← You Are Not Broken
Loading summary
Transcript119 lines
- [00:04]
A
Welcome to youo Are Not Broken. The podcast that challenges everything we've been taught about midlife hormones and sexuality. I'm Dr. Kelly Casperson, board certified urologist, author, and a leading voice in women's sexual and hormone health. Enjoy the show.
- [00:17]
B
Hey, everybody. Welcome back to the you Are Not Broken podcast. I have. This is like the most long overdue competition to have Dr. Elizabeth Komen on this podcast. Because broken, by no fault of her, I've had to reschedule like multiple times. So welcome finally to the youe're Not Broken podcast. Dr. Elizabeth Cohen.
- [00:33]
C
Thrilled to be here. You're a busy lady, but we made it work.
- [00:35]
B
Between you and me, we're busy people. So you are a practicing oncologist in New York City, nyu. And you wrote a very popular book that everybody loved. And I loved it. I took a while to read it, then I like read it in a weekend. Cause it was so effing good. And it's called All In Her Head. And it's phenomenal. And it's about the history. For anybody who likes the history of medicine, it's a very good history book. And it also gets you a little pissed if you thought like, maybe things aren't equal in healthcare between the genders. If you ever thought that, this book proves it.
- [01:08]
C
Thank you. I really appreciate your endorsement.
- [01:11]
B
It's phenomenal. And you have a. You. I'm gonna get it wrong, but your undergrad was in history or history of medicine. This book's been coming right, this.
- [01:20]
C
I've always wanted to do this. So I majored in the history of science at Harvard, which became really the history of medic. And for me, I really was. I knew I wanted to be a doctor, but I was always fascinated by the culture, the religious influences, the societal influences on science. And if you think about even just the COVID vaccine or Covid, nothing happens in a vacuum. Science does not happen in a vacuum. But we can tend to think that it's this objective pursuit of truth, which it's not. It's influenced by the people who have the seat at the table, those who have the instruments, the tools, the power, the money, and the questions that can be answered. And for me, I always was fascinated by women's health. In particular, I became a breast oncologist. And over time taking care of women. I really was overwhelmed by just the gaps in our healthcare. And I wanted to understand them better. And this was my way to do it.
- [02:12]
B
I've written two books, which is insane. Cause I'm still like. I'm like Do I even identify with the word author? But I have two under my belt, so I feel like I could be like, I understand it takes a lot of work to write a book, but your book is so fact after fact after history after story. Like, this thing is packed with receipts.
- [02:32]
C
Well, initially, when I thought I wanted to write, well, when I was talking to an agent, they thought, would you just want to write about breast health or breast cancer? And I said, absolutely not. I don't want to write the. Here are the five things that you need to know to optimize. Like, that's been done. I really wanted to write an intellectual book that was accessible, that would show the things that I was learning by looking back at, you know, 17th century medical records or looking at an Egyptian mummy who had evidence of urinary incontinence. How long have these embedded narratives been in Women's health? So the book has over 800 citations. I loved every historical rabbit hole I went into. And there were all these women along the way that I felt like I could identify with. Like the women that were thrown in asylums for having too high sex drives and reading, wrote romance novels and died in Worcester, Massachusetts. Like, that could have been me. That could have been me if I were just born in a different era, or I could have been a witch burned at the stake. And I wanted to really show a broader audience that history is accessible and that it's not only accessible, but really necessary to understand the legacy that we inherit when we go to the doctor's office, whether we're showing up as a doctor, a healthcare provider, or as a patient. And for me, it was just such a joy and gift to be able to have the time to do it.
- [03:44]
B
I think you are the absolute right person to write this book. Your history, the educational pathway you went on, the perspective you bring as a female who is a female physician in the system. There was nobody else who could write this book as well as you did.
- [03:59]
C
Well, I think there are other people who could do it, but I think for me, that it became sort of not a formula, but thinking about, okay, what are the diagnoses that we think of today? Or just the syndromes? Because there are certain conditions that affect women that we just call syndrome, because no one even has labeled it a diagnosis, and saying, well, where did it start? Who are the people that labeled it? What did they say about the patients who had it? And who were the stakeholders? And then it just got wilder and wilder and wilder. Like the number of times male physicians referred as females masturbating as being the problem for all their ills. When did this happen? Why did this happen? Why do we care so much what people are doing in private spaces? And no, it doesn't cause your scoliosis or asthma, but there were a lot of people that thought it did.
