
You know, there are many women who just want to
see women doctors. So not only do they have a
choice to see a women doctor, but the women are
incredibly talented, well trained. I've chosen almost every one of them. Elf.
(07:01):
We have an interest in women's health, all of us.
We've been working in women's health for years. So that's
number one. If you want to see women doctors, that's
a building. We're a building full of them. Number two
another important thing I think that's often overlooked. It's important
for the doctors. I never had the chance to work
(07:23):
with all women. Most of the time, I was the
only woman in the room. I'm sure you know what
that feels like. I was the only woman with lots
of men. So it's really gratifying for me at this
point in my career to work with all these talented women.
We're all friends, we get along, there's no drama, unlike
what people think when there's a building of women together.
(07:45):
That's number two, and number three is what we really
try to do. The whole point of the Women's center
is everything's available in one place. So women are busy.
They often don't take care of themselves. They take care
of their children, their spouses, their partners, everybody, their parents,
and they don't take care of themselves. So you come
to our building, You see your internists, do you have
(08:07):
your annual physical, you have your mammogram, your bone density,
see your gynecologist, and have whatever you need to have done. Shop.
Speaker 1 (08:14):
That's right, very best, that's right, and well we'll talk
about scheduling those kinds of examinations too, and how important
they are for every single woman. I've always liked going
to women doctors just because I think, well, they know
how I feel because they're a woman, I agree with you,
and they should know more about it than any male doctor.
(08:36):
Not and I have nothing against male doctors, but it's
so funny. I've just really appreciated a female gynecologist anything
because of the familiarity of the problems. At what stage
in life should a woman start looking at a center
like yours.
Speaker 2 (08:54):
Well, so I take care of women of all ages
starting at eighteen. And what something that's very gratifying for
all physicians I think is I take care of multi
generational families. I take care of grandparents, parents, children, and
that's good for research, isn't it. Oh, it's just great.
But also it's very gratifying to take care of multiple
generations in one family. So we start at eighteen. I
(09:17):
don't think women are too young at all, because you
want to The whole point now is to get women
and everyone, not just women. But I'm talking about the
Women's Center to have women enter later years in life
the healthiest.
Speaker 1 (09:34):
So well, yes, with longevity comes so many problems, and
to have the experience of first of all family, but
also I just have all those different practices in one place,
you can really help people. It's like, I just love
the idea of the Women's Center. So any age you
come at eighteen.
Speaker 2 (09:53):
Eighteen and older, yes, And you know, we do obviously
different things at different ages, and eighteen year old's needs
are different from an eighty year old's needs, but we
are trained to take care of patients of all ages
eighteen and over.
Speaker 1 (10:08):
What is the cancer risk program that I've read about?
Speaker 2 (10:11):
How does it work? So one of my personal passions.
I have a very close friend in NYU who is
the world expert on cancer genetics. Like the Broca gene
and other gene mutations that we know about. She is
the expert on these genetic mutations, and she happens to
be at her institution. She works at the cancer Center,
(10:31):
and I've spent a lot of time talking to her
about mutations and cancer risk. So her focus and the
cancer center focus, is on patients who've been diagnosed with cancer.
You're diagnosed, if you have a risk, you have genetic
testing for whatever reason. My focus is on the rest
of the population. So I see patients every day who
(10:55):
don't necessarily have cancer, but who have strong family histories
of cancer, a personal history of cancer, but have multiple
members in their family who had cancer, and they need
to have genetic testing to see if there's a mutation
in their family that puts them at risk for particular
types of cancer. You're finding. So we find in patients
(11:15):
who are sent for cancer genetics to a high risk program,
they're selected out and we're not sending average risk people.
Up to twenty five percent of those patients have a mutation,
and many patients don't. And for patients who have strong
family histories, we just may not have found those mutations yet.
(11:36):
So we retest our patients every five years. So the
reason I wanted to set up a risk program in
our building is my program is for keeping a close
eye on patients who have strong family histories. We surveil them.
So in other words, if you're at average risk, you're
in a screening program, you have a screening mammogram, But
(11:59):
if you're at high risk, you might need a breast MRI.
So for patients who are at higher risk because of
their family history, we follow them. Now in our cancer
risk program at a non cancer center, we are a
regular practice, so I think it's important for general practices
to incorporate cancer risk into their programs.
Speaker 1 (12:18):
So describe or explain for our listeners, what is the
Broca gene that we hear about.
