Beyond Survival: A Special Conversation with Rachel Frankenthal

Episode Transcript
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Speaker 1 (00:01):
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate, all with a dash of

(00:22):
humor and a lot of heart. So pull up your
chair and join the conversation. Before we dive in, Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only, and it is not a substitute
for medical advice. We encourage you to partner with your
own medical clinician to address your unique health needs. This

(00:43):
is the Dusty Muffins, All right, Welcome back to another
episode of The Dusty Muffins, the podcast where we keep
it real about midlife menopause and all the magic and
a little bit of the mayhem that comes with it.
I'm doctor Christine Hartcress and as always I'm joined by
my fabulous hosts, Doctor Rebecca Hurdle and doctor Ifa O'Sullivan.

Speaker 2 (01:04):
I am a doctor Rebecca Hurdle. I'm a Board certified
ostopathic family medicine physician and a Menopause Society Certified practitioner.
I have a private telemdisine practice and I see patients
in several different states.

Speaker 3 (01:18):
I am doctor Ifa O'Sullivan, a Board certified family physician
and Menopause Society Certified practitioner, and I see patients through
my telemedicine practice here in Oregon and Washington.

Speaker 1 (01:30):
I'm doctor Christine Harcrass, a Board certified Women's Health Nurse
practitioner and Menopause Certified practitioner, and I see patients via
telemedicine in several states as well.

Speaker 3 (01:40):
And today we're tackling a big topic, menopause after gynecologic cancer,
because menopause is already enough of a wild ride, but
for cancer survivors, it's next level challenging.

Speaker 2 (01:52):
So we brought an incredible expert to help us break
it all down. She's a powerhouse in gynecologic oncology and
menopause care, the founder of a survivorship program in Minopause
Clinic for Cancer Survivors at UCLA, and an all around
advocate for midlife women. Rachel Frankenthalum, Hi, guys.

Speaker 1 (02:11):
So, Rachel is a Board certified physician associate, a Menopause
Society certified practitioner, and a total rock start in the field.
She's also a national speaker, a course creator for clinicians,
and fun fact, a certified yoga and pilates instructor.

Speaker 4 (02:25):
On the side. We love a well rounded queen, Rachel.

Speaker 3 (02:30):
Welcome to the Dusty Muffins.

Speaker 2 (02:32):
We have so much to get into, so let's dive
right in.

Speaker 5 (02:37):
Welcome Rachel.

Speaker 4 (02:42):
So excited to be here with you all today.

Speaker 6 (02:44):
And to be honest, the reason I really said yes
to this podcast is because I really just wanted an
opportunity to hang out with you three.

Speaker 2 (02:54):
This is the craziness right here in this room. Oh
thank you. We absolutely have a blast with you every
time that we have been able to hang out, and
so it's just been fantastic.

Speaker 3 (03:07):
We do thanks for hanging out with us, Rachel, for
having me.

Speaker 1 (03:11):
Really, what we should be saying is best of luck
for the next hour, Rachel, because chaotic today, it's like
a rodeo.

Speaker 4 (03:22):
People don't realize is like none of this phases me.

Speaker 6 (03:26):
Before I was a medical clinician, I was a Broadway
performer and spend so many of my days like basically
half naked backstage with people like running around doing ridiculous
things to each other.

Speaker 4 (03:38):
So you know, like this is.

Speaker 2 (03:41):
That sounds like a lot of fun.

Speaker 3 (03:43):
Oh, you have a very colorful and interesting history.

Speaker 2 (03:47):
I know I want to hear about that. I do
not know that so much. Take us into some of.

Speaker 4 (03:52):
That out of water. Sometimes I'm silling, is this am
I here?

Speaker 6 (03:57):
No?

Speaker 4 (03:57):
I mean I don't want to get into it so
much because we have so much to tell.

Speaker 2 (04:00):
Do we do? That's way more fun?

Speaker 4 (04:02):
Go ahead, interesting.

Speaker 6 (04:04):
I mean, my whole life, I was a performer. I
was a competitive dancer and a very one track minded,
like my my real passion, My everything that I ever
wanted was to be on stage was to be performing.
And ultimately, once I discovered what musical theater was and

(04:24):
the ability to sing, dance and act while telling stories
on a stage, I was just sold. And so my real, my,
my childhood, my whole upbringing, that was my dream and
I always really believed that I would do it, and
I worked really hard, and I was also very talented,
and I I studied you know, music and theater and

(04:46):
acting at Northwestern University and started performing while I was
you know, living in Chicago professionally, moved to New York City,
kind of like the quintessential dream of wanting to be
on broad and I moved to the Upper West Side
and was really lucky, like I had an agent just
because of where I went to college and how they facilitated.

Speaker 4 (05:07):
Us moving into the business.

Speaker 6 (05:10):
So I was auditioning and started working really quickly. So
I moved to the city with a job off Broadway,
and you know, I started working regionally at different wonderful
theaters and then was cast in the national Broadway tour
of Mama Mia. I did that, and then interestingly, you know,
I was very young. I was twenty two when I

(05:31):
was twenty two twenty three when I was on the road,
and even at that young age, was starting to think,
you know, there might be something else for me out there.
I don't know what it is, but I had asked
my company manager to ask the producers of Mama Mia
if I could actually leave the show and work in
the production office. I was like, maybe I want to produce,
Maybe I want to produce theater. Because I'd done a

(05:51):
lot of producing in college and I was always very
interested in different areas of the business, and a few
weeks later, my company manager is like, well, sure, you know,
you could potentially work in the production office, but they're
actually interested in transferring you to Broadway. Would you be
interested in just being in the Broadway company instead? And
I was like, yeah, of course, how can I say

(06:13):
no to that? So, I, you know, performed on Broadway
for a few years and had really cool experiences like
I got to teach dance to you know, Mayor Bloomberg,
and there's like really cool things that happen when when
you're working at high levels. But you know, for whatever
reason I was, I just wasn't as fulfilled as I

(06:36):
thought I would be. And I think part of that
is because as an artist, as a creator, you go
into the arts to create, you go to create. But
then when you're you know, you're you're at the top
of your game, and what we in a long running
show like it was Jersey Boys, Wicked, Mama Mia.

Speaker 4 (06:50):
When you're in these shows and you're getting paid and
you have great benefits, it's really hard to leave.

