October 27, 2025 • 32 mins
In this episode of The Paid Leave Podcast, I speak to a professional about osteoporosis and bone health. In October it is International Osteoporosis Day on October 20th, National Health Education Week October 21-25th, and is also International Day of Older Persons on October 1st. Two out of three women with postmenopausal osteoporosis will break a bone in their lifetime.
I speak with Joan Doback, a certified Physician Assistant celebrating 36 years in the field. Doback, who works as a Bone Health Coordinator at the Connecticut Orthopedic Institute, explains the importance of bone health, particularly for women post-menopause. She highlights the significance of DEXA scans for diagnosing osteoporosis and osteopenia, and the role that lifestyle factors plays in bone health like diet, exercise, and avoiding smoking and excessive alcohol. She recommends weight-bearing exercises, resistance training, and balance exercises to improve bone density. Doback also discusses medical treatments for osteoporosis and the impact of fractures on caregivers of patients. She emphasized the importance that the Connecticut Paid Leave program is for caregivers. She says the good news is that Osteoporosis can be reversible.
For more information on the Bridgeport Bone Health program at the CT Orthopedic Institute at St Vincent's Hospital: Bone Health Program | CT Orthopaedic Institute | St. Vincent’s Medical Center
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nancy Barrow (00:00):
Hello Connecticut, and welcome to The Paid Leave
Podcast. The title basicallysays it all. I'm Nancy Barrow,
and I will be delving into thisnew state program and how it can
help you and your family. Thispodcast will give you
information you should knowabout Connecticut Paid Leave and
maybe just a little bit more.
Connecticut Paid Leave bringspeace of mind to your home,
(00:24):
family and workplace. Welcome toThe Paid Leave Podcast!
In October. It is InternationalOsteoporosis Day on October 20.
It's also National HealthEducation Week October 21
through the 25th andInternational Day of Older
Persons on October, 1. Two outof three women with
(00:46):
postmenopausal osteoporosis willbreak a bone in their lifetime.
And joining me to talk aboutosteoporosis and bone health is
Joan Doback. Joan is a certifiedphysician assistant who is
celebrating 36 years as a PAthis year, she worked in
neurosurgery for many years,before orthopedics, where she
has worked for the past 21years. She currently works as a
(01:10):
bone health coordinator at theConnecticut orthopedic Institute
at St Vincent's Medical Centerin Bridgeport, and hopes to
expand osteoporosis care in theHartford healthcare community.
Welcome to The Paid LeavePodcast Joan, I'm so happy to
have you here.
Joan Doback (01:26):
Thank you so much for having me.
Nancy Barrow (01:28):
Well, congratulations on 36 years as a
PA. By the way!
Joan Doback (01:32):
Thank you. Thank you so much. It's a great, great
occupation. I really love it.
Nancy Barrow (01:36):
Well, I would hope that you would love it. If
you've been in it for 36 years,that's a long time. So
congratulations on that. Tell meabout the Orthopedic Institute
and what you do as the BoneHealth Coordinator.
Joan Doback (01:49):
So I'm thrilled to talk about this. In addition to
all of those October milestonesand days set aside, September is
Fall Prevention Month, so thisis really opportune to be
talking about. The ConnecticutOrthopedic Institute is
essentially a hospital in ahospital dedicated to orthopedic
(02:10):
service. It provides ourorthopedic patients with
seamless care, safe educationalprocess throughout their
orthopedic procedure, mostlyelective orthopedic procedures
such as joint replacements orspine surgeries. And it's at
both mid State Medical Center inMeriden and St Vincent's Medical
(02:34):
Center here in Bridgeport. And Iwork on the orthopedic team as
one of the Orthopedic PA's andI'm also the Bone Health
Coordinator here for thehospital.
Nancy Barrow (02:45):
And so how do you help people who may come in with
osteoporosis?
Joan Doback (02:49):
The Bone Health Coordinator is both an inpatient
and an outpatient role. So onthe inpatient role, I help to
identify our fractures here inthe hospital, because in
orthopedics, we know that whenyou've had one fracture from a
slip and fall from standingheight, and it doesn't matter
(03:13):
what the reason it could be aslip and fall on ice here in
Connecticut, it could be thesmall dog ran between my feet,
or it could be the big dogpulled me over, but you're not
the roofer on a roof who fell agreat distance, and you're not
in a high speed car accident.
Those would be the scenarioswhere we would expect you to
probably fracture. But when youslip and fall from a standing
(03:36):
height and you're over 50 yearsold that in the orthopedic mind,
is saying we really need to puteyes on the bone health. And it
really gives us a greatopportunity to investigate your
bone health and to see whereyou're at in the continuum.
Nancy Barrow (03:55):
And women versus men, who gets osteoporosis more
frequently,
Joan Doback (04:00):
women do, and for good reason. So you grow your
bones through childhood, andyou're at your best bones ever
at 25 and women support thosebones with estrogen, and men
support those bones withtestosterone. So with women at
2535 45 we're good. We got greatbones, but at early 50s, or
(04:26):
thereabouts, by average, we'regoing to go through menopause,
in which case we're going tolose most of our estrogen. And
General gentlemen, willcontinue. They don't have an
event such as menopause, wherethey wane in their testosterone
and don't fully lose it until 65or 70. So if you compare a lady
(04:48):
who lost her estrogen at 50 to aguy who lost his his
testosterone at 70, he's got twodecades on us of good bone
support. So there are more.
Women with postmenopausalosteoporosis, as opposed to
guys. However, this is not justa lady's disease.
Nancy Barrow (05:10):
So it's not just women's disease, but it usually
affects the men a little later.
Joan Doback (05:13):
That's correct, because of that testosterone.
Nancy Barrow (05:15):
Let me ask you what is the Bone Health and
Osteoporosis Foundation, and howare you connected with them?
Joan Doback (05:22):
So the Bone Health and Osteoporosis Foundation is
the largest health entity thatis solely dedicated to bone
health and osteoporosis. So theyhave education and they've got
research that that supports allof the providers across the
(05:43):
country for the roles that weplay in the trenches with our
patients, but one of theirimportant roles is also to
educate our patients. So I givethat that website to my patients
all day, every day, and directthem to those websites, because
they're really great for patienteducation.
Nancy Barrow (06:06):
Let's start with the basics. Though, for some
people, they think osteoporosisa little old woman and she's
bent over and she has a hump onher back, like that's what I
think people believeosteoporosis to be and to look
like, and that may not becorrect. So I wanted to ask you,
what is osteoporosis?