- [04:41]
B
Insane. I mean, Freud said, and this is based upon his religion, right? So his religion teachings, his education teachings, the time of the times is that a vaginal orgasm is adult, the clitoral orgasm is juvenile. And then the surgeons, before this is before antibiotics were invented, the surgeons would try to take the clitoris and move it closer to the vagina because even then they knew, like, hey, this is where the orgasm comes from. Let's put it closer to the vagina so that when you put something in the vagina, you have an orgasm so you're more adult. Like the surgery reflected Freud, which reflected his community and his beliefs. And people died. When you have surgery without antibiotics and.
- [05:23]
C
There were famous people who had this surgery, can you imagine being so shamed about the way that you find pleasure that you think that you have to completely change your anatomy in a gruesome, potentially mortality causing way simply to have pleasure that you could, that you already knew you could have? It's tragic.
- [05:41]
B
Yes, absolutely. And for people who think like, we don't do that now, we're better than that now. Oh, really? So like small butts were in and now big butts are in. So now we have surgeries for big butts. And we don't know what normal genitalia looks like because our body parts are banned from the Internet. So now we have a massive booming industry cutting labia off.
- [06:02]
C
Yeah. So the first chapter of my book talks about the history of plastic surgery and this whole idea of what we are calling normal in the Barbie vagina. And yet when I was in medical school, I mean, and I'm certain today as well, you don't see anatomical variety because there is this assumption, is it voyeuristic? Are you looking at too much? Right. And so we haven't really. We don't leave anybody with anything other than porn. And it's really terrifying. And so when somebody asks, am I normal? What training have they had apart from maybe two to three weeks on a gynecology rotation? Is that really enough?
- [06:39]
B
Yeah. And who gets to be the author of normal? Is it a porn star? Is it a plastic surgeon who's profiting, Right. Is it somebody who's profiting off of saying what normal is? I want people to wake up because I just see it so much now I'm like, you guys, we're doing the same thing that they did in Freud. We're no better. We're changing what we think is attractive, and people are profiting off of it because of lack of education about. By women, about their bodies.
- [07:08]
C
But you're doing it, so thank you.
- [07:09]
B
Trying. I named the podcast you are not broken. I hope people understand that they're not broken.
- [07:15]
C
You're doing great. It's amazing. You've caused a revolution. It's awesome.
- [07:18]
B
Thank you. Yeah, it's super fun to be here. But also, I mean, we were talking before recording. Like, it's crazy to me that, like, it's crazy to me that your book, as excellent as it is, created such a storm because people are like, oh, women are treated differently in medicine. And you're like. You're like, really? Nobody sees this. And I'm like, I'm famous because of perimenopause. Like, really?
- [07:41]
C
Well, the interesting thing in my world is breast cancer is actually a relative success story in terms of women's health. Right. Obviously, we have so far to go, but when you look at the landscape of how we treat breast cancer outcomes, mortality has significantly declined. So when I initially told some of my mentors I really want to write about disparities in women's health, they're thinking, well, but look at what we've done for breast cancer and even philanthropy. You have these groundswells of people donating, and people are behind this. And I said, there's a lot more that we see when we take care of breast cancer patients, because it's certainly not just the biology of their breast cancer, but they could have ms, they could have a family member with Alzheimer's and worry about what estrogen deprivation might do for them. They could have a sports injury. They could be more at risk for heart disease. What are these other things that we're doing to take care of women outside just the biology of their breast cancer or, for God's sakes, their sexual health? I mean, majority of academic centers do not have a sexual health program for women in any capacity, let alone cancer survivors. But you can be damn sure if you've been diagnosed with prostate cancer, one of the first things, and you probably know this better than anybody else, they're going to talk to their patients about their erectile dysfunction, their sexual function, because God knows that's important.
- [08:52]
B
Yeah. If you don't talk about it, it can be held against you as failure of informed consent.
- [08:58]
C
I did not know this.
- [08:59]
B
Yes.
- [09:00]
C
And yet we effectively castrate so many women with breast cancer. Right. Through hormonal manipulation that is necessary for their treatment, and yet it's a failure.
