May 7, 2025 • 51 mins
This episode celebrates Women’s Health Month by emphasizing awareness, education, and empowerment in women's healthcare. Join Dr. Holly Thacker as she discusses essential health topics, from vital screenings and nutrients to effective self-advocacy during medical visits.
In addition to physical health, this episode highlights the significance of mental wellness, advocating for the self-care of women who often prioritize the needs of others over their own well-being.
Make sure to subscribe for more episodes and share your insights after listening!
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Speaker 1 (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI'm back in our sunflower house
for a new podcast on Speaking ofWomen's Health, and this is the
month of May.
(00:26):
It's a very important Women'sHealth Month for so many
different reasons.
What we're going to talk abouttoday is National Women's Health
Awareness Month, and so it'sfitting that we at Speaking of
Women's Health celebrate thisand talk about women's health.
(00:47):
And who's better to talk aboutthis topic than us, our team at
Speaking of Women's Health, anonprofit that is dedicated to
empowering you to be strong, behealthy and be in charge
empowering you to be strong, behealthy and be in charge.
(01:11):
So May starts out with May DayMay 1st ring around the roses.
We have Mother's Day, which isa special holiday for all moms.
It's Nurse Appreciation Monthas well.
We have fabulous nurses in ourSpecialized Women's Health
(01:33):
Center, and it's great thatthere is a celebration and
attention on women's healthduring the month of May, and
this recognizes the physical andmental health concerns of
American women.
And, interestingly, it was theNational Cervical Cancer
Coalition, the NCC, thatrecognized each May as Women's
(01:57):
Health Month, and so theofficial observation kicks off
every year around May 11ththrough the 17th.
So May is such a busy monthMother's Day, nurse Appreciation
, and it's also OsteoporosisAwareness Month, and we feel
(02:20):
very fortunate to have receivedawards related to our
osteoporosis health topics.
On speaking of women's health,and so, if you haven't listened
to our podcast interviews withosteoporosis experts,
information on prevention,treatment evaluation, newer
(02:41):
therapies, questions with ournurse, if you're someone who is
contemplating osteoanabolic bonebuilding therapy, or if you
just have questions aboutcalcium and vitamin D and
general musculoskeletal health,we have it all.
So be sure to go on our websiteunder podcast and you can
(03:02):
search for different topics.
To come up with the exact dateof a podcast that you might have
missed and so as to not misspodcasts, hit the subscribe or
follow button.
I have so many patients andfriends say, oh, I was listening
to this podcast.
I haven't listened to itrecently.
I'm like, well, did you hitsubscribe?
I mean, we're all very busy andsometimes time gets away from
(03:24):
us, but if it's an importanttopic, which hopefully women's
health is to all of you, it'simportant not to miss anything.
This is also the time that thereis actually an annual
observance that was pioneered byour United States Department of
Health and Human ServicesOffice on Women's Health.
(03:47):
So HHS is a big part of thefederal government, about 25% of
the budget, and there is aspecial office on women's health
.
So the goal of this holiday, soto speak the goal of this
(04:08):
holiday, so to speak, is toempower women in such a way that
they can make health a priority, and it also equips women with
knowledge to help other women ontheir journey to improve health
and with the efforts ofindividuals and healthcare
clinicians individuals andhealthcare clinicians we want
every woman to live a healthyand happy life.
So what are some of theactivities that occur during
(04:31):
Women's Health Week?
Well, this alliance ofgovernment organizations help to
raise awareness and educationabout proactive steps that women
can take to improve theirhealth, because we have lots of
concerns about the health of thepopulation, about chronic
disease in children and women,who are many times at the center
(04:55):
of families and communitiesthat care for the young ones as
well as some of the other agingindividuals in the community.
And it's important to empowerwomen to discuss with their
healthcare team which particulartests, therapies, evaluations,
interventions may or may not beright for them, how often they
(05:19):
should have them if they shouldhave them, and also it's
important to get full informedconsent and not feel like
there's anything you absolutelyhave to do.
I mean, I tell my patients thatthings that I think are
somewhat non-negotiable, thatare safe and effective and cheap
like, say, wearing your seatand not smoking and imbibing
(05:45):
chemicals, drugs of abuse, etcetera that seems to be pretty
common sense and most all peoplewould agree on that.
Everything else there's somechoices.
In terms of screenings, though.
The gold standard of cancerevaluation and early detection
(06:08):
and treatment to prevent cancerdeaths is really the pap smear,
and the pap smear, all thesedecades later, really remain a
pinnacle in women's health.
And January was cervical cancerawareness month, and I just see
with younger women and manymidlife women and even older
(06:29):
women in my practice being toldoh, I don't have a uterus or
cervix, I don't need a pap.
Maybe you don't, but maybe youdo.
Oh, I'm over 65.
I don't have to do that anymore.
Well, if you've had a lifetimeof negative cervical cancer
screenings maybe you don't, butyou may and if you've had
abnormal testing, if you've hadHPV, if you've had interventions
(06:53):
to treat precancers, it needsto be individualized.
Now a lot of women think thatNow a lot of women think that
mammography and breast cancerscreening is kind of the
pinnacle.
There's more pitfalls withmammography.
(07:15):
There is certainly benefit.
It's certainly used as adiagnostic test.
It's also used as a screeningtest and there are different
recommendations and you've hearda little bit about differences
of opinions on prior podcaststhat I've done with medical
breast specialist Dr HollyPeterson she calls herself the
other Dr Holly and we think that, based on your age, your
(07:42):
hormonal status, your personalpriorities, your own personal
medical history and your familyhistory, it's good to come up
with some individualizedassessments Now with breast
cancer screening.
If you feel that something'swrong, if you feel a lump, even
if you're a young woman, don'tlet someone blow you off because
(08:05):
even though it's maybe unlikelyespecially if it's new or
painful it could be a cyst Justbecause you're young.
If you think something's wrong,you need to get that pursued.
There's lots of differentrecommendations about when to
start screening mammography.
(08:25):
There's been this big push todigital mammography or
three-dimensional mammography,which does entail more radiation
.
I do have women who don't wantto do this.
Many women want the most amountof imaging possible.
Certainly, with mammography weget additional information about
(08:46):
breast density and many timesthe breast technologists may
collect information about yourreproductive and hormonal
history and family history,histories of breast biopsy, and
this information and your breastdensity may give further risk
stratifications about your riskfor breast cancer.
Now it's important to know yourfamily history.
(09:09):
Having an older family memberof advanced age being diagnosed
with breast cancer, particularlyon mammography, is not nearly
as concerning as a history ofbreast cancer under the age of
50 that's diagnosed in a firstdegree relative, or if there's a
pattern of cancers breastcancer, ovarian cancer, colon
(09:31):
cancer, uterine cancer.
So of your blood relatives,it's really important if you can
find out medical history andexact diagnosis because you may
need genetic testing and thoseat the very highest risk of
breast cancer do need moreintensive screening.
Now some women are told to geta baseline mammogram at 40 or 45
(09:52):
.
Some recommend even 50, butwomen in their 40s and even
earlier can have breast cancer,and others have recommended that
you should have a yearlymammogram for most all women
between 45 and 55 yearly, andthen average risk women between
the ages of 55 to 75 or so couldbe screened assuming they have
(10:16):
no symptoms every two years orso.
Now I always tell women ifyou're 105 and you have a breast
lump, we're going to evaluateyou.
So there's not an age limit.
But just like we change thefrequency of cervical cancer
screening after you've beenscreened for decades of your
(10:36):
younger and midlife, just assometimes when a person gets
much older, especially ifthey've had normal colonoscopies
, we may move to just Cologuardscreenings or less invasive
screenings.
Although my dear aunt, who hadmultiple colon polyps and every
(10:57):
time she had colonoscopies shehad precancerous colon polyps
removed and she's doing verywell, very involved in her
community, socializes, hasgrandchildren, has great
grandchildren, is very involvedwith the church.
So on her 80th birthday shewent in for a colonoscopy and
she had a tubular adenoma, aprecancerous colon polyp, and
(11:21):
they said oh, you're 80.
You don't have to come back forany more colon cancer
screenings.
Now I wish you would havecalled me and talked to me about
it, because at age 85, she'svery vigorous and 86 actually
and active and she got reallyweak and had severe anemia and
(11:48):
she had had a lesion, a coloncancer, that was eroding into
her bowel and causing bleeding.
So much to the fact that shewas so weak and needed blood
transfusions.
Now had she been rescreenedanother three or four years
because of all thoseprecancerous polyps.
I think that this could havebeen stopped and she wouldn't
have bled down so much Now.
(12:09):
Luckily she was able to getsurgery and stop the bleeding
and she is significantlyrecovered.
But it's very individual.
If you're healthy and activeand have several more years of
lifespan, it doesn't mean thatyou have to stop screening.
And certainly in people thathave had abnormal PAPs, who've
(12:34):
had breast cancer, who've hadcolon cancer or precancerous
colon polyps assuming that youfeel up to having the test done
and do not have some other major, severe comorbid problem these
really do involve individualdiscussions.
Now, when I see women withhysterectomies on estrogen doing
(12:57):
great who are past the age of75, many of them are 80, 85, 90
year olds in my practice doinggreat, if they don't have any
symptoms in their breast, Idon't recommend the screening
mammography because there arefalse positives and if they get
a biopsy and it looks abnormal,then they're not going to be
able to be on their estrogen,which we know helps with
(13:19):
function and longevity, and wehave good data that it actually
reduces breast cancer even intoyour 70s.