Joan Doback (06:25):
That is absolutely correct. That lady probably has
osteoporosis. When you saylittle, being little, that's one
risk factor. Being older, that'sanother risk factor. But the
fact that she's humped over aimsat probably she's got spinal
compression fractures, and wenever, never want it to get that
(06:46):
far so we can aim at primaryconvention or prevention. Sorry,
where we're we have eyes on onpeople's bone health, starting
at 60 years old, or 70 years oldfor the men where we do the gold
(07:07):
standard in investigation forbone health is called the DEXA
scan. And so at 60 years old,the guidelines tell us we should
be having a DEXA scan every twoyears, unless we have risk
factors that we needed earlierthan that. And then the men
start their DEXA scans every twoyears, at 70 years old, unless
(07:29):
they have risk factors thatcause us to to get that DEXA
scan prior to that.
Nancy Barrow (07:34):
So let me ask you about the risk factors so and
the diagnosis is always the DEXAscan. Is that correct?
Joan Doback (07:39):
Well, no, if you slip and fall from a standing
height and you have a hipfracture or a vertebral
compression fracture, those, bydefinition, give you a diagnosis
of osteoporosis. So you don'ttypically have to send a person
who has a lot of pain or orwhatnot with their hip fracture
or vertebral compressionfracture and ask them to lie
(08:02):
flat on the scanner. Right?
We're not going to delay thetreatment for that DEXA scan. We
can catch up to that whenthey're feeling better, but yes,
the most people will bediagnosed with osteoporosis by
their DEXA scan.
Nancy Barrow (08:18):
So what is osteopenia? Because some people
get an osteopenia diagnosis, anddoes osteopenia always go to
osteoporosis?
Joan Doback (08:29):
So let's talk about the continuum of bone health. So
when our bones are supportedprior to menopause, or when we
have testosterone, we're in thenormal range of bone, and then
once we lose that support, we'regoing with some natural aging.
You tend to have more breakdownof your bone than you have build
(08:54):
up. So your bones are a livingorganism, right? They're living
tissue, and they are constantlyremodeling themselves with a
build up and breakdown process.
And when we have the estrogen orthe testosterone in place, those
processes are very even. So youhave as much build up, then you
(09:15):
have breakdown after menopauseand after you lose your
testosterone, you have a littlebit more breakdown than you have
build up, okay, and so then youstart to go decline in your bone
health. So your first stage,after normal bone density,
you'll go into osteopenia. Andyou asked if people always
(09:39):
continue downhill toosteoporosis. No, not at all
there. There's some people whostay in the osteopenia range all
of the rest of their life. Butremember, this is a chronic
disease, just like somethinglike diabetes or hypertension.
And you got to keep your eyes onthis and see if you're going
(10:01):
down that hill really quicklytoward osteoporosis. We might
want to do something about that.
Nancy Barrow (10:10):
And what are some of the things that you can do
about that? So if you have anosteopenia diagnosis, Is there
stuff that you can do so you cansay, hey, I want to put off
osteoporosis as long as I can.
Can I do hormone replacementtherapy? Does that help women?
Because it seems that it's a youknow, when we lose estrogen, we
(10:30):
lose bone density.
Joan Doback (10:33):
Right, exactly. So the whole idea of hormone
replacement therapy, you'reabsolutely right. We love women
to have estrogen, and it hasbeen shown to be safe right
after menopause to a certainage, and your GYN provider can
(10:53):
have full discussions with youabout that. If you're using
estrogen for something like yourmenopausal symptoms, like
terrible hot flashes, thenthat's a really great reason to
be on estrogen. And then theside effect of that estrogen, in
that case, is going to be longerbone support, but, but it also
(11:19):
comes with its risks, theestrogen support hormone
replacement therapy, and so wedo not use it as a front line
treatment for osteoporosis,because it has more risks than
benefits in that situation. Letme go over those, because those
are important. So the the age isa risk factor, because the older
(11:43):
you get, the farther you arefrom your estrogen or your
testosterone, and so your riskincreases with age. Gender is a
risk because more women have ahigher risk, especially after
menopause. Ethnicity plays intoit, as Caucasian and Asian women
are at higher risk than AfricanAmerican ladies or patients, men
(12:07):
and women. Family history, ifyour parents had a hip fracture,
particularly before age 80, thatmay give you a little bit of a
genetic component to this sothat you want to maybe look at
your DEXA scan a little bitearlier than 60 years old, if
your mom had, if your mom wasthat lady you just described
(12:30):
with the hump in her back andleaning over a walker, then you
really want to put eyes on yourown bone Health, and then bone
size, small, thin, bonedindividuals, they're at greater
risk as well. Everything we doin medicine is by guidelines,
and that guideline is if youweigh less than 127 pounds,
(12:53):
which is an odd number, but therest of the world is on metric,
and it's 58 kilograms. So 58kilograms or less, 127 pounds,
that's a risk factor forosteoporosis, so you want to pay
attention to that. And then youhave some Those are, those are
risk factors that you can't doanything about, right, right?
(13:14):
Burly. What we do is justacknowledge them and then and
count them up, and then maybethat leads us to do a DEXA scan
a little bit earlier than 60 or65 years old. But there's other
modifiable risk factors that youcan look at, and that's things
like the estrogen or thetestosterone that we're talking
about, nutritional deficiencies,you can do a lot with your diet,
(13:40):
and particularly the buildingblocks of bone are calcium and
vitamin D. So I spend a lot oftime on diet with our patients
and making sure they understandthat we want them to get their
calcium in their diet, ratherthan taking a chunk pill of
calcium every day, which is alittle bit easier, but it's just
(14:03):
a matter of setting some somechanges in your diet and making
them a routine. So the guidelinefor calcium, how much calcium do
you need? For good bones,ladies, need 1200 milligrams of
calcium and and then need 1000so both of those are around
three to four dairy choices orgreen leafy vegetables. That's
(14:28):
where you're going to get yourcalcium in your diet. So if you
have cereal in the morning anddrink the milk out of the bowl,
there's one. Have a yogurt withlunch and a small glass of dit
of milk with dinner and you'vegot your calcium for the day.
Really works into our threemeals a day.
Nancy Barrow (14:48):
That's so fascinating. You know, a lot of
people don't think that greenleafy vegetables have calcium,
but they do.