Speaker 2 (12:24):
So, the Bronco gene, all of these mutication, it's an
accurate's b rca. Okay, it's the brcea. It's there are
many different genes where we have identified mutations on those
genes that confer an increased risk of certain types of cancers.
(12:46):
So most of these mutations are associated with risk for
more than one type of cancer. So for example, the Broca,
there's Broca one and Broco two, and there are many
other mutations that people may have heard about. Those were
the first that were described well widespread and are the
most well known. But we now know about probably four
(13:08):
or five hundred mutations, and so if we find a
mutation in a person, we know what cancer is they're
at risk for, so we watch them differently. So for example,
if you have a Bronco mutation, you're at risk for
breast cancer, you're at risk for ovarian cancer, you're at
risk for pancreatic cancer. Some question about colon, but let's
(13:30):
say breast, ovarian, and pancreatics. So every year these patients
have different testing than if you don't have this mutation.
So that's really why we one reason why we look
for these mutations. The other is if you have a mutation,
we test all your family members to see if they're
carrying the same mutation.
Speaker 1 (13:48):
Yeah, because those tests, two of my siblings died of embolisms.
Speaker 2 (13:53):
So then the doctor started to think, oh.
Speaker 1 (13:55):
Gosh, maybe we should all be tested for propensity for
such a writing.
Speaker 2 (14:00):
That's right now.
Speaker 1 (14:00):
We were all tested and no one else had that propensity,
which is we're so lucky, right, But so it was
really more and I think habitual or environmental. How spontaneous
the spontaneous okay, that's the right word, spontaneous than hereditary.
But my daughter who's half Jewish, had to have a
test for the brocogene.
Speaker 2 (14:21):
Right, So in Israel they test everyone. They do. In
this country we don't. But in Israel they test everyone
for brocogene. There are some other countries where the broca
carriage or the prevalence of brocogene is very high, for
example Ethiopia, it's very high. Yes, So it's very interesting.
And this is Julia Smith, who's our expert, is also
(14:42):
interested in history and will tell you exactly where in
the world you came from based on your mutation.
Speaker 1 (14:47):
And that's all reading the genome, the human genome.
Speaker 2 (14:50):
It's knowing about the mutations and where people migrated. Yes, absolutely,
I find that very fascinating. And I love the idea
of having your own geno rid by appropriate doctors to
see what your history is and what it could be.
I had it done in Iceland, And do you ever
(15:10):
send people to Iceland to have it done. I have
not sent them there to have it done. What did
you learn?
Speaker 1 (15:14):
I learned that I had no propensity for any life
threatening disease? Which seemed to be kind of accurate because
no one in our families had cancer and no one
had really heart disease. But that I was prone to obesity.
Speaker 2 (15:31):
Isn't that weird? Interesting? You're not not at all obese?
Speaker 1 (15:35):
No, no, but I mean if I guess, if I
ate a lot, I could get fat. But that was
the only bad thing that came out of my first
test there.
Speaker 2 (15:44):
Well, it makes sense. You're not sixty and you're in
great health, so it makes sense. It was very interesting.
Speaker 1 (15:51):
So what do you wish that all of your patients
would do for their preventative health?
Speaker 2 (15:57):
Oh boy, So first of all, currently on all my
patients having a blood pressure machine at home. That's my
new kick. We all have a scale at home. Every
one knows how much they weigh, and you basically know
how much you weigh without getting on the scale. If
you have a reference point, mine is right, mine is
my genes, right, that's my point. You know how much
(16:19):
you weigh. You don't have to get on the scale,
But you have no idea what your blood pressure is, right, Nope.
So I think it's an important vital sign. It's an
important risk factor. And coming to the doctor once a
year and checking your blood pressure once a year is
not adequate. So I have a blood pressure machine on
my desk now, and every patient that comes in, I say,
you should have one of these. So that's one thing
(16:41):
I think people should. Which do you like the best,
any of the digital ones? I mean, I have an
omron on my desk, but any of the digital machines
that you have to put on your upper arm not
a risk one. The risk ones are not accurate. People
do that, or finger ones not accurate. That's one. Two
is people should start exercising you and make it a habit,
(17:01):
because we know when you get to for women in particular,
when you get to menopause, you're going to gain weight.
So start your habits young. Start exercising young. And in
New York it seems to be much more common that
people exercise regularly rather than leaving you know, the further wing.
Speaker 1 (17:20):
The games around and your friends do it, so you
do it. I think I think you're right. And also
people will buy machines at home. They can they keep
the treadmill in their home now that they build little
gyms for themselves. Many apartment buildings have gyms, right, that's right,
which I think are so terribly important.