So each type of cancer isdifferent, just like you might
be 90 and have a skin lesionthat's bothering you and it
could be cancer or pre-cancerthat should be locally treated.
(13:39):
So there's just a hierarchy.
Not all cancers have as muchevidence that early detection
makes a difference.
Sometimes it's better treatmentonce the person has the
clinical disease.
And there are cancers wherepeople can have what looks like
clinical disease if you gobiopsying the tissue, like the
thyroid, like the breast, likethe prostate in men.
(14:01):
So older men without symptoms.
You know we don't recommendjust routine PSA screenings, for
instance, unless there'ssymptoms.
Again, if you're older you knowgentlemen in your family who
has symptoms, then of course youwant to be evaluated.
So screening is not therapy andsymptoms require diagnosis.
(14:27):
And so ideally to have ascreening intervention, it
should really only have upsideand no downside as much as
possible.
And there is gradations in thisand that's why one size does
not fit all and it really doestake nuance.
Now, going back to our goldstandard the pap smear.
(14:51):
The cervix is the opening ofthe uterus and we generally now
recommend the first pap smear byage 21.
Now, certainly before then youmay want to of course have a
pelvic exam and see agynecologist or a women's health
clinician.
Health clinician my niece, whois 20, on synchodomyo 5505, she
(15:17):
was born, you know called me upand said, aunt Holly, you know I
was at the healthcare centerand they didn't say I needed to
get a pap smear.
But I'm a woman and shouldn't Ibe evaluated?
I said, well, you know,cervical health is very
important but you're not yet 21.
And what's important is thatyou get information and pelvic
(15:39):
exams.
If you have symptoms, you getevaluated.
And yes, on your 21st birthday,which won't be until 2026, then
you can go in and have yourfirst pap smear and we generally
do them every three years.
After age 30, we add a routineHPV human papilloma virus
(16:02):
assessment test.
In addition, now, if the HPV isnegative, kind of the bottom
basement, kind of guidelines,are that?
Well, you could go every fiveyears and I don't let my
patients usually go that longbecause I certainly have seen
some cases of cervical cancer atthe four and a half year mark.
(16:23):
So there are such things asfalse negative tests, just like
there's such a thing as falsepositive test.
You know we could get into astatistical discussion about
sensitivity and specificity.
If you have a very sensitivetest, you don't want to miss
anything and you mayover-diagnose and for some
things that may not be as bad,for other things that can
(16:45):
actually be kind of pretty bad.
Now, specificity if you want atest very, very specific, that
means you're not going to havefalse positives and you're going
to actually be fairly confidentthat if that's your diagnosis,
that's the real diagnosis andit's this yin and yang, and
knowing what the positivepredictive value of a test is is
(17:08):
important.
And so, really, with any test,there are false positives and
there are false negatives, andthat's one reason why I tell my
patients from 30 to 65 that, ingeneral, if you're an average
risk woman not high risk, butaverage risk I want you to get
the scrape of the cervix everythree years.
Because what if you're at thefour, four and a half year mark
(17:30):
and your clinician says becausewhat if you're at the four, four
and a half year mark and yourclinician says, oh, you're not
quite due yet it hasn't hit thefive year mark.
Well, what if you've moved oryou forget to make your
appointment or you have someother crisis?
I have seen women who generallyare responsible with their
health and aren't adverse togoing in and seeing a physician
and have health insurance, whoactually just don't think about
(17:56):
it because it's not emphasizedas much.
Just like I see womendetermined to get their
mammogram when they don't havesymptoms and they're a healthy
80 year old traveling the worldLike why do you want to have
this test done?
That's a little bituncomfortable, that could give
you a false positive and lead toyou becoming a patient.
So again, it's personal choice.
(18:22):
I have active, you know womenwho you know have their 80 and
they may easily live tillthey're 95 and they just want
the test.
As long as you understand therisk and the benefits.
And I think too often we justsay, oh, it's screening, so it's
all good.
You know, it's just likegetting a bonus check or extra
money in your bank account.
Right, that seems all good,although I guess there's taxes
(18:44):
potentially.
So maybe there still is adownside to most things Once
you're 65, then if you've alwaysbeen negative your whole life
and your mother didn't take DES,diethylstilbestrol, which
unfortunately was given topregnant women um to prevent
miscarriage and that can beassociated with vaginal and
(19:06):
cervical cancer If you haven'thad abnormal PAPs, leaps, cones,
hpv then you don't necessarilyhave to continue to get the
scrape of the cervix, but youstill need periodic pelvic exams
and generally speaking, youknow, medicare covers that
annual gynecologic exam, notannually but every two years and
for most women without symptoms, generally that is fine.
(19:29):
Again, has to be individualizedbased on your history.
Again it has to beindividualized based on your
history Women with HIV, humanimmunodeficiency virus, women
with immunocompromised they'reon immunosuppressants, women
with abnormal tests, smoking,other complex medical histories
we may make differentassessments.
What's really nice at theCleveland Clinic is we have a
(19:53):
service where if a clinician isnot exactly sure what to do with
an abnormal PAP or what shouldbe the interval, you know,
because some guidelines havesome differing opinions and
again they're usually the bottombasement recommendations, not
necessarily the top tier levelof what you may or may not want.
And again, more isn't better.
So maybe you would want tofollow, you know, the more
(20:17):
minimalistic evaluation andagain some of that has to do
with your own, you know,personal values and approach.
I mean it'd be nice to be a lotmore definitive but we always
can't be Certainly.
If you have smoked, if you'vehad multiple sexual partners, if
you've had known HPV, which isone of the causative agents of
(20:40):
cervical cancer, it's not theonly one.
I mean I do have some women inmy practice who have done HPV
cervical cancer.
It does happen.
That's why I'm not really sucha big proponent of saying, oh,
just only do self-HPV testing.
We did talk about that inJanuary on January's podcast.
(21:00):
And so for women who otherwisewould not seek any exams or
health care or don't have access, certainly a self-directed HPV
assessment test that the womancollects the swab herself is
better than nothing.
Just like I tell patients andI'm thinking of one of my
friends who's a patient, she'slistening, she knows who she is
(21:25):
she's like I don't have a familyhistory, I'm, you know, 50.
And I think I just want thecoligard.
I really don't want acolonoscopy and I'm like you're
like 50, almost 51 and youhaven't even had a colonoscopy.
Our new guidelines are screenat 45.
I said you need at least onecolonoscopy and she really
didn't want to do it.
(21:46):
You know the holidays werecoming up, she's busy, you don't
work, it's the prep.
You got to drink all that fluid.
And if you want moreinformation on colorectal cancer
screening, then definitely tuneinto our March of 2024's
podcast.
You know which marchescolorectal cancer awareness.
We're seeing definiteskyrocketing rates, especially
(22:09):
in younger people, and so we'vepushed down screening to 45.
It used to be 50.
A lot of people still thinkit's 50.
It's not, and if you'vepersonally had symptoms or a
family history.
But anyway, getting back to thisfriend patient, I think I kind
of shamed her into it and youknow she was very happy she had
it done because she had someprecancerous colon polyps and
(22:32):
you know a and a lesion that waspressing on her bowel that led
to other tests that led her toget a low-grade cancer treated
and cured and she might andprobably not would have had that
outcome had she just had theCologuard.
Maybe the Cologuard would havebeen positive and that would
have led to other tests, butmaybe by then this tumor could
(22:52):
have ruptured.
So, um, there is risk thoughwith colonoscopies and, um, you
know, if you talk to enoughpeople, somebody will tell you a
bad experience.
Certainly an inexperiencedcolonoscopist could rupture a
colon.
There are diverticula in inpeople many times who are over
50 and there is that chance ofrupturing the colon.
(23:17):
It's very, very rare.
Knock on wood, the only patientI've had in my practice who ever
had it done was someone who hada tumor again and that I think
was the cause and she wouldn'thave known about the tumor and
being cured of the tumor, hadshe not had that complication.
So it ended up turning out okay.
(23:37):
And so that's why people who'vealready had a normal
colonoscopy and they don't haveany symptoms or family history
or increased genetic risk likefamilial polyposis or one of the
Lynch syndrome variants or afamily history of uterine and
colon cancers, that you could doColigard and there are some
(23:58):
other screening tests.
So again, it's personaldecision and it's a discussion,
you know, with your healthcareteam.
We don't really do the annualhemocult blood testing, um, we
don't really do the annualhemocult blood testing.
(24:19):
If you have, you know, steaktartar with a little, you know,
red meat and blood, it could befalsely positive.
Vitamin c can affect it, um,and it can be falsely negative.
And by the time you're bleedingfrom a colon tumor, like I was
talking about my lovely dearaunt, um, you know, maybe it's
gone a lot farther than youwould like it to go.
And colonoscopy is one that, ifyou remove these precancerous
(24:40):
colon polyps, most all not all,but most all colon cancer starts
in polyps that are there forseveral years.
And I tell all of my patientsthat it's very important that
when somebody removes tissuefrom your body.
It's good to keep a hard copy ofthe pathology report Because
you may not be able to locatethe records.
(25:02):
Just because it's onlinedoesn't mean you're extremely
busy.
Healthcare clinician has timeto check in the thousand
different boxes that you canpossibly click on.
Or sometimes you can click onthem and they're so small you
can't even really see thedetails.
Or you can see that they had acolonoscopy but you don't know
where the pathology is.
So keep a copy of it becauseeven though it's benign which I
(25:25):
think the average lay personjust thinks, ah, it's not cancer
.
