When you do step back and take a look at the whole picture, you understand how important sleep is, how important nutrition is, moving your body. We all kind of know this, but really, when you're in the medical system, like, you don't have the capacity really to step back to see how they're all connected.
Welcome back to another episode of Uplift for Her. I am so excited to share this with you, because I have one of my favorite people on for a guest. Her name is Dr. Molly Gilbert, and Dr. Gilbert and I worked together at our last OB-GYN practice. And now I'm excited to announce that she will be joining us here as a new physician at Uplift. For her, she is going to join us in taking care of women from a whole woman approach, an integrative health approach, and I could not be more excited for myself, and also for our wonderful community of women. Now, today's episode, we're going to be talking all about the state of women's health, and this is going to shock some of you as we talk through the way things are. We are going to give you a peek behind the curtain of why things are the way they are as two practicing physicians who have been in women's health for quite a while now. And then we're going to talk about where we really hope things will go and where we as physicians are trying to help things to go. I can't wait to share it with you. Let's dive in.
You talk a lot about nervous system regulation, gut health, detoxing, all of those things really is what sets the foundation of health, so that's really any time a patient comes in is really what's going to be focused on wholly, and going over all of those pillars to be able to figure out, okay, where are we lacking, where do we need to start, what is the biggest foundational issue, which one is actually going to tip to make it collapse, and that's where we got to put the focus first.
Well, welcome back. We are so excited to have this episode up. We've taken a little pause, but now we're back for this episode, and we are here with our new doctor, Dr. Molly Gilbert. I'm so glad you're here, Molly. You too. So excited to be here.
So you are joining us here at Uplift, but you and I go way back because we were partners at Cottonwood OBGYN as OBGYNs. Yes, so I have wanted so badly to have another OBGYN in this space, and so we are talking today from the perspective of being women's health experts of specialists and really diving into what is going on out there with women's healthcare. We're going to talk a little bit about the patient experience, but also give people a little bit of a peek behind the curtain of what it's like to be a conventionally trained OB-GYN who now maybe we're changing how we're approaching things a little bit from more of an integrative and functional medicine approach, that's absolutely perfect. Love it. Well, first, tell us a little bit about yourself. Let us get to know you, and I want to go back a little bit to why did you decide you wanted to become a doctor specifically in women's health.
Well, first starting, I'm so excited to be here. Thank you for having me. Can't wait to join the team, and excited to be a part of it. You know, when I first was into medical school, I decided initially that absolutely not obstetrics gynecology, because I like to sleep. Yeah, that's a funny way that life has a way of working itself out. And when I got into my obstetrics and gynecology rotations, I immediately fell in love with it. I loved being with women, taking care of them in very vulnerable points in their lives, and then continuing that relationship afterwards, and seeing how their lives developed. It was really special. It's also an exciting field, so many different areas - you're in the clinic with them, then you're in the hospital, or in the OR, and it was different every single day, which was exciting and fun and all good. But as I got further into practicing, you know, I really understood and started to understand and see we're missing something in conventional obstetrics and gynecology. This is why I'm here. I'm excited to dive deeper with women and really get to understand what's going on and see if we can help them get to where they want to be and meet their goals.
I want to be careful not to totally like dis on our specialty, because it is a magical specialty.
It
is, and I am so proud to be an OB-GYN. You know, I'm so proud of my training, and I'm so proud of all of the years that I spent helping people in that way. So, I want to talk a little bit about that, but before we do that, tell us a little bit more about what are some examples where you started to feel like I wonder if I could do this. Is one of the things you told me. Like, I'm so excited to see if I can do more for women. What are some of the examples where you started to wonder if you were missing something from the training that we received in our conventional approach to medicine?
I feel like I have so many examples, but firsthand, I think you know good and bad with social media. I've been seeing lately a lot more women coming in with perimenopause and menopausal symptoms, and you know, I on my own did a kind of a deep dive in how to initiate, you know, the hormone replacement therapy, and how to do that safely, and I would do that and only get so far with them, so they come back and they'd feel good in some symptoms. But then there was a lot of other symptoms that I was like, I don't know, I think these are all connected, but I don't know what to do next.
Yeah,
and it felt like, you know, here's what I can do, here's like my 10 minute maybe lifestyle options that you can try, and then good luck, and send them on their way.
That's the like, have you tried diet and exercise, you know? And people are like, I guess, yeah, yes, try
some strength training, and they're like, what do I do, and I'm like, don't know exactly, but give it a shot, you know, and so I just knew deep down there's I'm missing something, and the women are asking for it, which is so cool, and they know something is missing, and so, yeah, I'm excited to dive deeper, just for that reason. Let's, let's heal people.
Yeah, I remember for myself practicing in my old practice, and feeling like women would come to me and ask these questions, and I knew I didn't know the answers, but I also knew that I didn't know where to send them, and sadly all I would say was, well, maybe see your primary care provider, and man, hats off to primary care providers, because they do a lot, absolutely, and they know so much, but there is just this area of our health that is not super well served by medical training in primary care or gynecology, and those are the situations where mostly things like fatigue or like these funny symptoms that that I believed women were having, but I didn't know what to tell them, and I know if I, as their doctor, I mean, a lot of people identified me as their doctor, right? I delivered their babies, I did their annual exams, I took care of their perimenopause, I was their person, and if I didn't know where to send them, who's going to know, like, where are they gonna go, and that's that was one of the things for me that was like, oh gosh, I gotta do something different,
and it's also a system issue too. You know, there's be you'd see patients and say we really gotta focus on your nutrition, but I don't have that training, and I couldn't get them to see a nutritionist because insurance didn't cover it, because they don't have diabetes yet. Yeah, and just because they had maybe some insulin resistance starting, they didn't, they wouldn't cover that, so it was challenging, and patients just felt stuck, and I felt stuck, to be quite honest, yeah, yeah,
so why, why the disconnect? I will say, when my daughter was playing soccer, I would go to her soccer games, and I'd meet some soccer moms there, you know, and, oh, what do you do? And I'd tell them about my clinic here, and integrative approach, and whole woman approach, and without fail, I would hear that is so amazing, we need that so badly, this is such a wonderful thing that you're doing, but when I talk to other doctors, the response I would hear most is, yeah, I totally hear you. Like, I already do that in my clinic. I'm already talking about nutrition all day, and I don't know, are we as OB-GYNs talking? I couldn't, I didn't know how, and I also didn't have time. You know, I would be with this patient who's being vulnerable and sharing her symptoms, and my pager would go off, and I'd be like, I have a baby that is coming out. So, our options are, you can hold that thought, and I'll be back in an hour.