Speaker 6 (06:56):
But at the same time, you're doing the same thing
eight times a week for years and years years, and
that's really not why I became a performer or a creator.
So I felt very stifled actually while doing it, and
I did projects on the side. But during that time,
I was already a pilates instructor. I wanted to get

(07:17):
my yoga teaching certification because I was studying yoga and
studying Ari Euveda and really experiencing the healing qualities in myself.
I asked for a leave of absence from the show
to get my yoga certification. They said no, so I said, okay,
so I'm leaving. I still had an agent, but I
always thought that I would go back to performing, just assumed.

(07:38):
And what happened was that I got my teacher certification,
my yoga certification, and just like this, started teaching yoga
full time in the city and started getting all of
these private clients with these very interesting medical conditions. And
when I look back at my life now, I was
always like a geek in high school, like studying biology,
like I always found everything like so f fascinating. I'd

(08:00):
be up late with my best friend talking about these things.
But then I was really stimulated by anatomy and physiology
and medicine, and you know, it was this just kind
of at a fork in the road and not knowing
what to do. And there was a program at Mount
Sinai in New York and it was actually an anatomy

(08:21):
course for movement instructors in the cadaver labs and it
was taught by the medical school teachers.

Speaker 1 (08:27):
Wow.

Speaker 6 (08:27):
So I went to this program where I was petrified
of like holding bones and feeling and seeing cadavers because
that just wasn't my thing. But I had this, you know,
life altering moment in the cadaver lab where I was vibrating,
like actually having a moment where you're so aligned where

(08:50):
you have to listen right, you don't have a choice,
and the universe was very clearly telling me you need
to go into healthcare some somewhere. I had no pre
med classes. This was not on my radar. This was
I was like, this was just kind of out of
left field. But also who I am as I moved

(09:11):
from my gut and I moved from these moments. So
when things are very clear, I go and so I am.

Speaker 4 (09:15):
This was over the summer.

Speaker 6 (09:16):
I immediately signed up for a postback program at Fordham and
then just dove right into like bio and keem not
knowing where I would end up in medicine or healthcare.

Speaker 4 (09:25):
I thought maybe i'd be a PT.

Speaker 6 (09:27):
Just as a as a physical person, as a dancer
and as a plate and you know, yoga instructor. I
thought this was it, but then I became really fascinated
by so many different organ systems. And then ultimately, you know,
definitely knew I wouldn't go to med school because that
would shatter my spirit.

Speaker 4 (09:44):
Like I knew that that that was just not the
right path for me.

Speaker 2 (09:47):
It does do it does do that.

Speaker 4 (09:51):
And also I was already on my third career.

Speaker 6 (09:53):
I was like, I can't invest because you were I
even know if I was gonna like it, Like I
had no.

Speaker 2 (09:58):
Experience, and at this point this was you know how
how I wouldn't want to say how old you are,
but that's kind of what I want to know.

Speaker 4 (10:08):
You know, I'm forty. Now.

Speaker 6 (10:10):
This all happened only like five years into my for
I had only been performing for a few years. So
my whole life I spent leading up to this career
that I had a successful career, and then I left
it so quickly.

Speaker 4 (10:24):
It ended up. You know, I always knew.

Speaker 6 (10:25):
I wanted to work with women always wanted to work
with women. I went to an all girls like summer camp,
performing arts camp. But you know, even when I worked
in theater, being in dressing rooms with women, like they
really became my family, and I knew I wanted to
take care of women. And then ended up shadowing a
PA on labor and delivery at Mount Sinai and she
was a badass, and she was like running the show

(10:47):
and teaching the residents and doing the deliveries. And I
was like, if I can go to school for twenty
seven months and come out and be able to change
specialties or like create my own career and do what
she's doing, then like it. And then I don't like it.
It's only two years of my life essentially, like going.
So that's that's a little bit of my journey into medicine.

Speaker 3 (11:10):
What we need to find, you know, is a specific
area where you can give your talks while singing on.

Speaker 4 (11:19):
Site, something better than the musical.

Speaker 5 (11:25):
Yeah, we may have created the perfect job for you, yes,
but conferences gonna be so boring. Imagine day you've had.

Speaker 6 (11:36):
I've literally gone to people who run these these conferences.
I'm like, we need to move. I was like, you
I will let me move everyone every hour or two, like,
let us, we got to dance, we got a stretch,
we got to move, like it's just so important.

Speaker 4 (11:50):
We all are falling asleep.

Speaker 2 (11:52):
Yes, that is important. Yeah, that's really nice when you
go to certain events, and I've been to some events
where then in between the lecturers, you're up, you're moving,
you're jumping around, you're doing really fun things. We just
did that. And when we were in Orlando Sea remember yeah, yeah,
and so totally it was we were It was so great.

(12:14):
It was so much fun. Yeah, it was. And I
think that's really it's really important, and I think it
stimulates your brain in a completely different way. And why
the hell does medicine have to be so boring and
learning have to be so boring? Who who like made
that a law? Right? Yes?

Speaker 4 (12:35):
If wo?

Speaker 2 (12:36):
When women the world were way more fun and we
get shipp done a lot easier and quicker and you
know all the things.

Speaker 1 (12:44):
So Rachel I digressed, Yeah, tell us tell us about
your survivorship program and how you even got the green light.

Speaker 4 (12:54):
Gough to have a menopause clinic.

Speaker 6 (12:57):
Like, so, I startarted working in gun On College. It
was my first job out of PA school, I had
like Z and.

Speaker 2 (13:05):
You knew you wanted to do that?

Speaker 4 (13:06):
No, that was like, this was the grace of God.
I was put in touch with.

Speaker 6 (13:12):
A gyn on coologist through a mutual friend during PA
school because I was in Florida, South Florida doing my
PA training. But my husband and I, my husband's a
singer songwriter, he's a musician. We knew that we wanted
to come to LA. We wanted to be around artistic communities,
we wanted to be around the industry. He now has

(13:33):
a business where he brings mental health to the music industry.
And I have all my friends from college who are
still in the business out here, so we were like,
we got to come to LA. So I was put
in touch with a gyan oncologist at UCLA and basically
he mentored me through PA school and read my cover letters,
my resumes, and I was like, how do I get
a women's health job. There's so many nurse practitioner jobs.

(13:53):
Did I make a huge mistake becoming a PA? So
he was guiding me essentially, And then when I came
out to LA to interview for jobs, and they were
mostly like planned parenthood, other women's health clinics is like,
you know, if you're starting out, these are the jobs
that you're being offered, and I was excited to do them.
He was like, well, would you be interested in doing
gyan oncology? And initially I kind of couldn't believe it

(14:16):
because I didn't.

Speaker 4 (14:17):
I was like, I have no experience.