Speaker 2 (17:37):
And so different from when we grew up. It wasn't
like that, not at all. You know, there were not
a lot of people exercising. Jack o'laane was exercising and
that was it. And so exercise, check your blood pressure,
Eat healthfully, obviously, start with good eating habits when you're young.
Get your age appropriate immunizations. Have your see your guy ecologists,
(18:01):
have your PAP smears, have your HPV testing. And when
I talk about vaccines, get your HPV vaccine. Cervical cancer
is preventable by getting the HPV vaccine is So those
are some of the things for preventative care.
Speaker 1 (18:25):
What's the latest guidance on mammograms for how many years
do we have to get them?
Speaker 2 (18:29):
That's a great question. At least we start at forty
The guidance will say every one to two years. Most
doctors believe every one year. So I am of the
camp that every one year is the right way to go.
And the guidance, the guidelines or the United States Preventive
Services Task Force guidelines stop at seventy five. We continue
(18:54):
in most patients beyond seventy five, and most doctors, I
think will agree with me for all the screening tests
for colonoscopy, for mammograms, there are upper age limits, but
we don't abide by them. If someone's coming in to
see me at ninety and they're well and still seeing me,
I'm still doing a mammogram and a colonoscopy. I have
(19:15):
a ninety year old woman who works full time as
a lawyer. I have plenty of ninety year old women
who are still working full time.
Speaker 1 (19:22):
Why when I stop doing that? I know several of them.
Speaker 2 (19:24):
Right, right, So why would we stop testing them? Exactly?
Speaker 1 (19:27):
What are the conditions women should pay attention to at
each age. Let's start at forty. Okay, so forty.
Speaker 2 (19:34):
You know already the average age of menopause in this
country is fifty two. It's dropping. The average age that
women go through menopause around fifty two. Is that lower
than it used to be? I don't know that we
knew the average age before, you know when when I
first went into practice. So at around forty, a woman
should be starting to have her mammogram, she should be
(19:55):
seeing her gynecologist at once a year, having a pap
smere at that point. So the pap smear guidelines have
changed and we have a lot of trouble convincing patients
about this. So the PAP smear guidelines starting at thirty
or you do a PAP with an HPV and if
the HPV is negative, you can do a PAP every
(20:15):
five years. From under thirty, the paps are the are
every three years, but once you hit thirty, if your
HPV is negative, you do it every five years. And
patients in our day were used to having paps every year,
but we now know that the cause of cervical cancer
almost overwhelmingly is the HPV virus. So if your HPV
(20:38):
virus is negative, you do not need a PAP every year,
So start having your regular paps, your regular mammograms. A
regular physical. Blood drawing is very controversial. You know, we
do all this blood every year. It is, in many
people's opinion, overkill. If somebody doesn't have any complaints, the
chances of finding something abnormal on the blood are limited,
(21:00):
similar to finding something abnormal on the physical if you
have no complaints. But we do a physical every year,
we do some basic blood work. I do some blood
testing every year. We definitely need baseline lipids. You need
to know what your cholesterol is. I think all women
need to know what their thyroid function is because thyroid
disease is so common in women. And I think all
women need to know what the hemoglobin A one C is,
(21:20):
which is their blood sugar. And so I do those
tests plus others every year. Get your routine immunizations. The
pneumonia vaccine age. Up until October of twenty twenty four,
we gave a pneumonia vaccine at sixty five the age.
In October of twenty four, the CDC dropped the age
down to fifty. Shingles vaccine the Shinrik starts at fifty
(21:42):
two doses. COVID vaccines. You know, we can talk about
that a bit because I'm a big proponent of the
COVID vaccine. It was a game changer for COVID, and
those are.
Speaker 1 (21:54):
Some I believe it kept me healthy. Yes, despite contracting.
I think I probably contracted COVID twice, but the vaccine
saved me from any serious illness.
Speaker 2 (22:03):
There you go. I was sick for a day or two,
and that's the point of the vaccine. That's right.
Speaker 1 (22:08):
You said that the most discussed topic amongst your patients
is perimenopausal weight gain.
Speaker 2 (22:14):
Isn't that weird. Well, so I have so many stories
about this. If you think about women walking down the street,
and you think about postmenopausal women, kind of the postmenopausal
woman outfit is a tunic top and black leggings right
to cover that mid right mid body weight gain right.