Yep,
or we can reschedule you when I'm not sure, because my schedule is overbooked. I might be able to squeeze in 10 minutes between two other patients,
like
it just was overall just this problem. So, when I hear from other doctors that, like, oh, we deal with that all the time, I don't know how they're doing it. And to be honest, when I hear from patients, I'm not sure patients feel like they're doing it either.
I think they're probably doing it very surface level, right? They're counseling on general guidelines of what we were told, of how much exercise you should get per week, and the what we should eat as a on your plate, and that's it. There's really no specific personalized individual training there.
Yeah,
but I think, yes, I think we're all doing it very surface level, and that's honestly how we were trained
to do
it, we weren't trained in that capacity, good and bad, right? We were trained to take care of people in really acute situations. We treat the problem that's in front of us. We make sure that this mom and baby are okay, and everybody is safe at the end of it. We make sure that we know our surgical steps and make sure that we're keeping people safely through surgery and recovery, there wasn't time to learn it genuinely, and I think when you're thinking about, and patients, and people in the public thinking about wanting more of a conventional or more holistic approach, excuse me, we're not the right people right now,
yeah, as an OB-GYN.
Yes,
let's go back, because I want to go into that a little bit. Will you tell us about your training as an OB-GYN? What were you focused on? What did it train you really well for, and what, as an OB-GYN, what did you feel like you were doing really well for women? I don't want women to be anti-DR, anti-OBGYN. There's a need, a big need. Yeah. And it's not going away, but I want people to understand when, when to go where. So, tell us about your training and what really you were very good at in your conventional practice.
So, in in training, really we focused on hospital care, I would say mostly right, taking care of somebody in labor and delivery, keeping the sick people less sick, so preeclampsia and diabetes in pregnancy, and all of the major things, needing a C-section, being able to perform that well. Education, I do feel like, in a pregnancy standpoint, overall education was pretty decent, being able to guide patients through their pregnancy, and keeping them, you know, on track, and knowing what to do when, and all of those things, I think, was was there. We also had a lot of surgical training, which is a huge part of the field of obstetrics and gynecology, which I do think some patients forget about that sometimes the day of the week we spend in the or operating on people, and that should require a lot of time and training to get it right.
Yeah,
so all of those situations, I feel like we are needed, even the most what you think would be the most uncomplicated pregnancy and delivery doesn't always go how we expect, and in those situations you want us there, or you want a conventionally trained OB-GYN there to get you through that situation, so I think that that's where we shine.
I'm so glad you said that. I don't think people often realize how much surgical training OB-GYNs have. Like, we are proceduralists, mostly, so that means that we do a lot of hands-on, which is what you and I really liked about parts of it, but that can be things like Nexplanon, the birth control little rod in the arm. We learned how to place that and place it well, but we were also the ones who learned how to deal with the really complicated removals. We do IUD insertions, but also the complicated, you know, if the IUD causes a problem, who goes and gets it? Your surgical gynecologist, you know, people can get benign tumors on their ovary, or endometriosis, or just big problematic cysts, or the ovary can twist on itself and and die, called torsion. Right, you could be hemorrhaging from your uterus. Any hemorrhage from the uterus is your friendly surgical gynecologist. These are things that we spent what, half more than half of our training, and we're good at it. You know, you want that.
Yes,
and if you've ever had to use a surgical gynecologist, then you want a good one. If you've had a miscarriage in the ER, heaven forbid, like we're the ones that get called in the middle of the night, and our training was long and involved to make sure we can do that really, really well.
Yes, on little sleep,
yes, yeah,
just muscle memory. You can do, yes.
In the middle of, okay, I'm going to take care of this preeclamptic patient over here. I'm going to counsel them how to make these really difficult decisions in their pregnancy, what to do. And then I'm going to run over here and do a DNC on a patient who was hemorrhaging in the ER, then I'm going to go back, and I'm going to deliver my fun patient that I love so much, that I've seen for her last three babies, and we deliver that baby, then we go back, right?
Yeah,
it's very involved, and so all the love and respect for OB-GYN, I loved that part of my career, and miss a lot of parts of it, and when would you have learned what women expect us to learn, I'm not saying expect like they shouldn't, but maybe let's go down that road a little bit. Tell us just a little bit more about your training, that was it, was four years of medical school,
correct? Yes, and then four years of residency training, and then jumped right into private practice. Yeah, you know, as a quick story, I was listening to a menopause book as I'm racing between the clinic and then going to a delivery, trying to learn this, right? It's the learning. If anybody is good at it as an obstetric gynecologist, they're doing their own independent learning. So I would have a two and a half minute drive from the hospital back to clinic, and I'd be listening to these menopause books
two times.
Yes, yes, exactly. And in one of them, she talks about being an obstetric provider and what that's like, and the demands during the daytime, seeing, you know, waking up, rounding on patients, seeing 20 patients in the clinic, racing between the hospital, maybe having an emergency in between there, then being up all night and doing it again the next day, and she talks about that in this book, and I like burst into tears on the drive to the hospital. I was like, "Oh, somebody else gets it, but we also want to help our patients, so that is what it takes right now, and a lot of people don't have the capacity for it, which I also think is really understandable. It takes a lot of intentional learning outside of the conventionally trained position,
so we've talked about what the training was. We learned a lot about surgery, we learned a lot about gyn issues, even things like sexually transmitted infections, or what are some clinical issues. I'm trying to not be. Too involved here, but you know, chronic vaginal issues, or things like prolapse, or we would cover a lot in clinic. Where do you feel like the gaps were in our training, knowing what you know now and being where you are now? What are the things that you kind of think you should have learned in residency but didn't?