Joan Doback (14:55):
Right exactly they they do, and it's it. You can
consider that one of yourservings of getting your
calcium, right? Yeah, the anumber one way of helping
yourself is to exercise. Soexercising includes weight
(15:16):
bearing exercise, resistanceexercise and balance training.
So weight bearing exercise isabout going to walk in the
neighborhood, and your legs arecarrying your upper half and so
they're weight bearing. But ifyou carry some small dumbbells,
two pounds, three pounds, ormaybe up to five pounds, for
(15:39):
men, now you're inviting yourarms for the walk with you. I
advise our patients that ifyou're going to stop and shop or
Big Y to do your groceries, justpark in the back of the parking
lot, if it's a nice day, and getyour steps that way, or do a
circuit around the outside ofthe store. Before you pick up
your carriage and do yourgroceries, you're just adding
(16:02):
steps, and it might be rainingout, but you're getting your
walk in.
Nancy Barrow (16:05):
Is there a certain amount of steps that you say is
good per day, or amount of ?
Joan Doback (16:11):
Okay remember, we started it, I think it was like
7500 then they went up to 10,000and the more recent literature
is more like some somewhereabout 7000 or 8000 is what,
what's optimal, and that'spretty doable, if you're
intentionally putting in someextra steps every day.
Nancy Barrow (16:32):
Yeah, I think that you can get to that seven to
8000 pretty easily, right?
Joan Doback (16:37):
And I think that's the current research so and so
you have the weight bearingexercise, and you have the
resistance exercise, and thenthe third kind of exercise you
need is balance training, andthat really lends itself to
getting good at your balance.
And then you're not going to bethe 80 year old who falls a lot,
right? So things like juststanding at the counter, hold on
(17:01):
to the sink and practicestanding on one leg, 30 seconds
on each leg, you might just do10 seconds at the beginning,
realizing that your other leg ispretty hard to hold up, right?
So you have to build up. And ifyou can stand 30 seconds without
holding on. That's really goodbalance, but the better you can
(17:23):
get at it, the more youpractice, the better you're
going to get, the better you canget, the less you're going to
fall as an older person.
Nancy Barrow (17:33):
Yeah, so lifestyle factors really matter. Diet,
exercise. What about likealcohol and smoking? Can they
affect your bone health?
Joan Doback (17:42):
Absolutely. And so those are the base those two
round out the five universalrecommendations that everyone
can do. So from the topexercise, then two and three are
calcium. And then we're going totalk about some vitamin D. But
let me ask answer that question.
When you smoke, nicotine floatsin your blood, and it just
(18:06):
poisons everything. It certainlywe all know it poisons our
heart, it poisons our lungs, butit definitely poisons the bones
as well. And so any smoking,vaping, it just it counts.
There's no excuses. Any nicotineproducts are just bad for you,
and they cause cancer, so, butso they need to be eliminated.
(18:27):
And nobody says that lightly. Weall understand that that's not
an easy thing to do, right? Itcan take several times or many
times in a lifetime of trying toquit before you're successful.
But I encourage our patients,just please keep trying, because
you're going to be successfulone of these days of leaving
(18:47):
that bad habit behind and thenalcohol. What is too much
alcohol? How much alcohol isgood for my bones or not good
for my bones? Yeah, that comesout to two drinks a day is okay?
Three or more that's too muchfor the bones.
Nancy Barrow (19:05):
Okay? And is there something that's better? Is wine
better? Or does it matter?
Joan Doback (19:10):
Yeah, so that's a good question, actually, because
when we're talking aboutalcohol, one ounce of liquor in
a drink is the same as one beeris the same as four ounces of
wine, and they all have the sameeffect.
Nancy Barrow (19:25):
They all have the same effect okay. Mmm-hmm.
Joan Doback (19:28):
September is Fall Prevention Month, and so I don't
want it to go away withouttalking about it. So fall
prevention. 90% of our brokenbones are fractures, are because
of a fall, and it's a simpleslip and fall, I took one step
out on the deck to get themorning paper, and my life
changed because I was on theground before I knew it. Nobody
(19:51):
expects to fall, and most of thefalls happened in the bathroom,
so taking care of things like onas. Slippery surfaces and things
make sure you have grab handles,by the toilet, by the tub, where
you're most likely to slip orlose your balance. That can help
(20:12):
two things that people do notthink about that increase your
fall risk is decreased visionand decreased hearing. So
getting annual checkups on bothof those is really important,
because if your vision, if youreyeglass prescription, is just
not what you really need rightnow to give you clear vision,
(20:36):
trying to maneuver stairwellsand things around the house or
outside, might be much moredifficult if you're trying to
adjust your glasses and moveyour head around to make sure
you have a clear path ahead ofyou.
Nancy Barrow (20:52):
So what are some current medical treatments
available for osteoporosis?
Joan Doback (20:58):
Once we determine that by the guidelines you you
have undertaken, the universalrecommendations, and you're
doing what you can to to takecare of your home, your bone
health. Sometimes we add in amedicine, and we've got several
safe and effective medicines,and they all do. There's two
(21:21):
different categories. So they dodifferent things. So depending
on what your situation is, I ifI'm doing primary prevention,
and you're a post menopausallady and you're just getting
from osteopenia intoosteoporosis, we might give you
a pill once a week. Those arecalled bisphosphonates, and
(21:44):
they're so easy and they're veryeffective and safe, and millions
of people are on them worldwidethat also if you that one of the
side effects of those medicinesis they just love to cling to
the esophagus, the food tube onthe way down, and they can cause
heartburn. So we drink thosepills with a big glass of water
(22:06):
in order to wash it down. Sothat is usually fine, but if
somebody has trouble with theirswallowing already, we don't
want to add to that, right? Sowe can give that medicine by the
IV form once a year, and thatavoids all of the swallowing
problems that we might get into.
So for different reasons, wepick different medicines, right?