(22:35):
So we know this is why when you ask about
preventative health and what do we tell women to do,
we know that when you enter menopause, if you make
no changes, if you eat the same way, if you
exercise the same way, if you make zero changes, you
will gain weight. You will not maintain your weight. Your
metabolism changes in menopause, your insulin resistance changes in menopause,
(22:58):
your estrogen levels change, pause, you will gain weight. Some
women will gain five pounds, some women will gain thirty
five pounds. But every woman will gain weight. Many of
those women also become pre diabetic. Oh, and that is
associated with the weight gain. So and bad diet and
bad diet, that's correct. So what the conversation I have
(23:21):
most frequently is, as women are approaching menopause and their
sugars starting to creep up and their weights starting to
creep up, is what to do about it? So it
is we are recognizing it more and more now, which
is why I say have these start these good habits earlier. Start.
You must exercise, you must do aerobic exercise. You must
reduce your carbs. You must pay attention to your diet
(23:44):
or you'll gain weight. Good advice, Very good. I'm thinking
back to my own history.
Speaker 1 (23:52):
I because when I got married, I was nineteen and
I was like one hundred and I don't know, nineteen pounds.
There you go, and I'm nowhere near one hundred and
night and never have been since. That's right, But I did.
I did put on weight after pregnancy and my but
now I'm wearing clothes that I wore thirty years ago.
Speaker 2 (24:13):
Which is good. And you're taking care of yourself and.
Speaker 1 (24:15):
Not exercising you know a lot, right, and lifting weights
and doing pilates and horseback riding, doing all the things
at my age that here's before probably weren't done. But
now everybody my age is doing all of this stuff.
Speaker 2 (24:30):
Well not everybody, you're an exception. I mean many people
are exercising more, but what you just described you're doing
a lot longer than many people. But that's why you're
keeping the weight off.
Speaker 1 (24:39):
This. I am keeping the weight off and keeping agile.
Speaker 2 (24:42):
And the other thing I want to say about exercise
is you needed for your bones. Right, we didn't even
talk about osteoporosis in your bones. When you go through menopause.
You need to do both weight bearing exercise anaerobic exercise
for your bones. You didn't mention hormone replacement, right, we
didn't talk about that either. Hormone replacement is another topic
we can talk about for a long time. You know,
(25:05):
years ago, when hormone replacement first became a thing, we
were giving higher doses of hormones. There were some articles
that were published talking about the downsides of hormone replacement
therapy and the risk of heart disease. A lot of
the original studies have been debunked, especially using lower doses
of hormones, so more and more women now are using
(25:26):
hormone replacement therapy. It's best to use it within ten
years of going through menopause. Beyond ten years, there's some
increased risk of cancer if you start later on. Oh really, yes,
So it's best to use it within the to begin
it within the first ten years of going through menopause.
Speaker 1 (25:44):
So we hear a lot of buzz around mental health.
M hm, Why is there so much attention paid to
this subject? Are you seeing an influence?
Speaker 2 (25:55):
Well, I'll tell you my personal my personal experience. And
then because I'm not a I'm not a psychiatrist, But
in my experience in practice, I'm seeing much more anxiety
now in younger girls, much more depression, many more people
on medication now than when I first went into practice.
(26:15):
And it's kind of staggering how many people now are
on anxiolytic medications like benzodiazepines, xanax, drugs like that, klonipin,
and antidepressants. And I may be wrong, it's just what
I'm observing in my practice. Oh, I think you're I
think you're right.
Speaker 1 (26:33):
I mean, I have never taken any of those things,
but I know everybody around me is taking those.
Speaker 2 (26:39):
Right add meds and and sleeping pills. It's a habit.
I agree, it's a habit. Well, the sleeping pills definitely
are a habit, and we can we can easily get
people to to taper off the sleeping pills, but people
don't refuse to do it. You know the best method
now to go to sleep. They're recommended by the Sleep
Associations Sleep organizations is cognitive behavioral therapy, but it's not
(27:05):
a pill. It's not a quick fix, and there's lots
of over the counter things people can try. We've been
touch on sleep either, but sleep is a huge issue,
especially after women go through menopause. Women have interrupted sleep,
poor sleep, wake up to go to the bathroom, have
difficulty sleeping, and a lot of people have trouble falling
asleep and rely on medication. And it's a difficult situation
(27:29):
both for the patient and the doctor.
Speaker 1 (27:30):
So if you're taking if you're having trouble sleeping and
the doctor is telling you you have to get more
sleep right and you don't take a sleeping pill, is
that better than taking a sleeping pill.
