Podcasts about Gyn

On this episode, Dr. Sadaf welcomes UCLA's Rachel Frankenthal, PA-C to the show for a discussion on everything you need to know about hormones after Gyn cancer. Having played an integral role in designing and implementing UCLA's Gynecologic Cancer Survivorship program, Rachel shares her expertise to shine a light on the various challenges that come with Gyn cancer survivorshop. Learn how surgery, chemotherapy, and radiation can induce menopause and result in extreme symptoms, plus why old myths about certain systemic hormones for different cancers are now being debunked.Disclaimer: Anything discussed on the show should not be taken as official medical advice. If you have any concerns about your health, please speak to your medical provider. If you have any questions about your religion, please ask your friendly neighborhood religious leader. It's the Muslim Sex Podcast because I just happen to be a Muslim woman who talks about sex.To learn more about Dr. Sadaf's practice and to become a patient visit DrSadaf.comLike and subscribe to our YouTube channel where you can watch all episodes of the podcast!Feel free to leave a review on Apple Podcasts and share the show!Follow us on Social Media...Instagram: DrSadafobgynTikTok: DrSadafobgyn

Dr. Linda Duska and Dr. Kathleen Moore discuss key studies in the evolving controversy over radical upfront surgery versus neoadjuvant chemotherapy in advanced ovarian cancer. TRANSCRIPT Dr. Linda Duska: Hello, and welcome to the ASCO Daily News Podcast. I am your guest host, Dr. Linda Duska. I am a professor of obstetrics and gynecology at the University of Virginia School of Medicine.  On today's episode, we will explore the management of advanced ovarian cancer, specifically with respect to a question that has really stirred some controversy over time, going all the way back more than 20 years: Should we be doing radical upfront surgery in advanced ovarian cancer, or should we be doing neoadjuvant chemotherapy? So, there was a lot of hype about the TRUST study, also called ENGOT ov33/AGO-OVAR OP7, a Phase 3 randomized study that compares upfront surgery with neoadjuvant chemotherapy followed by interval surgery. So, I want to talk about that study today. And joining me for the discussion is Dr. Kathleen Moore, a professor also of obstetrics and gynecology at the University of Oklahoma and the deputy director of the Stephenson Cancer Center, also at the University of Oklahoma Health Sciences.  Dr. Moore, it is so great to be speaking with you today. Thanks for doing this. Dr. Kathleen Moore: Yeah, it's fun to be here. This is going to be fun. Dr. Linda Duska: FYI for our listeners, both of our full disclosures are available in the transcript of this episode.  So let's just jump right in. We already alluded to the fact that the TRUST study addresses a question we have been grappling with in our field. Here's the thing, we have four prior randomized trials on this exact same topic. So, share with me why we needed another one and what maybe was different about this one? Dr. Kathleen Moore: That is, I think, the key question. So we have to level-set kind of our history. Let's start with, why is this even a question? Like, why are we even talking about this today? When we are taking care of a patient with newly diagnosed ovarian cancer, the aim of surgery in advanced ovarian cancer ideally is to prolong a patient's likelihood of disease-free survival, or if you want to use the term "remission," you can use the term "remission." And I think we can all agree that our objective is to improve overall survival in a way that also does not compromise her quality of life through surgical complications, which can have a big effect. The standard for many decades, certainly my entire career, which is now over 20 years, has been to pursue what we call primary cytoreductive surgery, meaning you get a diagnosis and we go right to the operating room with a goal of achieving what we call "no gross residual." That is very different – in the olden days, you would say "optimal" and get down to some predefined small amount of tumor. Now, the goal is you remove everything you can see.  The alternative strategy to that is neoadjuvant chemotherapy followed by interval cytoreductive surgery, and that has been the, quote-unquote, "safer" route because you chemically cytoreduce the cancer, and so, the resulting surgery, I will tell you, is not necessarily easy at all. It can still be very radical surgeries, but they tend to be less radical, less need for bowel resections, splenectomy, radical procedures, and in a short-term look, would be considered safer from a postoperative consideration. Dr. Linda Duska: Well, and also maybe more likely to be successful, right? Because there's less disease, maybe, theoretically. Dr. Kathleen Moore: More likely to be successful in getting to no gross residual. Dr. Linda Duska: Right. Yeah, exactly. Dr. Kathleen Moore: I agree with that. And so, so if the end game, regardless of timing, is you get to no gross residual and you help a patient and there's no difference in overall survival, then it's a no-brainer. We would not be having this conversation. But there remains a question around, while it may be more likely to get to no gross residual, it may be, and I think we can all agree, a less radical, safer surgery, do you lose survival in the long term by this approach? This has become an increasing concern because of the increase in rates of use of neoadjuvant, not only in this country, but abroad. And so, you mentioned the four prior studies. We will not be able to go through them completely. Dr. Linda Duska: Let's talk about the two modern ones, the two from 2020 because neither one of them showed a difference in overall survival, which I think we can agree is, at the end of the day, yes, PFS would be great, but OS is what we're looking for. Dr. Kathleen Moore: OS is definitely what we're looking for. I do think a marked improvement in PFS, like a real prolongation in disease-free survival, for me would be also enough. A modest improvement does not really cut it, but if you are really, really prolonging PFS, you should see that-  Dr. Linda Duska: -manifest in OS. Dr. Kathleen Moore: Yeah, yeah. Okay. So let's talk about the two modern ones. The older ones are EORTC and CHORUS, which I think we've talked about. The two more modern ones are SCORPION and JCOG0602. So, SCORPION was interesting. SCORPION was a very small study, though. So one could say it's underpowered. 