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Welcome to the youe Are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a
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board certified urologist, thought leader and conversation
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starter on midlife living, hormones and sexuality. Enjoy the show.
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Hey, everybody. Welcome back to the youe Are Not Broken podcast. Excited today to have a podcast, Newbie, Dr. Katie Kennedy. I'm literally telling her to, like, save her energy till I hit record. It's very exciting. We're going to talk today about aging underneath a microscope. So Dr. Kennedy is a pathologist who spent 20 years looking at tissues underneath a microscope. When you get a skin biopsy and it goes to the hospital and they tell you if it's cancer or not, a human does that. We're getting more into AI, assisting them at this point. But a human looks under the microscope and tells you basically how bad it is. So today we're going to intersect health, menopause, quality of life, and what our bodies look like underneath a microscope. And I welcome Dr. Katie Kennedy, a double board certified pathologist, to the show. Welcome. Yay.
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C
Hi, Kelly. Thank you. I'm so excited to be here and talk about all things pathology, all things related to histopathology.
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B
Very exciting. So we connected on Instagram because you messaged me about, like, what things look like under the microscope. And I think that was in regards to low estrogen. Do you remember?
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C
Yeah, it was. Well, it was both alcohol. I think you had something on. We were talking about alcohol and also with you all talking about low estrogen. And from my perspective, I validate every woman that comes in and complains of these issues. Right. I see it on the Pap smears. I see atrophic Pap smears where all I see are the basal cells. And so I had to get involved because I want to validate women when they come in. Right. You know, I've been looking at, like I said, Pap smears for decades of atrophic smear. Atrophic smear, day in and day out. And I think to myself, what is going on? Are these women getting help?
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B
Don't you kind of want to put on your pathology reports? Consider vaginal estrogen.
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C
Bingo. That's exactly right. Exactly. Atrophic smear. C comment. Exactly. In the appropriate clinical context. Estrogen. Topical estrogen. Yes. Should be considered. Exactly. Which is what we do with a lot of other things where we'll go further. Like wide excision is recommended if you have a melanoma on the skin or some other helpful tool for the referring physician in the path report. And I think with pathology, we're kind of behind the scenes. And so I just want to kind of back up and let folks know what is even pathology. Right. Kelly, who are we? What do we do? Where are we? Right. We're down usually in the basement of the hospital. We. We are the doctor's doctor. That's how I like to tell people. We are the doctor's doctor. When the doctor is having a challenge and they need a biopsy of a tissue, whether it's a breast, brain, kidney, any tissue, if they have to take it, it comes to the pathologist. So we see the worst of the worst. We see everything. Everything bad that hits the hospital, hits the pathology department. Whether it's lab work, whether it's an infectious disease, leukemia, lymphoma, primary cancers, everything. The definitive resection, everything comes to the pathologist. So that's why I love, when I hear you all talk, I think, oh, my gosh. Okay, that's what I'm. I'm seeing this under the microscope. And so I think it's important to know that what you all see by your physical exams is validated on the histopathology of the glass slide. And so we were. So it was talking about with the loss of the estrogen, of course, and then also I think it was something else about alcohol. My goodness. Every specialty is impacted by alcohol in one way, shape or form.
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B
What do you see under the microscope to the tissues where alcohol's been a player.
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C
How much time do we have? How much time, Kelly? Cause that could be an eight hour lecture. But we'll just hit the high points, right? We'll just kind of hit the high points. And I thought it would be kind of fun. I poured out some fun volume in terms of what is kind of considered okay for us to drink. What is a correct portion size, if you will. Right. Because I think there's a lot of confusion about that. I think folks go to the restaurant, they get a glass of wine, and then it's two glasses of wine, maybe it's two and a half. You know, we're kind of working blind, I think, sometimes with that. So I thought it would be kind of fun. But we'll just talk about some of the key organs that alcohol really, truly impacts tremendously. Of course, the liver, a number one. Right? Of course, we always think of alcohol impacting the liver. And there's a spectrum of injuries that occur when alcohol gets absorbed through the gut and goes to the liver and is broken down. Right. We know it's. It's the metabolites from alcohol, ethanol is what I'm talking about, gets broken down to acetaldehyde and you have the free radical oxidative species that are also released in the breakdown process within the hepatocytes. And you have lipid dysregulation, your fat is dysregulated. And so what happens kind of in the spectrum, we'll just kind of really quick talk about the liver here, because the liver takes the brunt of the injury. The liver is what takes the brunt. So first you can have fatty liver change in the liver. And that is seen on my end when someone would take a core biopsy of a liver, evaluating it, because maybe they had elevated liver enzymes, maybe they want to rule out metabolic liver disease. Fatty liver changes, right? Metabolic syndrome, hyperlipidemia, type 2 diabetes, obesity. Right. So we're looking for NASH, non alcoholic steatohepatitis or fatty liver disease. So we evaluate that, we evaluate it for your autoimmune diseases, hematochromatosis, Wilson's disease, so primary biliary cirrhosis, all of that. So will look at it, I'll see the fatty change, and I'll report that out to the gastroenterologist and we'll be able to kind of tell them how much of the liver is involved with fatty changes. Is it 10%, 30%, 60%?