- [09:10]
B
Of informed consent because you can't hold that to be true for the men and not hold that to be true for the women. And did you also. I mean, you probably know this. You know that there's no female word for castration. Well, fuck it.
- [09:22]
C
What is that? I had no idea.
- [09:24]
B
Yeah, so castration is technically the removal of male gonads. It came from, like, you know, farming when we castrate sheep and all the things. And so it's technically the removal of male gonads. So you're like, what's the word for removal of female gonads? There isn't a word.
- [09:41]
C
I had no idea.
- [09:42]
B
Right. Book two.
- [09:43]
C
Book two, yeah. That's for you. That's your third book.
- [09:49]
A
Like.
- [09:50]
B
Yeah, because we're like, should we just call this castration? Like, it's removal of gonads? Because I think, you know, especially getting into the menopause conversation of, like, the miseducation of it, of, like, it's hot flashes and you can't get pregnant anymore. Those are the symptoms of what's happening. It's not. That's not actually what's happening. And that lack of education and misinformation for women, they're like, oh, it's just a hot flash. I'll tough it out. Like, no, no, no, it's no more hormones. And people don't know that.
- [10:20]
C
And not to sidetrack and be very specific about breast cancer, but there's a lot of misinformation about certain drugs that we use to treat breast cancer. Some truly do suppress your estrogen levels. Sometimes we are giving shots that shut down ovarian function. And on top of that, we're lowering circulating estrogen levels with medication. But a drug like tamoxifen is not causing menopause. It's causing menopausal symptoms. Symptoms, but it's not actually causing menopause. And there's a lot of misinformation there.
- [10:48]
B
Yeah. If you are diagnosed with stage one breast cancer, survival right now is like 90, 95%.
- [10:55]
C
Yeah. I mean, survival from early stage breast cancer is excellent. There are different subtypes of breast cancer. They have different receptors and things that. That help trigger the growth of the cancer. And it depends a little bit by subtype. But this is why early detection is so critical, because the earlier we detect a cancer, not only is your survival higher, ideally, but it also means less invasive treatment, less likely to need a disfiguring surgery, less likely to need chemotherapy. And you know, that's why we really try to make sure that women are getting the appropriate screening that they need. Not just by age, but by personal risk factors. If they have a strong family history, for example.
- [11:29]
B
Yeah, but with one of the, and I can't remember these calculators. One of the calculators.
- [11:34]
A
This show is sponsored by MIDI Health. When we experience perimenopause, menopause and midlife issues, we feel unheard, dismissed and unserved by the traditional healthcare industry. And here's the powerful truth. It's time for a change. It's time for miti. MITI is not just a healthcare provider. It's a woman's telehealth clinic founded and supported by world class leaders in women's health. MITI is leading the way by providing expert personalized insurance covered virtual health care for women in midlife. Empowering us to thrive and experience our second act with vitality and confidence. Ready to feel your best and, and write your second act script. Visit joinmitty.com today to book your personalized insurance covered virtual visit. That's joinmitty.com MIDI the Care Women deserve. Now back to the show.
- [12:25]
C
Yes. Breast cancer risk assessment tool.
- [12:27]
B
Yeah, one of them makes you put in if you're on hormones or not. And my understanding is it's using old data and it actually puts you at higher risk if you say you're on hormones. And so I know there's a big push to cruziac something. Tyler.
- [12:40]
C
Tyler, Tyra Cusick.
- [12:41]
B
Tyler has a button for if you're on hormones or not and it increases your risk if you're on hormones. And so we need to figure out who's behind that calculator to be like what papers are you actually using to make these women seem higher risk when they choose to take hormone therapy.
- [12:58]
C
I need to fact check that. I was not aware that it's on there.
- [13:01]
B
Well, Lupi, Corinne, men is in on this conversation because women are getting the memo of assess your risk, blah blah, blah.
- [13:11]
C
Yes. Have you ever, have you ever used hormone replacement therapy? It is part of the tyrekusic so I should have known that. I spent most of my fellowship actually I was very interested early on in hereditary genetics and I did those calculations for hundreds and hundreds of families. That just shows you how long ago it was. Although botox has worked.
- [13:30]
B
I had a woman who her mom had breast cancer young and I said do you want because my understanding, again, I'm not an oncologist but my understanding is, like, if you wanted to get tested for breast cancer, 1 BRCA 2 that's your choice. And you're right. Correct.