(22:30):
Yeah, and then so there's that,that one category that's called
the anti resorptive medicines,and those are used in primary
prevention, and often after weuse the second category of
medicine. Those are calledanabolics, and that's we use
those when we really want tobuild up the bone, when we know
(22:53):
someone is really in troublebecause they've had a fracture,
they're at high risk for morefractures. And we don't want to
give them a medicine that's justgoing to hold them where they
are and then slowly turn themaround and move them toward
toward osteopenia. We reallywant to help them to move
quicker. And we so we would useanabolic medicines, and those
(23:18):
are self injections, orinjections at an infusion
center, more like that. I try toeducate them that the one of the
best things about osteoporosisis it's reversible and it's
preventable. So if we keep eyeson it and we look early and get
them before the fracture, it'snot such a devastating diagnosis
(23:41):
where people are reallydistraught over it, because
they've got a lot of power to dosomething about it, and that's
really encouraging to them,right? It's not there are many
diagnosed, several diagnoses,right off the bat, I can think
of them, but that you say to apatient, you have this, and I'm
(24:03):
really very sorry we don't haveany good treatments for that.
That's not the case withosteoporosis, and so I spend a
lot of time letting them knowthis is reversible, and you've
got a lot of power to take careof this.
Nancy Barrow (24:19):
You said that osteoporosis can be reversible.
How is that possible that youcan reverse the diagnosis of
osteoporosis? That's fascinatingto me.
Joan Doback (24:30):
Yeah, so studies show so we take these big
studies that are done atuniversities worldwide, and they
have participants in them,sometimes 10,000 or 10s of
1000s. And we take those largestudies and we know that things
do happen if you do X and Yright, and that way, we can
(24:53):
bring our conversations to oneon one in the provider's office.
So we know that x or. Size, plusgetting enough calcium in your
diet, plus taking your vitaminD, is those three things
together can move you fromosteoporosis up into osteopenia,
(25:13):
and as you improve your bonedensity, you are decreasing your
fracture risk. Those areopposites usually. I do want to
talk about vitamin D, becauseonce you get the calcium in your
gut, you you're drinking yourmilk and you're eating your
yogurt and and getting yourgreen leafy vegetables, you
(25:34):
really have a hard time usingthat calcium if your vitamin D
tank is empty, right? So I getmy patients to think about a
vitamin D tank, and we want thatfull, and full is by a blood
draw, and we can check yourlevel, and we've got guidelines
that tell us what's good, what'swhat's better, what's not so
(25:55):
great. So vitamin D, actually,the skin is a miracle worker,
and it can take sunshine and ithydroxylates it once in the
kidneys and once in the liver.
So everybody's working and we itturns it into a usable form of
vitamin D. But that's only ifthe if the sunshine is directly
overhead. So if we all lived insunny Costa Rica, we would be
(26:20):
great, but we live in cloudyConnecticut, right? So we're
going to take our vitamin D. Andactually, studies have shown
that most of us north of theCarolina latitude are vitamin D
deficient.
Nancy Barrow (26:35):
So let's talk a little bit about caregivers of
people who have osteoporosis andhave fallen and had fractures.
Do you see the caregivers aswell with the patients?
Joan Doback (26:44):
I do and our very typical older patients who are
here at Saint Vincent's after ahip fracture, a slip and fall at
home, and it might be thatthey're they're doing well at
home, I go from very spry andactive and they are out in the
community every single day,volunteering, etc, etc, and this
(27:05):
is truly life changing for them.
And then I it goes to people whoare still living at their house,
but they're in a precarioussituation, and this is just
going to be life changing forthem. But the imagine that
they're attached to a daughteror a son here in the community,
and they tend to be working age,and they're trying, they're in
(27:27):
they might have children oftheir own that are, you know, do
it, going to high school orgoing to college, and they're a
sandwich in between these twocompeting priorities, right?
Sure. So and, now we have a hipfracture, and we have hospital
visits, and we have anoperation, perhaps. And now
where is dad or mom going to goafter St Vincent's? And then
(27:48):
they've got visits to the shortterm nursing facility, because
typically you won't go straighthome after a hip fracture,
although that is changing, butyou need a lot of support, so
maybe now they have to take moretime off from work to help with
care at home or transport todoctors visits. Right? It really
(28:12):
weighs on the minds of ourcaregivers how much time they
need to take off after afracture, particularly while
they're caring for theirparents.
Nancy Barrow (28:25):
Yeah, and that's something that Connecticut paid
leave really does. It gives youup to 12 weeks of income
replacement away from work totake care of your own serious
health condition or that of aloved one with caregiver leave.
And one thing that I find thatis really important to note is
that with caregiver leave, it isrelated by affinity, so it
doesn't have to be a bloodrelative. It can be a neighbor
(28:46):
or a best friend or a co workeror a partner that you live with,
but maybe aren't married tosomeone who is like family. So
you can take time away from workto care for them and get income
replacement from ConnecticutPaid Leave. And how important do
you think Joan, these programsare to the people that you
(29:06):
treat?
Joan Doback (29:08):
They are going to be very important for people
with fractures, particularlybecause that's a process of
mending where you just need morecare. You need more support at
home once you get there, evenafter, if you leave St Vincent's
and you go to a short termnursing facility, you're there
for four maybe, maybe a littlemore four weeks, say, and then
(29:32):
you're returning home, andyou're just not back to normal,
back to your baseline. Yet, ittakes a lot of care, and I see
the stress that this causes, onon families, on children,
particularly who have so manycompeting priorities, one of
them being, I really need to goto work. I'm taking too much
(29:53):
time off, and they're worriedabout not losing their their
position at work.
Nancy Barrow (29:59):
Right? Yeah, and it's great. You can take it all
at once. You can take itintermittently. You can take a
reduced schedule from work. Sothere's a lot of flexibility
with the program, and I thinkthat's important for caregivers
to have that flexibility
Joan Doback (30:12):
Exactly. And I love that you don't need to be a
family member, per se, becauseso many people in the community,
the older people, maybe theirtheir children don't live around
here. They may be, you know, asfar as California or or whatnot,
but the neighbor is whotypically is the one that checks
(30:34):
on on them daily, like that. Sothere's all types of situations
that this this will play to.
Nancy Barrow (30:45):
Yeah, and I'd love to get any information I can to
you so you can get it into thehands of the caregivers, because
I do think it's an importantsegment of the population that
you probably see, and they doneed those resources and help.
So we'd love to help you any waywe can great.
Joan Doback (31:02):
And I'd love to pass it on to the people who are
stressed, both financially orwith their work constraints
while they're trying to helptheir family.
Nancy Barrow (31:11):
Joan Doback is certified physician assistant
who is celebrating 36 years as aPA this year, so congrats again
on that one, Joan. Thanks somuch. She currently works as the
bone health coordinator at theConnecticut Orthopedic Institute
at St Vincent's Medical Centerin Bridgeport. And thank you so
much for joining me on The PaidLeave Podcast. It was a
(31:31):
pleasure.