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B
But let's focus on alcohol. What's alcohol doing to the liver?
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C
So fatty liver disease, first you'll see the fatty changes, which is steatosis.
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B
So alcohol makes the liver fatty.
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C
Correct, Exactly.
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B
And why is it, why is that bad?
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C
Because it's injury that's a response to the toxin of alcohol, of ethanol.
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B
Can you reverse that if you stop drinking?
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C
Yes, you can reverse fatty change. So that's the good news. So the good news is that you can stop, you can. Abstinence is always the solution, right? If you think you have some type of drinking solution, you know, issue that's the solution, right? Is abstinence, cessation. So fatty change is reversible, which is a great thing if you catch it early. If you catch it early, you know, you have the right treatment, you have the right support in place. And the next phase is steatohepatitis is what we would call it, so that now you're progressing. And so what those changes show on the slide that we look at is we have fatty change now we have the inflammation coming in, now we have the inflammatory response coming, coming in. And so now we're starting to see neutrophils, which are our first immune cells on the scene, if you will. And so those cells are starting to come in. And so now you're progressing to steatohepatitis. You still can reverse even Kelly at that stage. Right? You still can reverse those changes. So this is your spectrum of injury. First you have the fatty change without the inflammation. Then you have the fatty change where now you have the inflammatory cells. And then you can progress to full blown cirrhosis or fibrosis.
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B
By the time you hit cirrhosis, you're in trouble.
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C
Absolutely. We have trouble. Trouble is coming your way. Exactly.
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B
And how long can you live with cirrhosis?
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C
Right, so it depends, right, on the individual. Everybody's a little different. The gender, women. We don't tolerate alcohol like men. So, you know, it's half the amount of alcohol that a man can. Can handle. That's just our genetics.
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B
Yeah, it's not just genetics. It's water distribution, fat amount in your body. We're just smaller people. I don't want people to think it's just their genes that makes a woman unique to this. There's a lot of things about our body that makes alcohol not tolerated.
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C
Some people may not have as much of the enzymes, depending what their descent is. Right. What the race is. So all these factors play a role. Two for binge drinking, too. Did you eat something before you had your alcohol intake? What's the frequency and the duration? How much the volume? How much are you drinking and how often are you drinking? All these things matter. So for everybody, it's gonna be a little bit different.
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B
Okay. We're gonna.
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C
We're.
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B
We're gonna move on from the liver because we can't spend all. We can't spend all hour talking about the liver. I gotta keep you going. So let's talk about alcohol changes on the GI tract because we know it's associated increased risk of eight different GI things. Everything it touches, from oropharyngeal to stomach to colon to anus. So what are in the GI tract because of alcohol?
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C
Right. So you swallow your alcohol, you can start to have changes in the esophagus. You can have injuries there to the mucosa. You can have gastritis, inflammation of the stomach, inflammation. Right. An acute gastritis, which would be your inflammatory reaction again. Remember, this is all. It's always a response to injury. So we're having the toxin of ethanol come into the body. And we do have alcohol dehydrogenase, the enzyme actually in the stomach that will start a little bit of the. Will start the process of the breakdown. We don't get a lot of alcohol, ethanol absorbed through the stomach. The vast majority is through the gut, the small intestines. But we do start that absorption. That's why when you take a drink, it can impact you very quickly. You take your drink and woo. Okay, you're starting to feel that disinhibition and so it can happen fast. So gastritis, which of course then you can progress all the way to ulcers. You can drink your way to an ulcer in the stomach. Right. So these types of changes are happening within the esophagus. If you go down the pathway as what we were talking about, when you have a cirrhotic liver, what you can start to see are what we call varices, right, the old esophageal varices and the esophagus, which are the dilated vessels kind of in that more distal part, the more further down part of the esophagus. So when those get very dilated, you're at risk for rupture. So those can rupture just like a gastric ulcer can rupture. And then you could have an acute bleed. And that's very bad. So obviously you're starting, you know, you can have vomiting of blood and you have to go to the emergency room, then GI doctor will come down and tamponade you. Right.
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B
And then alcohol is an increased risk of colon cancer.
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C
Right now we have our cancer risks. Exactly. Gastric cancer, esophageal cancer, colorectal cancer, liver cancer, breast cancer, bladder cancer, the whole thing. Right. So there's many different cancer risks for alcohol intake. And again, going back, because it's a carcinogen. So it's a toxin, it's a carcinogen and it's a teratogen.