- [13:44]
C
So the interesting thing is, is that historically we thought the main genes were BRCA1 and BRCA2. Those are the first genes, or BRCA1 BRCA2, that we found to be associated in some families with very strong hereditary risk. Now, there's a much bigger panel. Many, many, many, many genes from different companies that you can have tested through your doctor to look if you had an inherited risk of breast cancer or other types of cancers. Remember, you get half your genes from your mom, half your genes from your dad. So if you have any family history of cancer, you really need to talk to your doctor about what genetic screening could be appropriate for you. Sometimes it's covered by insurance, depending on your family history, and sometimes it's not. But there are some affordable companies, relatively affordable, that you can work through online. Spit in a tube. It's analyzed by a team of doctors. And that's another way because maybe.
- [14:34]
B
Maybe because she. I was seeing this patient, and she's like, oh, they wouldn't let me get genetic testing. And I'm like, did she misinterpret? Insurance isn't covering this. Because I'm like. I'm like, I'm pretty sure you can. Anybody can. I want to make sure people have that knowledge. Like, anybody at any time can get their genes tested.
- [14:51]
C
It just may not be covered by insurance, and you may have to pay out of pocket for it. Correct.
- [14:56]
B
But that's very different than I can't.
- [14:58]
C
Yes, you should be able to. Correct.
- [15:01]
B
Let's jump quickly to Chat, GTP and AI so, because right before we started recording, you were telling me about your recent conversation with ChatGPT about can breast cancer survivors use vaginal estrogen.
- [15:13]
C
ChatGPT and I are going through a break. It's been very traumatic. I. I don't want to say who broke up with who, but I was looking at something else for ChatGPT and it tried to tell me that breast cancer patients cannot use intravaginal estrogen, which is not the case. And I will tell you. So I was at Memorial Sloan Kettering before I moved to NYU, and one of my colleagues, Dr. Sherry Goldfarb, did a lot of this work with breast cancer patients and vagifen, showing that, if anything, the absorption is very, very minimal, that it is safe in breast cancer patients, that it's something that you should talk to your doctor about if you have any symptoms at all. I Treat patients very young and very old and everything in between. And many of them have significant. I don't need to tell you this. Significant impact on their quality of life that could dramatically be improved by intravaginal estrogen. And ChatGPT is apparently not up to speed.
- [16:06]
B
Don't you know what we did last year? We got the boxed warning removed off of estrogen because the data was wrong.
- [16:11]
C
I said, I said that. I said, then why was the Black label removed? ChatGPT. And then it says old warning was based on outdated science. Yes. So why are you not with this, the evidence, my friend.
- [16:23]
B
I know what I'm learning. The more I'm learning about AI.
- [16:26]
C
It's terrible in bed, but terrible. ChatGPT doesn't know how to do anything.
- [16:31]
B
It's not actually a great search engine. And it's only. And it does a lot of, like, validation bias, right? Like, it'll kind of tell you what you want to hear, which in this case, it told you not what you wanted to hear. But I asked, I asked Chat GTP to write me an email introducing two people. They said, Introduce Susie to Dr. Carlson. Whatever. Chat GTP made Dr. Carlson a man in my email. So it assumed male gender for the doctor. And I was like, it's just a reminder, Chad. GTP is only as good as the people who programmed it.
- [17:03]
C
I'm going to do that afterwards. We're going to test ChatGPT for its.
- [17:07]
B
And I was like. And so I asked Chad, I'm like, chat, why did you assume this doctor was male? And it's like, oh, my. You know, my bad. And I was like, oh, you're only as good as the. As the people who made you. I'm so sorry. So I'm thinking in any cancer treatment, not just breast cancer, I think breast cancer gets the loudest voice for the damage because of the castration and the low hormones, the sexual dysfunction. But people spend time, money, medications on trying to preserve hair follicles during chemo. And they call it pre treatment, right? And you're like, well, you can live without hair, but it's a quality of life issue. It's a body image issue. It's not gonna extend your life, but it's worth it for quality of life issues. Why are we not doing pretreatment for pelvic health, for bladder health, for vaginal health with vaginal estrogen?
- [17:58]
C
I think that's a very good question.
- [17:59]
B
Why don't we have pre treatment pelvic health protocols?