I think so much more focus on if the menstrual cycle isn't normal,
yeah,
what are you actually going to do about it, or why? Why is it abnormal,
and what is abnormal, right? Yes, because I think as OB-GYNs, you're like, oh, you have crippling pain a few days a month. Well, I can do something about that, but there's never this.. I don't think women hear enough that, like, gosh, that must be hard. That's not how it's supposed to be, like, exactly. Your period should not be that way,
right? Yes, exactly. So we have, like, the major categories for what could be going on, structural things, or why you're having heavy bleeding. We've got the basics. We can rule out thyroid dysfunction, we can rule out structural things with imaging, like an ultrasound, but we don't, we, I don't feel like we were often trained in let's really break this down at every point in the cycle. What is actually going on? What could be causing this patient's symptoms in that moment? So, focusing more on that, we were really good at, like, providing symptom management at the time, right? So, if that's what somebody wants and they're like, "Yes, give me something just to feel better. And it's a birth control pill, then amazing. But a lot of women, especially now, don't really want that. They actually want to understand what's going on, and we weren't taught that.
Have you ever tried red light therapy at Uplift? For her, we are big fans, and we and I use it ourselves regularly. Red light therapy helps support energy healing, reduce inflammation, and improve skin health. And there's more and more data to support that. One of my favorite at-home options is the Loom Box, a powerful clinical-grade device that combines red light with near infrared light, so you're getting both surface level and deeper tissue support. It's easy to use, and makes consistent red light therapy actually doable. One of the things that I love about the Loombox is how easy it is, and how compact it is. So, you can grab it out really quickly, use it while you're in bed, getting ready to go to sleep, and then put it away, and not have to unpack a big complicated device. I use it most nights, as I'm going to bed, mostly just for relaxation. I find I feel very calm and wake up with good energy. So, it is one of my favorite wellness add-ons. If you're thinking about adding it to your wellness routine, we have a link in the show notes that will save you $250 off of a Loom box. You can also find it on our favorite products [email protected] Now, back to the show. Anything else that you feel like you would have, you should have learned in residency.
Talk about HRT hormone replacement. Yes, and perimenopause. I don't know if I actually ever learned what perimenopause was at all in residency training. Hormone, you know, menopause for sure, and how to diagnose menopause, the very basics of hormone replacement therapy, but really very little talk about what other symptoms, besides hot flashes, night sweats, vaginal dryness. That was pretty much it. Those are the symptoms that you associated with menopause, and you can fix those with these prescriptions. Yeah, but all of the rest of it, brain fog, fatigue, change in weight patterns, joint pain. Yeah, all of the things that could be associated with it, which is a number of symptoms. Until recently, I never really associated with that.
Yeah,
so I think that's a huge lack.
And shout out to women, because I think that it's been there, have been a couple key, I mean, several key players from physicians, from the physician standpoint, that have really been bringing this to light, but it's mostly women, like well done women, because you're making enough of a fuss and you're demanding it and you're interested in it and you're empowered enough to go get this information that I think people, women, every average everyday women are the ones that are being like, why isn't my doctor telling me this? And I will say there is a big push in the medical community for people to do this. I don't always agree with the way that it's happening, because I think that it's missing, it's, it's still being approached as very protocolized, of like, here's what you do when you treat perimenopause, you start this, this, this, and as, as a perimenopause artist, as you know, I will call myself, there's a lot of nuance, there's a lot of skill, there is a lot of understanding that when you really get into the nitty gritty, you will treat patients differently and treat them better than if you took a course over the weekend and you got your list of things to prescribe, now I won't complain, because I'm just glad that women are getting some help. So, I'm glad that there's a lot of doctors getting involved, but there's a lot of doctors who are not doing it the way that I like to do it, you know, that are that are kind of doing it surface level, and I think there's still. Lot of patients who are like I'm not where I want to be, right. Okay, so we've talked a little bit about training and what obgyns should learn. Anything else you want to say about why this system is like this? Because this is what I hear from patients, is like why you've just told me all this, like why is it that way? Like, who is learning about perimenopause? Who is learning about these deeper understandings? Like, surely someone in medicine is understanding the physiology of the women's body, right? Right, you're the one
learning about it. I honestly, from like a conventionally trained medical school perspective, I don't know if anybody is getting trained on it.
We learn normal physiology, yes, but pretty quickly, yeah. And then we learn a lot of diagnoses, so this is adenomyosis, these are fibroids, these are endo, these are, this is, you know, infection, and here's how you fix it, but there's this giant gap from normal physiology to the evolution of the diagnosis,
right?
That's like a black hole.
Yes,
yeah. Why?
That's a great question.
I don't know either. I don't know,
you know, part of it, I think. I mean, certainly physicians, we as a whole have an obligation to learn it, I think, and take care of patients, and I think a lot of that is lacking. I don't want to leave insurance out of this a little bit, because right now being a physician is tough. There are demands, and you know, number of patients that you have to see in order to get paid for that. Insurance is reducing their reimbursement every year and reducing their reimbursements for higher level stuff, which we would bill out for longer visits, say things like that. So physicians are saying, like, I can't afford to do that, I can't afford to spend the time with patients to do that. So I do think that it's two sided there, a little bit. Insurance also doesn't reimburse for wellness visits, really, they reimburse for preventative medicine, which I think is different than wellness a little bit in my brain, whereas we can do screening like colonoscopies and mammograms and dexa screening and things like that, which is paid for, but they're not really necessarily covering, like, let's talk about your nutrition, let's talk about your sleep, let's talk about your lifestyle overall, your relationships. There's no codes for that.
Yeah,
so I do think that physicians should have ownership of their patients and really wanting to heal them, and if they can't, then they should be sending them to somebody who can, which I think is a problem. But I don't know where to go. There's nowhere to go, number one, and also there's a little ego in there too, right? Like, you are mine and only mine, and I'm not going to send you somewhere else.