So I'm happy, I want to getback to my life, I don't want to
think about this medical stuffand we can't really expect you
to understand the lingo always.
I mean, we talk so fluentlymedically doctors and nurses
about this, but it's not alwayssecondhand nature.
(25:46):
It really crystallized to mewhen my husband was frustrated
because one of the eyetechnicians who was doing his
eye exam said what is your bloodsugar?
And he said I don't know.
Let me look at my chart andhe's like looking for blood
sugar.
He knew what his glucose was,which is normal.
(26:06):
He knew what his hemoglobin A1Cwas, which is a measurement of
his blood sugar over the last,you know, three months, which
was excellent.
He knew those numbers, he knewglucose, he knew hemoglobin A1c,
but he didn't know blood sugar,which is like more of a
colloquial term, and so I haveto always remind myself that
(26:27):
that.
You know, not everybody speaksthis language.
It's like you know, you knowpeople that are multilingual.
It's great when you can speakin a lot of different languages.
I only really know English, alittle tiny bit of Spanish and a
little tiny bit of French, butnot enough to be conversational.
And so that's how a lot ofpeople are medically they just
(26:48):
know a little bit of words butthey can't really converse.
So keep your records, okay, andjust because something's a
benign polyp doesn't mean youdon't need screening.
You may even need screening ina couple of years, a year or two
, especially if there's not agood colon prep.
You may need it in three yearsif someone removes polyps and
(27:09):
tells you, oh, you can go 10years.
I saw a lady today and we werehaving that discussion and she
said, oh, they said 10 years.
And I'm like, well, that wouldbe if everything was perfectly
clean and they didn't seeanything at all and maybe you
had already had a colonoscopyprior, but they said that they
had.
There was still some stool inyour colon and they did remove
polyps, even though they werebenign and hyperplastic.
(27:31):
Those aren't as concerning astubular adenomas, tubular villus
adenomas, sessile, serratedpolyps, multiple polyps.
So the next cancer is skin.
It's the biggest organ.
We have a lot of podcasts onthe skin, from dry skin to
(27:51):
rosacea to you know, cosmetichelp for aging skin.
Certainly, sun exposure canincrease squamous cell and basal
cell and early sunburns.
Ironically, though, tellingpeople to slather themselves
with sunscreen and not checkingtheir vitamin D or correcting
low vitamin D levels from lackof sun exposure can actually
(28:14):
increase melanoma and othercancers.
So that's why most of mypatients and again, this is not
medical advice, this is just ashow to educate you and
entertain you and empower youFor most people that are over 40
, that live in a northernclimate or aren't exposing them
their naked skin to somesunlight at the right latitude,
(28:35):
generally, unless you eat likean Alaskan, you need vitamin D,
and if you didn't listen topodcast number three in season
one, all about vitamin D, it'slike a miracle pro-sterile
hormone.
It's not even a classic vitamin.
We have lots of ways to protectyour skin and sunscreen, but
(28:55):
you've got to make sure you'regetting your vitamin D Now.
Other screenings and other testslike screening for sexually
transmitted infections.
Certainly women under age 25 to26, certainly under 24, should
be checked because if you havesome occult case of chlamydia
you could have scarring of yourtubes and be infertile.
(29:16):
You need to be counseled aboutHIV and sexually transmitted
infections, understand symptomsand what your options are.
So screening for chlamydia andgonorrhea is something that
should be done in high-riskpopulations, regardless of age.
I mean, you might live in thevillages in Florida where there
(29:39):
can be some pretty wild sexualactivity.
You can't just only limit it toyoung women.
So again, it's very importantto be honest with your physician
.
It's confidential, it'spatient-physician
confidentiality.
I mean, unless you're going totell someone that you plan to
kill yourself or kill someoneelse.
(30:00):
That's when we, you know, haveresponsibilities to break that
confidentiality.
But everything about yourintimate personal life is
important to feel comfortabletalking to your healthcare
clinician about.
I had a new nurse who wasrotating with me and wanting to
learn about midlife women'shealth and she was like I'm just
(30:20):
, you just were so comfortableand relaxed and it was so
nonchalant.
You asking you know those verypersonal questions and that's
the way it should be, you know,very comfortable and clinical
and what is important to assessfor your health.
Now pregnancy is a whole othertopic.
(30:42):
There's lots of screening bloodpressure, kidney function, the
fetal heart tones, the bloodpressure, screening for
gestational diabetes.
There's a lot of things, youknow.
Nutrition, early nutrition,having adequate folic acid
levels and then early inpregnancy having the right,
(31:04):
having enough choline for braindevelopment and the omega-3s and
we've got an upcoming podcaston omega-3, which is a really
important one, I think.
Now, menopausal women, you knowwhich is my professional passion
and I got interested in itbecause I thought why, at
(31:25):
midlife, when you're just doneraising your children and you've
established your life andpotential career and community
involvement, then everything,finally, you can maybe enjoy
some things you know in yoursecond beginning of your
adulthood.
And then boom, I would seewomen that look like wilted
flowers, you know, with hotflashes and sleep problems and
(31:45):
brain fog and increased risk forheart disease and osteoporosis.
It seemed like so many diseasesof aging took root then.
So definitely having acardiovascular risk assessment
and osteoporosis risk assessmentis very important as part of
that risk factor and so much ofwhat we eat and how we live our
(32:09):
life and what our exercise is,and avoidance of toxins.
Excessive alcohol.
Tobacco is very important and Ithink our food supply is
finally getting some attention.
And, uh, I did a column and apodcast in season two last fall
of 2024 all about things thatare banned in other countries,
(32:32):
that have just infiltrated, allabout things that are banned in
other countries, that have justinfiltrated our food supply,
things that are addictive,things that might make the food
look more appealing to youngchildren but might be
carcinogenic.
So if you didn't listen to thatone, please go back, and even
if you did, it's really worth alisten.
Heart disease you know Februarywas our women's heart month, but
(32:53):
really every month of the yearyou need to think about that
ticker and your wholecardiovascular system because it
is the number one cause ofdeath in American women and even
though male sex is a riskfactor, you know, for earlier
disease, women do catch up andwhen they lose estrogen things
can accelerate.
(33:14):
And certainly a bad lifestyle,a family history, smoking,
advancing age.
In women, hypertension is abigger issue and you know, women
have more atrial fibrillationactually, and knowing what your
lipid panel is is not so much,just solely the cholesterol.
(33:34):
But I want to know what yourtriglycerides are, because if
your weight is up, your bloodpressure is up, your
triglycerides are up, your goodHDL cholesterol is low, maybe
your sugar is creeping up andyou have so-called syndrome x or
diabesity.
That's really a problem anddiabetes is a much greater risk
(33:55):
for heart disease in women thanin men.
Many times I will get a baselineultrasensitive CRP in women to
further assess inflammation,because that is more of a
correlate than actually plaincholesterol and I see a lot of
knee-jerk reactions just toprescribe statins, and statins
certainly have a role,particularly in established
(34:17):
heart disease in women, butthere's no real evidence for
primary prevention.
So you really have to have agood reason to put a
50-something-year-old woman on astatin if she doesn't have any
vascular disease.
And coronary calcium scores canbe helpful.
They only show calcifiedlesions, they don't show
everything.
So again, one test and onesimple assessment may not give
(34:40):
the whole picture.
Now we can't interpret anultra-sensitive CRP if you
happen to be on oral hormonetherapy or oral contraceptives
because there's an effect in theliver.
That's a secondary phenomenon.
It's not real inflammation, butit kind of obscures the test
results.
And speaking of obscuring testresults, including hormones and
(35:03):
cardiac tests, is biotin.
So if you didn't listen to thepodcast I did a few months ago
on biotin, that's one to listento Now.
Medicines that are proven toreduce cardiovascular risk,
including heart attack andstroke generally, are
(35:23):
medications in women thatalready have known disease and
so we're talking about.
If you've got existingatherosclerosis, you may need a
statin.
If you have hypertension, youshould be treated.
Ace inhibitors many times areused.
If you have diabetes, youshould definitely have it
controlled and try to get itinto remission, and anti-aging
(35:48):
agents like metformin orglucofage can be very helpful,
although can go through thekidneys and liver and can lower
B12.
So, again, everything has riskand benefits that you need to
get informed consent, andstatins in females have not been
shown to be effective againstprimary prevention of heart
(36:10):
disease and in women theyincrease the risk of diabetes,
and I see women every week whoare on a statin.
They don't have heart disease.
Nobody's even checked theirhemoglobin A1c, they haven't
been doing intermittent fastingor taking the carbs out of their
diet, and no one's evencounseled them about the
benefits of menopausal hormonetherapy.
If you start with healthyarteries, estrogen has a panoply
(36:32):
of effects increasing nitricoxide, improving cholesterol
ratios, being a mild calciumchannel blocker.
There's effects genomically andnon-genomically.
Sometimes sleep is better, sothat the person's able to focus
and eat right and exercisebetter than just being miserable
(36:53):
with hot flashes.
So there is cardiovascularbenefit and some longevity
promotion that we now haveevidence on.
Again, one size does not fitall.
Nothing is risk-free.
There are rare women that canhave blood clots, particularly
on oral estrogen.
There can be annoying sideeffects with breast tenderness
(37:13):
and bleeding.
So what works for one womandoesn't work for another and
that's why really having ananti-aging, comprehensive
midlife physician whounderstands the importance of
all these different domains,looking at you individually,
taking into effect your goalsand preferences and giving you
(37:37):
options and sometimes I say youknow you might not know until
you try.