- [18:02]
C
Oh, well, I mean, you know, how much, how little Space. I have three children. I never even knew what pelvic floor PT was. How is that possible? How is that possible? Right. I think you make a very interesting case for that. But the other thing is that even the story of women and hair loss has taken forever. It's only. Only in New York's. I don't know about other states, but only as of this year is that covered by insurance. The cold capping for hair loss. Right. If that had been something that I think men acutely suffered from in the same way that women may had the same stigma, I think it would have been covered far earlier by insurance companies. So we are even. Even in that aesthetic realm, far behind. But you make a very interesting point. Point about why. Why are we not preemptively thinking about these things for women and waiting them. Waiting for them to be uncomfortable and in pain before we preemptively treat it.
- [18:54]
B
In my experience. And I think a lot of experts who treat GSM will say the same thing is when it's bad, it's a lot harder to undo the damage.
- [19:05]
C
Can you, though? I mean, that's a very interesting question. When you have. So with dilators and all the things you can sort of. But it's much harder.
- [19:13]
B
But by the time they get to you, they are beat down, afraid of pain. There's so much work to be done. All of the things have already happened. And it's like we're pulling people out of the stream downstream at this point, not trying to give them a life raft up front.
- [19:30]
C
I'm gonna be humble here. I really thought that the issues with breast cancer patients. Cause I'm not examining their pelvic area, right. That's not what I do. I'm not trained to do that. For years, I really thought that the issue was just dryness itself, but the canal actually shrinks. Right. And I've seen pictures of this. How the fuck did I not know this? So when women are saying, it literally can't go in, it literally can't go.
- [19:53]
B
In, it can't go in. And then when there's pain, the muscles get tight to try to protect muscles, like, to protect, right? So there's pain, there's sensitivity. Now the muscles get tight. Now the muscles are tight. So it's like it just gets worse and worse.
- [20:08]
C
And I had no clue. And I take care of women all day, every day with breast cancer. That just tells you. And I wasn't. It's not like I wasn't trained at the best of places, Right. In theory, right. Harvard's not. But I never learned anything that should.
- [20:23]
B
Be Harvard's marketing terms for like 2026. Harvard, we're not.
- [20:27]
C
Yeah. I mean, they're not bang. They're not banging down my door for marketing. But I'm available.
- [20:33]
B
Yeah, you're available in 2025. Not that long ago, a breast cancer survivor at a prominent New York City cancer center was told to use Crisco. Dramatic pause.
- [20:46]
C
You know, we're totally going to tell about this. Offline.
- [20:49]
B
Dramatic pause for effect.
- [20:51]
C
I'm not beyond tea and gossip. Wow.
- [20:54]
B
2025 in Manhattan, a breast cancer survivor at a clinic was told to use Crisco. We don't even bake with Crisco anymore.
- [21:04]
C
I mean, that is, that's atrocious. But also, women were being told to have a glass of wine.
- [21:08]
B
Oh, I know.
- [21:09]
A
The.
- [21:09]
B
I think the best thing that has helped to have a glass of wine myth is the kind of anti drinking health craze that's happening right now. Because now they're like, wait, hold on. Maybe that's not even healthy. That's really bad advice.
- [21:21]
C
Yeah.
- [21:22]
B
No, it's like sex ed is doctors didn't get sex ed. Like, that's what's crazy about it. Like, we didn't get sex ed. And then where are people supposed to go for help? Again, who's assuming expertise? In this category, Quince is all about elevated essentials that feel effortless. Designed for layering and mixing, each piece helps build a timeless wardrobe made to last with versatile silhouettes and thoughtful details. They're the kind of styles you wear again and again. And they have towels. I didn't realize how old my bathroom towels were until I replaced them. There's something wildly underrated about stepping out of the shower and wrapping yourself in a towel that's actually soft, absorbent, and feels good on your skin. It sounds small, but it completely changed my shower experience. It's that moment when you realize this isn't about towels. It's about upgrading the everyday things we've learned to tolerate. Fresh towels shouldn't feel like a luxury. They should feel like the standard. Refresh your wardrobe with quince. Go to quince.com notbroken for free shipping on your order and 365 day returns. Now available in Canada too. That's Q U I n c e.com Notbroken to get free shipping and 365 day returns. Quince.com Notbroken.