Yeah, and don't worry about that thing that you're talking about, like that's no big deal,
right? Right, very, yeah, minimizing symptoms or fatigue. It's like, oh, you just gotta sleep more or drink more water, or
whatever. You're 40, and you've got four kids, that's what I hear. Yeah, 40, you've got four kids, you're going to be tired.
Yes,
I disagree.
I agree. Yes, agreed. So, I do think that it's twofold.
Will you spend like two minutes, because I don't want to go too deep on this, but I do think a lot of people don't understand how this whole thing works. So, from the doctor's perspective, as a medical clinic, will you just spend two minutes talking about how the insurance reimbursement, like what happens? So, a woman goes to the doctor. What happens from the physician side?
Yeah, so you write a note, you document, then you list their problems, which are coded,
and there has to be a problem. There
has to be a problem, apart from just like a general annual wellness visit, but there has to be a problem, and a diagnosis, and a plan, and there has to be certain components within that. We submit that to your insurance company, and then insurance decides if that's worth paying for or not, essentially. And we don't really know. We don't know every insurance company is different, even programs within an insurance company is different. So then on the backside we get paid an amount for what they think that's worth.
So, what if, like, what if you have this belief that women should have longer visits, and you just wanted to do longer visits? Why don't doctors just do longer visits?
I think a lot of physicians didn't become a physician as a hobby.
Yeah,
to be honest, that's harsh, right? But you don't get paid for that.
Yes,
and you can't really.. I mean, I think a lot. There's a little bit of a misunderstanding about how much physicians actually get paid within the healthcare system, which is only a tiny fraction of what
you're paying a patient.
Yes, so taking an hour per patient, I think physicians would love and want to do, and that's what I want to do, and that's what you are doing, which is what patients need, but you wouldn't be able to survive on that.
Yeah, insurance doesn't re the way that insurance reimburses. If I say, like, okay, in order for me to see you for an hour, I need to charge x number of dollars, I can totally bill that.
Yes,
I can say, you know, if I'm being totally exorbitant here, I want. To make $1,000 an hour, because I am going to provide gold standard care during that hour. I can bill that to the insurance, and the insurance will say, "Thank you very much. I will give you $125. Right? Insurance sets their rates, and they stay kind of in the ballpark with each other, but I have no.. I have no option to say, but, but I can't see patients for an hour, if that's what you're going to tell me. They say that's right, you can see them in 15 minutes. So then I have to do the math of, okay, if I want to have an income, then then I need to see more patients, because that's what insurance tells me to do. So insurance really is a limiting step,
or the hospital system, too.
Yeah,
so physicians have some control over that, but private practice really is kind of going away,
meaning private practices. I opened my own practices,
self-employed physicians, and the majority of physicians in this country are hospital employed, and sometimes the hospital tells you you're not meeting your production,
that's right
standards, and they are forced to see more patients,
and it's not even like you could get paid less, or you could see more. There's just the hospital wants to make a money, money, a certain amount of money off the doctor.
Yes,
and they will force them, they will change the template in the schedule to say you now see 30 patients a day. So that doctor has to see you for only 20 minutes, and if you have too many problems, that doctor has no choice but to say I'm gonna have to bookmark this, and you have to come back,
right?
Yeah, so I just wanted to go into that a little bit, because I do think there can be this perception of, like, why is my doctor so rushed, and it really is not in the control of doctors the vast majority of the time. Yeah,
and also, when you think about it, from a functional or integrative care, now here. Why is it not insurance-based? Right, it's just not really an option.
No,
you can't. We can't see people in that way, so
I can't even begin to talk about enough things in 15 minutes, you know? Like, if I'm treating your fatigue, I need to know a lot about your fatigue. How would I do that in 15 minutes, especially if I'm getting paid to go to a surgical emergency. The last thing I'll say about that is also insurance values surgical reimbursement much more than face to face time, so face to face time is is not nearly as valued in really the medical community. I would say from a financial standpoint, you will not get paid much to sit and talk to a patient. I get paid way more to remove someone's uterus than I would get to meet with them multiple times to help them decrease their inflammation.
And we don't have to get down this rabbit hole necessarily, but for the same procedure, let's say that a gyn gynecologist performs versus a urologist,
yeah,
you get paid less as a gynecologist on a woman, which is a
female surgery,
yeah, that's right, but it is, it is, there's a lot of,
there's a lot of,
there's not a sense, there
a lot of nonsense going on. Okay, we've talked about the bad stuff long enough.
Yes,
let's talk then about what we do. This is why we do this, not just for them, I mean, not for the money, like you and I both want to have a good career, and we want to have a good lifestyle, but we are so excited to be able to provide care for women in a way that's so meaningful for them, and if we don't have to remove your uterus surgically, that's great news, like we would love to do that for you, so let's talk a little bit more about what the integrative approach actually is. So, how is it? How you're now transitioning correct from your conventional practice into our integrative and functional practice. How is that going to be different in the way that you approach a patient?
Different options, number one, so being able to use different things in order to help somebody get to where they want to go, whether that is medication, if they want to stay with that, then that's fine, whether that's kind of supplements, and you talk about these different options in these different buckets, or focusing on lifestyle, so being able to combine those things and being able to take the time to figure out where we're at, what is actually needed, what is actually going on to cause your symptoms, and then using all the resources that are available, depending on what the patient wants to do, and sometimes that is simply like, okay, we want to solve what's going on, but maybe a medication for now is what what a patient wants, and that's great, and maybe they totally want to steer clear of that, but being able to use these other tools and really focus on lifestyle, and be able to tell them specific instructions, or specifically what what can be helpful. It's not a blanket answer, it's not just these foods and this way for everybody. Yeah, so being able to use all of that, I think I'm most excited about.
Tell us, give us an example of that. So, take for example a patient with PCOS. First, tell us briefly, what is PCOS, and what your conventional approach would have been, and what now your functional approach to that? What you're excited to be able to spend the time doing differently.