Really, one of the biggestthings of most importance is
diet and you can controlgenerally what you put in your
mouth and having a Mediterraneanheart healthy diet, even though
I think down the road we'llhave more evidence that maybe
some diets are better for somepeople's nutrigenomic profile
(38:00):
than others.
But right now we do know thatthe Mediterranean diet heart
healthy fats like olive oil,avocado, taking out every trans
fat, getting rid of the seedoils, getting rid of sugar and
additives and simplecarbohydrates.
(38:20):
There's no such thing as anessential carbohydrate.
There are essential fatsomega-3 and 6, and there are
several amino acid proteinswhich are essential, meaning our
body cannot make them.
Several amino acid proteinswhich are essential, meaning our
body cannot make them.
Applepectin flaxseed can lowercholesterol.
Garlic one of my favorites myhusband always says my perfume
(38:43):
of choice is garlic, onions, oatbran and I would much rather
someone use butter or lard thanseed oils if you're going to be
using extra fats.
But I really want people tofocus on those healthy fats that
are good for your brain andyour mood and your skin and your
(39:04):
heart.
And the omega-3s are somethingthat so many of my patients are
low in.
Even when they think that, oh,they eat healthy, they don't
really eat junk food.
They don't usually eat out toomuch.
They read labels sometimes, butnot completely, and when I
check those women's levels a lotof times they're really
suboptimal.
So fatty fish and almonds andwalnuts and flaxseed and seaweed
(39:28):
and omega-3 eggs.
I had a lady today tell me well, I've never seen that I'm like
well, just look at the egg labeland they'll tell you if the
chickens were fed omega-3, thenthere's omega-3 inside the egg,
so those are like the only eggsthat I buy.
Now.
Hormone therapy in women whotake it for several years,
(39:52):
starting within 10 years ofmenopause or under age 65, it's
associated with lesscardiovascular disease, less
heart attack, less heart failure.
But there are some women whohormones, especially oral
hormones, make the blood thicker.
So if you're generally somebodywith no family history, you've
had a child or two or so, maybea C-section, maybe you've been
(40:14):
on hormonal contraceptive agentsfor several decades, that's a
much greater risk.
But sometimes age anddehydration and other factors.
You know there are peoplewho've had hypercoagulability in
their life, who never had ituntil a confluence of other
agents happened, and so ifthere's any concern about blood
(40:36):
clot, that's when we usuallyturn to transdermal estrogen.
And women who aren't onsystemic estrogen, if they're
post-menopausal, can use vaginalestrogen to keep the vagina and
bladder healthy and reducebladder infections.
And if you didn't listen to myOctober 2024 podcast on the
incredible large volume ofevidence of hormone use various
(40:59):
doses, routes in 11 millionwomen in America for 13 years, I
mean that's a huge data trove.
That was one of my favoritepodcasts to do.
Now women are naturallyconcerned about breast cancer
(41:21):
and really the Women's HealthInitiative, which came out
saying there was an increasedrisk if you took PremPro for
over five more like 10 years.
One extra case per thousandwomen.
There was no increase in deathsand when that study was looked
at closer, the placebo group hadan abnormally low risk of
breast cancer.
So there's a lot of us in themenopausal field that don't
think there's any increase in adiagnosis, even with estrogen
(41:42):
and systemic progestin, and mostof us use progestins that
aren't as anti-estrogen asmedroxyprogesterone acetate.
But it is good at protectingthe uterus and I do have women
on PremPro.
Again, one size does not fit all, but I sometimes think
something gets demonized andsomeone says, well, just do this
(42:03):
, this has no risk if it's aquote bioidentical.
I have women try to recite tome a book of a certain Instagram
article influencer who you knowthey read.
Well, you should just do thisand take continuous transdermal
estrogen and progesterone.
Well, that's only FDA approvedto cycle and oral progesterone
(42:24):
is not always well absorbed.
I saw another lady today whowas on oral progesterone who had
pretty bad heartburn, so thatwasn't right for her.
So what might be good even foryour sister or your best friend
isn't necessarily what's rightfor you.
And probably one of the mosthighly individualized assessment
is really menopause and midlife.
(42:45):
It's a little easier to makegeneral recommendations about
cervical cancer screening andbreast cancer screening and
colon cancer screening and skincancer screening.
Screening and skin cancerscreening.
We still mainly use hormonetherapy to treat symptoms.
Because if you're treatingsymptoms you accept a higher,
you know, potential risk.
(43:05):
But everything has risk, evenpreventive things like an
immunization.
I've had patients say well, youknow, the one time I didn't
wear my seatbelt and I was gladI didn't, cause I could get out
of the car.
So you know, anything that ispreventive still potentially may
(43:25):
have a risk.
Um, like we tell everyone toexercise and walk, well, you
know, if you're not careful andyou slip and you fall you could
crack your skull and, you know,have a subdural hematoma.
So again, everything has to beindividualized.
But at midlife you need a riskfor what's your cardiovascular
risk?
What's your blood sugar, sincediabetes is increasing?
(43:47):
If you're over 45, that shouldbe checked.
Colon cancer 45 is an age Withintwo years of menopause or
certainly by age 65, you knowyour physician or nurse
practitioner should have ordereda baseline bone density Sooner
if you have other risk factorsor a personal history of
fracture over age 45.
(44:08):
And osteoporosis is such animportant topic.
Calcium and vitamin D are soimportant and we have several
podcasts that are dedicated tothe evaluation and the treatment
and the screening what a bonedensity entails, also assessing
(44:30):
if you're at risk for violenceintimate partner violence.
We're going to have an upcomingpodcast on this topic because
it affects women of allbackgrounds and just having a
trusted primary care physician,particularly once you hit
midlife, is important and a lotof women who are healthy, who
(44:51):
maybe are just having babies orneeding contraception or some
menstrual assessment, are soused to seeing their OBGYNs and
some OBGYNs kind of age withtheir patients and they start
doing more midlife menopausalwomen's health.
I have a lot of OBGYNstransitioning their practice who
come and kind of want minitrainings and want to focus
(45:12):
their practice and don'tnecessarily want to be up at
three in the morning deliveringbabies anymore.
But you know people have veryindividualized practices.
So maybe good for you at onestage in your life but not for
another stage in your life andyou really want to have a team
that you feel comfortable withand so while the OBGYN who
(45:36):
delivered your babies willalways have a special place in
your heart.
He or she may not be the one tokeep taking care of you after
midlife.
One place that you can go tolook to see if someone has taken
a test to get credentialed isthe menopauseorg website, the
Menopause Society.
(45:57):
I know some patients find methat way, some people find me
through word of mouth and, ofcourse, find me through
physician referral.
Unfortunately, there's not asmany experts in this field as
there should be and I've beenrunning a fellowship, I've done
podcasts on the fellowship andwe have a lot of different
(46:18):
initiatives to try to expandthat access for women.
Immunizations are something thatare addressed during different
stages of life.
Again, it has to beindividualized and risk benefit.
You have to know whatinfections you may have had or
what your risk factors based onyour personal life or your
(46:39):
occupation are.
But again, that has to be withinformed consent and looking at
your full picture and generallythat is like your long-term
primary care team and I want tojust wish all the moms and the
(47:01):
Mimi, grandmothers and thecaregivers out there a very
happy Mother's Day and I want togive a shout-out to just the
most wonderful nurses that wehave.
I love our nurses in our Centerfor Specialized Women's Health.
It's National Nurses Week, may6th to May 17th, and I just know
(47:25):
that women are often in thebusiness of taking care of
everyone except themselves, sothat's a no-no.
If you're neglecting yourself,so treat yourself to good health
care.
Pamper yourself If you haven'tseen your physician make an
appointment.
It's easier to cancel anappointment than get one.
If you didn't listen to how toget an appointment medical
(47:46):
appointment last fall, that'slike a critical one and get the
screenings and the evaluationthat you need and come organized
and attentive so that you canfocus on what you need to focus
on.
And maybe you won't be able toget everything taken care of and
you may have to break it upinto a couple of visits.
We in our Center forSpecialized Women's Health offer
(48:09):
a concierge custom fit cash payprogram where that covers the
nurse to take in the intake andget things personalized and set
up and give a woman a whole hour.
And I think that sometimesthat's like how you fly, like,
(48:31):
do you fly first class?
My husband likes to do that.
He's happy to pay extra moneyand I would rather sit and coach
and save the money becausewe're all going to get there at
the same time.
Maybe he'll get off the plane,you know, a minute or two before
I do so some of it just dependson your lifestyle and your
budget.
You know, some women wouldreally like that extra time, but
(48:51):
increasingly we're seeing morepeople seek out concierge care
or direct primary care becausethey want more time with their
physician.
And if you don't have that as anoption in your area or you
don't want to do that, that'sfine.
But you really have to beorganized with your appointments
and you may need moreappointments or may need some of
(49:11):
your care split up.
Or maybe you'll see yourphysician for an initial
assessment and then other partsof your care can be delegated to
the nurse practitioner orphysician assistant in the
practice, and I've interviewedseveral of our APPs who were
excellent and we talked aboutthe role of those caregivers.
(49:34):
So thank you so much forjoining me in the Sunflower
House, thanks for listening andif you haven't already
subscribed, please do.
Anywhere you listen to podcastswe're on Spotify and Apple and
Podbean, amazon Music.
(49:56):
Just support our podcast byhitting subscribe or follow and
give us a five-star rating.