- [22:43]
C
It'S not even just. It's who's assuming expertise and then the lack of availability is really challenging. I don't know the numbers, but I can tell you that at least just in my work alone, how little resources anybody has, but especially women and the amount of shame that they live with, that is really, it's an abomination. And the fact that you are doing what you're doing in the spaces that you're doing is so critical. And I think we both from different places have come from. Certainly in academia there was not this resounding support initially, I'm very supported now at nyu. But there was not this initial support of translating this higher level of seeming knowledge and education in ways that was accessible to people because somehow that wasn't elevated or elegant or academic enough. But you and I both know nobody's going to the conferences with PowerPoint presentations. No one's listening, they're not getting reported on. And so you have this explosion of social media where people are getting terrible information with some people that are, you know, these shining lights like you and others. But it's hard to weed through that and it's hard for patients and people in the community who are suffering to find the solutions, support that they need.
- [23:49]
B
Yeah, I very rarely go on social like to go down the rabbit hole of like not doctors who are giving health advice and like it gets crazy so fast. But why does it exist? Right? It exists because I always, I always want to understand it of like it exists because people are innately curious about their bodies. A lot of people want quick fixes. They're not getting great care in the healthcare system. And I think it's like that humility of like hey everybody who's. Because we're working so hard and we're burnt out and it's a tough job. But realize like we don't hold the golden beacon of knowledge anymore like physicians did after the Flexner report. And Flexner was like these are the medical schools. These people aren't medical. These people are like again going back to the culture of who was allowed to have the knowledge, who was allowed to be the healers. And I think with the advent of social media and our healthcare system cracking is changing.
- [24:48]
C
I want to read you something because it made me think of the idea of charlatans and snake oil and people selling particularly women. Something is not, is not new at all. Right. But we just have this platform that is so rampantly available that it just the things spread like wildfire. But the idea of people capitalizing on fear, fear, using that fear to really make money and offer false bill of goods and selling people things is not, is not new. But it just has a platform that's absolutely viral.
- [25:25]
B
Totally. I was talking to some patients and they were saying, like, their great aunt was like, if you want to have a boy instead of a girl, you need to lay upside down and put vinegar in your vagina after you have sex. And this is way before social media.
- [25:38]
C
So let me read you something. In 1896, there was something for. It's called an advertisement for Pierce's pleasant Pellets. These were these famous pellets that were sold all over, and it was a catalog. And this Dr. Pierce, who had an MD said, quite often the doctor is too busy and too hurried to make the necessary effort to obtain the facts. He frequently treats symptoms for what they appear to be on the surface when the real cause and the real sickness is deeper and more dangerous. It sounds like something that we would hear today, right? Could be written right now. And then he goes on to say, it's a derangement of female organs and that's why everybody's so terribly sick. But these pleasant pellets are going to fix everything.
- [26:19]
B
What was in the pellet? Do you know?
- [26:21]
C
Who the hell knows?
- [26:22]
B
Okay. I'm like, opium, maybe, maybe.
- [26:26]
C
But I think the point really is that this is why history becomes so relevant, because human nature has evolved, but not that much. Right? Fear is a huge driver, and everybody wants also that magic. I mean, as much as we can talk about the benefits of HRT or hormones for both genders, in some ways, they're not magic bullets for everybody. Right? And that's the other thing, is that the pendulum, we don't want it to swing so far because there are some patients that can't take systemic hormones for whatever reason. And we want to make sure that we're not just wildly saying that it's a magic bullet for every single patient, for every single symptom.
- [27:02]
B
I mean, I think about it a lot because I try to be a thoughtful thought leader, but I'm like, we are doing so much education on hormones because we have had. We have 25 years at this point. If you come from the WHI, we've got two and a half decades of fear and misinformation that we're trying to undo, Right? But it makes people feel bad if they can't have access to that. Then I say, you guys exercise, eating right, sleeping, not drinking alcohol. We gotta do all of that. You can't just take a hormone and not do those things and have it work. Like, it won't work. And so I think we miss the forest for the Trees. When we try to educate on this one thing that was taken so far afield.
- [27:45]
C
Yeah.
- [27:46]
B
What was your favorite chapter to write? Do you have a favorite body part or, like, the body part that has been maligned the most or forgotten?