Joan Doback (31:31):
So welcome. It was a pleasure to be with you.
Nancy Barrow (31:33):
For more information or to apply for
benefits, please go toctpaidleave.org. This has been
another edition of The PaidLeave Podcast. Please like and
subscribe, so you'll be notifiedabout new podcasts that become
available. Connecticut PaidLeave is a public act with a
personal purpose. I'm NancyBarrow, and thanks for
(31:54):
listening.
Hello Connecticut, and welcome to The Paid Leave
Podcast. The title basicallysays it all. I'm Nancy Barrow,
and I will be delving into thisnew state program and how it can
help you and your family. Thispodcast will give you
information you should knowabout Connecticut Paid Leave and
maybe just a little bit more.
Connecticut Paid Leave bringspeace of mind to your home,
(00:24):
family and workplace. Welcome toThe Paid Leave Podcast!
In October. It is InternationalOsteoporosis Day on October 20.
It's also National HealthEducation Week October 21
through the 25th andInternational Day of Older
Persons on October, 1. Two outof three women with
(00:46):
postmenopausal osteoporosis willbreak a bone in their lifetime.
And joining me to talk aboutosteoporosis and bone health is
Joan Doback. Joan is a certifiedphysician assistant who is
celebrating 36 years as a PAthis year, she worked in
neurosurgery for many years,before orthopedics, where she
has worked for the past 21years. She currently works as a
(01:10):
bone health coordinator at theConnecticut orthopedic Institute
at St Vincent's Medical Centerin Bridgeport, and hopes to
expand osteoporosis care in theHartford healthcare community.
Welcome to The Paid LeavePodcast Joan, I'm so happy to
have you here.
Joan Doback (01:26):
Thank you so much for having me.
Nancy Barrow (01:28):
Well, congratulations on 36 years as a
PA. By the way!
Joan Doback (01:32):
Thank you. Thank you so much. It's a great, great
occupation. I really love it.
Nancy Barrow (01:36):
Well, I would hope that you would love it. If
you've been in it for 36 years,that's a long time. So
congratulations on that. Tell meabout the Orthopedic Institute
and what you do as the BoneHealth Coordinator.
Joan Doback (01:49):
So I'm thrilled to talk about this. In addition to
all of those October milestonesand days set aside, September is
Fall Prevention Month, so thisis really opportune to be
talking about. The ConnecticutOrthopedic Institute is
essentially a hospital in ahospital dedicated to orthopedic
(02:10):
service. It provides ourorthopedic patients with
seamless care, safe educationalprocess throughout their
orthopedic procedure, mostlyelective orthopedic procedures
such as joint replacements orspine surgeries. And it's at
both mid State Medical Center inMeriden and St Vincent's Medical
(02:34):
Center here in Bridgeport. And Iwork on the orthopedic team as
one of the Orthopedic PA's andI'm also the Bone Health
Coordinator here for thehospital.
Nancy Barrow (02:45):
And so how do you help people who may come in with
osteoporosis?
Joan Doback (02:49):
The Bone Health Coordinator is both an inpatient
and an outpatient role. So onthe inpatient role, I help to
identify our fractures here inthe hospital, because in
orthopedics, we know that whenyou've had one fracture from a
slip and fall from standingheight, and it doesn't matter
(03:13):
what the reason it could be aslip and fall on ice here in
Connecticut, it could be thesmall dog ran between my feet,
or it could be the big dogpulled me over, but you're not
the roofer on a roof who fell agreat distance, and you're not
in a high speed car accident.
Those would be the scenarioswhere we would expect you to
probably fracture. But when youslip and fall from a standing
(03:36):
height and you're over 50 yearsold that in the orthopedic mind,
is saying we really need to puteyes on the bone health. And it
really gives us a greatopportunity to investigate your
bone health and to see whereyou're at in the continuum.
Nancy Barrow (03:55):
And women versus men, who gets osteoporosis more
frequently,
Joan Doback (04:00):
women do, and for good reason. So you grow your
bones through childhood, andyou're at your best bones ever
at 25 and women support thosebones with estrogen, and men
support those bones withtestosterone. So with women at
2535 45 we're good. We got greatbones, but at early 50s, or
(04:26):
thereabouts, by average, we'regoing to go through menopause,
in which case we're going tolose most of our estrogen. And
General gentlemen, willcontinue. They don't have an
event such as menopause, wherethey wane in their testosterone
and don't fully lose it until 65or 70. So if you compare a lady
(04:48):
who lost her estrogen at 50 to aguy who lost his his
testosterone at 70, he's got twodecades on us of good bone
support. So there are more.
Women with postmenopausalosteoporosis, as opposed to
guys. However, this is not justa lady's disease.
Nancy Barrow (05:10):
So it's not just women's disease, but it usually
affects the men a little later.
Joan Doback (05:13):
That's correct, because of that testosterone.
Nancy Barrow (05:15):
Let me ask you what is the Bone Health and
Osteoporosis Foundation, and howare you connected with them?
Joan Doback (05:22):
So the Bone Health and Osteoporosis Foundation is
the largest health entity thatis solely dedicated to bone
health and osteoporosis. So theyhave education and they've got
research that that supports allof the providers across the
(05:43):
country for the roles that weplay in the trenches with our
patients, but one of theirimportant roles is also to
educate our patients. So I givethat that website to my patients
all day, every day, and directthem to those websites, because
they're really great for patienteducation.
Nancy Barrow (06:06):
Let's start with the basics. Though, for some
people, they think osteoporosisa little old woman and she's
bent over and she has a hump onher back, like that's what I
think people believeosteoporosis to be and to look
like, and that may not becorrect. So I wanted to ask you,
what is osteoporosis?
Joan Doback (06:25):
That is absolutely correct. That lady probably has
osteoporosis. When you saylittle, being little, that's one
risk factor. Being older, that'sanother risk factor. But the
fact that she's humped over aimsat probably she's got spinal
compression fractures, and wenever, never want it to get that
(06:46):
far so we can aim at primaryconvention or prevention. Sorry,
where we're we have eyes on onpeople's bone health, starting
at 60 years old, or 70 years oldfor the men where we do the gold
(07:07):
standard in investigation forbone health is called the DEXA
scan. And so at 60 years old,the guidelines tell us we should
be having a DEXA scan every twoyears, unless we have risk
factors that we needed earlierthan that. And then the men
start their DEXA scans every twoyears, at 70 years old, unless
(07:29):
they have risk factors thatcause us to to get that DEXA
scan prior to that.