And thanks again, and I'll seeyou next time in the Sunflower
House, remember be strong, behealthy and be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI'm back in our sunflower house
for a new podcast on Speaking ofWomen's Health, and this is the
month of May.
(00:26):
It's a very important Women'sHealth Month for so many
different reasons.
What we're going to talk abouttoday is National Women's Health
Awareness Month, and so it'sfitting that we at Speaking of
Women's Health celebrate thisand talk about women's health.
(00:47):
And who's better to talk aboutthis topic than us, our team at
Speaking of Women's Health, anonprofit that is dedicated to
empowering you to be strong, behealthy and be in charge
empowering you to be strong, behealthy and be in charge.
(01:11):
So May starts out with May DayMay 1st ring around the roses.
We have Mother's Day, which isa special holiday for all moms.
It's Nurse Appreciation Monthas well.
We have fabulous nurses in ourSpecialized Women's Health
(01:33):
Center, and it's great thatthere is a celebration and
attention on women's healthduring the month of May, and
this recognizes the physical andmental health concerns of
American women.
And, interestingly, it was theNational Cervical Cancer
Coalition, the NCC, thatrecognized each May as Women's
(01:57):
Health Month, and so theofficial observation kicks off
every year around May 11ththrough the 17th.
So May is such a busy monthMother's Day, nurse Appreciation
, and it's also OsteoporosisAwareness Month, and we feel
(02:20):
very fortunate to have receivedawards related to our
osteoporosis health topics.
On speaking of women's health,and so, if you haven't listened
to our podcast interviews withosteoporosis experts,
information on prevention,treatment evaluation, newer
(02:41):
therapies, questions with ournurse, if you're someone who is
contemplating osteoanabolic bonebuilding therapy, or if you
just have questions aboutcalcium and vitamin D and
general musculoskeletal health,we have it all.
So be sure to go on our websiteunder podcast and you can
(03:02):
search for different topics.
To come up with the exact dateof a podcast that you might have
missed and so as to not misspodcasts, hit the subscribe or
follow button.
I have so many patients andfriends say, oh, I was listening
to this podcast.
I haven't listened to itrecently.
I'm like, well, did you hitsubscribe?
I mean, we're all very busy andsometimes time gets away from
(03:24):
us, but if it's an importanttopic, which hopefully women's
health is to all of you, it'simportant not to miss anything.
This is also the time that thereis actually an annual
observance that was pioneered byour United States Department of
Health and Human ServicesOffice on Women's Health.
(03:47):
So HHS is a big part of thefederal government, about 25% of
the budget, and there is aspecial office on women's health
.
So the goal of this holiday, soto speak the goal of this
(04:08):
holiday, so to speak, is toempower women in such a way that
they can make health a priority, and it also equips women with
knowledge to help other women ontheir journey to improve health
and with the efforts ofindividuals and healthcare
clinicians individuals andhealthcare clinicians we want
every woman to live a healthyand happy life.
So what are some of theactivities that occur during
(04:31):
Women's Health Week?
Well, this alliance ofgovernment organizations help to
raise awareness and educationabout proactive steps that women
can take to improve theirhealth, because we have lots of
concerns about the health of thepopulation, about chronic
disease in children and women,who are many times at the center
(04:55):
of families and communitiesthat care for the young ones as
well as some of the other agingindividuals in the community.
And it's important to empowerwomen to discuss with their
healthcare team which particulartests, therapies, evaluations,
interventions may or may not beright for them, how often they
(05:19):
should have them if they shouldhave them, and also it's
important to get full informedconsent and not feel like
there's anything you absolutelyhave to do.
I mean, I tell my patients thatthings that I think are
somewhat non-negotiable, thatare safe and effective and cheap
like, say, wearing your seatand not smoking and imbibing
(05:45):
chemicals, drugs of abuse, etcetera that seems to be pretty
common sense and most all peoplewould agree on that.
Everything else there's somechoices.
In terms of screenings, though.
The gold standard of cancerevaluation and early detection
(06:08):
and treatment to prevent cancerdeaths is really the pap smear,
and the pap smear, all thesedecades later, really remain a
pinnacle in women's health.
And January was cervical cancerawareness month, and I just see
with younger women and manymidlife women and even older
(06:29):
women in my practice being toldoh, I don't have a uterus or
cervix, I don't need a pap.
Maybe you don't, but maybe youdo.
Oh, I'm over 65.
I don't have to do that anymore.
Well, if you've had a lifetimeof negative cervical cancer
screenings maybe you don't, butyou may and if you've had
abnormal testing, if you've hadHPV, if you've had interventions
(06:53):
to treat precancers, it needsto be individualized.
Now a lot of women think thatNow a lot of women think that
mammography and breast cancerscreening is kind of the
pinnacle.
There's more pitfalls withmammography.
(07:15):
There is certainly benefit.
It's certainly used as adiagnostic test.
It's also used as a screeningtest and there are different
recommendations and you've hearda little bit about differences
of opinions on prior podcaststhat I've done with medical
breast specialist Dr HollyPeterson she calls herself the
other Dr Holly and we think that, based on your age, your
(07:42):
hormonal status, your personalpriorities, your own personal
medical history and your familyhistory, it's good to come up
with some individualizedassessments Now with breast
cancer screening.
If you feel that something'swrong, if you feel a lump, even
if you're a young woman, don'tlet someone blow you off because
(08:05):
even though it's maybe unlikelyespecially if it's new or
painful it could be a cyst Justbecause you're young.
If you think something's wrong,you need to get that pursued.
There's lots of differentrecommendations about when to
start screening mammography.
(08:25):
There's been this big push todigital mammography or
three-dimensional mammography,which does entail more radiation
.
I do have women who don't wantto do this.
Many women want the most amountof imaging possible.
Certainly, with mammography weget additional information about
(08:46):
breast density and many timesthe breast technologists may
collect information about yourreproductive and hormonal
history and family history,histories of breast biopsy, and
this information and your breastdensity may give further risk
stratifications about your riskfor breast cancer.
Now it's important to know yourfamily history.
(09:09):
Having an older family memberof advanced age being diagnosed
with breast cancer, particularlyon mammography, is not nearly
as concerning as a history ofbreast cancer under the age of
50 that's diagnosed in a firstdegree relative, or if there's a
pattern of cancers breastcancer, ovarian cancer, colon
(09:31):
cancer, uterine cancer.
So of your blood relatives,it's really important if you can
find out medical history andexact diagnosis because you may
need genetic testing and thoseat the very highest risk of
breast cancer do need moreintensive screening.
Now some women are told to geta baseline mammogram at 40 or 45
(09:52):
.
Some recommend even 50, butwomen in their 40s and even
earlier can have breast cancer,and others have recommended that
you should have a yearlymammogram for most all women
between 45 and 55 yearly, andthen average risk women between
the ages of 55 to 75 or so couldbe screened assuming they have
(10:16):
no symptoms every two years orso.
Now I always tell women ifyou're 105 and you have a breast
lump, we're going to evaluateyou.
So there's not an age limit.
But just like we change thefrequency of cervical cancer
screening after you've beenscreened for decades of your
(10:36):
younger and midlife, just assometimes when a person gets
much older, especially ifthey've had normal colonoscopies
, we may move to just Cologuardscreenings or less invasive
screenings.
Although my dear aunt, who hadmultiple colon polyps and every
(10:57):
time she had colonoscopies shehad precancerous colon polyps
removed and she's doing verywell, very involved in her
community, socializes, hasgrandchildren, has great
grandchildren, is very involvedwith the church.
So on her 80th birthday shewent in for a colonoscopy and
she had a tubular adenoma, aprecancerous colon polyp, and
(11:21):
they said oh, you're 80.
You don't have to come back forany more colon cancer
screenings.
Now I wish you would havecalled me and talked to me about
it, because at age 85, she'svery vigorous and 86 actually
and active and she got reallyweak and had severe anemia and
(11:48):
she had had a lesion, a coloncancer, that was eroding into
her bowel and causing bleeding.
So much to the fact that shewas so weak and needed blood
transfusions.
Now had she been rescreenedanother three or four years
because of all thoseprecancerous polyps.
I think that this could havebeen stopped and she wouldn't
have bled down so much Now.
(12:09):
Luckily she was able to getsurgery and stop the bleeding
and she is significantlyrecovered.
But it's very individual.
If you're healthy and activeand have several more years of
lifespan, it doesn't mean thatyou have to stop screening.
And certainly in people thathave had abnormal PAPs, who've
(12:34):
had breast cancer, who've hadcolon cancer or precancerous
colon polyps assuming that youfeel up to having the test done
and do not have some other major, severe comorbid problem these
really do involve individualdiscussions.
Now, when I see women withhysterectomies on estrogen doing
(12:57):
great who are past the age of75, many of them are 80, 85, 90
year olds in my practice doinggreat, if they don't have any
symptoms in their breast, Idon't recommend the screening
mammography because there arefalse positives and if they get
a biopsy and it looks abnormal,then they're not going to be
able to be on their estrogen,which we know helps with
(13:19):
function and longevity, and wehave good data that it actually
reduces breast cancer even intoyour 70s.
So each type of cancer isdifferent, just like you might
be 90 and have a skin lesionthat's bothering you and it
could be cancer or pre-cancerthat should be locally treated.
(13:39):
So there's just a hierarchy.
Not all cancers have as muchevidence that early detection
makes a difference.
Sometimes it's better treatmentonce the person has the
clinical disease.
And there are cancers wherepeople can have what looks like
clinical disease if you gobiopsying the tissue, like the
thyroid, like the breast, likethe prostate in men.