170 patients. And they looked at only patients that were incredibly high risk. So, they had to have a Fagotti score, I believe, of over 9, but they were not looking at just low volume disease. Like, those patients were not enrolled in SCORPION. It was patients where you really were questioning, "Should I go to the OR or should I do neoadjuvant? Like, what's the better thing?" It is easy when it's low volume. You're like, "We're going." These were the patients who were like, "Hm, you know, what should I do?" High volume. Patients were young, about 55. The criticism of the older studies, there are many criticisms, but one of them is that, the criticism that is lobbied is that they did not really try. Whatever surgery you got, they did not really try with median operative times of 180 minutes for primary cytoreduction, 120 for neoadjuvant. Like, you and I both know, if you're in a big primary debulking, you're there all day. It's 6 hours. Dr. Linda Duska: Right, and there was no quality control for those studies, either. Dr. Kathleen Moore: No quality control. So, SCORPION, they went 451-minute median for surgery. Like, they really went for it versus four hours and then 253 for the interval, 4 hours. They really went for it on both arms. Complete gross resection was achieved in 50% of the primary cytoreduced. So even though they went for it with these very long surgeries, they only got to the goal half the time. It was almost 80% in the interval group. So they were more successful there. And there was absolutely no difference in PFS or OS. They were right about 15 months PFS, right about 40 months OS.  JCOG0602, of course, done in Japan, a big study, 300 patients, a little bit older population. Surprisingly more stage IV disease in this study than were in SCORPION. SCORPION did not have a lot of stage IV, despite being very bulky tumors. So a third of patients were stage IV. They also had relatively shorter operative times, I would say, 240 minutes for primary, 302 for interval. So still kind of short. Complete gross resection was not achieved very often. 30% of primary cytoreduction. That is not acceptable. Dr. Linda Duska: Well, so let's talk about TRUST. What was different about TRUST? Why was this an important study for us to see? Dr. Kathleen Moore: So the criticism of all of these, and I am not trying to throw shade at anyone, but the criticism of all of these is if you are putting surgery to the test, you are putting the surgeon to the test. And you are assuming that all surgeons are trained equally and are willing to do what it takes to get someone to no gross residual. Dr. Linda Duska: And are in a center that can support the post-op care for those patients. Dr. Kathleen Moore: Which can be ICU care, prolonged time. Absolutely. So when you just open these broadly, you're assuming everyone has the surgical skills and is comfortable doing that and has backup. Everybody has an ICU. Everyone has a blood bank, and you are willing to do that. And that assumption could be wrong. And so what TRUST said is, "Okay, we are only going to open this at centers that have shown they can achieve a certain level of primary cytoreduction to no gross residual disease." And so there was quality criteria. It was based on – it was mostly a European study – so ESGO criteria were used to only allow certified centers to participate. They had to have a surgical volume of over 36 cytoreductive surgeries per year. So you could not be a low volume surgeon. Your complete resection rates that were reported had to be greater than 50% in the upfront setting. I told you on the JCOG, it was 30%. Dr. Linda Duska: Right. So these were the best of the best. This was the best possible surgical situation you could put these patients in, right? Dr. Kathleen Moore: Absolutely. And you support all the things so you could mitigate postoperative complications as well. Dr. Linda Duska: So we are asking the question now again in the ideal situation, right? Dr. Kathleen Moore: Right. Dr. Linda Duska: Which, we can talk about, may or may not be generalizable to real life, but that's a separate issue because we certainly don't have those conditions everywhere where people get cared for with ovarian cancer. But how would you interpret the results of this study? Did it show us anything different? Dr. Kathleen Moore: I am going to say how we should interpret it and then what I am thinking about. It is a negative study. It was designed to show improvement in overall survival in these ideal settings in patients with FIGO stage IIIB and C, they excluded A, these low volume tumors that should absolutely be getting surgery. So FIGO stage IIIB and C and IVA and B that were fit enough to undergo radical surgery randomized to primary cytoreduction or neoadjuvant with interval, and were all given the correct chemo. Dr. Linda Duska: And they were allowed bevacizumab and PARP, also. They could have bevacizumab and PARP. Dr. Kathleen Moore: They were allowed bevacizumab and PARP. Not many of them got PARP, but it was distributed equally, so that would not be a confounder. And so that was important. Overall survival is the endpoint. It was a big study. You know, it was almost 600 patients. So appropriately powered. So let's look at what they reported. When they looked at the patients who were enrolled, this is a large study, almost 600 patients, 345 in the primary cytoreductive arm and 343 in the neoadjuvant arm. Complete resection in these patients was 70% in the primary cytoreductive arm and 85% in the neoadjuvant arm. So in both arms, it was very high. So your selection of site and surgeon worked. You got people to their optimal outcome. So that is very different than any