Speaker 2 (27:44):
So sleep is the most important, But an induced sleep
is better than less well from in my opinion, not
with sleeping pills, not with prescription, not with benzos. But
there are some simple things you can do, like try magnesium,
try melatonin, controversial base but tribenadrill benadryl isn't over the
counter safe medication that sedates people. It's a sedating antihistamine.
(28:09):
So we take advantage of the sedating.
Speaker 1 (28:10):
Properties by the non sleeping type drowsy.
Speaker 2 (28:15):
By the drowsy type to go to sleep. You're right,
and you know some of this doesn't that dry you out,
But it's better than taking ambient.
Speaker 1 (28:22):
Oh it is.
Speaker 2 (28:23):
It's better to sleep, and it's better than taking ambient
in my estimation, gummis or another option. People swear by gummies,
but those are non prescription things that you can try
to get to sleep. And cognitive behavioral therapy. There are
online services that offer online CBT for sleep that may help.
And you're right. I mean, we tell people you must sleep,
(28:45):
and then what do we do for them. It's a
bit of a quandary. I wanted to say one more thing.
I was thinking about the postmenopausal weight gain that we
didn't talk about, and that's alcohol.
Speaker 1 (28:54):
Oh the workohol is a.
Speaker 2 (28:55):
Big culprit in particular for women poor postmenopausal. If you
remember during COD, how many women were having these zoom
meetings and drinking on their zooms, you know, the line
zooms and they were home right, and it created a
lot of alcoholics and a lot of weight gain from
the alcohol. People forget that alcohol is a corb. I know.
Speaker 1 (29:12):
I saw that with many of my friends. I saw
a big weight.
Speaker 2 (29:15):
Gain right, that's right, and it was a lot of
it was from Alcolman. Some people during COVID they were
home and they ate healthier, and the other you know,
it was it was two groups of people. There were
people who used to go out to restaurants all the time,
and during COVID they were home and they were healthier now.
And then there were the people who ate better when
they were out and ate junk when they were home
(29:35):
and gained weight. But the alcohol was a big issue
during COVID and after COVID alcohol has to be limited.
Do you find that.
Speaker 1 (29:43):
I mean, I had one doctor who told me that
smoking was better than alcohol.
Speaker 2 (29:47):
No, I don't agree with that doctor smoking alcoholic I
don't agree with that. I'm sorry, Well what.
Speaker 1 (29:54):
About And then I met another I met another doctor
or researcher who showed me his lit of the most
dangerous substances that you can put in your body.
Speaker 2 (30:03):
Right Number one? Alcohol, Well, alcohol is not I'm not. Yeah.
I think smoking cigarettes.
Speaker 1 (30:13):
After that was heroin, after that was cocaine, then tobacco.
Speaker 2 (30:19):
Well, I think probably because more people drink, there's more
morbidity and mortality from alcohol because it's except it's legal.
Unlike heroin, it's legal. So people drink frequently, so I
think by sheer numbers, there's more.
Speaker 1 (30:35):
So I drink so very little because of that. That
scared me.
Speaker 2 (30:40):
One of the other reasons why you're healthy, right, I mean,
you have very I don't have to have this conversation
for you.
Speaker 1 (30:49):
So so mental mental health, I mean after nine I
think nine to eleven started, it started at all for
New Yorkers. It was a terrible time, yes, that, and
I think mental health started on a decline after that. Fearfulness,
all kinds of stuff.
Speaker 2 (31:07):
And then COVID just right, COVID was horrible. It was
we were I mean I worked every day during COVID,
and you know, for the first three months of COVID.
In March of twenty twenty, I went to work at
the hospital because the hospitals asked for outpatient doctors to
come work in the hospital, so I volunteered for a
couple of months. And the streets it was frightening. There
(31:29):
were days that I was on the train by myself,
I was on the subway by myself, I was on
the commuter train by myself. I never knew who if
somebody was going to get on at the next step.
I would walk for blocks in Manhattan and nobody was there.
And people what COVID did was people who had some
social anxieties and social phobias. It made it normalized it
(31:49):
for them because then that's right, and they continued afterwards.
So I saw that with children a lot, right, children,
that's right. Yeah, COVID was a very bad time for
mental health. And I would just comment on mental health also,
not only do I think there's more medication, but accessibility
to mental health care providers is terrible now. It's very
(32:10):
hard to find mental health care providers. They're overworked for
many of them don't take insurance. The access to mental
health care is very difficult these days.