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And nobody questions this. That's a fact. And the fact that this is sold legally on every street corner should blow people's minds. But it is well known that it is cancer causing.
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C
My kids ask the same question. My 13 year old says, mom, if this is so bad, why is it legal? So my child is asking these questions, which I'm very happy about that she's questioning that. Right. When a whole aisle in our grocery store, Kelly, is dedicated to this substance that is a triple threat neurotoxin, carcinogen and a teratogen. Right? Fetal alcohol syndrome. So it's a triple. It's a triple.
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B
Goodness gracious. Let's talk about the brain. Let's talk about the brain and alcohol. Because women, if women are afraid of the next thing after Breast cancer, which alcohol is associated with breast cancer risk, too. But the next thing they're scared about is dementia.
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C
That's right.
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B
And if you're scared about dementia, you shouldn't drink alcohol. So what's alcohol do to the brain?
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C
Right. Okay, so alcohol with the brain, lots of changes there, right? Lots of changes. And again, with alcohol, you have two ways that it enters the body. Nutritional deficiencies, which would be your vitamin deficiencies, like thiamine B1, your vitamin B1, and then the toxic injuries, nutritional insult. And then you have the toxin. So up in the brain, let's just first focus on memory. Right? So the blackouts, the memory. So the hippocampus is the part of the brain that's responsible for memory. And we all learn going through medical school, right? The Wernicke Korsakoff pathway. Right. So first you have Wernicke encephalopathy, which then can progress to Korsakoff syndrome.
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D
Right.
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B
But most people don't have Wernicke Korsakoff. Like, that's like end stage. I wanna talk about the housewife who's got the high powered job, has got two kids at home, and just drinks wine a little bit every day. It adds up to an increased risk of dementia. She's not going to get Wernie Korsakoff. I'm not worried about that. Let's talk about dementia and memory loss.
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C
Exactly. But you can go down, of course. Korsakoff dementia is the progression too. So it impacts cerebellum, gray matter, white matter. Right. So over time, the brain gets smaller. So that is something that will happen over time because of the toxic injury.
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B
And your brain will get. Just to clarify, your brain will get smaller. Memory, like your brain's just getting smaller because you're using alcohol.
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C
Right. And you can see these changes on radiology. Right. So you can. You can see this. So if you get a, you know, ct, MRI of the head, you can start to see these types of changes. So you have global atrophy. So loss of gray matter, which are your neurons, the part of the brain that's the most peripheral, outer part, and then the white matter as well. And the white matter in the brain is responsible for the communication. So if you think there are the communication tracks, right, the left hemisphere and the right hemisphere need the ability to talk and communicate and send these types of signals. And so you have the corpus callosum, which is our white matter tracks from left hemisphere to right hemisphere. The. That's all impacted, Kelly. So all these brain cells are getting killed.
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B
I Mean, I just think of, I think of perimenopause and menopause as. So we know that estrogen and testosterone are neuroprotective, they're anti inflammatory. So these protectors are going away. This is a particularly vulnerable time for the brain. If you're going to continue drinking like you used to drink, you've lost your neuroprotective hormones at the same time.
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C
Exactly. So it's a synergistic insult to the brain. So you have a loss of estrogen and now you're throwing in a toxin. So it's a synergistic insult to the brain.
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B
I think that's so helpful. I think people are really gonna start to understand. Cause, you know, like alcohol, we drink it. Cause it makes us feel good. That part we know. We don't know what's happening underneath the hood.
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C
That's exactly Right. We're, we're first. It's a biopsychosocial disease. Right. It's classified in the DSM 5. Right. It's a biopsychosocial social disease. Because that's how we start. It's a social. And we drink because you have disinhibition. You become a little more social at a party. And then as you drink though, you become a little more loud. Right. The, the person who's a little, you know, look it up. They're, they're louder. Right. And, and then you have poor judgment. So these are the things that are impaired. Right.
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B
And what that is is it's brain changes.
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C
Absolutely.
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B
Like, that's why, that's why the personality is changing is because your brain has a drug in it.
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C
The biochemistry of the brain, all those neurotransmitters are all impacted. Ethanol is a gaba A receptor agonist. And that helps to relax you at first, you know, so you, like I said, you feel a little. Disinhibition is more social. So I understand why in the beginning it feels good to drink because of that reason. It allows you to be a little more social. However, you'll end up doing things and saying things that you normally would not do. And this is where it becomes very problematic. Right. You're gonna say something to somebody and that's how you're gonna fracture relationships. And this is where these types of things really add up socially to impact you. But the dependency is certainly because the neurotransmitters are disrupted with the chronic insults that we're talking about. Between the nutritional deficiencies and the toxins entering the brain.
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B
I want to talk about one More thing with alcohol. Erectile dysfunction.
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C
Well, small testicles, right?
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B
Yeah. Low testosterone also.