other study that has been reported to date. But what we saw when we looked at overall survival was no statistical difference. The median was, and I know we do not like to talk about medians, but the median in the primary cytoreductive arm was 54 months versus 48 months in the neoadjuvant arm with a hazard ratio of 0.89 and, of course, the confidence interval crossed one. So this is not statistically significant. And that was the primary endpoint. Dr. Linda Duska: I know you are getting to this. They did look at PFS, and that was statistically significant, but to your point about what are we looking for for a reasonable PFS difference? It was about two months difference. When I think about this study, and I know you are coming to this, what I thought was most interesting about this trial, besides the fact that the OS, the primary endpoint was negative, was the subgroup analyses that they did. And, of course, these are hypothesis-generating only. But if you look at, for example, specifically only the stage III group, that group did seem to potentially, again, hypothesis generating, but they did seem to benefit from upfront surgery.  And then one other thing that I want to touch on before we run out of time is, do we think it matters if the patient is BRCA germline positive? Do we think it matters if there is something in particular about that patient from a biomarker standpoint that is different? I am hopeful that more data will be coming out of this study that will help inform this. Of course, unpowered, hypothesis-generating only, but it's just really interesting. What do you think of their subset analysis? Dr. Kathleen Moore: Yeah, I think the subsets are what we are going to be talking about, but we have to emphasize that this was a negative trial as designed. Dr. Linda Duska: Absolutely. Yes. Dr. Kathleen Moore: So we cannot be apologists and be like, "But this or that." It was a negative trial as designed. Now, I am a human and a clinician, and I want what is best for my patients. So I am going to, like, go down the path of subset analyses. So if you look at the stage III tumors that got complete cytoreduction, which was 70% of the cases, your PFS was almost 28 months versus 21.8 months. Dr. Linda Duska: Yes, it becomes more significant. Dr. Kathleen Moore: Yeah, that hazard ratio is 0.69. Again, it is a subset. So even though the P value here is statistically significant, it actually should not have a P value because it is an exploratory analysis. So we have to be very careful. But the hazard ratio is 0.69. So the hypothesis is in this setting, if you're stage III and you go for it and you get someone to no gross residual versus an interval cytoreduction, you could potentially have a 31% reduction in the rate of progression for that patient who got primary cytoreduction. And you see a similar trend in the stage III patients, if you look at overall survival, although the post-progression survival is so long, it's a little bit narrow of a margin.  But I do think there are some nuggets here that, one of our colleagues who is really one of the experts in surgical studies, Dr. Mario Leitao, posted this on X, and I think it really resonated after this because we were all saying, "But what about the subsets?" He is like, "It's a negative study." But at the end of the day, you are going to sit with your patient. The patient should be seen by a GYN oncologist or surgical oncologist with specialty in cytoreduction and a medical oncologist, you know, if that person does not give chemo, and the decision should be made about what to do for that individual patient in that setting. Dr. Linda Duska: Agreed. And along those lines, if you look carefully at their data, the patients who had an upfront cytoreduction had almost twice the risk of having a stoma than the patients who had an interval cytoreduction. And they also had a higher risk of needing to have a bowel resection. The numbers were small, but still, when you look at the surgical complications, as you've already said, they're higher in the upfront group than they are in the interval group. That needs to be taken into account as well when counseling a patient, right? When you have a patient in front of you who says to you, "Dr. Moore, you can take out whatever you want, but whatever you do, don't make me a bag." As long as the patient understands what that means and what they're asking us to do, I think that we need to think about that. Dr. Kathleen Moore: I think that is a great point. And I have definitely seen in our practice, patients who say, "I absolutely would not want an ostomy. It's a nonstarter for me." And we do make different decisions. And you have to just say, "That's the decision we've made," and you kind of move on, and you can't look back and say, "Well, I wish I would have, could have, should have done something else." That is what the patient wants. Ultimately, that patient, her family, autonomous beings, they need to be fully counseled, and you need to counsel that patient as to the site that you are in, her volume of disease, and what you think you can achieve. In my opinion, a patient with stage III cancer who you have the site and the capabilities to get to no gross residual should go to the OR first. That is what I believe. I do not anymore think that for stage IV. I think that this is pretty convincing to me that that is probably a harmful thing. However, I want you to react to this. I think I am going to be a little unpopular in saying this, but for me, one of the biggest take-homes from TRUST was that whether or not, and we can talk about the subsets and the stage III looked better, and I think it did, but both groups did really well. Like, really well. And these were patients with large volume disease. This was not cherry-picked small volume stage IIIs that you could have done an optimal just by doing a hysterectomy. You know, these were patients that needed radical surgery. And both did well. And so what it speaks to me is that anytime you are going to operate on someone with ovary, whether it be frontline, whether it be a primary or interval, you