Speaker 1 (32:23):
What about life coaching and those kinds of things.
Speaker 2 (32:25):
I mean to me, that's not really mental health care,
you know, I don't consider that a mental health provider.
But also, when we trained, and when you and I
were younger, you would go to a psychiatrist both for
your therapy and your medication. No more now psychiatrists basically
for the most part, just you medication and a therapist.
A psychologist, a social work or a therapist does the therapy.
(32:49):
So no more, one person you need two people.
Speaker 1 (33:01):
What simple advice would help any patient manage their stress
and their well being?
Speaker 2 (33:06):
Any simple guys, I think, find an exercise that you like,
because exercise with the endorphins clearly helps you manage stress.
That's number one. Socialize. I ask my patients three questions.
Are you mentally active, are you physically active? And are
you socially active? Because I learned in COVID that people
were not socially active anymore, and we know there have
(33:28):
been all these studies published in the New York Times
and medical journals that socialization really helps people with longevity.
So find an exercise, find friends and family, and find
a hobby.
Speaker 1 (33:42):
It's very good advice. I mean I say that too,
but I see struggles. I see struggles in young people.
I see struggles even in my own family, where withdrawal,
they look lonely, but they say they're not lonely, but
they are lonely.
Speaker 2 (33:59):
All phone addictions, the phone and computer addictions.
Speaker 1 (34:02):
But not speaking on the phone right, texting, no, never talking,
no human interaction. I like talking on the phone. I
like getting twenty five phone calls a day because I
feel like I'm connecting right. And yet children are not talking.
Speaker 2 (34:18):
People are having entire relationships on it through text. They
meet through a text, they break up through a text,
and they don't talk to each other. I hate it also, okay,
I remember the day texting started.
Speaker 1 (34:31):
Yes, tell us, Well, first it was phones, then it
was emails and phones, right then texting in silence, silence
in the office.
Speaker 2 (34:42):
People are texting from desk to desk. People on the
train when I commute, no one looks. I used to talk.
I used to talk to the person sitting next to me.
They're texting on a plane. Everybody's texting. People at a restaurant.
Couple are out together, sitting at a table together with
(35:02):
their children, and they're all voices. Yes, there's no The
human interaction is really suffering. No, I totally agree, and
I think that's contributing to mental illness also of course,
to this isolation. Absolutely, I don't like it at all.
I'm big on talking, as you can see. Yes, well
that's what I liked about you.
Speaker 1 (35:21):
I like that when we sat down at a lunch table,
not knowing each other, you started to.
Speaker 2 (35:25):
Talk and I loved it because you were talking. Uh huh.
Speaker 1 (35:29):
Heart disease is the leading killer of women. I keep
reading what do women need to do to prevent and
monitor heart disease?
Speaker 2 (35:39):
That's a brilliant question. It's very complicated. So women's cardiac
profiles change when they go through menopause. That's one thing
that we know. Cholesterol starts to go up, the good
cholesterol goes down, the bad cholesterol goes up. That's one
thing that happens. So the main risk factors for heart
(35:59):
to disease that you have a control over. One is
don't smoke. Smoking is a huge risk factor for heart disease.
So don't smoke, don't start smoking, and if you smoke,
stop smoking. I don't see many smokers anymore. That's also
changed in my career.
Speaker 1 (36:13):
Oh but there's hidden smokers.
Speaker 2 (36:16):
Yeah, but not like there was. We didn't see. We
saw so much smoking when I first went into practice,
and a lot of smoking related disease. I don't see
as much anymore. Maybe it's because I practice in the
middle of New York City now and the message has
gotten out, but don't smoke. Monitor your blood pressure. High
blood untreated high blood pressure is a huge risk factor
for heart disease. So that's why I say get a
(36:37):
blood pressure machine at home check your blood sugar. Diabetes
is a risk factor for heart disease. Family history is
a risk factor for heart disease. And when you go
through menopause. I believe that women should be evaluated differently
once they go through menopause. We have to keep on
top of their lipids, we have to keep on top
of their coronary arteries after they go through menopause because
(36:58):
our profiles change. So an exercise, exercise, exercise, I say again,
I can't say it enough.
Speaker 1 (37:05):
Well, one thing that I've noticed on Instagram, which we
all are slightly addiction to, is that there are lots
and lots and lots of variations of very good exercises
appearing Chinese taichi, you know. And I think that's a
good I think that's a good sign because people are
starting to pay attention to more and more to a
(37:26):
good exercise. I hope, I hope. What do you think
about supplements? This is another big question. Everybody wants to
have a supplement. They want to be selling supplements that
they think are going to help and save the world. Right,
So what do you think?