So, PCOS is kind of a misnomer, polycystic ovarian syndrome. Most people think about having big ovaries or lots of cysts on your ovaries, which you actually don't. Don't even have to have to be diagnosed with it. It's really more of a metabolic dysfunction. So, in the conventional,
what happens? What do people feel?
Yes, they've got irregular periods. Sometimes they have issues with weight gain and acne, and they just feel just off, gross, hard to lose weight, trying all the things, and not having any success there,
infertility,
infertility, yes, all of those things. So, in the conventional world, we have, you know, people meet two out of three things to make a diagnosis, whether they have those cystic ovaries on ultrasound, they have signs of high androgens, or kind of, we think about testosterone, and those kind of things, where they're growing a beard, or they have hair loss or lots of acne, and the other thing is the irregular periods. So, in the conventional world, we think about treatment options of those symptoms: birth control pill to get those periods regular, spironolactone to get the hair growth and the acne under control. I'm missing one, metformin, metformin, yes, metformin, just to see if we can help some insulin resistance to see if that will help get the periods under control. In more of a functional approach, we really focus on lifestyle and seeing, you know, lab markers to figure out where we're actually at. And then I think from a PCOS standpoint, really focusing on diet, anti-inflammation, all of those things to actually help get blood sugar under control, to see if we can actually get the ovaries functioning as they should be.
I think from the integrative and functional approach, it's interesting because when you talk about lab work, I do think back to when I was working in my old practice, and the way that I was trained, we would do like hormone labs, sometimes. I mean, I do think most people do hormone labs, and it is standard of care to get some various hormones, like a 17 hydroxy progesterone and an FSH and an LH, and some different things like that. I do think we should be getting glucose markers as conventional. I don't think we're really trained to fully understand the metabolic picture through labs. We might get like a hemoglobin A 1c Even then, there's layers in people who are pretty good at PCOS, and I think we weren't necessarily trained to be really good. We were trained pretty generically, and so I see a lot of people who come from their gynecologist where it's like, well, they told me my hormones looked okay, and they, they just told me to take birth control, and I do think that happens a lot. And instead, understanding, like, what is your full metabolic picture? Labs are so fun in that way, like they're not that expensive, they're actually very affordable. Insurance covers them. I just don't think that we were ever really trained to kind of take a step back to look at the whole picture. And so, what are you seeing and hearing from patients if they do go to a gynecologist and they're like, I went to my OB-GYN and I asked for these labs, I listened to the podcast, I asked for, you know, the insulin and the glucose. What are they hearing from from their doctor?
Yes, and I think I probably have a little different view on it, because independently I've been trying to do a lot of my own research and understanding, so I do have patients coming from a different OB-GYN somewhere else, and then coming to see me in my office, where I have like a tiny little bit more understanding at the point, and it would be that, like, they would ask for it or say, like, everything was normal, and then I look at what those tested, and it was just like the bare minimum, really not a picture
normal.
I also think that unless you are diabetic, like we don't know what to do with it, and there's not a lot of resources. Just going back to training, we weren't really trained to look at insulin resistance, or what markers, or how to find the ratio between glucose and insulin, and all of that, that wasn't part of the standard training.
Yeah,
so I see, or have seen, a lot of patients come to me with that, or like, I, somebody told me I had PCOS, and I'm like, well, how were you diagnosed with that? And they have no idea, or maybe we're never told, or somebody coming saying, like, I think I have PCOS, and then what has been done? They're like nothing.
Yeah,
it just basically was told that I don't, because I don't fit the mold. I'm not, you know, I don't have, not overweight, and all of those things. So patients come frustrated.
I'm often asked exactly what items I use and recommend. So I have a little gift for you. I have gathered my go-tos in one spot on our Amazon storefront. If you need deeper sleep, you'll find the light-blocking sleep mask that lives on my nightstand, and that I use every night. If you're working on your bone density or your posture, check out the weighted vest I recommend for walks and workouts. We've also added the magnesium body lotion I reach for to calm the nervous system, my favorite laundry soap and cleaning products, and even the cast iron skillet that's currently sitting on my stovetop. All of these and more are organized by categories, so you can browse trusted products without the overwhelm of trying to figure out what's the best thing to buy. You can head to amazon.com backslash shop backslash uplift for her. Or tap the link in the show notes or from our website to explore the items I personally use and love. I hope this makes your life just a little bit easier. Now, back to the show. Yeah, I think that's right. I think there is, there can be stereotypes of like, well, you don't fit the stereotypical mold, so I don't know what you have, and I think that can be really frustrating for patients, because they're like, well, what do I do right, and I think a lot of times they're not really told what to do. Go into a little more detail, then, of what.. what can we do? What can.. like, why do we do these long visits? What are we doing in these long visits that can actually help people start to heal and feel better?
Well, really diving into a full history. When did these symptoms start? What is actually what could be a cause of it? Is it actually PCOS, or is it something else going on? What, what other underlying factors could be causing irregular periods or your symptoms? Then doing that full lab panel, like you talked about, and really getting into the nitty gritty of all of the markers to tell us a full picture of what the body is up to, is it just a digestive issue, you know, or is it there something else that's going on to cause it? So that is, I think, a beautiful part of it, and then really helping patients understand and take hold of their own care to what they can do about it, because it's not a terminal diagnosis, there's a lot of things that people can do to get their symptoms feeling better, which is amazing. They just don't know what
it is.
Yeah, so being able to spend the time with people to really educate them on what's going on and what they can do in their own personal lives to help that, whether that is, you know, a lot of assistance from us, or if they're just like, I want to head hoe into this lifestyle and do it all on my own, and that's amazing, but oftentimes just being able to like track progress and see where we're at and add on the next thing is a beautiful part of this.