(14:01):
So older men without symptoms.
You know we don't recommendjust routine PSA screenings, for
instance, unless there'ssymptoms.
Again, if you're older you knowgentlemen in your family who
has symptoms, then of course youwant to be evaluated.
So screening is not therapy andsymptoms require diagnosis.
(14:27):
And so ideally to have ascreening intervention, it
should really only have upsideand no downside as much as
possible.
And there is gradations in thisand that's why one size does
not fit all and it really doestake nuance.
Now, going back to our goldstandard the pap smear.
(14:51):
The cervix is the opening ofthe uterus and we generally now
recommend the first pap smear byage 21.
Now, certainly before then youmay want to of course have a
pelvic exam and see agynecologist or a women's health
clinician.
Health clinician my niece, whois 20, on synchodomyo 5505, she
(15:17):
was born, you know called me upand said, aunt Holly, you know I
was at the healthcare centerand they didn't say I needed to
get a pap smear.
But I'm a woman and shouldn't Ibe evaluated?
I said, well, you know,cervical health is very
important but you're not yet 21.
And what's important is thatyou get information and pelvic
(15:39):
exams.
If you have symptoms, you getevaluated.
And yes, on your 21st birthday,which won't be until 2026, then
you can go in and have yourfirst pap smear and we generally
do them every three years.
After age 30, we add a routineHPV human papilloma virus
(16:02):
assessment test.
In addition, now, if the HPV isnegative, kind of the bottom
basement, kind of guidelines,are that?
Well, you could go every fiveyears and I don't let my
patients usually go that longbecause I certainly have seen
some cases of cervical cancer atthe four and a half year mark.
(16:23):
So there are such things asfalse negative tests, just like
there's such a thing as falsepositive test.
You know we could get into astatistical discussion about
sensitivity and specificity.
If you have a very sensitivetest, you don't want to miss
anything and you mayover-diagnose and for some
things that may not be as bad,for other things that can
(16:45):
actually be kind of pretty bad.
Now, specificity if you want atest very, very specific, that
means you're not going to havefalse positives and you're going
to actually be fairly confidentthat if that's your diagnosis,
that's the real diagnosis andit's this yin and yang, and
knowing what the positivepredictive value of a test is is
(17:08):
important.
And so, really, with any test,there are false positives and
there are false negatives, andthat's one reason why I tell my
patients from 30 to 65 that, ingeneral, if you're an average
risk woman not high risk, butaverage risk I want you to get
the scrape of the cervix everythree years.
Because what if you're at thefour, four and a half year mark
(17:30):
and your clinician says becausewhat if you're at the four, four
and a half year mark and yourclinician says, oh, you're not
quite due yet it hasn't hit thefive year mark.
Well, what if you've moved oryou forget to make your
appointment or you have someother crisis?
I have seen women who generallyare responsible with their
health and aren't adverse togoing in and seeing a physician
and have health insurance, whoactually just don't think about
(17:56):
it because it's not emphasizedas much.
Just like I see womendetermined to get their
mammogram when they don't havesymptoms and they're a healthy
80 year old traveling the worldLike why do you want to have
this test done?
That's a little bituncomfortable, that could give
you a false positive and lead toyou becoming a patient.
So again, it's personal choice.
(18:22):
I have active, you know womenwho you know have their 80 and
they may easily live tillthey're 95 and they just want
the test.
As long as you understand therisk and the benefits.
And I think too often we justsay, oh, it's screening, so it's
all good.
You know, it's just likegetting a bonus check or extra
money in your bank account.
Right, that seems all good,although I guess there's taxes
(18:44):
potentially.
So maybe there still is adownside to most things Once
you're 65, then if you've alwaysbeen negative your whole life
and your mother didn't take DES,diethylstilbestrol, which
unfortunately was given topregnant women um to prevent
miscarriage and that can beassociated with vaginal and
(19:06):
cervical cancer If you haven'thad abnormal PAPs, leaps, cones,
hpv then you don't necessarilyhave to continue to get the
scrape of the cervix, but youstill need periodic pelvic exams
and generally speaking, youknow, medicare covers that
annual gynecologic exam, notannually but every two years and
for most women without symptoms, generally that is fine.
(19:29):
Again, has to be individualizedbased on your history.
Again it has to beindividualized based on your
history Women with HIV, humanimmunodeficiency virus, women
with immunocompromised they'reon immunosuppressants, women
with abnormal tests, smoking,other complex medical histories
we may make differentassessments.
What's really nice at theCleveland Clinic is we have a
(19:53):
service where if a clinician isnot exactly sure what to do with
an abnormal PAP or what shouldbe the interval, you know,
because some guidelines havesome differing opinions and
again they're usually the bottombasement recommendations, not
necessarily the top tier levelof what you may or may not want.
And again, more isn't better.
So maybe you would want tofollow, you know, the more
(20:17):
minimalistic evaluation andagain some of that has to do
with your own, you know,personal values and approach.
I mean it'd be nice to be a lotmore definitive but we always
can't be Certainly.
If you have smoked, if you'vehad multiple sexual partners, if
you've had known HPV, which isone of the causative agents of
(20:40):
cervical cancer, it's not theonly one.
I mean I do have some women inmy practice who have done HPV
cervical cancer.
It does happen.
That's why I'm not really sucha big proponent of saying, oh,
just only do self-HPV testing.
We did talk about that inJanuary on January's podcast.
(21:00):
And so for women who otherwisewould not seek any exams or
health care or don't have access, certainly a self-directed HPV
assessment test that the womancollects the swab herself is
better than nothing.
Just like I tell patients andI'm thinking of one of my
friends who's a patient, she'slistening, she knows who she is
(21:25):
she's like I don't have a familyhistory, I'm, you know, 50.
And I think I just want thecoligard.
I really don't want acolonoscopy and I'm like you're
like 50, almost 51 and youhaven't even had a colonoscopy.
Our new guidelines are screenat 45.
I said you need at least onecolonoscopy and she really
didn't want to do it.
(21:46):
You know the holidays werecoming up, she's busy, you don't
work, it's the prep.
You got to drink all that fluid.
And if you want moreinformation on colorectal cancer
screening, then definitely tuneinto our March of 2024's
podcast.
You know which marchescolorectal cancer awareness.
We're seeing definiteskyrocketing rates, especially
(22:09):
in younger people, and so we'vepushed down screening to 45.
It used to be 50.
A lot of people still thinkit's 50.
It's not, and if you'vepersonally had symptoms or a
family history.
But anyway, getting back to thisfriend patient, I think I kind
of shamed her into it and youknow she was very happy she had
it done because she had someprecancerous colon polyps and
(22:32):
you know a and a lesion that waspressing on her bowel that led
to other tests that led her toget a low-grade cancer treated
and cured and she might andprobably not would have had that
outcome had she just had theCologuard.
Maybe the Cologuard would havebeen positive and that would
have led to other tests, butmaybe by then this tumor could
(22:52):
have ruptured.
So, um, there is risk thoughwith colonoscopies and, um, you
know, if you talk to enoughpeople, somebody will tell you a
bad experience.
Certainly an inexperiencedcolonoscopist could rupture a
colon.
There are diverticula in inpeople many times who are over
50 and there is that chance ofrupturing the colon.
(23:17):
It's very, very rare.
Knock on wood, the only patientI've had in my practice who ever
had it done was someone who hada tumor again and that I think
was the cause and she wouldn'thave known about the tumor and
being cured of the tumor, hadshe not had that complication.
So it ended up turning out okay.
(23:37):
And so that's why people who'vealready had a normal
colonoscopy and they don't haveany symptoms or family history
or increased genetic risk likefamilial polyposis or one of the
Lynch syndrome variants or afamily history of uterine and
colon cancers, that you could doColigard and there are some
(23:58):
other screening tests.
So again, it's personaldecision and it's a discussion,
you know, with your healthcareteam.
We don't really do the annualhemocult blood testing, um, we
don't really do the annualhemocult blood testing.
(24:19):
If you have, you know, steaktartar with a little, you know,
red meat and blood, it could befalsely positive.
Vitamin c can affect it, um,and it can be falsely negative.
And by the time you're bleedingfrom a colon tumor, like I was
talking about my lovely dearaunt, um, you know, maybe it's
gone a lot farther than youwould like it to go.
And colonoscopy is one that, ifyou remove these precancerous
(24:40):
colon polyps, most all not all,but most all colon cancer starts
in polyps that are there forseveral years.
And I tell all of my patientsthat it's very important that
when somebody removes tissuefrom your body.
It's good to keep a hard copy ofthe pathology report Because
you may not be able to locatethe records.
(25:02):
Just because it's onlinedoesn't mean you're extremely
busy.
Healthcare clinician has timeto check in the thousand
different boxes that you canpossibly click on.
Or sometimes you can click onthem and they're so small you
can't even really see thedetails.
Or you can see that they had acolonoscopy but you don't know
where the pathology is.
So keep a copy of it becauseeven though it's benign which I
(25:25):
think the average lay personjust thinks, ah, it's not cancer
.
So I'm happy, I want to getback to my life, I don't want to
think about this medical stuffand we can't really expect you
to understand the lingo always.
I mean, we talk so fluentlymedically doctors and nurses
about this, but it's not alwayssecondhand nature.
(25:46):
It really crystallized to mewhen my husband was frustrated
because one of the eyetechnicians who was doing his
eye exam said what is your bloodsugar?
And he said I don't know.
Let me look at my chart andhe's like looking for blood
sugar.