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C
Yeah.
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B
But also the vascular changes. I mean, there's a great study on they, you know, I think it was in China. They had men stop drinking and the rate of return of erections was profound.
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C
Yeah. So, right. Sexual dysfunction. Absolutely. All of it impairs your sleep. Right. Everything or sleep. So there's, there's nothing good here. Right. So for me, I don't drink. Ironically, my father does. My father's a pathologist and I think we inherited his taste buds because as I think, I'm probably one of the only people on the planet that, that doesn't drink. Kelly. And I'm not a coffee drinker either, so I'm not. Because for me, my taste buds, I don't care for the flavor. To me, it's almost like lemons to me in my taste buds. So I was always in my 20s, you know, going through college at a party. I was always the person that kind of diluted it or I throw it out, you know, to get rid of it, you know, and that's kind of what I'm trying to help my kids because there's so much pressure for the young people. My son is in college now and there's so much pressure for them to drink. And one hospital admission for a college age student puts them at risk for alcohol use disorder, which I thought was interesting. Talking about treatment not to go off but naltrexone. So some of the ER docs in some of these college cities are giving these students naltrexone as kind of, you know, the opioid receptor blocker to help them not get as intoxicated if they feel under the social pressure, which I thought was kind of interesting as a means to kind of try to cope and navigate that peer pressure, that social pressure.
- [19:03]
D
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- [19:31]
B
well, yeah, the other interesting thing, the thing that's increasing is ozempic and the GLP1s people's craving of alcohol is going down. So that's also going to be very interesting to see what happens long term with that. Okay, let's move on. Let's move on. Explain to us on a microscopic pathologic level what inflammation is. We all hear like, oh, our bodies are inflamed. There's lots of inflammation. Inflammation, like, what does inflammation look like? Why should we care? And what do we do about it?
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C
Right? And so, okay, that's actually good. Let's kind of break that down. So for me, if I have a hysterectomy specimen, which would be removal of the uterus, removal, a bilateral salpingo oophorectomy, both ovaries are removed. Hysterectomy, where the uterus and the cervix are removed. So from a pathologist standpoint, we section and we evaluate all the tissue. So we'll take sections of the ovaries, we'll take sections of the endometrium of the cervix, both the endocervix and the ectocervix. Which part of the cervix? That's the outer part and the inner part. For people, kind of just anatomy. So basically, the job behind the scenes is to evaluate the tissue thoroughly, make sure nothing is hiding or lurking in those tissues, and to identify the main reason for why that tissue was removed, whether it's a leomyoma, meaning a fibroid uterus, which is one of the most common reasons why women would have a hysterectomy a little bit later on. So we evaluate it, and when we look at it, I'll report it out as the vast majority, Kelly, have some type of inflammation. The older the patient is, I'll say acute and chronic cervicitis. What does that mean? What that means from my end that I see is the inflammatory response has come in to those tissues and infiltrated. So I will see the neutrophils, which is the acute inflammatory response. I'll see the lymphocytes, and what I'll see is tissue destruction.
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B
Why is it happening and is it inevitable with aging?
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C
Well, with estrogen loss is a humongous contributor. Okay, that is a huge, huge contributor. And that's why I say I will validate any woman that comes in complaining of pain.
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B
God, why can't we measure, like, why can't we measure that?
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C
Thank you. I can't tell you. Thank you. Right.
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B
Why can't we do a test and say, like, your estrogen is this. That means Your inflammation is this. And why can't we watch it change when we give women estrogen? Like, is that in the works?
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C
Well, for us, we don't like, I'll say mild, I can use it as degrees, mild, moderate, severe. But the tissue's already out. I would have to have a secondary tissue. Right. So if I, if I already have the whole cervix, I'm done. Right, Right. So but there's other tissues. But certainly for gastric biopsies, obviously, yes, you get, you know, acute and chronic gastritis, treat her. What's the follow up? So, yes, I mean, our gastroenterologists are absolutely doing that as they're treating, you know, acute and chronic gastritis with our proton pump inhibitors. Or is it Helicobacter pylori gastritis? What is the issue at hand? But inflammation is so linked to estrogen. And so what's interesting, cause I'm sitting there thinking to myself, why I'm seeing all of these inflamed tissues and what are we doing about it? And comparing that if I have a younger patient where she may get something removed for whatever reason, a benign cyst, ovary, benign cyst, endometriosis or something like that. Right. Then I'll also evaluate and I will see this inflammatory response as well. But if I have to compare a younger patient specimen to a midlife woman specimen, the inflammation, the difference in the inflammation is there. I mean, it's there.
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B
And that usually, it's not just usually in using a hysterectomy example, but like that's also in her blood vessels, that's also in her heart, that's also in her brain. Usually not localized.
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C
Absolutely, absolutely 100%. All tissues, your bladder, biopsies galore. Right.