need a high-volume surgeon. That is what I think this means to me. Like, I would want high volume surgeon at a center that could do these surgeries, getting that patient, my family member, me, to no gross residual. That is important. And you and I are both in training centers. I think we ought to take a really strong look at, are we preparing people to do the surgeries that are necessary to get someone to no gross residual 70% and 85% of the time? Dr. Linda Duska: We are going to run out of time, but I want to address that and ask you a provocative question. So, I completely agree with what you said, that surgery is important. But I also think one of the reasons these patients in this study did so well is because all of the incredible new therapies that we have for patients. Because OS is not just about surgery. It is about surgery, but it is also about all of the amazing new therapies we have that you and others have helped us to get through clinical research. And so, how much of that do you think, like, for example, if you look at the PFS and OS rates from CHORUS and EORTC, I get it that they're, that they're not the same. It's different patients, different populations, can't do cross-trial comparisons. But the OS, as you said, in this study was 54 months and 48 months, which is, compared to 2010, we're doing much, much better. It is not just the surgery, it is also all the amazing treatment options we have for these patients, including PARP, including MIRV, including lots of other new therapies. How do you fit that into thinking about all of this? Dr. Kathleen Moore: I do think we are seeing, and we know this just from epidemiologic data that the prevalence of ovarian cancer in many of the countries where the study was done is increasing, despite a decrease in incidence. And why is that? Because people are living longer. Dr. Linda Duska: People are living longer, yeah. Dr. Kathleen Moore: Which is phenomenal. That is what we want. And we do have, I think, better supportive care now. PARP inhibitors in the frontline, which not many of these patients had. Now some of them, this is mainly in Europe, will have gotten them in the first maintenance setting, and I do think that impacts outcome. We do not have that data yet, you know, to kind of see what, I would be really interested to see. We do not do this well because in ovarian cancer, post-progression survival can be so long, we do not do well of tracking what people get when they come off a clinical trial to see how that could impact – you know, how many of them got another surgery? How many of them got a PARP? I think this group probably missed the ADC wave for the most part, because this, mirvetuximab is just very recently available in Europe. Dr. Linda Duska: Unless they were on trial. Dr. Kathleen Moore: Unless they were on trial. But I mean, I think we will have to see. 600 patients, I would bet a lot of them missed the ADC wave. So, I do not know that we can say we know what drove these phenomenal – these are some of the best curves we've seen outside of BRCA. And then coming back to your point about the BRCA population here, that is a really critical question that I do not know that we're ever going to answer. There have been hypotheses around a tumor that is driven by BRCA, if you surgically cytoreduced it, and then chemically cytoreduced it with chemo, and so you're starting PARP with nothing visible and likely still homogeneous clones. Is that the group we cured? And then if you give chemo first before surgery, it allows more rapid development of heterogeneity and more clonal evolution that those are patients who are less likely to be cured, even if they do get cytoreduced to nothing at interval with use of PARP inhibitor in the front line. That is a question that many have brought up as something we would like to understand better. Like, if you are BRCA, should you always just go for it or not? I do not know that we're ever going to really get to that. We are trying to look at some of the other studies and just see if you got neoadjuvant and you had BRCA, was anyone cured? I think that is a question on SOLO1 I would like to know the answer to, and I don't yet, that may help us get to that. But that's sort of something we do think about. You should have a fair number of them in TRUST. It wasn't a stratification factor, as I remember. Dr. Linda Duska: No, it wasn't. They stratified by center, age, and ECOG status Dr. Kathleen Moore: So you would hope with randomization that you would have an equal number in each arm. And they may be able to pull that out and do a very exploratory look. But I would be interested to see just completely hypothesis-generating what this looks like for the patients with BRCA, and I hope that they will present that. I know they're busy at work. They have translational work. They have a lot pending with TRUST. It's an incredibly rich resource that I think is going to teach us a lot, and I am excited to see what they do next. Dr. Linda Duska: So, outside of TRUST, we are out of time. I just want to give you a moment if there were any other messages that you want to share with our listeners before we wrap up. Dr. Kathleen Moore: It's an exciting time to be in GYN oncology. For so long, it was just chemo, and then the PARP inhibitors nudged us along quite a bit. We did move more patients, I believe, to the cure fraction. When we ultimately see OS, I think we'll be able to say that definitively, and that is exciting. But, you know, that is the minority of our patients. And while HRD positive benefits tremendously from PARP, I am not as sure we've moved as many to the cure fraction. Time will tell. But 50% of our patients have these tumors that are less HRD. They have a worse prognosis. I think we can say that and recur more quickly. And so the advent of these antibody-drug conjugates, and we could name 20 of them in development in GYN right now, targeting tumor-associated antigens because we're not really driven by mutations other than BRCA. We do not have a lot of things to come after. We're not lung cancer. We are not breast