Yeah, one of the reasons I'm so glad you're coming and joining us as another physician, as another OB-GYN, is I built this clinic to be this bridge, you know, I think there's a lot of support out there for women that is either only conventional based. Here are your options: you can have a birth control pill, you can have spironolactone, you can have a diabetes pill, right, get your blood sugar under control, or you can go get electrolysis, right? Like, and that's the only options they're given, or they'll go other places, like hormone clinics, and they say we can give you potions, and we can give you, you know, only nutrients, and we despise any medications. We would never use a prescription medication to treat, and it.. I think that most patients live somewhere in the middle, where they're like, "Okay, I don't want it to be dangerous for me to have PCOS. I don't, you know, sometimes if patients go way over here to the maybe I call it the hippie side, but I am the hippie side, so it's okay, but like the anti-medicine side, maybe they don't hear some of the worries of if we don't get this right, you could be at risk for, you know, problems with your uterus, like a uterine cancer, or you could be at risk for developing diabetes. I think sometimes from the nonconventional approach it's maybe not taken as seriously, and sometimes people don't put all of the pieces together of the whole person, meaning I still have to prevent pregnancy, like we're not in a place that we want to have a baby, so I want to be able to get my hormones right, but also I need birth control or contraception of some sort, and I'm scared of that. But I tried, you know, natural family planning, and I got pregnant, and we can't do that again. Like every woman has her own combination of things, and I think there's this concept that, like, if you really want to do it naturally, then you should be able to do it 100% Like, you should track your cycles, and you should never touch a birth control pill, and you should eat perfectly. And I just think we're all on a journey,
right?
Some of us are like that - we don't want just the conventional options, but maybe we're not able or understand how to dive in, and we get to like bridge that gap with them. We get to go all the way over to the conventional side, and I have patients that are treated mostly the same way as I did conventionally, and I explained to them the pros and the cons, and I can educate them a little bit more, of like, let's do the birth control pill for now, and let's do these other things underneath, so we can get you off of the birth control pill, or have other people weigh on the other end of the spectrum, that it's like, great, let's get into your nutrients, and I mean, I'm going to do that on everyone anyway, and we're always going to talk about food, and like, how do we let your food help you? But I love that we live in this space, and like, shout out to you, because you have so much training now, because, because you have all of this conventional training that's going to help keep patients safe, and help counsel them, and help them not have fear of the conventional medical system, but also be able to personalize their care, so you understand the bridge, and then you understand the full hippie, you know, when we want to go all hippie, yeah, then you understand that as well, and that's it's such a gift. So, thank you for putting in the time as a doctor. To be willing to learn this, because it is not for the faint of heart, going through it myself. Yes, it is a ton of information that we have to put together to really be able to offer this to patients. So, I'm just so grateful to you for doing that. I don't know if you have anything you want to add to that.
Well, you're like my inspiration and pioneer in this field, honestly, though, like you said, there's not that bridge is not out there, and you are, you've created it for women, which is really special environment. So, I'm just excited to be a part of it, and you know, as you talked about, I'm kind of in my transition here, so learning a lot from you, and just trying to like soak up every little bit of information, and it just feels like it's a little fire hose coming at me, but I'm excited to continue in my journey, and just like learn and be able to care for women how they deserve to be cared for.
Yeah, I love that. Will you talk a little bit more about the integrative approach of we use the words like whole person, whole woman approach? What is what exactly does that mean? Because like in conventional medicine, were they not treating the whole woman, and we don't have to compare it, but like, what is what does that mean exactly?
Well, I would say let's, let's talk about it from the conventional approach. If somebody came to me in my clinic before, early on, and said I've got stomach pain, abdominal pain, I'm gonna rule out all the causes from a gyn perspective. We're gonna do an ultrasound, we're gonna see if it's associated with a period, and if it's not, I'm like, all right,
yeah,
head on out. You're either going to go back to your primary care provider, you're going to go to GI and figure out if there's something else. But here it's much more of everything truly is connected and everything, one body truly affects each other. So, if you have, if you're coming in and saying that you are fatigued and you have a stomach ache and your periods are wonky, or you have brain fog. There's something going on that is really connected. So, I think that's that's what's different, and that's the whole point of this, right? Is when you're treating the whole person, it really is like, let's talk about your toe. Why is that painful? Yeah, or let's talk about your headaches. Why are you having them? What is it associated with your food, and when is it not? Those things are amiss if you have a headache in the conventional world. Like, okay, go to neurology, or let's try these different medications just for your headache, but that's not going to treat your bloating,
right?
Those are separate.
Gosh, I love that you say this, because having treated patients like this, I learned so much from patients, and you start seeing patterns that I don't think the way that the medical model is, where we're so compartmentalized. I wouldn't even know to ask about your migraines or your gut health or your abdominal symptoms. I might be like, "Oh, you're talking about abdominal pain, like non-novary insist, it's not your period, so like, go see a gastroenterologist, but now that I'm doing it, where I actually get to spend the time asking about all the symptoms. Oftentimes, we still have to treat one thing at a time, so we're really focusing on balancing hormones, and that's where I'll hear things like, do you know what my acne is getting better, or my migraines are getting better? I didn't think they were related to my hormones, but they're better now, and I will say very often to patients, like, I don't know what made them better, because we were fixing so many different things, but I'm just really glad they're better, and so keep doing what you're doing. Very often we don't know what helped, but as the body gets better, the body gets better. I'll give one example, is one that comes up a fair bit is when I have someone with either absent periods or really heavy periods, usually is the way that it comes up, and then they'll have pretty severe iron deficiency anemia, and usually we would just blame that on heavy periods, but sometimes it's like, why, like I've gotten your periods under control, but I can't get the iron fixed, and two big gaps that I find now somewhat frequently is hypothyroidism and actually celiac disease. It, we actually do learn this in iron deficiency, that's unexplained, just for celiac, but I don't know that it's, I don't know that it's top of mind for most of us who are rushing through a busy man day, and it comes up not that infrequently, and that's one of the things that that we see a lot is when people go on a gluten-free diet, which is not the end all be all, but some people, it will make a tremendous improvement in their abdominal pain and their heavy periods, so it's really exciting to be able to put those pieces together for people, and then, like I said, to learn from the patient and be like, oh, now I've seen five patients that when we fixed this, also their acne got better, their hair lost after their, you know, gut pain got better. Like, we can really start to connect those dots when we see the patient over and over, that same type of patient.