Speaker 2 (37:42):
So the important take home point about supplements is that
the supplement vitamin industry is completely unregulated. You have no
idea what you're getting. Please know that could be just
sugar pear. It could be that's correct. What I tell
my patients about supplements is two things. One, if you
eat a healthy diet over the course of a week,
(38:04):
If you get all your food groups in the course
of a week, chances are you're fine. Number one. But
number two, I check for important vitamins. I check every
year a vitamin D level, a B twelve level, your
iron studies, your blood counts which reflect your iron studies,
And if there's anything that you're missing of those specific vitamins,
I will let you know. Beyond that, you really don't
(38:27):
need to take anything else if you want to. You're
generally making expensive urine because you're just peeing it all out.
Speaker 1 (38:34):
What about ann and your urine as yellow?
Speaker 2 (38:38):
You're as brownie, you're dehydrated. Drink more waters, I should
drink more. About collagen? What about it?
Speaker 1 (38:46):
Are any of these collagen supplements any good at all?
Speaker 2 (38:49):
Are they going to help us?
Speaker 1 (38:51):
I don't get in osteoporosis.
Speaker 2 (38:53):
No, no, I don't think we know the answer to that.
But my guess is no. Again, another supple, and that's unregulated.
Speaker 1 (39:00):
We're eating up ground or bones of something.
Speaker 2 (39:02):
Well, that's differently eating sardines. Eating fish with bones is
a good source of calcium. We do recommend that women
take twelve hundred milligrams of calcium every day. Best way
to get it is dietary calcium. So dairy and you
can have fat low fat dairy of skim milk, fat
free dairy sardines with bones. That is a good thing.
Speaker 1 (39:21):
Sardines I buy the most beautiful. You got to eat
a can like every other day.
Speaker 2 (39:27):
Okay, those are good, right, excellent, Those are great for
your calcium and vitamin D. Okay.
Speaker 1 (39:31):
Now, the other big thing that's happening in the city.
Not every every block, but many blocks have body scan
operations going on. You can go in and have a
body scan and they're going to tell you if you
have signs of anything.
Speaker 2 (39:45):
I can an what do you think? So I asked
our expert, our cancer risk cancer genetics person, and the
answer to that is no, no need to do that.
So I want to try to explain this so it
makes some sense. So we screen. We do screening tests
again like a mammogram, a colonoscopy, and in order for
(40:06):
a test to be recommended as a screening test, it
has to fulfill for criteria, the disease has to be common. So,
for example, breast cancer occurs in one in seven to
eight women in this country randomly, so very common, and
if you have a family history, it can be as
much as one and two so extremely common, as opposed
to something like pancreatic or ovarian cancer, where they're not common,
(40:30):
so we don't screen for those in the whole population.
So disease has to be common. The test we use
for screening has to have be sensitive and specific, low
false positive, low false negative rate. Right, we can't have
a test where all the values are way off. It's
got to be a relatively reliable test. Third criteria is
the doing the test has to have an impact on
(40:53):
your longevity. So for example, if we tested everyone for
pancreatic cancer, we're probably not going to make a d
in significant in longevity by testing the entire population. And
the fourth criteria is it has to be relatively inexpensive,
So you can't do a screening test that costs ten
thousand dollars on everybody every year. Mammograms are cheap, disease
(41:16):
is common, we have clearly an impact on outcome and
low false positives and negatives. So with the body scans,
they don't fulfill those criteria, so we most of what
they do is they send people down rabbit holes because
they find incidental things that are meaningless. Anyway, if you
have a symptom, if you have an abnormal blood test,
(41:38):
that's different, I'll get the cat scan on you, or
I'll get whatever scan is appropriate. But for asymptomatic people,
you should not be doing these total body scans. Okay,
that's good news.
Speaker 1 (41:49):
Do we still need to worry about COVID a reoccurrence
of COVID?
Speaker 2 (41:53):
Yes, so there's still COVID around. There's still a fair
amount of COVID around. And again I'm going to say
something that's my own personal opinion from my practice. It's anecdotal.
You know, we're still recommending people get COVID vaccines. They're
change they change the code the strains like a flu vaccine.