Nancy Barrow (07:34):
So let me ask you about the risk factors so and
the diagnosis is always the DEXAscan. Is that correct?
Joan Doback (07:39):
Well, no, if you slip and fall from a standing
height and you have a hipfracture or a vertebral
compression fracture, those, bydefinition, give you a diagnosis
of osteoporosis. So you don'ttypically have to send a person
who has a lot of pain or orwhatnot with their hip fracture
or vertebral compressionfracture and ask them to lie
(08:02):
flat on the scanner. Right?
We're not going to delay thetreatment for that DEXA scan. We
can catch up to that whenthey're feeling better, but yes,
the most people will bediagnosed with osteoporosis by
their DEXA scan.
Nancy Barrow (08:18):
So what is osteopenia? Because some people
get an osteopenia diagnosis, anddoes osteopenia always go to
osteoporosis?
Joan Doback (08:29):
So let's talk about the continuum of bone health. So
when our bones are supportedprior to menopause, or when we
have testosterone, we're in thenormal range of bone, and then
once we lose that support, we'regoing with some natural aging.
You tend to have more breakdownof your bone than you have build
(08:54):
up. So your bones are a livingorganism, right? They're living
tissue, and they are constantlyremodeling themselves with a
build up and breakdown process.
And when we have the estrogen orthe testosterone in place, those
processes are very even. So youhave as much build up, then you
(09:15):
have breakdown after menopauseand after you lose your
testosterone, you have a littlebit more breakdown than you have
build up, okay, and so then youstart to go decline in your bone
health. So your first stage,after normal bone density,
you'll go into osteopenia. Andyou asked if people always
(09:39):
continue downhill toosteoporosis. No, not at all
there. There's some people whostay in the osteopenia range all
of the rest of their life. Butremember, this is a chronic
disease, just like somethinglike diabetes or hypertension.
And you got to keep your eyes onthis and see if you're going
(10:01):
down that hill really quicklytoward osteoporosis. We might
want to do something about that.
Nancy Barrow (10:10):
And what are some of the things that you can do
about that? So if you have anosteopenia diagnosis, Is there
stuff that you can do so you cansay, hey, I want to put off
osteoporosis as long as I can.
Can I do hormone replacementtherapy? Does that help women?
Because it seems that it's a youknow, when we lose estrogen, we
(10:30):
lose bone density.
Joan Doback (10:33):
Right, exactly. So the whole idea of hormone
replacement therapy, you'reabsolutely right. We love women
to have estrogen, and it hasbeen shown to be safe right
after menopause to a certainage, and your GYN provider can
(10:53):
have full discussions with youabout that. If you're using
estrogen for something like yourmenopausal symptoms, like
terrible hot flashes, thenthat's a really great reason to
be on estrogen. And then theside effect of that estrogen, in
that case, is going to be longerbone support, but, but it also
(11:19):
comes with its risks, theestrogen support hormone
replacement therapy, and so wedo not use it as a front line
treatment for osteoporosis,because it has more risks than
benefits in that situation. Letme go over those, because those
are important. So the the age isa risk factor, because the older
(11:43):
you get, the farther you arefrom your estrogen or your
testosterone, and so your riskincreases with age. Gender is a
risk because more women have ahigher risk, especially after
menopause. Ethnicity plays intoit, as Caucasian and Asian women
are at higher risk than AfricanAmerican ladies or patients, men
(12:07):
and women. Family history, ifyour parents had a hip fracture,
particularly before age 80, thatmay give you a little bit of a
genetic component to this sothat you want to maybe look at
your DEXA scan a little bitearlier than 60 years old, if
your mom had, if your mom wasthat lady you just described
(12:30):
with the hump in her back andleaning over a walker, then you
really want to put eyes on yourown bone Health, and then bone
size, small, thin, bonedindividuals, they're at greater
risk as well. Everything we doin medicine is by guidelines,
and that guideline is if youweigh less than 127 pounds,
(12:53):
which is an odd number, but therest of the world is on metric,
and it's 58 kilograms. So 58kilograms or less, 127 pounds,
that's a risk factor forosteoporosis, so you want to pay
attention to that. And then youhave some Those are, those are
risk factors that you can't doanything about, right, right?
(13:14):
Burly. What we do is justacknowledge them and then and
count them up, and then maybethat leads us to do a DEXA scan
a little bit earlier than 60 or65 years old. But there's other
modifiable risk factors that youcan look at, and that's things
like the estrogen or thetestosterone that we're talking
about, nutritional deficiencies,you can do a lot with your diet,
(13:40):
and particularly the buildingblocks of bone are calcium and
vitamin D. So I spend a lot oftime on diet with our patients
and making sure they understandthat we want them to get their
calcium in their diet, ratherthan taking a chunk pill of
calcium every day, which is alittle bit easier, but it's just
(14:03):
a matter of setting some somechanges in your diet and making
them a routine. So the guidelinefor calcium, how much calcium do
you need? For good bones,ladies, need 1200 milligrams of
calcium and and then need 1000so both of those are around
three to four dairy choices orgreen leafy vegetables. That's
(14:28):
where you're going to get yourcalcium in your diet. So if you
have cereal in the morning anddrink the milk out of the bowl,
there's one. Have a yogurt withlunch and a small glass of dit
of milk with dinner and you'vegot your calcium for the day.
Really works into our threemeals a day.
Nancy Barrow (14:48):
That's so fascinating. You know, a lot of
people don't think that greenleafy vegetables have calcium,
but they do.
Joan Doback (14:55):
Right exactly they they do, and it's it. You can
consider that one of yourservings of getting your
calcium, right? Yeah, the anumber one way of helping
yourself is to exercise. Soexercising includes weight
(15:16):
bearing exercise, resistanceexercise and balance training.
So weight bearing exercise isabout going to walk in the
neighborhood, and your legs arecarrying your upper half and so
they're weight bearing. But ifyou carry some small dumbbells,
two pounds, three pounds, ormaybe up to five pounds, for
(15:39):
men, now you're inviting yourarms for the walk with you. I
advise our patients that ifyou're going to stop and shop or
Big Y to do your groceries, justpark in the back of the parking
lot, if it's a nice day, and getyour steps that way, or do a
circuit around the outside ofthe store. Before you pick up
your carriage and do yourgroceries, you're just adding
(16:02):
steps, and it might be rainingout, but you're getting your
walk in.