cancer. But we do have a lot of proteins on the surface of our cancers, and we are finally able to leverage that with some very active regimens. And we're in the early phases, I would say, of really understanding how best to use those, how best to position them, and which one to select for whom in a setting where there is going to be obvious overlap of the targets. So we're going to be really working this problem. It is a good problem. A lot of drugs that work pretty well. How do you individualize for a patient, the patient in front of you with three different markers? How do you optimize it? Where do you put them to really prolong survival? And then we finally have cell surface. We saw at ASCO, CDK2 come into play here for the first time, we've got a cell cycle inhibitor. We've been working on WEE1 and ATR for a long time. CDK2s may hit. Response rates were respectable in a resistant population that was cyclin E overexpressing. We've been working on that biomarker for a long time with a toxicity profile that was surprisingly clean, which I like to see for our patients. So that is a different platform. I think we have got bispecifics on the rise. So there is a pipeline of things behind the ADCs, which is important because we need more than one thing, that makes me feel like in the future, I am probably not going to be using doxil ever for platinum-resistant disease. So, I am going to be excited to retire some of those things. We will say, "Remember when we used to use doxil for platinum-resistant disease?" Dr. Linda Duska: I will be retired by then, but thanks for that thought. Dr. Kathleen Moore: I will remind you. Dr. Linda Duska: You are right. It is such an incredibly exciting time to be taking care of ovarian cancer patients with all the opportunities.  And I want to thank you for sharing your valuable insights with us on this podcast today and for your great work to advance care for patients with GYN cancers. Dr. Kathleen Moore: Likewise. Thanks for having me. Dr. Linda Duska: And thank you to our listeners for your time today. You will find links to the TRUST study and other studies discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. More on today's speakers:   Dr. Linda Duska  @Lduska Dr. Kathleen Moore Follow ASCO on social media:     @ASCO on X (formerly Twitter) ASCO on Bluesky   ASCO on Facebook     ASCO on LinkedIn     Disclosures of Potential Conflicts of Interest:    Dr. Linda Duska:   Consulting or Advisory Role: Regeneron, Inovio Pharmaceuticals, Merck, Ellipses Pharma  Research Funding (Inst.): GlaxoSmithKline, Millenium, Bristol-Myers Squibb, Aeterna Zentaris, Novartis, Abbvie, Tesaro, Cerulean Pharma, Aduro Biotech, Advaxis, Ludwig Institute for Cancer Research, Leap Therapeutics  Patents, Royalties, Other Intellectual Property: UptToDate, Editor, British Journal of Ob/Gyn  Dr. Kathleen Moore: Leadership: GOG Partners, NRG Ovarian Committee Chair Honoraria: Astellas Medivation, Clearity Foundation, IDEOlogy Health, Medscape, Great Debates and Updates, OncLive/MJH Life Sciences, MD Outlook, Curio Science, Plexus, University of Florida, University of Arkansas for Medical Sciences, Congress Chanel, BIOPHARM, CEA/CCO, Physician Education Resource (PER), Research to Practice, Med Learning Group, Peerview, Peerview, PeerVoice, CME Outfitters, Virtual Incision Consulting/Advisory Role: Genentech/Roche, Immunogen, AstraZeneca, Merck, Eisai, Verastem/Pharmacyclics, AADi, Caris Life Sciences, Iovance Biotherapeutics, Janssen Oncology, Regeneron, zentalis, Daiichi Sankyo Europe GmbH, BioNTech SE, Immunocore, Seagen, Takeda Science Foundation, Zymeworks, Profound Bio, ADC Therapeutics, Third Arc, Loxo/Lilly, Bristol Myers Squibb Foundation, Tango Therapeutics, Abbvie, T Knife, F Hoffman La Roche, Tubulis GmbH, Clovis Oncology, Kivu, Genmab/Seagen, Kivu, Genmab/Seagen, Whitehawk, OnCusp Therapeutics, Natera, BeiGene, Karyopharm Therapeutics, Day One Biopharmaceuticals, Debiopharm Group, Foundation Medicine, Novocure Research Funding (Inst.): Mersana, GSK/Tesaro, Duality Biologics, Mersana, GSK/Tesaro, Duality Biologics, Merck, Regeneron, Verasatem, AstraZeneca, Immunogen, Daiichi Sankyo/Lilly, Immunocore, Torl Biotherapeutics, Allarity Therapeutics, IDEAYA Biosciences, Zymeworks, Schrodinger Other Relationship (Inst.): GOG Partners

+++ Infos zu unseren Sponsoren, Links zu Rabattaktionen etc.: lnkfi.re/einfachganzleben +++ Hormone spielen nicht nur zyklusbedingt im täglichen Leben einer Frau eine große Rolle. Auch der Ursprung überraschend vieler weiblicher Krankheiten liegt in den Hormonen. Bekanntere Beispiele sind Haarausfall, Gewichtsschwankungen oder psychische Probleme. Weniger bekannt ist, dass auch Erkrankungen des Verdauungstrakts, Tinnitus oder Herzstolpern häufig auf hormonelle Veränderungen zurückgehen. Gynäkologin Dr. med. Judith Bildau klärt Frauen jeden Alters auf Basis neuester wissenschaftlicher Erkenntnisse über die hormonellen Vorgänge in ihrem Körper auf – vom Kinderwunsch bis zur Postmenopause. Im Gespräch mit Jutta Ribbrock beantwortet sie Fragen, die ihr über Jahre von ihren Patient:innen gestellt wurden. Außerdem erklärt Dr. Bildau, welche konkreten ganzheitlichen Therapien wirklich helfen: von der richtigen Ernährung über Mikronährstoffe bis hin zu Phytopharmaka und Hormontherapie. Denn in unseren Hormonen steckt auch eine Menge Kraft, die wir für unseren Alltag nutzen können.Zum Weiterhören und Stöbern:www.dr-med-judith-bildau.comwww.instagram.com/dr.med.judith_bildauDr. med. Judith Bildau, Body in Balance – Hormone verstehen und unerklärliche Beschwerden loswerden (Buch und Hörbuch)Die Titelmelodie dieses Podcasts findet ihr auf dem Album balance moods – Ein Tag in der Natur.Noch viel mehr Tipps zu einem bewussten Lebensstil findet ihr auf einfachganzleben.de.Besucht uns auch bei Facebook und Instagram.Ihr habt Fragen, Lob, Kritik oder Anmerkungen? Dann meldet euch auch gern per Mail: einfachganzleben@argon-verlag.deIhr könnt Jutta auch direkt schreiben: jutta@juttaribbrock.deUnd ihr findet sie bei Instagram: @jutta_ribbrock Hosted on Acast. See acast.com/privacy for more information.