Speaker 6 (14:18):
I can't believe this guy, this incredible doctor, is even
interested in hiring me at UCLA. But I didn't know
emotionally if oncology was something that I wanted to do,
and I purposefully did not do any oncology rotations in
PA school because again I am a very like porous individual.
I absorb a lot and I wasn't sure truly if emotionally,

(14:43):
spiritually it was going to be the healthiest thing for me.

Speaker 4 (14:47):
But I also know that I couldn't. I knew that
I couldn't.

Speaker 6 (14:49):
Say no to working with him, to working in clinical trials,
to working with fellows, to working with some of the
best world renowned doctors in this fe So I said yes,
and then I completely just fell in love with the work.
I mean, I feel like it's really a calling that
I didn't know existed until it was presented to me,

(15:13):
and I think Gyan Oncology is such a special part
of a niche and oncology because most cancer patients kind
of get sectioned off right. If they need surgery, they're
going to see a surgical oncologist. If they need chemo
or immunotherapy, whatever systemic therapy, they're going to go to
a medical oncologist. But Gyan Oncology is the only one

(15:35):
where we do everything. So we meet patients when they
are diagnosed, if it's in the er, if they are
referred to us, we do their surgeries. Like Gyan oncologists,
they do their surgeries, we do their chemo, we do
their treatment. We're involved in every part of their journey,
including end of life. And so for someone like me
who wanted to go into medicine to have relationships and

(15:59):
to really get to know people and to be a
part of, you know, these vulnerable moments, you really just
it's just this unbelievable experience meeting them, meeting family members,
and really being with them for their entire journeys.

Speaker 4 (16:16):
It's so so.

Speaker 6 (16:17):
Special and I really really feel like it is a
true honor and privilege to do the work that I do.
And so that's how I got into Guan oncology, and
I still credit his name is doctor Joshua Cohen for
inspiring me also through his work and the way that
he treated patients. I mean, he treated patients the way
I would want to be treated, the way any of
us would want to be treated, And so learning from

(16:40):
someone like that instilled in me the kind of clinician
that I am today, and so I credit a lot
to him as well.

Speaker 3 (16:49):
It's tally, isn't that, Because Oh sorry, Rachel, I was
going to say, you know, as a patient, you would
want your oncologists to be so empathetic, but yet as
a doctor or a p or an NP, it's one
of the most difficult specialties to be in as an EmPATH,
you know, because you are absorb it all.

Speaker 6 (17:11):
I've learned how to protect myself, and I also do
reiki like physical somatic work, and I've learned how to
do certain exercises before and enter leaving a room. And
I've also learned through getting really close to patients that
I just can't hold all of that anymore, especially now
that I have children and I take care of mothers much,

(17:32):
and so there is definitely a wall that I have
to put up that I have to just to protect myself.
But of course you can't help but fall in love
with people.

Speaker 2 (17:43):
You know, that just.

Speaker 6 (17:44):
Happens, and they're family members, because it's really, you know,
it's it's the kids that are showing up for all
these appointments, the partners who sometimes struggle more than the
patients that you're there for.

Speaker 4 (18:02):
So yeah, it's a lot.

Speaker 6 (18:05):
It's kind of like the highest of highs and the
lowest of lows, and you really see how precious life is.
And I think that that's also something that I take
home with me every day that I feel very grateful for.

Speaker 3 (18:17):
Your patients are very lucky to have you.

Speaker 2 (18:20):
Very lucky.

Speaker 4 (18:21):
Well, I'm lucky to help them.

Speaker 6 (18:23):
And in terms of survivorship, I mean, I think I
spent the first four plus years just like getting down
the bread and butter of g waan oncology, like really
learning all the different treatments, how to take care of patients,
the nuts and bolts, right. I had no experience coming
out of Peace School. I had two weeks of a
women's health rotation, and I also had two children in
those first you know, four years as well, so it

(18:45):
was just a busy time.

Speaker 2 (18:46):
For me.

Speaker 6 (18:48):
But then we got a new division director and she
was a survivorship expert and she had written a lot
of the NCC and guidelines on cancer survivorship for GUA
and cancer survivors. So when she joined in twenty two twenty,
she sat down with me and said, what is your thing? Like,
what do you want to do? And no one had
ever asked me that before ever, you know, and I

(19:09):
do you want to do research?

Speaker 4 (19:11):
I was like, Eh, She's like, do you want to
do survivorship? And I was like, yes, that I want
to do.

Speaker 6 (19:18):
And she essentially gave me full rain, which was very
wonderful and also very creative for me as a creative human.
And it started off with a few things. One was
I did a pilot program during COVID where I led
a eight week virtual yoga and meditation class to a

(19:39):
cohort of GUA and cancer survivors. It was a twice
weekly thing. We did surveys before and after just to
kind of get a sense of if any of their
treatment side effects were improving. There's a lot of data
for breast cancer survivors when it comes to movement, meditation, yoga,
really anything. We lacked data for GUA and cancer survivors.

(20:00):
I didn't know how they would respond, but every single
participant experienced improvements in multiple treatment related side effects and
it was very healing for everyone also to just be together, right,
because it's very isolating experience to have cancer, especially some
of these more rare cancers, and.

Speaker 4 (20:17):
So it started with that that was very powerful.

Speaker 6 (20:20):
I still to this day teach a weekly virtual yoga
meditation class for patients. We started dedicated survivorship programs, which
I don't think happen maybe anywhere, I don't know, but basically,
we take patients a month after they finish treatment and
they meet with myself or our other PA and we

(20:40):
sit with them for about forty five minutes and we
talk about everything that they've been through and we bridge.
We kind of create a bridge between active treatment and
that time where survivors are kind of just going, going, going, going.
They're being seen frequently, they're getting their treatments, there's always
something to do, there's always a next thing, and then

(21:01):
there's nothing right. It's like then you finish treatment and
there's that kind of empty space where I think a
lot of survivors that's where a lot that they have
in process through comes up emotionally. It's where they really
come to terms with everything they've been through. And so
that's where we meet our patients and say, let's talk

(21:22):
about all of this. Let's talk about everything you've been through.
Let's get you plugged in with if we haven't already
plugged you in with different specialists, mental health, pelvic floor, PTE, acupuncture,
whatever it is, like, let's get you where you need
to be so that you can heal. And we talk
about what to expect, right, what does surveillance look like,
how do we take care of you? What are the

(21:43):
things that you need to be on the lookout for.
There's a lot of anxiety and hypervigilance about cancer occurrence,
so it's like when do you actually need to be worried?