Nancy Barrow (16:05):
Is there a certain amount of steps that you say is
good per day, or amount of ?
Joan Doback (16:11):
Okay remember, we started it, I think it was like
7500 then they went up to 10,000and the more recent literature
is more like some somewhereabout 7000 or 8000 is what,
what's optimal, and that'spretty doable, if you're
intentionally putting in someextra steps every day.
Nancy Barrow (16:32):
Yeah, I think that you can get to that seven to
8000 pretty easily, right?
Joan Doback (16:37):
And I think that's the current research so and so
you have the weight bearingexercise, and you have the
resistance exercise, and thenthe third kind of exercise you
need is balance training, andthat really lends itself to
getting good at your balance.
And then you're not going to bethe 80 year old who falls a lot,
right? So things like juststanding at the counter, hold on
(17:01):
to the sink and practicestanding on one leg, 30 seconds
on each leg, you might just do10 seconds at the beginning,
realizing that your other leg ispretty hard to hold up, right?
So you have to build up. And ifyou can stand 30 seconds without
holding on. That's really goodbalance, but the better you can
(17:23):
get at it, the more youpractice, the better you're
going to get, the better you canget, the less you're going to
fall as an older person.
Nancy Barrow (17:33):
Yeah, so lifestyle factors really matter. Diet,
exercise. What about likealcohol and smoking? Can they
affect your bone health?
Joan Doback (17:42):
Absolutely. And so those are the base those two
round out the five universalrecommendations that everyone
can do. So from the topexercise, then two and three are
calcium. And then we're going totalk about some vitamin D. But
let me ask answer that question.
When you smoke, nicotine floatsin your blood, and it just
(18:06):
poisons everything. It certainlywe all know it poisons our
heart, it poisons our lungs, butit definitely poisons the bones
as well. And so any smoking,vaping, it just it counts.
There's no excuses. Any nicotineproducts are just bad for you,
and they cause cancer, so, butso they need to be eliminated.
(18:27):
And nobody says that lightly. Weall understand that that's not
an easy thing to do, right? Itcan take several times or many
times in a lifetime of trying toquit before you're successful.
But I encourage our patients,just please keep trying, because
you're going to be successfulone of these days of leaving
(18:47):
that bad habit behind and thenalcohol. What is too much
alcohol? How much alcohol isgood for my bones or not good
for my bones? Yeah, that comesout to two drinks a day is okay?
Three or more that's too muchfor the bones.
Nancy Barrow (19:05):
Okay? And is there something that's better? Is wine
better? Or does it matter?
Joan Doback (19:10):
Yeah, so that's a good question, actually, because
when we're talking aboutalcohol, one ounce of liquor in
a drink is the same as one beeris the same as four ounces of
wine, and they all have the sameeffect.
Nancy Barrow (19:25):
They all have the same effect okay. Mmm-hmm.
Joan Doback (19:28):
September is Fall Prevention Month, and so I don't
want it to go away withouttalking about it. So fall
prevention. 90% of our brokenbones are fractures, are because
of a fall, and it's a simpleslip and fall, I took one step
out on the deck to get themorning paper, and my life
changed because I was on theground before I knew it. Nobody
(19:51):
expects to fall, and most of thefalls happened in the bathroom,
so taking care of things like onas. Slippery surfaces and things
make sure you have grab handles,by the toilet, by the tub, where
you're most likely to slip orlose your balance. That can help
(20:12):
two things that people do notthink about that increase your
fall risk is decreased visionand decreased hearing. So
getting annual checkups on bothof those is really important,
because if your vision, if youreyeglass prescription, is just
not what you really need rightnow to give you clear vision,
(20:36):
trying to maneuver stairwellsand things around the house or
outside, might be much moredifficult if you're trying to
adjust your glasses and moveyour head around to make sure
you have a clear path ahead ofyou.
Nancy Barrow (20:52):
So what are some current medical treatments
available for osteoporosis?
Joan Doback (20:58):
Once we determine that by the guidelines you you
have undertaken, the universalrecommendations, and you're
doing what you can to to takecare of your home, your bone
health. Sometimes we add in amedicine, and we've got several
safe and effective medicines,and they all do. There's two
(21:21):
different categories. So they dodifferent things. So depending
on what your situation is, I ifI'm doing primary prevention,
and you're a post menopausallady and you're just getting
from osteopenia intoosteoporosis, we might give you
a pill once a week. Those arecalled bisphosphonates, and
(21:44):
they're so easy and they're veryeffective and safe, and millions
of people are on them worldwidethat also if you that one of the
side effects of those medicinesis they just love to cling to
the esophagus, the food tube onthe way down, and they can cause
heartburn. So we drink thosepills with a big glass of water
(22:06):
in order to wash it down. Sothat is usually fine, but if
somebody has trouble with theirswallowing already, we don't
want to add to that, right? Sowe can give that medicine by the
IV form once a year, and thatavoids all of the swallowing
problems that we might get into.
So for different reasons, wepick different medicines, right?
(22:30):
Yeah, and then so there's that,that one category that's called
the anti resorptive medicines,and those are used in primary
prevention, and often after weuse the second category of
medicine. Those are calledanabolics, and that's we use
those when we really want tobuild up the bone, when we know
(22:53):
someone is really in troublebecause they've had a fracture,
they're at high risk for morefractures. And we don't want to
give them a medicine that's justgoing to hold them where they
are and then slowly turn themaround and move them toward
toward osteopenia. We reallywant to help them to move
quicker. And we so we would useanabolic medicines, and those
(23:18):
are self injections, orinjections at an infusion
center, more like that. I try toeducate them that the one of the
best things about osteoporosisis it's reversible and it's
preventable. So if we keep eyeson it and we look early and get
them before the fracture, it'snot such a devastating diagnosis
(23:41):
where people are reallydistraught over it, because
they've got a lot of power to dosomething about it, and that's
really encouraging to them,right? It's not there are many
diagnosed, several diagnoses,right off the bat, I can think
of them, but that you say to apatient, you have this, and I'm
(24:03):
really very sorry we don't haveany good treatments for that.