- [27:54]
C
The book was written the same way we learned about the body in medical school, which is not how we want to be seen. Which was fragmented, right. By physiology, gastroenterology, cardiology, per musculoskeletal system or hormonal system. I actually really enjoyed the neurology chapter. The Bitches Be Crazy School of Medicine. That's what it's also called. And my agent or the editor was like, are you sure you want to call it that? And I said, I do. I do, because that is what people think about. So we're just fucking batshit crazy. And I really enjoyed going back in time to this hospital in France called salpetrier, where Dr. Martin Charcot, who was a famous neurologist, discovered so many things critical in the history of neurology. He was also trying to hypnotize women to do sexual acts. There's that famous painting of a woman sort of looking like she's fainting under his spell, surrounded by men. Freud often trained with this man and was in the audience there. And women were effectively imprisoned there for a variety of whatever ailments that someone could bring themselves, therefore, their husbands could bring them. But there was a famous patient of his, Augustine, who was frequently a patient of his and lived there and effectively almost imprisoned there. And when she finally escaped, she escaped dressed as a man. And I thought that that was just so fascinating that in order to be free in the world, this woman had to escape a hospital where she was effectively imprisoned as a man. And there was something just so overwhelming to me about that story. And the chapter opens with two stories that actually were during COVID But for a variety of reasons, I didn't want to say that it was around Covid. I didn't want that to conflate the story. But I had two stories. One was a patient of mine who had been orphaned, essentially because she had a strong family history of cancer. So she grew up really alone. I met her in the hospital when she was diagnosed with metastatic breast cancer. And she thought she was dying, which meant that the cancer had spread all over her body, her liver, her bones. And for years I had cared for her. And by the time, several years later, she had what's called no evidence of disease on her imaging, meaning she had cancer cells probably floating around, but they were no longer visible. And the key point to this is when I had met her a few years prior, you can imagine how alone this woman was in the hospital, thinking she was dying. Extremely anxious, appropriately anxious. Covid happens. She gets Covid very, very, very early on, and she has these acute symptoms of stuttering, of having difficulty with her gait, all sorts of neurologic findings. And when she gets to the hospital, she's effectively repeatedly dismissed as being just anxious. And it was absolutely fascinating because every neurologist, I kept saying, there's gotta be something. I met this woman when she was the most anxious in her life.
- [30:45]
B
She.
- [30:46]
C
She's not anxious right now. Something is wrong with her. Something is wrong with her. And every MRI that was done was looking for brain metastasis, but because they were looking for cancer, they missed all sorts of other inflammatory issues that were going on with her that were probably triggered by her acute infection by Covid. But I was so overwhelmed by this patient of mine who I had felt so proud that we had gotten to a point where, you know, she was living her life. She'd gone back to be an EKG tech and work with patients, and yet here she was being dismissed after having an acute viral reaction to something and being told, you're essentially anxious. And I think so much of women's. The history of women's health is. That's why I called it. It's all in her head, or all in her head, because so many women with real issues have been told, it's all in your head. Nothing's wrong with you. And, I mean, I just had a very dear person in my life who had. This relates to women's health. She is a hardworking attorney. She's very on top of her health. She went for a hike with her children and ended up fracturing her foot. Why would she fracture her foot? She's put in a boot. A week later, the other foot is now fractured. Did the orthopedic surgeon even think to order a DEXA scan on her and to see if she has osteoporosis? Why is she fracturing her foot? Oh, you just haven't worked out in a while, like this happens.
- [32:07]
B
You were just clumsy. You're just clumsy hiking.
- [32:10]
C
You just break both your feet. No. Then she has all these other GI symptoms. It's a long story, but she has quite a serious diagnosis that was wildly missed. And she just kept being told this smart attorney, you're just anxious. You haven't worked out, and that's why you're breaking bones in your body. That's Madness. Madness. And it still happens today.
- [32:30]
B
Madness. Tips for people. My biggest tip off the top of my head is if you can have an advocate be with you. It's hard to advocate for yourself in this system when you're feeling well. And now this is a system that you only tend to enter when you're feeling sick. So it's very, very hard to be your own advocate as much as you can bring a healthy pair of ears and eyes with you would be a tip. You're not bothering somebody to ask them to go to your doctor's appointment with you. It's a check on what did you hear and what the plan and what did I miss?
- [33:02]
C
And.
- [33:02]
B
And then I think the other thing is, like, don't give up. It's not in your head.