Yes, absolutely. In like the conventional world, kind of connecting it back to, is if you see somebody with anemia and heavy periods, you put them on iron, and then you kind of hope they get better if they don't, they're you're like, I don't know, keep on yard,
yes, stay on your own,
maybe eat some more dark green vegetables, and that's kind of it. So it is exciting to be able to see, like, okay, you are on this, but why? Why is it not improving now? And being able to spend the time with patients, that's that's you have to have it in order to figure those things out.
Yeah, I love that. Take just a second and tell us about our health foundations, because this is something that this is probably the biggest deficit. Well, I would say the contrast of my training to what is most impactful now is these health foundations. Like, we did not learn these foundations well, and yet they're the things that I think make the biggest impact in health. Will you review those?
Yes. And when we talk about, like, foundation of health, it makes sense, right? So when you do step back and take a look at the whole picture, you understand how important sleep is, how important nutrition is, moving your body. We all kind of know this, but really, when you're in the medical system, like, you don't, you just, you don't have the capacity really to step back to see how they're all connected. You talk a lot about nervous system regulation, gut health, detoxing, all of those things, really is what sets the foundation of health. So that's really any time a patient comes in is really what's going to be focused on wholly and going over all of those pillars to be able to figure out, okay, where are we lacking, where do we need to start, what is the biggest foundational issue, which one is actually going to tip to make it collapse.
Yes,
and that's where we got to put the focus first.
Yes, and I love that you say that, because I think when people hear that list, they're like, yeah, I know that's important, but what you just said, of find the one that's going to tip the in a good way, right? What's the one that's going to give me the biggest impact? That's our job, like that's that's what that's what we do, is help make sense of all of this different information. When we go through those foundations, you can make a pretty long list of like all the things that all of us should be doing.
Yes,
but when patients come in, they're like, I don't know. I heard this from Instagram, and then I heard this from someone else. My doctor said this, my friend and neighbor said this, like, I don't know where to start. And that's what we get to do, is to connect the dots of yes, we could make some changes in your how you're supporting your gut microbiome, and we could make some changes in how you're dealing with stress, but man, your insomnia is so bad. We start there, and then we get to use our full toolkit of, do we need to use a prescription medication? Gosh, I hope not. Like, that's not my favorite for insomnia, but if your mental health is suffering, and all of these other things are suffering, then we have to fix sleep, so we get to help make sense of all of these moving pieces, instead of just being like, well, you heard that supplement was good for this symptom, and that supplement was good for this symptom, we get to say, I think, by my professional opinion, sleep needs to be your number one focus, so yeah, keep working on the other things, but zero in right here, and let me teach you all the tools that we can use, prescription supplements, lifestyle, and get that one fixed first.
Yes,
and then I'm going to help you move on.
I love that. I also think that in a world, good and bad, of information overload, it's kind of a recency bias. Somebody sees on Instagram, like, oh, they got to do this workout routine or this amount of whatever in their day, and think that applies to everybody when it really doesn't, and then it's the next day you see a different post, and you're like, oh my gosh, I got to do this red light therapy, and oh my gosh, now I got to do this vibration plate, and it's just like, whew, overwhelming, and they're doing it all, but not really getting better, which is where we come in here to be able to like actually figure out, okay, what about you as a person, individually, what's actually going on with you, because it's not the same as that influencer over there.
So, help us understand that a little bit of where some of that nuance is. For example, if you have a patient who is really starting from the beginning, they know they want to improve their diet, but they're still mostly eating kind of a standard American diet of like I eat out a fair bit, maybe I make a casserole, maybe I eat a lot of pasta, meat and potatoes, I skip breakfast a lot, my sleep isn't great, my bowels aren't super great, but I don't know where to start, maybe I'll start with red light, right? How, where does what would you guide that person to do compared to the example of like someone who is at their ideal body weight, they're eating quote unquote clean all the time, but they're exhausted. Like, can you just walk us through kind of how you, how do you take those patients and help them take the next best step and make sense of all of these different recommendations of how they understand what's the next best step for them,
I think. For the first patients in your example, it's really the basics and helping them just understand how your body functions with fuel or food that they eat, and at what points during the day how they feel and how their diet is going to impact that, and also maybe just even starting with, like, let's just figure out what you're eating, and let's help you understand what you're actually eating, and monitor that for a little while, just to be able to break it down. Sometimes it's just as easy as that to say, what do you think now about your health, now that you're seeing it out. Sometimes that, I think, is going to be very helpful for people, just to basic education. To get them in the right track, making small adjustments every day, somebody who is maybe more at a peak fitness level and already feeling really well doing the things, but just wants a little extra. I think that's a lot more where labs can come into play to figure out what really is missing here. Are you just not absorbing something as good as we think you are, or what else is going on that maybe we're missing there? What are relationships like in your life? All of those other things play an impact more than probably what we all recognize.
Yeah, I love that. There definitely is, you know, a progression. There's there's definitely a journey, and I think you're so good at walking people through that, of helping them, you know, meeting them where they're at, and that's what we hope to do, is meet them where they're at, and help them know what is the next step, and then the next step, and for some people that's going to be a bunch of steps, and for some people that's going to be little tweaking, and it's fun for us in this position to be able to do either one, to be able to say, okay, there's a lot going on here. We get you through these big changes that you're doing. It's going to be hard, and I'm going to push you, and, and, but I'm going to be right here next to you when it gets really hard to support you through that. And then we get patients who are doing, you know, 99% thing, percent of things correctly, and we get to say, hey, did you know this cool thing about longevity, you could add that in, you know, and so we really get to help people all along the way, and this person who maybe is starting from the beginning, we get to help them get to that point, and we've had some patients, I've had some patients this week that that we've gotten to see really clearly graduate of, like, oh, you were here, and now we just bumped you up a level. You're no longer the person that's starting from scratch and starting over with their foundations. You're the person who gets - we get to level you up, and it's super exciting as a, as a practitioner too.