That's not the case withosteoporosis, and so I spend a
lot of time letting them knowthis is reversible, and you've
got a lot of power to take careof this.
Nancy Barrow (24:19):
You said that osteoporosis can be reversible.
How is that possible that youcan reverse the diagnosis of
osteoporosis? That's fascinatingto me.
Joan Doback (24:30):
Yeah, so studies show so we take these big
studies that are done atuniversities worldwide, and they
have participants in them,sometimes 10,000 or 10s of
1000s. And we take those largestudies and we know that things
do happen if you do X and Yright, and that way, we can
(24:53):
bring our conversations to oneon one in the provider's office.
So we know that x or. Size, plusgetting enough calcium in your
diet, plus taking your vitaminD, is those three things
together can move you fromosteoporosis up into osteopenia,
(25:13):
and as you improve your bonedensity, you are decreasing your
fracture risk. Those areopposites usually. I do want to
talk about vitamin D, becauseonce you get the calcium in your
gut, you you're drinking yourmilk and you're eating your
yogurt and and getting yourgreen leafy vegetables, you
(25:34):
really have a hard time usingthat calcium if your vitamin D
tank is empty, right? So I getmy patients to think about a
vitamin D tank, and we want thatfull, and full is by a blood
draw, and we can check yourlevel, and we've got guidelines
that tell us what's good, what'swhat's better, what's not so
(25:55):
great. So vitamin D, actually,the skin is a miracle worker,
and it can take sunshine and ithydroxylates it once in the
kidneys and once in the liver.
So everybody's working and we itturns it into a usable form of
vitamin D. But that's only ifthe if the sunshine is directly
overhead. So if we all lived insunny Costa Rica, we would be
(26:20):
great, but we live in cloudyConnecticut, right? So we're
going to take our vitamin D. Andactually, studies have shown
that most of us north of theCarolina latitude are vitamin D
deficient.
Nancy Barrow (26:35):
So let's talk a little bit about caregivers of
people who have osteoporosis andhave fallen and had fractures.
Do you see the caregivers aswell with the patients?
Joan Doback (26:44):
I do and our very typical older patients who are
here at Saint Vincent's after ahip fracture, a slip and fall at
home, and it might be thatthey're they're doing well at
home, I go from very spry andactive and they are out in the
community every single day,volunteering, etc, etc, and this
(27:05):
is truly life changing for them.
And then I it goes to people whoare still living at their house,
but they're in a precarioussituation, and this is just
going to be life changing forthem. But the imagine that
they're attached to a daughteror a son here in the community,
and they tend to be working age,and they're trying, they're in
(27:27):
they might have children oftheir own that are, you know, do
it, going to high school orgoing to college, and they're a
sandwich in between these twocompeting priorities, right?
Sure. So and, now we have a hipfracture, and we have hospital
visits, and we have anoperation, perhaps. And now
where is dad or mom going to goafter St Vincent's? And then
(27:48):
they've got visits to the shortterm nursing facility, because
typically you won't go straighthome after a hip fracture,
although that is changing, butyou need a lot of support, so
maybe now they have to take moretime off from work to help with
care at home or transport todoctors visits. Right? It really
(28:12):
weighs on the minds of ourcaregivers how much time they
need to take off after afracture, particularly while
they're caring for theirparents.
Nancy Barrow (28:25):
Yeah, and that's something that Connecticut paid
leave really does. It gives youup to 12 weeks of income
replacement away from work totake care of your own serious
health condition or that of aloved one with caregiver leave.
And one thing that I find thatis really important to note is
that with caregiver leave, it isrelated by affinity, so it
doesn't have to be a bloodrelative. It can be a neighbor
(28:46):
or a best friend or a co workeror a partner that you live with,
but maybe aren't married tosomeone who is like family. So
you can take time away from workto care for them and get income
replacement from ConnecticutPaid Leave. And how important do
you think Joan, these programsare to the people that you
(29:06):
treat?
Joan Doback (29:08):
They are going to be very important for people
with fractures, particularlybecause that's a process of
mending where you just need morecare. You need more support at
home once you get there, evenafter, if you leave St Vincent's
and you go to a short termnursing facility, you're there
for four maybe, maybe a littlemore four weeks, say, and then
(29:32):
you're returning home, andyou're just not back to normal,
back to your baseline. Yet, ittakes a lot of care, and I see
the stress that this causes, onon families, on children,
particularly who have so manycompeting priorities, one of
them being, I really need to goto work. I'm taking too much
(29:53):
time off, and they're worriedabout not losing their their
position at work.
Nancy Barrow (29:59):
Right? Yeah, and it's great. You can take it all
at once. You can take itintermittently. You can take a
reduced schedule from work. Sothere's a lot of flexibility
with the program, and I thinkthat's important for caregivers
to have that flexibility
Joan Doback (30:12):
Exactly. And I love that you don't need to be a
family member, per se, becauseso many people in the community,
the older people, maybe theirtheir children don't live around
here. They may be, you know, asfar as California or or whatnot,
but the neighbor is whotypically is the one that checks
(30:34):
on on them daily, like that. Sothere's all types of situations
that this this will play to.
Nancy Barrow (30:45):
Yeah, and I'd love to get any information I can to
you so you can get it into thehands of the caregivers, because
I do think it's an importantsegment of the population that
you probably see, and they doneed those resources and help.
So we'd love to help you any waywe can great.
Joan Doback (31:02):
And I'd love to pass it on to the people who are
stressed, both financially orwith their work constraints
while they're trying to helptheir family.
Nancy Barrow (31:11):
Joan Doback is certified physician assistant
who is celebrating 36 years as aPA this year, so congrats again
on that one, Joan. Thanks somuch. She currently works as the
bone health coordinator at theConnecticut Orthopedic Institute
at St Vincent's Medical Centerin Bridgeport. And thank you so
much for joining me on The PaidLeave Podcast. It was a
(31:31):
pleasure.
Joan Doback (31:31):
So welcome. It was a pleasure to be with you.
Nancy Barrow (31:33):
For more information or to apply for
benefits, please go toctpaidleave.org. This has been
another edition of The PaidLeave Podcast. Please like and
subscribe, so you'll be notifiedabout new podcasts that become
available. Connecticut PaidLeave is a public act with a
personal purpose. I'm NancyBarrow, and thanks for
(31:54):
listening.
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Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
Stuff You Should Know
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.