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B
There's so much, there's so much inflamed bladder in postmenopausal women. And it's hardly in the published studies. It's never talked about in residencies. Like their bladders are driving them nuts. So I tell them it's like bladder arthritis as a way to explain it to people. I usually get them better with vaginal estrogen, of course, but like an anti inflammatory diet, like, and people will come back and they'll be like, my skin's better, my joint aches and pains don't hurt as much. Like there's something to that I have
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C
to agree on 100%. And I love in your book, Kelly, where you say that the vaginal estrogen cream should be part of routine. Right. Here's your mammogram here's your colonoscopy, and here's your vaginal topical estrogen cream. I don't know why that is such a difficult.
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B
Because Western medicine doesn't. We're not preventative health people. We treat disease.
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C
Right. That mindset has got to change.
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B
Is there a good blood test for inflammation? Like, there's C reactive protein. Can you watch C reactive protein go down when you put people on hormones? I don't know.
- [24:38]
C
Yeah, I don't know is. I don't know. That's a good. That would be a very interesting study to do. Right. We know, basically, even if we don't have that research, we already know by how patients just feel better.
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B
Thank you for the words of wisdom. It's like, let's just. Let's just use the tools we have, ask them how they feel.
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C
Right, Exactly. If we have somebody that's reporting that they're feeling better, we know that. But I want to go back to. I want to go back to talking about atrophic mucosa in the vulva, in the vagina, on the cervix. Okay. And that relates to what I would see on a Pap smear. Now, we don't do. We don't do Pap smears for vaginal atrophy, but I will see biopsies looking for another lesion, vaginal intraepithelial neoplasia, you know, looking for dysplasia, hpv, lichen sclerosis, these types of other types of diseases where you want to rule out something or Bartholin cyst or what have you. So there's a lot of other different pathologies that somebody would get. A vulva biopsy, a vaginal mucosa biopsy. What I want to make the point is when I see it in a midlife woman or older that she's not on estrogen cream. The mucosa is very, very thin, Kelly. Very thin. You're down to the basal layer. Parabasal cells up there. Okay? We're talking the squamous epithelium, the mucosa of the vulva, the mucosa of the vagina and the ectocervix, which is the outer portion of the cervix, are all lined by squamous epithelium, which is what our skin is. Right. This is squamous epithelium. We want that to be nice and thick as much as we can. And it is estrogen that keeps that mucosa that you all are talking about nice and thick, which is what we Want, Right? Protective. Protective, protective. So all those issues with sex, the micro tears that you talk about, all this with the infections and the bad bacteria, they can penetrate much easier when that mucosa is very thin down to that basal layer, which is what I'll see on a Pap smear when our obgyns will scrape the cervix. Right? We wanna get both parts, the ectocervix and the endocervix on the Pap smears. But that's what I'll see. I'll see basal cells and I'll see inflammation and I'll see. Rarely will I see a full bloomed. If you will, a full bloomed squamous epithelial cell, which is the very top layer, the most superficial layer, where that matures, right. You have maturation from the lower cells to the upper cells and the squamous epithelium. So when someone comes on estrogen, and it's a beautiful sight for a pathologist. Okay? This is a beautiful thing for me, and I love that when I see it. I would love it if I get a Pap smear. Kelly. I get a Pap smear and I can't tell if the patient is 22 or is she 66. I should be our goal that if I see a Pap smear, you can fool me. You can fool me. So I can't tell if you're 22 or if you're 65. Why? Because I'll have all those beautiful big. We call them aryngophilic squamous epithelial cells on our Pap smears.
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B
So it looks. It looks healthy. It doesn't have inflammation in it. You know that she's protected from injury a lot better.
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C
Absolutely. She's going to feel so much better. And that's what I would love to see. So it kills me when I hear you guys trying to help get this to be the standard of care. Okay? I'm back here looking at this, and I'm looking at some of this stuff, and I'm just shaking my head sometimes going, why is this not the standard of care?
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B
Yeah, because, I mean, you have such a unique view because you can literally see it under the microscope with the
- [28:28]
C
inflammation that I'm seeing with these thin, thin mucosas. I'm looking at that when I get it, and I'm looking at slide after slide after slide, and. And I see thin, thin, thin on every section. I'm thinking, this poor woman. How many years has she been like this? Kelly? How many years? If she's 68. How many years has she been living like this? What was her marriage like? How many urinary tract infections has she possibly had? And the list goes on and on, which you all elegantly talk about.
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B
I love it. It's so unique. So I'm shifting for a second to the men. I have a friend who's a surgeon, can tell the quality of the bones after a certain age in men if they're on testosterone or not. Do you believe it?
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D
Oh, yeah.
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C
Oh, yes. Okay, you're talking about a physical exam, right? You're talking about their weight, the way they move, the gait, the agility, everything.