Speaker 4 (21:52):
What is normal? What is not?

Speaker 6 (21:56):
And I think that that is a really important moment
in a survivor's journey that people just aren't doing survey
visit and then we have lots of other things that
I'm very proud of our program.

Speaker 4 (22:09):
We have hair clinics, We bring in Hollywood hair stylists
to do wig styling.

Speaker 6 (22:14):
We bring in alopecia experts, we have sexual health workshops
with pelvic floor pts and oncology social workers and myself,
and we have a mental.

Speaker 4 (22:24):
Health weekly support group. So we have lots of.

Speaker 6 (22:26):
Programs that we you know, annual conferences that we're doing,
so we do a lot. And then the menopause clinics
started because I couldn't take watching people suffer anymore.

Speaker 4 (22:38):
That was really like enough is enough.

Speaker 6 (22:41):
So I really just spent the last about four years,
five years.

Speaker 4 (22:46):
Educating myself.

Speaker 6 (22:49):
And becoming you know, hormone therapy expert, getting certified, reading
as much as I can, and you kind of just
have to start from nothing and and.

Speaker 4 (23:01):
Trust and believe in yourself.

Speaker 6 (23:02):
And that's what we did, and so we started this
menopause Clinic for cancer survivors and again I've been very supported.
I'm with six Guyan oncologists that are my attendings and
they basically are like, this is your you know more
about this than we do. You do your thing. If
you have questions, like, let us know. But we've created

(23:24):
guidelines for our division for hormone therapy that are all
of our division.

Speaker 4 (23:27):
Is comfortable with. And it's been it's been really amazing.
I'm really really incredible.

Speaker 3 (23:35):
Yeah, how and incredible for those patients to have that
opportunity to go and speak to someone about hormone therapy
after their cancer treatment's finished, when really no woman has
that opportunity anywhere else.

Speaker 1 (23:51):
Right, And I think, you know, like we hear like
on other podcasts or on Instagram or social media, there's
all kinds of talk about the breast cancer survivors, but
I cannot even tell you anywhere. And I listen to
a lot of podcasts and I'm on social media a
lot anybody talking about the end of mutual cancer survivors,

(24:13):
the uterine, the cervical cancer, the ovarian cancer survivors, And
I would, I mean, I think it's fair to say that,
you know, it's unchartered waters for clinicians. You know, are
you finding that you know, like that women come to
you because you know they're just being told no, like

(24:36):
the breast cancer survivors, or and that they that they
think they have no options, or are you finding that
people are coming to you on hormone therapy and just
need to be adjusted.

Speaker 4 (24:47):
For quality of life, like what's your experience? Well sent The.

Speaker 6 (24:52):
Vast majority of my patients are funneled to me from
our clinics So I am in a moment right now.

Speaker 4 (24:59):
I am really trying trying.

Speaker 6 (25:00):
To start menopause care at the time of diagnosis. So
a lot of these patients, I do all the chemo teaching,
so there's two PA's. We do all the treatment teaching.
So we are meeting patients right away. So I am
already talking to them about this.

Speaker 2 (25:16):
So you're like the front line.

Speaker 6 (25:18):
I'm trying because I think one of the biggest problems
as we see is the lack of counseling, the lack
of counseling prior to induce.

Speaker 4 (25:25):
Menopause, and that is just unethical in my book.

Speaker 6 (25:29):
So I'm really and I'm so I'm lecturing our fellows,
I'm lecturing our doctors. I'm really trying to start these
conversations because survivorship starts the day you're diagnosed with cancer,
so vivership care shouldn't start once you finish treatment.

Speaker 4 (25:43):
We should be taking care of our patients holistically, starting
from day one.

Speaker 3 (25:47):
I was just going to say, even that is a
novel approach.

Speaker 2 (25:50):
I mean, yes, to be diagnosed with.

Speaker 3 (25:52):
Cancer is one thing. To be diagnosed with cancer and
go into your appointment and be met by someone who
says hello, I'm from the servi vership group. I mean, yes, aspletely.
It just sings around.

Speaker 2 (26:04):
Can you mentione that, like deep breath of like.

Speaker 3 (26:07):
Yes, okay, so there's person things I'm going to survive this.

Speaker 2 (26:10):
Yeah, okay, you're not.

Speaker 3 (26:12):
I have a chance, and.

Speaker 2 (26:13):
You're not allowing them to even get gas lit. That's
what I love about it, Like, you know, you're just
it's like if we plucked medical students out before they
got you know, all of these other misconceptions from other attendings,
you know, or you know, if you could do that
with a patient. So you're getting these patients who are
then obviously diagnosed at a pre premenopausal state, knowing that

(26:38):
they are going to go into menopause if that's what
they're what their treatment entails, and you're just not even
so they're really you know, kind of missing that like
gaslighting phase, and you're just giving them all of the
information before anyone else can get their fingers into it.

Speaker 3 (26:58):
You're going in with the assumption they're going to do
really well and they're gonna need help after everything's.

Speaker 6 (27:03):
Been so many things to say to that. I mean,
I think what's interesting is a lot of these younger
women don't even know about menopause, so when I talk
to them about it, it's like, what are you talking
about this?

Speaker 4 (27:17):
I had a.

Speaker 6 (27:18):
Really sad situation happen, and I'll tell you the story
because I think it's really important as to why I'm
trying to do things differently. But I met with a
thirty eight year old who's one of our patients a
few weeks ago for a pre chemo visit. This was
like not supposed to be. It was a fifteen minute
like we do visits before everyone gets treatment to make

(27:38):
sure they're good to go, and she was not well,
like you could just see when you see a patient.

Speaker 4 (27:44):
You're like you are just you're not okay.

Speaker 6 (27:48):
She was thirty eight, so she's a cervical cancer patient,
so she'd undergone chemo radiation. So I knew she had
went through radiation induced menopause because ovaries can't survive the
toxicity from pelvic radiation. But I also saw in her
chart that no one had mentioned this to her, and
so she was complaining to me, and she was like shaking,

(28:10):
like obvious anxiety, obvious, like unwell, mentally hot, was talking
about her hot flashes and night sweats, and then I
said to her, I was like, well, you know that
you're menopausal now, right, And it was this awful moment
where clearly no one had informed her. And then she

(28:33):
asked me, well, does that mean I can't have children? Oh?

Speaker 4 (28:37):
No, Rachel, No, no.