Authors Drs. Jessica Ross and Alissa Cooper share insights into their JCO PO article, "Clinical and Pathologic Landscapes of Delta-Like Ligand 3 and Seizure-Related Homolog Protein 6 Expression in Neuroendocrine Carcinomas"  Host Dr. Rafeh Naqash and Drs. Ross and Cooper discuss the landscape of Delta-like ligand 3 (DLL3) and seizure-related homolog protein 6 (SEZ6) across NECs from eight different primary sites. TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, podcast editor for JCO PO and an Associate Professor at the OU Health Stephenson Cancer Center. Today, I'm excited to be joined by Dr. Jessica Ross, third-year medical oncology fellow at the Memorial Sloan Kettering Cancer Center, as well as Dr. Alissa Cooper, thoracic medical oncologist at the Dana-Farber Cancer Institute and instructor in medicine at Harvard Medical School. Both are first and last authors of the JCO Precision Oncology article entitled "Clinical and Pathologic Landscapes of Delta-like Ligand 3 and Seizure-Related Homolog Protein 6 or SEZ6 Protein Expression in Neuroendocrine Carcinomas." At the time of this recording, our guest disclosures will be linked in the transcript. Jessica and Alissa, welcome to our podcast, and thank you for joining us today. Dr. Jessica Ross: Thanks very much for having us. Dr. Alissa Cooper: Thank you. Excited to be here. Dr. Rafeh Naqash: It's interesting, a couple of days before I decided to choose this article, one of my GI oncology colleagues actually asked me two questions. He said, "Rafeh, do you know how you define DLL3 positivity? And what is the status of DLL3 positivity in GI cancers, GI neuroendocrine carcinomas?" The first thing I looked up was this JCO article from Martin Wermke. You might have seen it as well, on obrixtamig, a phase 1 study, a DLL3 bi-specific T-cell engager. And they had some definitions there, and then this article came along, and I was really excited that it kind of fell right in place of trying to understand the IHC landscape of two very interesting targets. Since we have a very broad and diverse audience, especially community oncologists, trainees, and of course academic clinicians and some people who are very interested in genomics, we'll try to make things easy to understand. So my first question for you, Jessica, is: what is DLL3 and SEZ6 and why are they important in neuroendocrine carcinomas? Dr. Jessica Ross: Yeah, good question. So, DLL3, or delta-like ligand 3, is a protein that is expressed preferentially on the tumor cell surface of neuroendocrine carcinomas as opposed to normal tissue. It is a downstream target of ASCL1, and it's involved in neuroendocrine differentiation, and it's an appealing drug target because it is preferentially expressed on tumor cell surfaces. And so, it's a protein, and there are several drugs in development targeting this protein, and then Tarlatamab is an approved bi-specific T-cell engager for the treatment of extensive-stage small cell lung cancer in the second line. SEZ6, or seizure-like homolog protein 6, is a protein also expressed on neuroendocrine carcinoma cell surface. Interestingly, so it's expressed on neuronal cells, but its exact role in neuroendocrine carcinomas and oncogenesis is actually pretty poorly understood, but it was identified as an appealing drug target because, similarly to DLL3, it's preferentially expressed on the tumor cell surface. And so this has also emerged as an appealing drug target, and there are drugs in development, including antibody-drug conjugates, targeting this protein for that reason. Dr. Alissa Cooper: Over the last 10 to 15 years or so, there's been an increasing focus on precision oncology, finding specific targets that actually drive the cancer to grow, not just within lung cancer but in multiple other primary cancers. But specifically, at least speaking from a thoracic oncology perspective, the field of non-small cell lung cancer has completely exploded over the past 15 years with the discovery of driver oncogenes and then matched targeted therapies. Within the field of neuroendocrine carcinomas, including small cell lung cancer but also other high-grade neuroendocrine carcinomas, there has not been the same sort of progress in terms of identifying targets with matched therapies. And up until recently, we've sort of been treating these neuroendocrine malignancies kind of as a monolithic disease process. And so recently, there's been sort of an explosion of research across the country and multiple laboratories, multiple people converging on the same open questions about why might patients with specific tumor biologies have different kind of responses to different therapies. And so first this came from, you know, why some patients might have a good response to chemo and immunotherapy, which is the first-line approved therapy for small cell lung cancer, and we also sort of extrapolate that to other high-grade neuroendocrine carcinomas. What's the characteristic of that tumor biology? And at the same time, what are other targets that might be identifiable? Just as Jesse was saying, they're expressed on the cell surface, they're not necessarily expressed in normal tissue. Might this be a strategy to sort of move forward and create smarter therapies for our patients and therefore move really into a personalized era for treatment for each patient? And that's really driving, I think, a lot of the synthesis of this work of not only the development of multiple new therapies, but really understanding which tumor might be the best fit for which therapy. Dr. Rafeh Naqash: Thank you for that explanation, Alissa. And as you mentioned, these are emerging targets, some more further along in the process with approved drugs, especially Tarlatamab. And obviously, DLL3 was something identified several years back, but drug development does take time, and readout for clinical trials