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B
He's talking about like cutting on bone.
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C
Oh, yeah. Orthopedic. Yeah, of course. Oh, okay. Don't even get me started on the bone, okay?
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B
I want to get you started on the bone.
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C
All those hip fractures, all those shoulder surgeries, all those knee replacement surgeries, okay? All the bones that are removed from the patients. And again, this is where pathology comes in, because nobody really thinks about, where's my specimen, Right? Where'd my femoral head go? Where'd all the knee bones go? Where's my shoulder?
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B
Right?
- [29:51]
C
Where's my humerus? So I see all of that, right? So we gross that in. The specimens get dropped in formalin in the container. Patient doesn't think about it. They never think about it later, right? So we gross it in. In pathology, just so folks kind of understand what we do in the background. It is embedded in wax. So once we cut it up into small little pieces, the tissue is actually embedded in wax. Paraffin. And we cut it very thin, and that's how we evaluate it on the microscope. But now, talking about bones, osteopenia to osteoporosis, we'll sign it out as degenerative joint disease, right? So I'll say left hip arthroplasty, degenerative joint disease. Now, I see the surface of the femoral head with all that cartilage that's stripped away. We call it ebronation, right? Ebonation of that femoral head. All that cartilage is wiped out, destroyed. The bony trabeculae are thin, and a lot of them, of course, with the fracture, we'll see inside the bony trabeculae. Hemorrhage, right? We'll see all the fracture. And again, all the process of the bone was attempting to heal. And at what point do we get the specimen. But we'll see it. We see the avascular necrosis of the hip. So all again, here we go, what are we doing to prevent this progression? When we know that there's a lot that we can do to prevent these horrific hip fractures that keep our midlife and elder women or senior women in the hospital, Then they go to the rehab center. They're frail. I've had at least two, if not more of my mother's friends that I've kind of ushered through the system and have been with them at the bedside and just witnessed their frailty where I've sat and fed them too. Kelly. Right? Fed them, and they're not able to fully chew. I had some green beans. I was feeding one of my mother's dear friends, and the food bolus is getting caught in her cheek. And so I thought, there's nobody there. I'm doing that, right? I'm working and I'm sitting there spending time with her, helping her feed the nutrition that she needs to heal her body. It's not happening. And, you know, the nurses don't have time. Right? Nobody has time to sit and really work with these patients in the manner really that they should be. I always say, if you're volunteer in the hospital, we need feeders. We should go around and have feeders. Sounds like so basic, Kelly, but time that we should with the patients. So this issue of the hip fractures, that knee joint replacements, the shoulders, all this, we're not doing a good job with that at all.
- [32:33]
B
But I want people to understand and you know, from your pathology view, like, you don't just turn 80 and break a hip. That's years and years and years of that bone declining.
- [32:47]
C
That's exactly right. And so we need to get it early. We need to get that early 30s, 20s, start working on building up our bone reserve, our muscle reserve. And I think I heard. I forget who it was. One of you all talking about the DEXA bone scan. Not getting that until the age of 65.
- [33:08]
B
Yeah, 15 years after menopause.
- [33:10]
C
I was gonna say malpractice, but we'll be kinder.
- [33:14]
B
We'll be kinder and call it insanity.
- [33:16]
C
I don't wanna go that. But like I said, it kills me when I. And I, you know, every day, intramedullary hemorrhage with fracture. Intramedullary hemorrhage with fracture. That's how I sign out the cases, right, Kelly? It's so common. It's a daily basis. This is a daily, daily, daily basis that we need to do something about it. One in two women have a fracture, a hip fracture. Getting over a hip fracture is a very Long, brutal process that can have poor outcomes. As we know, we used the old phrase, fall down, break a hip and die. That's kind of as our old, you know, medical school, I'm sure you guys used to. Or residency is how kind of our old phrase. Those of us that train through conventional programs here in the US but like I said, I look at some of these changes under the microscope, and I said, I've got to start talking about it. I, too, I feel like I've got to start talking about osteoporosis. I have to talk about the fractures that I see, the cartilage stripped away, and what in the world can we start to do about it? To take on these preventative measures, you gotta start with estrogen. You have to be able to chew. Kelly, this is where kind of I came in with the head and neck. One of the areas I think, too, that we're really overlooking is the head and neck region. The head and neck region, right? We all kind of know our area, right? We're all kind of focused in our area, you know, urology or orthopedic surgery. So we kind of, you know, as our careers go, we kind of, you know, the focus kind of narrows, right? And we kind of know what we know in our little niche, right? But for me, like I said, kind of going through my little personal health journey with allergies and breathing and going down the pathway of mouth breathing.
- [34:56]
D
Right?