Speaker 6 (28:39):
And I'm with a nurse practitioner student, I have a
medical student. I mean, this was not the moment to
be you know, You're just like, Okay, we're here, We're
in this moment, and now I'm the one who's going
to have to tell this poor patient that not only
is she I'm an a pausele, but she can't have

(29:03):
biological children and her uterus will never be able to
carry a pregnancy because it's been radiated. Right, So I
had to share that news, to which she then said
to me, I would have never never gone through this
treatment if I had known that I could not have

(29:23):
a child.

Speaker 4 (29:27):
And this is why this work.

Speaker 6 (29:30):
Is so important and why I honestly have a tough
relationship with social media. But the reason I'm on it
is because I'm trying to advocate for these women.

Speaker 4 (29:41):
I'm trying to educate. This has to change.

Speaker 6 (29:45):
It is completely unethical to ever do anything to someone's
body especially. And the thing is is that like sadly,
this patient likely isn't going to make it. She has
recurrent cervical cancer. The odds are whatever, But it's still
her choice. It's still her choice whether or not she
wants to undergo standard of care treatment. And even if

(30:06):
it doesn't make sense to us because we know she'll
probably never get to the point of having children, it's
not our choice to make that for her.

Speaker 3 (30:13):
I know we say we shouldn't make those decisions about
someone's body. It's not someone's body, it's women's bodies. I
can tell you now. There is no way we would
do anything to a man that would affect his reproductive
future without having an in depth conversation and giving him
the choice about whether or not he would like to

(30:34):
go that route. We wouldn't not in a fit right,
So it's not somebody's body, it's just women's bodies. You're
right that we do this too.

Speaker 6 (30:43):
You're right, and we think we know it's like, you know,
she came in through the er, which is not uncommon
for cancer patients when they're you know, have widely metastatic
disease or they don't have health insurance. They show up
at an er and then people start, you know, just
they want to get treatment going quickly.

Speaker 4 (30:58):
But then you bypass, but you miss all the things.

Speaker 2 (31:02):
Shit, would she have wanted to conserve?

Speaker 3 (31:05):
Yeah, but it's not that the doctor she was seeing
only you know, saw men and women and children, and
it got missed somehow. They only see women.

Speaker 5 (31:15):
They only see women.

Speaker 4 (31:17):
Well that's the other thing. And that's the other crazy
part is this work is so obvious to me.

Speaker 6 (31:22):
I mean clearly, all I think about is menopause, like
all of us, we like only think about menopause.

Speaker 4 (31:28):
But it's crazy to me that.

Speaker 6 (31:31):
There's no required education for gynecologic oncologists. These are people
who are routinely putting people into menopause. Like thirty to
forty of g U I N oncology survivors are premenopausal.
This is not like a rare situation. This is happening
all the time, and they're not being taught how to counsel.

(31:52):
They don't understand the implications for quality of life fan longevity.
And I remember being a new PA and like my
attendings saying to these early stage uterine cancer survivors, like
you're cured you're more likely to die from cardiovascular disease
than uterine cancer. And it was they said it in
a way that was supposed to be a really positive thing.

(32:15):
But now looking back on that, I'm like, ah, we're
really you.

Speaker 2 (32:20):
Just put it an increase risk.

Speaker 4 (32:24):
Putting her now at increase risks for all of these
chronic diseases.

Speaker 3 (32:27):
Right.

Speaker 6 (32:27):
So it's just the work here is so obvious to
me and so crazy to me, right that oncologists are
not are required to really.

Speaker 4 (32:36):
Understand this work. And I and I don't think.

Speaker 6 (32:39):
That it's their job to like be menopause experts, you know,
we don't. They don't have the time for that. But
they should know what they're doing to people's bodies, yeah, right, and.

Speaker 2 (32:49):
They should know how right. They should either have someone
like you on board everywhere or more than one of you,
or they have someone that they're working really close with, like, Okay,
this is your next person that you are going to
go see first before we do anything, so you understand
what is going on, because you know, people underestimate when

(33:10):
you a put someone into menopause, but b when you
take away their fertility and their ability to say, yes,
I want to have children or no, I do not.
That's that's a lot. That is a lot for a
woman to have that option or to not have that option,

(33:35):
to have that option completely taken away, you know, not
just the menopausal portion and the risk factors that you did,
but to say, do not give her that option, to say, hey,
you cannot have your own biological children if we do this.
You know there are other options. I mean that is
just for some women, like you said, they would choose no,

(33:57):
thank you, I want to be a mom, a biological mom.

Speaker 6 (34:02):
Well, it's like we give women when we talk about chemo,
we talk about hair loss. Some women say like, I'm
not going to do that chemo if I lose my hair,
and we say, okay, we'll give you this one.

Speaker 4 (34:10):
It should be the same thing, right. It's like, yeah,
it's the same thing they have.

Speaker 3 (34:15):
And I also thinks what's wrong with us as humans?
Because that woman who said that to you, that patient
you gave the example of there, I'm sure as all
guyinnanc clinicians have had patients say those that's those same
words to them. Right, So how is it that the
first time another human being looks at you and says,

(34:37):
I would never have gone through that treatment, had you
told me this, How is it not at that moment
that you change your practice forever? Right and educate your
patient every single one after that. Maybe someone didn't say
it to you for fifteen years and then on that day,
from that moment onwards, you never do that to a
woman again.

Speaker 2 (34:55):
Great, that's what we learn as clinicians, right, How many
times have we changed practices because you're like, well, I
just put my big old foot, my big old mouth,
and I'm not going never that again, you know. I
mean that is part of what we do. It's part
of medicine. That's part of your rotations and your clinical
experience because no one can teach you those things, you know, And.

Speaker 3 (35:18):
Yeah, making mistakes right, Yeah.

Speaker 6 (35:22):
Well, I just think that it's rare to have these
conversations and oncology. I don't think that oncologists are asking
these questions, even in like surveillance and survivorship.

Speaker 4 (35:32):
Right.

Speaker 6 (35:32):
It's like I ask all my questions about sexual health,
I ask all my questions about their mental health, and yeah,
it takes longer, and it is draining, and it sometimes
requires additional visits and all the things.

Speaker 4 (35:44):
But it's you.

Speaker 6 (35:46):
Know, oncologists are there to treat cancer and to prevent
cancer from coming back. And I think part of it
is not their fault. I think part of it is
their training. And I think I think there I think
medical curriculums need to change, you know, and that it's
going to take time. It's not on their radar. You know,
it's these up to.

Speaker 4 (36:09):
Right we do.

Speaker 6 (36:10):
I mean ninety percent if female cancer survivors report sexual
concern is like a really big concern of theirs.