- [33:07]
C
Gosh, we are so aligned. The first thing I would say is I one to a million, agree with you. The conclusion of my book is about an injury that I had. I had written my entire book about advocating. I mean, I feel so ashamed. I shouldn't even say ashamed, but I feel vulnerable and humble, even sharing this with you, that the entire book is written. I'm talking about women's health. I'm advocating for be. You know, this is all the shit that women's gone through. And then right before I wrote the conclusion, I had a minor back surgery. I had a very serious complication from it, and I almost could have died from that complication because it went so long. And I was so dismissed and I could not advocate for myself. And here I am with all the resources in New York. I've got a lot of them. I've got good people that could have helped me. And yet when I was in pain and when I was anxious, I got completely steamrolled, and I even apologized. By the time I got to the emergency room, I'm telling the nurse, you know, I'm so sorry. I couldn't shower. I couldn't shower because I couldn't pick my head up off the ground, right? And yet I'm worried about what the nurse is going to think, that, like, I haven't showered in a day. I think that there is so much to be said for really giving yourself grace when you're anxious, when you're stressed, when you're in pain. I don't care if you're Einstein. I don't care if you run a hospital. Everybody needs somebody with them. So I really agree with you. I really agree with you. And it's hard, but you can't give up in our medical care. System because there are people that do care and almost everybody who goes into medicine does it with good intentions. We're just all working in a system that is explosively bad at times.
- [34:39]
B
Yeah, I think, I mean the now times where people our age are now taking on thought leader roles, writing books. And I was idealistic. We were all idealistic. Our medical schools, everybody was equal. Equality for all. Like, we were like taught that everything was equal and fair. And then we got into the real world and we started seeing things and we started learning things. And I think that we can actually talk about it now of like, no, women don't have it as equal as men do in the healthcare system, let alone if you are a minority woman or a woman with a significant disability. Like all these like hits against you and advocating for the system. And I think in the before times we felt very alone in speaking that truth. And now I think the receipts are undeniable and we get to do something about it.
- [35:33]
C
I mean, I think that's so fantastic. And I think also for me, I very much felt in a bubble and on a one way track. And as an oncologist, there wasn't really a model for kind of how you break free and think about medicine a little bit differently. But I, as much as I've put down social media, I wouldn't be here unless I hadn't heard about you from social media and just connecting with men and women who think a little bit differently, a little bit out of the box. And I think the more we give a platform for people who don't, who look a little bit different, say it a little bit differently, challenge the cultural norm a little bit more, but with the street cred to back it up. AKA we're board certified and we've done the work. We're not just trying to hang up a plaque and say we know something about women's health or health in general. I think it's really, I think it's really incredible and I feel very blessed to be part of that.
- [36:19]
B
I feel very honored to be your friend.
- [36:21]
C
Oh, I'm, I love being your friend. I'm always like, what's she doing now? What, what's happening? What's happening?
- [36:28]
B
What do I need to know?
- [36:29]
C
What more do I need to know about my sex life? Give it to me.
- [36:33]
A
I love it.
- [36:33]
B
Okay, so where can people find you? We've got the book all in Her Head. It's available where all the books are on Amazon. You're on social media.
- [36:40]
C
I'm on social media and I treat patients at NYU Langone Health. We're also building an entire Women's Health Collaborative to invest in the research clin clinical care delivery and education of women's health across the board. So I feel really lucky. I made a pivot in my career after I wrote the book and it was a good decision.
- [36:55]
B
Oh, that's so cool. See what books can do.
- [36:58]
C
Yeah. Changed my life.
- [37:00]
B
Changed your life.
- [37:01]
A
I love it.
- [37:02]
B
Well, thank you so much for coming on the podcast. It was an honor to have you and we'll talk to you soon.
- [37:07]
C
Thanks, Kelly.
- [37:09]
A
If you found this episode funny, helpful, insightful, please take a moment to follow, rate and share the youe Are Not Broken podcast with someone who might need this conversation too. That support is how this information reaches more people, and thank you. For courses, books and my monthly membership and the Caspersen clinic information, visit KellyCaspersonMD.com this podcast and all content from Dr. Kelly Casperson is intended for educational and informational purposes only, and this is not a substitute for individual medical coaching or psychological advice, diagnosis or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here. And remember, you are Not Broken.