- [34:56]
C
And snoring at night, and my hemoglobin A went up. I have horrific allergies. I have. I had. I just got my lab work back. I have, finally, the first time, I think, probably in 20 years, I have a normal, complete lab work. And I'm so excited about it because I did it all with breathing back through the nose, right on ht, right. All my good supplements that I take. And it paid off. So all this effort paid off.
- [35:26]
B
I think that's so important. It's so important because people think when their doctor says, you have osteoporosis, you have high cholesterol, you have allergies, people think it's a fixed state. And we were taught that way. This person has this. And then you always have it. Anxiety, depression, it's a fixed state. You will always have it. And we need more voices to be like, our health can change based upon things we do.
- [35:50]
C
Absolutely. We can change these things. And it begins with education, awareness, right? First it's education, first it's awareness. Then you kind of have to do a little self evaluation. What is going on with me? What are my habits during the day? Am I really lifting weights? What am I eating? You know, all that, all that inventory, all the personal inventory that we all have to do. Right?
- [36:09]
B
My really. Lifting weights, Right, exactly.
- [36:12]
C
Right. I know, I know, right? Five pounds. Don't get it. All right, I'm up. I'm doing 25. I'm doing 25 now. Okay. So all this, we have to kind of look at it. So that's where I kind of came in with this head and neck region. And I went down this whole journey of mouth breathing, snoring, sleep related breathing disorders, snoring leading to obstructive sleep apnea. What's going on here? And oxygenation. Right. Are we getting enough REM sleep at night? We're not. We are society. We know that OSA is our big epidemic now. So the big epidemics. OSA obstructs sleep apnea, where so many people are on cpap.
- [36:49]
D
Right.
- [36:50]
C
I'm seeing CPAP stores pop up on the corners of every street. Do you have a CPAP store near you and the dialysis center?
- [36:58]
B
You're in Florida, so.
- [36:59]
C
Yeah, yeah. So I got their CPAP on a major street here. Right. And I have two family members on cpap. Do you have anybody on. In your family on cpap? Do you have. No. Okay. Shock. I'm surprised to hear that.
- [37:12]
B
They're probably just undiagnosed, my friend.
- [37:14]
C
Undiagnosed. Exactly. Exactly. There you go. Undiagnosed, which is the vast majority of people, right? So anyway, so I started doing my little. I started doing some of these types of exercises to help me retrain my swallow, get my tongue strong enough where I can have it up on my palate where it needs to be and making these types of changes. And so I was doing some of the exercises, and we see these exercises in ptot, right? Physical therapy, occupational therapy, myofunctional therapy, speech and language pathology. A lot of these different disciplines that support rehab medicine. Right. Our physical rehab medicine floors, too, are doing these types of exercises to strengthen. So you have a strong swallow. So I started doing all this, and I was able to change Kelly from mouth breathing to nasal breathing. Now I still do my nasal saline flushes. That was another addition. My ENT friends got me doing those with head colds because I was having. I have frequent head colds. People who have allergies have many more head colds, and those with asthma are at much more risk for snoring, mouth breathing, and heading down that bad health pathway of obstructive sleep apnea. And all the bad things that come with obstructive sleep apnea. I mean, which comes first, the chicken or the egg? Right? Obesity or osa? Or is it because you're snoring? OSA is causing the obesity. And the more I kind of am digging into this, these are areas that I think we're really overlooking is this head and neck region tying it in with everything that we want to accomplish in the body. Building the bone, building the muscle. We've got to keep this area strong. And we need to be nasal breathing.
- [38:56]
D
We're.
- [38:56]
C
The nose has our function, right? Filters air, right? Gets all the bad stuff. That's what the function of our nasal hairs are in our nose warms the air, humidifies the air, nitric oxide is produced. All these good, wonderful functions of the nose that the mouth does not do. We are obligate nasal breathers. So I think that this is really an area that I think that we really should emphasize, too, and that these changes of muscle atrophy and tongue weakness with dysphagia, we don't want oral frailty. We don't want sarcopenic oral changes going on here, right? And so. But. So this is where I started to do my. That's how I ended up creating my little product that I created, the little beauty balloon. Your triangle of youth.
- [39:45]
B
You have to market it to men, too.
- [39:47]
C
Yes, exactly.
- [39:48]
B
You need to change the color and market it to men, too, because they've got sleep apnea.