And I think the beauty of being able to see people in this way is to remind people to be kind to themselves in this process, too. Right, we are all living in this chaotic world with a lot of outside influence in a world that doesn't really support our foundations, just at a baseline. So, just being present with people and reminding them to be graceful to themselves, but then giving them the tools to be able to navigate in a world that doesn't really support that, I think, is a really awesome, awesome thing. Yeah,
I want to come back to perimenopause for just a minute, because we just, it's just such an issue. Will you give us just the lived patient experience of what you're hearing from people that they're getting, and then how your approach is different to perimenopause?
Yes, patients will come in, and, like I said, good and bad before, all over social media, similar symptoms, though. I mean, people come in just feeling most often. I feel like they just don't feel like themselves. They're snappy, they're irritable at their partner, they're worried about their jobs. Actually, I've had a lot of patients just worried about them keeping their job because they're so irritable, brain fog, not being able to think like they used to, and not being able to manage as much as they used to, which is a lot of type A women, where it's really hard to let some of that go, and a lot of, you know, why, why is that happening to people, of course, sleep, weight gain in different areas, despite doing the exact same thing they've always done, and despite exercising and eating well, new joint pain, sometimes ringing your ears, itchiness, dryness, lack of libido, all of those things. In just a conventional approach, really, we think about from a perimenopausal standpoint. Okay, some maybe some lifestyle, if we can talk about, if we have time for that, even a little bit, and then progesterone. Let's see if we get you sleeping, maybe throw on some magnesium, try it out, can't hurt, kind of thing. And that's pretty much it. And then it's like, okay, good luck. From a more conventional, or, sorry, from a more integrative standpoint, those things can still be really helpful. The progesterone, which is used a lot, and it's still a really yummy medication, and still still amazing and magnesium still great, but all of the other lifestyle things. What else are what else is going on with your body? There's real changes happening hormonally that's affecting every system in your body. So let's, yes, let's talk about and correct some of the hormone changes, but then, how is this going to help your energy, and how is this going to help your sleep, and how is this going to affect your diet and your mood, and all of those things, which is lacking in the conventional system?
I think there's also this other kind of model where patients are going to hormone clinics, like standalone hormone clinics, and those people, too, are not getting what you're talking about is the full picture, because a lot of people who go to standalone hormone clinics, a lot of them get treated very well, but a lot of patients that come from hormone clinics, where in medicine we use that saying of to a hammer everything looks like a nail, right, to a hormone clinic everything sounds like a hormone, and so if you have. More symptoms, oftentimes they'll just keep tweaking and keep tweaking, oftentimes keep going up and keep going up on hormone replacement therapy until the patient is like, I'm not getting better, right? And, and oftentimes that's what, what I will get to have that conversation with the patient of maybe it's not your hormones or maybe it's something affecting your hormones that's not insufficiency, right? When we do hormone replacement therapy, that's really just fixing a deficiency, like, yes, you didn't have enough, so we gave it to you, and, and sometimes there's more to it, like female bodies are really exciting and really complex, yes, and so sometimes it's not just a hormone deficiency, and we get to then say, do you know what? You've tried all of these hormone things. Can we talk a little bit about your cortisol and about your stress? Right, can we talk a little bit more about your sleep? Can we talk a little bit more about your metabolic health? Because the estrogen didn't help you stop losing, stop gaining weight. Do you think maybe it's your insulin resistance that we see now, because we did lab work, and I know exactly what to tell you to do about insulin resistance, and let's see if that might do the trick. So I love that we get to be the hormone experts, but also sometimes it's not the hormone, right? And we get to, we get to do that too.
Yes, great point. Yes,
yeah, we are just about out of time, but I want to close by saying, by hearing from you, what do you hope for in women's health? We've talked, hopefully, about a lot of hope, and that there are good ways to do this, and there are so many ways that people can try to feel better, and will feel better. But we also talked about some of the bleak sides, about some of the frustrating sides that still exist in medicine. What would your hope be of what this looks like, and maybe even what is the right model here? We, because we talked about some problems, like ob-gyns don't have a ton of time in residency, even to train on this, even if they wanted to. So, like, what are some pictures of where maybe this could go in the future?
I hope that women keep talking, keep bringing it up, keep it to have to force people and providers and physicians to learn it, even if they are resistant to it. I hope that with with more conversations, then people will keep looking for the right people as well. They got to keep looking for providers and physicians and people available to them that they can find the answers that that they need, so I'm, I'm hopeful that that is going to start driving more of a system change. I think that there's a huge gap, like we've talked about, of people just doing this, which should be a field in and of itself, is just whole women care, and probably for men too, and but I think that there is good and bad, women are little more complex in a lot of ways, we need people focused on that entirely, I mean, there's just so much there, there's so much we can do for women, and there's so many life changes that women experience, and their bodies go through, and physically and mentally, and all of the things that they're.. I'm hopeful that at some point there would be a career path just for that.
Yeah, yeah,
and I
don't know where that comes from. If that comes from medical school, or does it come from a whole separate training system? Who knows? But I think that we're the world's thinking about
it. Yeah, I think so too. Well, thank you so much for being here and sharing your expertise, and your excitement, and your, your passion, and your light. You're just such a joy to have around. So, we're so excited to have you here, and you're going to be accepting new patients, Utah, to start with.
Yes,
adding on, hopefully, South Dakota.
Yes, that's right.
Sounds interesting, but so you'll be doing virtual only for Utah patients, and we're super excited. So, for those patients who are not right here with us in the Salt Lake Valley, this will open that up to them. And I couldn't be happier about it.
Thanks so much for having me. I can't wait to be part of the team.
Thank you so much for tuning in to today's episode. A huge thank you to our guests for sharing their insights and time with us. We are grateful for the incredible support from our sponsors, and to all of you listening. We couldn't do this without you. If you enjoyed this episode, please consider subscribing on your favorite platform. You can find us on our website, uplift for her.com YouTube, Apple Podcast, Spotify, or wherever you love to listen. And if you found value here today, please share this episode with someone who would benefit from it, leave us a comment or give us a review. It really helps us reach more listeners like you. Thank you for being part of our community. Stay tuned for our next episode. Lastly, this information is for educational purposes only and not intended to be medical advice.
Transcribed by https://otter.ai