Speaker 4 (36:16):
But it's not like oncologists are taught how to talk
about these things with them, right. So there's a huge disconnect.

Speaker 2 (36:22):
Right, No one's taught to talk about these things with
them right, And.

Speaker 4 (36:27):
A lot of oncologists don't go into oncology walk about
these things. They're not comfortable, isn't they?

Speaker 2 (36:33):
And isn't it It's it's crazy to you because that's
what they're looking at, right, They're looking at their reproductive parts.
You actually have to have sex in order to reproduce.

Speaker 6 (36:42):
I think it's really I think there's you know, there's
so there's this is so layered and so complex, really
this topic. It's also you know, it's hard and a
lot of these oncologists are seeing thirty forty patients a day, and.

Speaker 4 (36:55):
Yeah, they're there's not there's no time or space.

Speaker 3 (36:58):
There's a really really funny British show that's old, absolutely fabulous.
I don't know if you've ever heard of it, but
there's one clip where she goes gynecologists the guy who
can look you straight in the vadge but not in
the eyes.

Speaker 4 (37:14):
That's awesome.

Speaker 2 (37:16):
Yes, yes, you're like this is all new.

Speaker 4 (37:20):
You're like this talk about Oh my gosh, you Irish
people got the greatest things.

Speaker 2 (37:29):
I love it. It's you know, And if I can
digress for a second in what you were talking about
before too, you know, Rachel, when you were talking about
the you know, just the the trauma, because it really
is for clinicians when they are in practices that are

(37:54):
dealing with patients that are you know, going through some
pretty traumatic events or or not serve. And I think, honestly,
you know, none of us are taught how to deal
with trauma, right and so, and trauma does change our
brain a little bit. And I think, you know, we're
often criticized as clinicians for not having a soul or

(38:17):
not caring or whatnot. But like you said, there's also
a point where you're like, I need to be able
to go home and be mom and be a wife
and not break down and not be able to do
my job. And I think, you know, maybe it's just
something that we can touch on a little bit. I
don't think people. I think our listeners and most people

(38:40):
don't understand that we are not given the tools to
know how to deal with repetitive trauma, whether it's family medicine,
whether it's emergency medicine, whether it's oncology, or really in
any medical practice. You know, when we're telling you know,
calling you know, codes and then having to go counsel

(39:05):
patients that they're loved one passed or deliver a baby
that didn't survive, or you know whatnot like we're not
taught how we're we're not given any type of resources
to help us through those things. I mean I remember
being a resident and going home and just losing it
and rocking my children to sleep, and you know, those

(39:27):
are things that I think those things have to change too, right,
just for just the clinicians that are that have to
learn to deal with this so that we can be
better at being empathetic without being traumatized. If there's such
a thing. I don't know, is it.

Speaker 3 (39:45):
Do you think it's nice Rachel to go home and
have a partner that is not in medicine. Does that
help a little bit? Or would it be nice sometimes
to debrief? Kind of.

Speaker 6 (40:00):
I am grateful. I think I'm grateful that he's not
in medicine.

Speaker 4 (40:04):
He's also a.

Speaker 6 (40:04):
Therapist, so oftentimes I'll say to him, Oh, I wish
I had your skills right, because, just like Rebecca, what
you were saying when I was with that patient, like
I didn't know the right thing to say.

Speaker 4 (40:16):
I did myself.

Speaker 2 (40:17):
Your heart just sinks. You try not to cry.

Speaker 4 (40:20):
Try well, I did cry. She was crying, of course.

Speaker 6 (40:23):
And you're literally witnessing a moment where someone's life is changed,
and there is that before moment, and there is that
after moment, and you are in that moment with them,
and there was even the students who were with me,
like everyone walked out of the room and we were
all shaking because it's so intense. And no, we're not

(40:44):
trained in that, not at all. I did not receive
one lecture in school on how to handle difficult conversations,
how I could take care of myself. After seeing traumatic things.
I mean, you know, like you're a student, you're going
into the car, you're going to surgery, like you're seeing

(41:04):
people die.

Speaker 4 (41:05):
Yes, yes to like process that.

Speaker 6 (41:09):
And I think that's a part of the burnout we
experience because we don't know how to process through these things.
I mean, I've done a lot of work on my own.
I also came to this work, you know, with tools,
but it's still something that I mean sometimes Well that
day when I got home from work, my husband looked
at me and he was like, I got the girls,
you go lie down, like he could see that I

(41:31):
was unwell, And yeah, it's.

Speaker 2 (41:33):
A lot and the lot, Yeah, it's a lot, and
it doesn't take just one day there. I'm sure with
all of this there's been you know, traumatic events that
we've experienced that I know have left weeks, if not
longer than that or still some things when I think back,
I am just like, you know, it's it's maybe that's
just a whole different podcast episode, but it's something that

(41:55):
I think needs to being delight and I think it
needs to change, and I think there needs to be support.

Speaker 3 (42:00):
Yeah, like when you look at your husband, Rachel, he
got years of training, right, on how to do those
things that you're just automatically supposed to know how to do.
Ye crazy when you think of it, what we expect
clinicians to be able to do just you know, and
so many of us have layers of trauma that would
affect how we deal with someone else's trauma.

Speaker 1 (42:21):
It's just.

Speaker 4 (42:23):
Menopause care, midlife health without the cancer part.

Speaker 6 (42:26):
You're still I'm sure all three of you here tons
of stories of the traumas that women have been holding
and that are going through and you have to listen
to that, and you you have to hold the space
for that as well.

Speaker 4 (42:39):
I mean, forget the cancer part.

Speaker 6 (42:41):
Right, It's like we've we take care of people and
we all have our stuff. So yeah, I agree, I
think that is an important podcast, right, and you know,
I yeah, we all. I think clinicians deserve more support.

Speaker 2 (43:00):
Yeah, absolutely, So talk to me a little bit about
the social media. So you're saying you don't really yeah,
because you do get fantastic So what Yeah, well, I
thought just about that because you're doing really great and
you're you know, this whole work life balance and getting
on and doing your thing.

Speaker 4 (43:18):
Well, I don't know, I think social media can be
really tough for people.