- [39:52]
C
Also, I wanted to bring it to women first because I feel like sometimes I feel like midlife women and our senior women are kind of left out, kind of overlooked. And I'm very pro women. I love to see women in leadership. I want to support women as much as I can. And so I thought when I was doing this, because I have to make different sizes, I had to make a little bit larger size for a male if I roll it out for men, and of course, in due time. But that's what I created. I created these two tools that work to help really strengthen the tongue. And like I said, it's called beauty balloon. So if anybody wants to follow, it's your triangle of youth is what I'm doing. And so we'll be talking about oropharyngeal dysphagia. We'll be talking about snoring and obstructive sleep apnea, all the health issues that come with mouth breathing. And the other thing, Kelly, this is really interesting, too, that needs to be touched upon, that how it can change your facial features. Use different muscles when you nasal breathe versus when you mouth breathe. When you mouth breathe, you're engaging much higher areas of the lungs, the scalene muscles, right. Which attach for the spine to the upper parts of the ribs. So you're engaging different muscles than when you nasal breathe, which is the deeper part of the lung, so you're able to oxygenate better. So there's different muscles that are used depending on what you predominantly breathe with. Right. And plus just all the previous issues with breathing through the nose. So so many benefits. And if you're snoring, you're going to grow a weak tongue. Cause it's a low resting position. So I would like to hear more people talk about the link of snoring to dysphagia. We all know, we all walk our rehab floors, our nursing homes, greater than 50% of our nursing home population has some form of oropharyngeal dysphagia, weak tongue. And so we see that with. They look like they're a sloppy eater, right? A little bit of drooling or food on the mouth. It's not because they became a sloppy eater. Or in our little ones, when they have all that food around, the little ones are forming those motor neuron connections. The older ones, it's because of weakening of the muscles, atrophy and the snoring in the open mouth position. So we need to keep all this tight and strong and functioning well. And the biggie, biggie, biggie. Risk aspiration. Why do we care. Why do we care about a weak tongue? Risk of aspiration. The weak tongue obviously sets you up for that. And you're not able to eat what we want people to eat. Protein. In order to eat protein, you have to have a really good swallow pattern, right? You don't want it to feel it getting stuck in the back of your throat. Cause that's one of the things that someone will complain about. And it's very insidious. These changes are very insidious. Just like osteoporosis. Kelly, you think you're doing great. You think you're walking. I'm carrying my groceries, I'm walking to my car. My activities of daily living are fine. I'm good. And then you slip and fall and you break your hip, right? Boom. How do you gauge that? Right. And remember too, about tongue strength and hand grip strength. Sign of frailty, right? Grip strength, tongue strength. You can objectively measure tongue strength. I'd love to see that more and more on our floors. And that's what keeps patients in the hospital. They don't come out of the rehab floors because of risk for aspiration. As a pathologist, this is why I'm, I kind of put it all in my brain as I see this. I get so many specimens from our pulmonologists rule out aspiration pneumonia. So what I see on the slide again, inflammation galore. I'll see it. And then, of course, the cells that line the airway. And I'm looking for microscopic little pieces of food. And I will see it. I'll see a little bit of piece of vegetable matter.
- [43:38]
B
Cheerio,
- [43:42]
C
Cheerio. I'll see a little striated muscle. So I will see that on the microscope. But it is the risk of aspiration that really sets a patient up for something very serious. Of course. And these can be silent. You can have silent aspiration, and these can be challenging to diagnose. So part of my preventative prevention for frailty is keeping this area strong.
- [44:05]
B
I love that. Let's wrap it up with a big picture takeaway. As a pathologist and innovator, what's one message you want people to take away about their health, beauty, lifestyle choices, and prevention?
- [44:18]
C
It's a head to toe process. Don't leave out the areas from the clavicle and up in the head and neck region. You need to focus on really think about everything that you can do from the head all the way down to the toe. Everything is connected, everything is related. What you do in one part of the body can impact what you do in another part of the body. And I will tell you, Kelly, it has taken my whole career to truly see that simple concept. I mean, it sounds like a simple concept, but it is so important. You have to think about the whole system, the whole body. And I love some of the holistic medicine that I think Dr. Mann is bringing in, too, with some of her breast cancer patients, too, which is wonderful to see. So every day makes a difference. Doing little steps every day to make that change. So it's head to toe. It's head to toe.
- [45:13]
B
Thank you for your insight. Super unique perspective on aging. Inflammation, the role of hormones. Thank you so much for joining us today.
- [45:21]
C
Alcohol, Kelly, and our.
- [45:23]
B
And yeah, well, no amount is a safe amount.
- [45:25]
C
This is. I was going to show people. This is what I was going to show.
- [45:28]
B
Okay, show us, show us. For the video podcast. She's showing a very full. A very full glass of wine.
- [45:34]
C
So that's five ounces and a wine glass. I was going to show these. That's five ounces.
- [45:40]
B
Yeah. So the point for the people who can't see you're drinking way more than you think you are.
- [45:44]
C
Yes, exactly. And that's the point. Exactly, exactly.
- [45:47]
B
Right.
- [45:47]
C
This is a 16 ounce glass and this is 5 ounces. So that's all you get.
- [45:51]
B
Yeah, it looks like a low pour. All right, my friend, thank you for joining us today.
- [45:58]
C
Thanks Kelly.
- [46:00]
A
Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the Master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests including on this podcast are not giving individual medical advice or practicing medicine. See it in consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.