takes time. Could you, for the sake of our audience, try to talk briefly about the excitement around Tarlatamab in small cell lung cancer, especially data that has led to the FDA approval in the last year, year and a half? Dr. Alissa Cooper: Sure. Yeah, it's really been an explosion of excitement over, as you're saying, the last couple of years, and work really led by our mentor, Charlie Rudin, had identified DLL3 as an exciting target for small cell lung cancer specifically but also potentially other high-grade neuroendocrine malignancies. Tarlatamab is a DLL3-targeting bi-specific T-cell engager, which targets DLL3 on the small cell lung cancer cells as well as CD3 on T cells. And the idea is to sort of introduce the cancer to the immune system, circumventing the need for MHC class antigen presentation, which that machinery is typically not functional in small cell lung cancer, and so really allowing for an immunomodulatory response, which had not really been possible for most patients with small cell lung cancer prior to this. Tarlatamab was tested in a phase 2 registrational trial of about 100 patients and demonstrated a response rate of 40%, which was very exciting, especially compared with other standard therapies which were available for small cell lung cancer, which are typically cytotoxic therapies. But most excitingly, more than even the response rate, I think, in our minds was the durability of response. So patients whose disease did have a response to Tarlatamab could potentially have a durable response lasting a number of months or even over a year, which had previously not ever been seen in this in the relapsed/refractory setting for these patients. I think the challenge with small cell lung cancer and other high-grade neuroendocrine malignancies is that a response to therapy might be a bit easier to achieve, but it's that durability. The patient's tumors really come roaring back quite aggressively pretty quickly. And so this was sort of the most exciting prospect is that durability of response, that long potential overall survival tail of the curve really being lifted up. And then most recently at ASCO this year, Dr. Rudin presented the phase 3 randomized controlled trial which compared Tarlatamab to physician's choice of chemotherapy in a global study. And the choice of chemotherapy did vary depending on the part of the world that the patients were enrolled in, but in general, it was a really markedly positive study for response rate, for progression-free survival, and for overall survival. Really exciting results which really cemented Tarlatamab's place as the standard second-line therapy for patients with small cell lung cancer whose disease has progressed on first-line chemo-immunotherapy. So that has been very exciting. This drug was FDA approved in May of 2024, and so has been used extensively since then. I think the adoption has been pretty widespread, at least in the US, but now in this global trial that was just presented, and there was a corresponding New England Journal paper, I think really confirms that this is something we really hopefully can offer to most of our patients. And I think, as we all know, that this therapy or other therapies like it are also being tested potentially in the first-line setting. So there was data presented with Tarlatamab incorporated into the maintenance setting, which also showed exciting results, albeit in a phase 1 trial, but longer overall survival than we're used to seeing in this patient population. And we await results of the study that is incorporating Tarlatamab into the induction phase with chemotherapy as well. So all of this is extraordinarily exciting for our patients to sort of move the needle of how many patients we can keep alive, feeling functional, feeling well, for as long as possible. Dr. Rafeh Naqash: Very exciting session at ASCO. I was luckily one of the co-chairs for the session that Dr. Rudin presented it, and I remember somebody mentioning there was more progress seen in that session for small cell lung cancer than the last 30, 35 years for small cell, very exciting space and time to be in as far as small cell lung cancer. Now going to this project, Jessica, since you're the first author and Alissa's the last, I'm assuming there was a background conversation that you had with Alissa before you embarked on this project as an idea. So could you, again, for other trainees who are interested in doing research, and it's never easy to do research as a resident and a fellow when you have certain added responsibilities. Could you give us a little bit of a background on how this started and why you wanted to look at this question? Dr. Jessica Ross: Yeah, sure. So, as with many exciting research concepts, I think a lot of them are derived from the clinic. And so I think Alissa and I both see a good number of patients with small cell, large cell lung cancer, and then high-grade neuroendocrine carcinomas. And so I think this was really born out of a basic conversation of we have these drugs in development targeting these two proteins, DLL3 and SEZ6, but really what is the landscape of cancers that express these proteins and who are the patients that really might benefit from these exciting new therapies. And of course, there was some data out there, but sort of less than one would imagine in terms of, you know, neuroendocrine carcinomas can really come from anywhere in the body. And so when you're seeing a patient with small cell of the cervix, for example, like what are the chances that their cancer expresses DLL3 or expresses SEZ6? So it was really derived from this pragmatic, clinically oriented question that we had both found ourselves thinking about, and we were lucky enough at MSK, we had started systematically staining patients' tumors for DLL3, tumors that are high-grade neuroendocrine carcinomas, and then we