He knew what his glucose was,which is normal.
(26:06):
He knew what his hemoglobin A1Cwas, which is a measurement of
his blood sugar over the last,you know, three months, which
was excellent.
He knew those numbers, he knewglucose, he knew hemoglobin A1c,
but he didn't know blood sugar,which is like more of a
colloquial term, and so I haveto always remind myself that
(26:27):
that.
You know, not everybody speaksthis language.
It's like you know, you knowpeople that are multilingual.
It's great when you can speakin a lot of different languages.
I only really know English, alittle tiny bit of Spanish and a
little tiny bit of French, butnot enough to be conversational.
And so that's how a lot ofpeople are medically they just
(26:48):
know a little bit of words butthey can't really converse.
So keep your records, okay, andjust because something's a
benign polyp doesn't mean youdon't need screening.
You may even need screening ina couple of years, a year or two
, especially if there's not agood colon prep.
You may need it in three yearsif someone removes polyps and
(27:09):
tells you, oh, you can go 10years.
I saw a lady today and we werehaving that discussion and she
said, oh, they said 10 years.
And I'm like, well, that wouldbe if everything was perfectly
clean and they didn't seeanything at all and maybe you
had already had a colonoscopyprior, but they said that they
had.
There was still some stool inyour colon and they did remove
polyps, even though they werebenign and hyperplastic.
(27:31):
Those aren't as concerning astubular adenomas, tubular villus
adenomas, sessile, serratedpolyps, multiple polyps.
So the next cancer is skin.
It's the biggest organ.
We have a lot of podcasts onthe skin, from dry skin to
(27:51):
rosacea to you know, cosmetichelp for aging skin.
Certainly, sun exposure canincrease squamous cell and basal
cell and early sunburns.
Ironically, though, tellingpeople to slather themselves
with sunscreen and not checkingtheir vitamin D or correcting
low vitamin D levels from lackof sun exposure can actually
(28:14):
increase melanoma and othercancers.
So that's why most of mypatients and again, this is not
medical advice, this is just ashow to educate you and
entertain you and empower youFor most people that are over 40
, that live in a northernclimate or aren't exposing them
their naked skin to somesunlight at the right latitude,
(28:35):
generally, unless you eat likean Alaskan, you need vitamin D,
and if you didn't listen topodcast number three in season
one, all about vitamin D, it'slike a miracle pro-sterile
hormone.
It's not even a classic vitamin.
We have lots of ways to protectyour skin and sunscreen, but
(28:55):
you've got to make sure you'regetting your vitamin D Now.
Other screenings and other testslike screening for sexually
transmitted infections.
Certainly women under age 25 to26, certainly under 24, should
be checked because if you havesome occult case of chlamydia
you could have scarring of yourtubes and be infertile.
(29:16):
You need to be counseled aboutHIV and sexually transmitted
infections, understand symptomsand what your options are.
So screening for chlamydia andgonorrhea is something that
should be done in high-riskpopulations, regardless of age.
I mean, you might live in thevillages in Florida where there
(29:39):
can be some pretty wild sexualactivity.
You can't just only limit it toyoung women.
So again, it's very importantto be honest with your physician
.
It's confidential, it'spatient-physician
confidentiality.
I mean, unless you're going totell someone that you plan to
kill yourself or kill someoneelse.
(30:00):
That's when we, you know, haveresponsibilities to break that
confidentiality.
But everything about yourintimate personal life is
important to feel comfortabletalking to your healthcare
clinician about.
I had a new nurse who wasrotating with me and wanting to
learn about midlife women'shealth and she was like I'm just
(30:20):
, you just were so comfortableand relaxed and it was so
nonchalant.
You asking you know those verypersonal questions and that's
the way it should be, you know,very comfortable and clinical
and what is important to assessfor your health.
Now pregnancy is a whole othertopic.
(30:42):
There's lots of screening bloodpressure, kidney function, the
fetal heart tones, the bloodpressure, screening for
gestational diabetes.
There's a lot of things, youknow.
Nutrition, early nutrition,having adequate folic acid
levels and then early inpregnancy having the right,
(31:04):
having enough choline for braindevelopment and the omega-3s and
we've got an upcoming podcaston omega-3, which is a really
important one, I think.
Now, menopausal women, you knowwhich is my professional passion
and I got interested in itbecause I thought why, at
(31:25):
midlife, when you're just doneraising your children and you've
established your life andpotential career and community
involvement, then everything,finally, you can maybe enjoy
some things you know in yoursecond beginning of your
adulthood.
And then boom, I would seewomen that look like wilted
flowers, you know, with hotflashes and sleep problems and
(31:45):
brain fog and increased risk forheart disease and osteoporosis.
It seemed like so many diseasesof aging took root then.
So definitely having acardiovascular risk assessment
and osteoporosis risk assessmentis very important as part of
that risk factor and so much ofwhat we eat and how we live our
(32:09):
life and what our exercise is,and avoidance of toxins.
Excessive alcohol.
Tobacco is very important and Ithink our food supply is
finally getting some attention.
And, uh, I did a column and apodcast in season two last fall
of 2024 all about things thatare banned in other countries,
(32:32):
that have just infiltrated, allabout things that are banned in
other countries, that have justinfiltrated our food supply,
things that are addictive,things that might make the food
look more appealing to youngchildren but might be
carcinogenic.
So if you didn't listen to thatone, please go back, and even
if you did, it's really worth alisten.
Heart disease you know Februarywas our women's heart month, but
(32:53):
really every month of the yearyou need to think about that
ticker and your wholecardiovascular system because it
is the number one cause ofdeath in American women and even
though male sex is a riskfactor, you know, for earlier
disease, women do catch up andwhen they lose estrogen things
can accelerate.
(33:14):
And certainly a bad lifestyle,a family history, smoking,
advancing age.
In women, hypertension is abigger issue and you know, women
have more atrial fibrillationactually, and knowing what your
lipid panel is is not so much,just solely the cholesterol.
(33:34):
But I want to know what yourtriglycerides are, because if
your weight is up, your bloodpressure is up, your
triglycerides are up, your goodHDL cholesterol is low, maybe
your sugar is creeping up andyou have so-called syndrome x or
diabesity.
That's really a problem anddiabetes is a much greater risk
(33:55):
for heart disease in women thanin men.
Many times I will get a baselineultrasensitive CRP in women to
further assess inflammation,because that is more of a
correlate than actually plaincholesterol and I see a lot of
knee-jerk reactions just toprescribe statins, and statins
certainly have a role,particularly in established
(34:17):
heart disease in women, butthere's no real evidence for
primary prevention.
So you really have to have agood reason to put a
50-something-year-old woman on astatin if she doesn't have any
vascular disease.
And coronary calcium scores canbe helpful.
They only show calcifiedlesions, they don't show
everything.
So again, one test and onesimple assessment may not give
(34:40):
the whole picture.
Now we can't interpret anultra-sensitive CRP if you
happen to be on oral hormonetherapy or oral contraceptives
because there's an effect in theliver.
That's a secondary phenomenon.
It's not real inflammation, butit kind of obscures the test
results.
And speaking of obscuring testresults, including hormones and
(35:03):
cardiac tests, is biotin.
So if you didn't listen to thepodcast I did a few months ago
on biotin, that's one to listento Now.
Medicines that are proven toreduce cardiovascular risk,
including heart attack andstroke generally, are
(35:23):
medications in women thatalready have known disease and
so we're talking about.
If you've got existingatherosclerosis, you may need a
statin.
If you have hypertension, youshould be treated.
Ace inhibitors many times areused.
If you have diabetes, youshould definitely have it
controlled and try to get itinto remission, and anti-aging
(35:48):
agents like metformin orglucofage can be very helpful,
although can go through thekidneys and liver and can lower
B12.
So, again, everything has riskand benefits that you need to
get informed consent, andstatins in females have not been
shown to be effective againstprimary prevention of heart
(36:10):
disease and in women theyincrease the risk of diabetes,
and I see women every week whoare on a statin.
They don't have heart disease.
Nobody's even checked theirhemoglobin A1c, they haven't
been doing intermittent fastingor taking the carbs out of their
diet, and no one's evencounseled them about the
benefits of menopausal hormonetherapy.
If you start with healthyarteries, estrogen has a panoply
(36:32):
of effects increasing nitricoxide, improving cholesterol
ratios, being a mild calciumchannel blocker.
There's effects genomically andnon-genomically.
Sometimes sleep is better, sothat the person's able to focus
and eat right and exercisebetter than just being miserable
(36:53):
with hot flashes.
So there is cardiovascularbenefit and some longevity
promotion that we now haveevidence on.
Again, one size does not fitall.
Nothing is risk-free.
There are rare women that canhave blood clots, particularly
on oral estrogen.
There can be annoying sideeffects with breast tenderness
(37:13):
and bleeding.
So what works for one womandoesn't work for another and
that's why really having ananti-aging, comprehensive
midlife physician whounderstands the importance of
all these different domains,looking at you individually,
taking into effect your goalsand preferences and giving you
(37:37):
options and sometimes I say youknow you might not know until
you try.
Really, one of the biggestthings of most importance is
diet and you can controlgenerally what you put in your
mouth and having a Mediterraneanheart healthy diet, even though
I think down the road we'llhave more evidence that maybe
some diets are better for somepeople's nutrigenomic profile
(38:00):
than others.
But right now we do know thatthe Mediterranean diet heart
healthy fats like olive oil,avocado, taking out every trans
fat, getting rid of the seedoils, getting rid of sugar and
additives and simplecarbohydrates.