Speaker 6 (43:22):
You know, it's hard not to compare yourself and to
spend too much time on social media to not be present.
I know what the data looks like for social media
for my children, and I want to be a present person.
I don't want to, you know, spend my time on
a you know, a device. But ultimately I made the
decision because I care so much about GUI and cancer
survivors and I want to educate and advocate. But you know,

(43:46):
even for me, like the word for me, one of
the words for me this year in twenty twenty five
is subtraction, Like I really feel like for me, for
my nervous system, for my well being. Given the world
we're living in, I think less is more and I
think social media, you're at least always feeling like you
got to be or if you want to be relevant
or you you know, there's just like people are creating

(44:09):
so much content, and I as someone who's like a
type a person who likes to succeed and likes to
be at the top of my game, it's hard for
me to pull back, but I have to.

Speaker 2 (44:18):
You know what I mean.

Speaker 6 (44:18):
It's just like it's finding that balance with adding one
more thing to our plates as busy mothers and partners
and full time jobs. I just think it's it's another
relationship that you have to contend with.

Speaker 4 (44:31):
Do you guys feel that way.

Speaker 2 (44:32):
It's really easy to get sucked in and then all
of a sudden, it's like two hours later or three
hours later that in Canva. Canva sucked you right in
for hours.

Speaker 3 (44:41):
As my god, I have last weeks of life, especially
over the last few weeks. But we did a conference
yesterday in Portland, four of us local docs here, and
there was so much Canva involved. If I never see
it again.

Speaker 7 (44:58):
Because type of part of bright Yeah, you're just like
I gotta get this done, and I gotta do it,
and you know, but it's going to take you half
an hour and four hours later you're still there and
half the day is gone, like yeah, and.

Speaker 6 (45:12):
I'm like, but I also I learned I wouldn't be
here without social media is the other thing.

Speaker 4 (45:21):
I wouldn't be here. I wouldn't let Heather Hirsh I
wouldn't have taken it. I wouldn't have let you three.

Speaker 6 (45:27):
I wouldn't have learned about Mary Claire Haver and Kelly
Casperson and doctor men and all of these amazing doctors
who I've learned from and have given me so much knowledge.

Speaker 4 (45:37):
I mean, that's the other pieces.

Speaker 6 (45:39):
I also realize how critically important social media is, you know,
for for in terms of educating.

Speaker 2 (45:49):
So it's all educating and the experiences. And then when
you have I think those those you know, women reach
out to you and say things like thank you for
you know, hearing me, and yes, that me too, me too,
me too, thank you. You know, that's what keeps you
doing it. And you know, sometimes like with the canvas stuff,

(46:09):
I was having my youngest daughter. She's the only girl
left in here. We've got a whole bunch of boys
and testosterone open this joint. But my youngest daughter is
still here and she helped me with she helps me
with projects. I'm like, hey, what do you think about that?
And so that's been really nice to just kind of incorporate,

(46:30):
you know, just their thought process on hey, what do
you think this? Sounds like? Do you like this? And
she's like, no, I think I should do this instead.
And so I've been trying to do that a little
bit more to a make sure I'm present definitely, but
then to also bring them in in this, you know.
I mean they all have to learn this boys and
girls and all of that as well. And so that's

(46:53):
been helpful at least for me personally.

Speaker 3 (46:56):
You know, how old are your kids?

Speaker 4 (46:58):
Rachel have two girls, they're five and seven.

Speaker 3 (47:02):
Oh, they still like you.

Speaker 5 (47:07):
He knew.

Speaker 4 (47:08):
I'm holding on to it.

Speaker 2 (47:10):
Yes, Oh it's so fun.

Speaker 4 (47:13):
You know, it's the cuddle. I actually said, oh, I know,
it's a moxy tocin. And yeah, you.

Speaker 5 (47:22):
Say that, or they say that.

Speaker 4 (47:24):
I do. I say it, love it.

Speaker 2 (47:28):
I know I have one that will still do that
with me. My youngest little boys still, yeah, I still
get all those snuggles. But I'll tell you what, sometimes
the thirteen year old will still snuggle up into my bed.
And you know, we were really lucky because even our
adult kids, when they were like sixteen seventeen, they would

(47:50):
come cuddle into our bed and study and well, and
it was just kind of a thing that we did.
We'd help them study. That was their cuddle time because
they knew, you know, it was those last few minutes
where the younger ones were in bed. And I miss
that time, you know. And sometimes it doesn't have to
be these long stints of time. They really just want

(48:11):
you without anything else in front of your face.

Speaker 3 (48:14):
Now, it's nice to come home from that work, you know,
that day at the office as well, and have some
disguss Yes, it.

Speaker 4 (48:22):
Is nice perspective too.

Speaker 6 (48:24):
It's like you come home and yeah, life is crazy
and there's so much going on. But you know, if
you're you know, if we're healthy and we're okay, you know,
and I think that you've got it working in oncology.
I'm very grateful for that daily perspective, right because you
see what the minute your your health changes, everything changes.

Speaker 3 (48:46):
And in the blink of an eyelid, like just so quickly.

Speaker 4 (48:50):
That before and after moment, and it happens like this.

Speaker 3 (48:54):
My dad always said that, He's like, if you have
your health, you can fix everything else.

Speaker 2 (48:58):
I agree with that. Yeah, yeah, yep, I agree with that.
You know, what do you see kind of you know,
the next the next thing that you you know you're doing.
Are you do you have any other endeavors? Not that
you're not busy enough and doing really awesome things, but
are you like, Hey, I'm gonna go actually go do

(49:19):
another Broadway event And.

Speaker 4 (49:21):
It's so funny.

Speaker 6 (49:22):
Adia's coming back to Broadway and it's going back to
the same theater that I performed at. So I texted
my friends, you guys, and I was like, if you
need a last minute. I was a swing so I
understudied nine people. I was like, if you need someone
last minute, I would love to fly out and do
it again, just for like a few days. But I
still I would love I still would love to produce

(49:46):
important stories.

Speaker 4 (49:47):
I would love to produce work.

Speaker 6 (49:48):
I was always a producer in college growing up, and
even when I moved to New York, I produced.

Speaker 4 (49:52):
Events in New York.

Speaker 6 (49:54):
But in terms of medicine, I really want to educate.
So I'm educating ju Wan on collegey fellow around the country,
starting to do that.

Speaker 4 (50:05):
Working on updating AUR.

Speaker 6 (50:07):
This is all like very early stages, but updating our
hormone therapy guidelines for guy and cancer survivors and pre vibers,
and really expanding the guidelines.

Speaker 4 (50:18):
As well, because our guidelines are good, but they could
be better.