Definitely get your COVID vaccines. The COVID vaccine was the
(42:15):
game changer in this country, undoubtedly in terms of keeping
people from dying out of the hospital less sick. It
was because of the vaccine. I witnessed that. I through
all my COVID work and after I worked in the hospital,
I was one of the co directors of the long
COVID program at NYU, so I had a lot of
COVID experience and the vaccine made a huge difference. We're
(42:35):
still seeing COVID most we're not seeing the sickness that
we saw in twenty twenty because of the vaccine largely,
and we have heard immunity and people have immunity from
getting the disease. You have some natural immunity. Also, the
point I wanted to make is because we're vaccinated, a
lot of people who are getting COVID have mild disease.
(42:56):
It presents as almost a cold. I have a running nose,
I have a sore throat. The home COVID tests, when
they're positive, are reliable, but when they're negative, I don't
trust them. I've had a lot of negative home COVID
tests where I've sent people for swabs, for a respiratory
swab and they come back positive. So if you do
a COVID test and it's positive, fine, But if it's negative,
(43:16):
it doesn't mean you don't have COVID. That was the
point I wanted to make here go get a swab.
Speaker 1 (43:21):
So, okay, we're gonna still worry about COVID.
Speaker 2 (43:24):
It is still present epidemic, it's not and it's also
not as deadly as it was in twenty twenty. We've
learned a lot about COVID and how to manage it.
So don't be frightened of COVID. Get vaccinated, but it
should still be on people's radar. And the difference between COVID.
One difference between COVID and influenza is influenza tends to
be a seasonal virus in cold weather. COVID seems to
(43:45):
be occurring all year round. It doesn't pick a season.
So I have patients with COVID right now. I've seen
patients with COVID. The last couple of weeks. I've had
a couple of patients with COVID.
Speaker 1 (43:56):
On your weekly radio show, you have featured moments of kindness?
Can you share moments of kindness? Which what does that mean?
So that started in COVID? I did, Yes, it started
in COVID, and people were so down that I wanted
to just point out some random moment of kindness that
I saw on the street anywhere I wanted people to
(44:17):
call in with moments of kindness, and I tried for
a long time every week to mention a moment of
kindness that I saw, that I witnessed, that somebody told
me about, and I had a lot of them, just
to kind of cheer people up, you know, because we
were so down, and it.
Speaker 2 (44:33):
Was a very poignant one that you heard. We did
a show on random acts of kindness. I did a
whole radio show about it, and somebody called in to
thank a kindergarten teacher that they had, which blew my
mind because I actually found my middle school biology teacher
after I graduated medical school to thank her for inspiring
(44:55):
me to go to medical school. That's nice, that was great.
I will say. I told my husband I would do
this about the moments of kindness that my husband retired
last week after almost fifty years in medicine, when my
daughter had a baby, and when my husband retired. The
kindness of our patients is mind boggling. I will one
(45:17):
of my patients came in one day who I don't
know very well. I see her once a year, and
she saw that I had a grandchild, and she's an artist,
and during COVID. She taught herself how to sew. She
was at the party, I believe, and I saw her
at nine o'clock in the morning, told her I had
a grandchild. At noon that day, her husband showed up
(45:37):
in my office with a little dress that she had
made and a hat and booties for my granddaughter. It
was so kind. And my husband has had patients who
people don't have. You know, they work at they work
very hard, don't have a lot of expendable cash. And
one particular group of sisters, the Carter Sisters that my
(45:58):
husband takes care of, got my granddaughter basically an entire wardrobe.
The kindness of people, when when you have events in
your life that you don't think touch them, is remarkable.
Speaker 1 (46:11):
That is a very nice thing to have. How does
the format of a live radio show help you with
your goals as a doctor?
Speaker 2 (46:19):
Oh, another good question. There's a lot of misinformation out there,
even in our country where we have the absolute best
medical care available in the world. It's a call in show.
We talk about two topics every week, and we do
two medical topics and people call in and I have
an expert on and ask us questions, and I have
(46:39):
learned that there's a lot of bad information, so we
correct a lot of bad information very important, which is
really important.
Speaker 1 (46:45):
Yes, yes, well, thank you so much. We have we
have over we have talked for longer than aloud. Well
and we can go on for you. Oh gosh, yes,
I have so many more questions.
Speaker 2 (46:59):
Come back again next time.
Speaker 1 (47:01):
Thank you for sharing all this great, great information, Doctor Bahar.
And for those of you at home, tune into doctor
Bayhart's show Women's Health Thursdays at ten am Eastern Time
on Doctor Radio Serious XM for lots of great medical expertise.
Thank you so much, thank you. This was a pleasure.
Host
Martha Stewart
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