(38:20):
There's no such thing as anessential carbohydrate.
There are essential fatsomega-3 and 6, and there are
several amino acid proteinswhich are essential, meaning our
body cannot make them.
Several amino acid proteinswhich are essential, meaning our
body cannot make them.
Applepectin flaxseed can lowercholesterol.
Garlic one of my favorites myhusband always says my perfume
(38:43):
of choice is garlic, onions, oatbran and I would much rather
someone use butter or lard thanseed oils if you're going to be
using extra fats.
But I really want people tofocus on those healthy fats that
are good for your brain andyour mood and your skin and your
(39:04):
heart.
And the omega-3s are somethingthat so many of my patients are
low in.
Even when they think that, oh,they eat healthy, they don't
really eat junk food.
They don't usually eat out toomuch.
They read labels sometimes, butnot completely, and when I
check those women's levels a lotof times they're really
suboptimal.
So fatty fish and almonds andwalnuts and flaxseed and seaweed
(39:28):
and omega-3 eggs.
I had a lady today tell me well, I've never seen that I'm like
well, just look at the egg labeland they'll tell you if the
chickens were fed omega-3, thenthere's omega-3 inside the egg,
so those are like the only eggsthat I buy.
Now.
Hormone therapy in women whotake it for several years,
(39:52):
starting within 10 years ofmenopause or under age 65, it's
associated with lesscardiovascular disease, less
heart attack, less heart failure.
But there are some women whohormones, especially oral
hormones, make the blood thicker.
So if you're generally somebodywith no family history, you've
had a child or two or so, maybea C-section, maybe you've been
(40:14):
on hormonal contraceptive agentsfor several decades, that's a
much greater risk.
But sometimes age anddehydration and other factors.
You know there are peoplewho've had hypercoagulability in
their life, who never had ituntil a confluence of other
agents happened, and so ifthere's any concern about blood
(40:36):
clot, that's when we usuallyturn to transdermal estrogen.
And women who aren't onsystemic estrogen, if they're
post-menopausal, can use vaginalestrogen to keep the vagina and
bladder healthy and reducebladder infections.
And if you didn't listen to myOctober 2024 podcast on the
incredible large volume ofevidence of hormone use various
(40:59):
doses, routes in 11 millionwomen in America for 13 years, I
mean that's a huge data trove.
That was one of my favoritepodcasts to do.
Now women are naturallyconcerned about breast cancer
(41:21):
and really the Women's HealthInitiative, which came out
saying there was an increasedrisk if you took PremPro for
over five more like 10 years.
One extra case per thousandwomen.
There was no increase in deathsand when that study was looked
at closer, the placebo group hadan abnormally low risk of
breast cancer.
So there's a lot of us in themenopausal field that don't
think there's any increase in adiagnosis, even with estrogen
(41:42):
and systemic progestin, and mostof us use progestins that
aren't as anti-estrogen asmedroxyprogesterone acetate.
But it is good at protectingthe uterus and I do have women
on PremPro.
Again, one size does not fit all, but I sometimes think
something gets demonized andsomeone says, well, just do this
(42:03):
, this has no risk if it's aquote bioidentical.
I have women try to recite tome a book of a certain Instagram
article influencer who you knowthey read.
Well, you should just do thisand take continuous transdermal
estrogen and progesterone.
Well, that's only FDA approvedto cycle and oral progesterone
(42:24):
is not always well absorbed.
I saw another lady today whowas on oral progesterone who had
pretty bad heartburn, so thatwasn't right for her.
So what might be good even foryour sister or your best friend
isn't necessarily what's rightfor you.
And probably one of the mosthighly individualized assessment
is really menopause and midlife.
(42:45):
It's a little easier to makegeneral recommendations about
cervical cancer screening andbreast cancer screening and
colon cancer screening and skincancer screening.
Screening and skin cancerscreening.
We still mainly use hormonetherapy to treat symptoms.
Because if you're treatingsymptoms you accept a higher,
you know, potential risk.
(43:05):
But everything has risk, evenpreventive things like an
immunization.
I've had patients say well, youknow, the one time I didn't
wear my seatbelt and I was gladI didn't, cause I could get out
of the car.
So you know, anything that ispreventive still potentially may
(43:25):
have a risk.
Um, like we tell everyone toexercise and walk, well, you
know, if you're not careful andyou slip and you fall you could
crack your skull and, you know,have a subdural hematoma.
So again, everything has to beindividualized.
But at midlife you need a riskfor what's your cardiovascular
risk?
What's your blood sugar, sincediabetes is increasing?
(43:47):
If you're over 45, that shouldbe checked.
Colon cancer 45 is an age Withintwo years of menopause or
certainly by age 65, you knowyour physician or nurse
practitioner should have ordereda baseline bone density Sooner
if you have other risk factorsor a personal history of
fracture over age 45.
(44:08):
And osteoporosis is such animportant topic.
Calcium and vitamin D are soimportant and we have several
podcasts that are dedicated tothe evaluation and the treatment
and the screening what a bonedensity entails, also assessing
(44:30):
if you're at risk for violenceintimate partner violence.
We're going to have an upcomingpodcast on this topic because
it affects women of allbackgrounds and just having a
trusted primary care physician,particularly once you hit
midlife, is important and a lotof women who are healthy, who
(44:51):
maybe are just having babies orneeding contraception or some
menstrual assessment, are soused to seeing their OBGYNs and
some OBGYNs kind of age withtheir patients and they start
doing more midlife menopausalwomen's health.
I have a lot of OBGYNstransitioning their practice who
come and kind of want minitrainings and want to focus
(45:12):
their practice and don'tnecessarily want to be up at
three in the morning deliveringbabies anymore.
But you know people have veryindividualized practices.
So maybe good for you at onestage in your life but not for
another stage in your life andyou really want to have a team
that you feel comfortable withand so while the OBGYN who
(45:36):
delivered your babies willalways have a special place in
your heart.
He or she may not be the one tokeep taking care of you after
midlife.
One place that you can go tolook to see if someone has taken
a test to get credentialed isthe menopauseorg website, the
Menopause Society.
(45:57):
I know some patients find methat way, some people find me
through word of mouth and, ofcourse, find me through
physician referral.
Unfortunately, there's not asmany experts in this field as
there should be and I've beenrunning a fellowship, I've done
podcasts on the fellowship andwe have a lot of different
(46:18):
initiatives to try to expandthat access for women.
Immunizations are something thatare addressed during different
stages of life.
Again, it has to beindividualized and risk benefit.
You have to know whatinfections you may have had or
what your risk factors based onyour personal life or your
(46:39):
occupation are.
But again, that has to be withinformed consent and looking at
your full picture and generallythat is like your long-term
primary care team and I want tojust wish all the moms and the
(47:01):
Mimi, grandmothers and thecaregivers out there a very
happy Mother's Day and I want togive a shout-out to just the
most wonderful nurses that wehave.
I love our nurses in our Centerfor Specialized Women's Health.
It's National Nurses Week, may6th to May 17th, and I just know
(47:25):
that women are often in thebusiness of taking care of
everyone except themselves, sothat's a no-no.
If you're neglecting yourself,so treat yourself to good health
care.
Pamper yourself If you haven'tseen your physician make an
appointment.
It's easier to cancel anappointment than get one.
If you didn't listen to how toget an appointment medical
(47:46):
appointment last fall, that'slike a critical one and get the
screenings and the evaluationthat you need and come organized
and attentive so that you canfocus on what you need to focus
on.
And maybe you won't be able toget everything taken care of and
you may have to break it upinto a couple of visits.
We in our Center forSpecialized Women's Health offer
(48:09):
a concierge custom fit cash payprogram where that covers the
nurse to take in the intake andget things personalized and set
up and give a woman a whole hour.
And I think that sometimesthat's like how you fly, like,
(48:31):
do you fly first class?
My husband likes to do that.
He's happy to pay extra moneyand I would rather sit and coach
and save the money becausewe're all going to get there at
the same time.
Maybe he'll get off the plane,you know, a minute or two before
I do so some of it just dependson your lifestyle and your
budget.
You know, some women wouldreally like that extra time, but
(48:51):
increasingly we're seeing morepeople seek out concierge care
or direct primary care becausethey want more time with their
physician.
And if you don't have that as anoption in your area or you
don't want to do that, that'sfine.
But you really have to beorganized with your appointments
and you may need moreappointments or may need some of
(49:11):
your care split up.
Or maybe you'll see yourphysician for an initial
assessment and then other partsof your care can be delegated to
the nurse practitioner orphysician assistant in the
practice, and I've interviewedseveral of our APPs who were
excellent and we talked aboutthe role of those caregivers.
(49:34):
So thank you so much forjoining me in the Sunflower
House, thanks for listening andif you haven't already
subscribed, please do.
Anywhere you listen to podcastswe're on Spotify and Apple and
Podbean, amazon Music.
(49:56):
Just support our podcast byhitting subscribe or follow and
give us a five-star rating.
And thanks again, and I'll seeyou next time in the Sunflower
House, remember be strong, behealthy and be in charge.
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Joyce Sapp, 76; Bryan Herrera, 16; and Laurance Webb, 32—three Miami residents whose lives were stolen in brutal, unsolved homicides. Cold Case Files: Miami follows award‑winning radio host and City of Miami Police reserve officer Enrique Santos as he partners with the department’s Cold Case Homicide Unit, determined family members, and the advocates who spend their lives fighting for justice for the victims who can no longer fight for themselves.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
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If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.