Speaker 6 (50:21):
If you've looked at the British Juaan Cancer Society guidelines,
they're way more comprehensive and some research actually, like I've
been one of the great things about working an academic
institution is having a clinical trials team, having support in
that regard, and working with doctors who have a lot
of experience with research and they're all very supportive of

(50:44):
menopause and survivorship. So we actually meet I meet with
two incredible researcher Guan oncologists once a month to talk
about this. So there are research studies that we're hoping
to do. I've actually there's no randomized controlled trial on
the safety of you know, vaginal estrogen for GUA and
cancer survivors. We're missing a lot of data for early
stage ovarying cancer survivors. We're just you know, we think

(51:07):
that when you talk about breast cancer survivors and they're
not being a lot of data, and then you start
looking for GUI and cancer survivors, it is bleak. So
I really love to gather even retrospective data, just gather
some more data so that our survivors can feel more
comfortable with the choices they're making when it comes to

(51:28):
hormone therapy. So yeah, I think educating, if you know,
I'm I'm also really on a mission to to try
to get all Guane Oncology fellowship programs to include menopause Education,
working with the Committee of Education at SGO to see
if at least I can put something together, you know
for our on College, our gan on College is and

(51:49):
fellas in the meantime. So yeah, there are a lot
of things that I would love to do that I'm
working on doing.

Speaker 4 (51:54):
It's I think everything is going to take some time.

Speaker 2 (51:57):
Maybe produce a menopause a menopause documentary.

Speaker 3 (52:00):
Yeah, Like you know, listening to you, it feels like
everything you've done in your past has been leading you
to this, and then this will lead you to the
next thing. And I feel like you're gathering all these
skills to put to come to some big famale that.

Speaker 4 (52:14):
Will sure benefit all of us. I stop, you know,
it's so funny.

Speaker 6 (52:18):
I like stopped trying to guess what was next, because
if you would have told me that I would be
doing this like fifteen to even ten years ago, I
would have been like, you've got the wrong gal. And
so that's kind of explaining it is like not knowing.

Speaker 4 (52:32):
Where things are going to lead you. I think it's
really that's exciting.

Speaker 2 (52:37):
Yeah, any you know any trustworthy information and resources for
both clinicians and for patients that you were like Okay,
if you listen to this, this is what I want
you you know, or where you should go or what
you can look at.

Speaker 6 (52:50):
Yeah, I want you, IIan cancer survivors and pre vibers
to know that a lot of survivors can safely use
hormone therapy a lot.

Speaker 4 (53:00):
And I think that they don't know that.

Speaker 6 (53:02):
And so the British Guian Cancer Society has a great
clinical practice statement on hormone therapy for Guy and cancer.

Speaker 4 (53:11):
Survivors with a great chart.

Speaker 3 (53:13):
Uh.

Speaker 6 (53:14):
The American Society of Gynecologic Oncology has a clinical practice
statement on hormone therapy that I think patients should be
aware of. They can bring these guidelines into their oncologist's
office just to get you know, conversations going. You know,
Clinicians should know that I have a course on hormone
therapy for Guy and cancer survivors and previvors that they

(53:34):
can take through the Heather hersh Academy Menopause and Cancer
is an amazing resource, an amazing podcast for female cancer survivors,
not just Gyn any Cancerny Vinson's amazing.

Speaker 4 (53:52):
She's incredible. Oh my god.

Speaker 6 (53:54):
So yeah, I mean, and I just want survivors to
know that that there's help out there, and even if
they're on collogists or not the right people for them,
that they can find people right, even if it's through
social media, they can find menopause specialists who have enough
information to help them. Whether it's hormonal non hormonal. They

(54:16):
don't need to suffer.

Speaker 4 (54:17):
I mean they really, I really really want survivors to
hear that.

Speaker 6 (54:21):
And I also want previvers to not be scared to
get genetic testing. I know people who are scared to
get genetic testing because they are so fearful of having
to decide to go understand.

Speaker 4 (54:34):
To go through with surgical menopause.

Speaker 6 (54:37):
And I don't want women to forego getting genetic testing
and finding out what their cancer risk is because they're
so fearful of induced menopause, because I've you know, the
alternative of getting an ovarian cancer. You don't want it.
It's just it's much better to take control, to know

(54:58):
what your risk is, to take the steps necessary to
reduce your risk when it's right for you, and to
know there are people out there like all four of us,
and there are so many more who can help manage
surgical menopause. It doesn't have to be one or the other.
And I want women to know that that we're moving
into an age where we do right. There are more

(55:19):
menopause experts. There's enough information on social media. You can
find people to help you, you know. And I always
say this and I mean it, like, you can always
reach out to me on social media.

Speaker 4 (55:28):
I will connect you with someone who can help you.

Speaker 6 (55:30):
And I do that for people because I don't want patients.
You know, I've seen what happens. I've seen women not
have the surgeries, not have genetic testing, and then they
end up with an advanced, aggressive ovarian cancer and it's
just not worth it.

Speaker 3 (55:45):
I was just going to ask you that, Rachel. For
our listeners, where can they follow you your work and
connect with you.

Speaker 6 (55:53):
They can find me on Instagram at Rachel Frankenthal. I
think that would be the best place. They can message
me directly there, and I do. I connect survivors with
trusted menopause experts, and I always tell them that if
you know they're working with someone who doesn't know the answers,
they can always.

Speaker 4 (56:10):
Talk to me.

Speaker 6 (56:11):
So I really want, you know, I want people to
know that I really am there.

Speaker 4 (56:14):
To help them.

Speaker 3 (56:17):
Thank you so much for sharing your knowledge, your passion,
and all this invaluable insight with us today.

Speaker 4 (56:23):
Rachel, thanks for having me. When can we go out
for drinks? Is what I want to as.

Speaker 2 (56:30):
A as ap? Yes, it's so, it's too far, too long.

Speaker 4 (56:37):
I just want to start help together.

Speaker 6 (56:39):
I want your listeners to know that I look up
to all three of you and.

Speaker 4 (56:42):
Have learned so much from all three of.

Speaker 6 (56:45):
You, truly through social media, and I've reached out to
all of you on individual occasions to get your advice
in tough situations. And I personally want to say thank you.
I look up to all of you, and I'm truly
so honored and so grateful to to be a part
of this new endeavor of yours and support it.

Speaker 4 (57:03):
I'm just so proud of you. Yeah, thank you for
having me. It's great to have you, Rachel. This was awesome.

Speaker 2 (57:11):
It was so so great. So all right, Dustin Muffins.
That's a wrap. If you love this episode, shirt with
your midlife besties and don't forget to subscribe, leave a review,
and follow us for more real talk on menopause and
midlife wellness.

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