had also more recently started staining for SEZ6 as well. And so we had this nice prospectively collected dataset with which to answer this question. Dr. Rafeh Naqash: Excellent. And Alissa, could you try to go into some of the details around which patients you chose, how many patients, what was the approach that you selected to collect the data for this project? Dr. Alissa Cooper: This is perhaps a strength but also maybe a limitation of this dataset is, as Jesse alluded to, our pathology colleagues are really the stars of this paper here because we were lucky enough at MSK that they were really forethinking. They are absolute experts in the field and really forward-thinking people in terms of what information might be needed in the future to drive treatment decision-making. And so, as Jesse had said, small cell lung cancer tumor samples reflexively are stained for DLL3 and SEZ6 at MSK if there's enough tumor tissue. The other high-grade neuroendocrine carcinomas, those stains are performed upon physician request. And so that is a bit of a mixed bag in terms of the tumor samples we were able to include in this dataset because, you know, upon physician request depends on a number of factors, but actually at MSK, a number of physicians were requesting these stains to be done on their patients with high-grade neuroendocrine cancers of of other histologies. So we looked at all tumor samples with a diagnosis of high-grade neuroendocrine carcinoma of any histology that were stained for these two stains of interest. You know, I can let Jesse talk a bit more about the methodology. She was really the driver of this project. Dr. Jessica Ross: Yeah, sure. So we had 124 tumor samples total. All of those were stained for DLL3, and then a little less than half, 53, were stained for SEZ6. As Alissa said, they were from any primary site. So about half of them were of lung origin, that was the most common primary site, but we included GI tract, head and neck, GU, GYN, even a few tumors of unknown origin. And again, that's because I think a lot of these trials are basket trials that are including different high-grade neuroendocrine carcinomas no matter the primary site. And so we really felt like it was important to be more comprehensive and inclusive in this study. And then, methodologically, we also defined positivity in terms of staining of these two proteins as anything greater than or equal to 1% staining. There's really not a defined consensus of positivity when it comes to these two novel targets and staining for these two proteins. But in the Tarlatamab trials, for some of the correlative work that's been done, they use that 1% cutoff, and we just felt like being consistent with that and also using a sort of more pragmatic yes/no cutoff would be more helpful for this analysis. Dr. Alissa Cooper: And that was a point of discussion, actually. We had contemplated multiple different schemas, actually, for how to define thresholds of positivity. And I know you brought up that question before, what does it mean to be DLL3 positive or DLL3 high? I think you were alluding to prior that there was a presentation of obrixtamig looking at extra-pulmonary neuroendocrine carcinomas, and they actually divvied up the results between DLL3 50% or greater versus DLL3 low under 50%. And they actually did demonstrate differential efficacy certainly, but also some differential safety as well, which is very provocative and that kind of analysis has not been presented for other novel therapies as far as I'm aware. I could be wrong, but as far as I'm aware, that was sort of the first time that we saw a systematic presentation of considering patients to be, quote unquote, "high" or "low" in these sort of novel targets. I think it is important because the label for Tarlatamab does not require any DLL3 expression at all, actually. So it's not hinging upon DLL3 expression. They depend on the fact that the vast majority of small cell lung cancer tumors do express DLL3, 85% to 90% is what's been demonstrated in a few studies. And so, there's not prerequisite testing needed in that regard, but maybe for these extra-pulmonary, other histology neuroendocrine carcinomas, maybe it does matter to some degree. Dr. Rafeh Naqash: Definitely agree that this evolving landscape of trying to understand whether an expression for something actually really does correlate with, whether it's an immune cell engager or an antibody-drug conjugate is a very evolving and dynamically moving space. And one of the questions that I was discussing with one of my friends was whether IHC positivity and the level of IHC positivity, as you've shown in one of those plots where you have double positive here on the right upper corner, you have the double negative towards the left lower, whether that somehow determines mRNA expression for DLL3. Obviously, that was not the question here that you were looking at, but it does kind of bring into question certain other aspects of correlations, expression versus IHC. Now going to the figures in this manuscript, very nicely done figures, very easy to understand because I've done the podcast for quite a bit now, and usually what I try to do first is go through the figures before I read the text, and and a lot of times it's hard to understand the figures without reading the text, but in your case, specifically the figures were very, very well done. Could you give us an overview, a quick overview of some of the important results, Jessica, as far as what you've highlighted in the manuscript? Dr. Jessica Ross: Sure. So I think the key takeaway is that, of the tumors in our cohort, the majority were positive for DLL3 and positive for SEZ6. So about 80% of them were positive for DLL3 and 80% were positive for SEZ6. About half of the tumors were stained for both proteins, and about 65% of those were positive as well. So I think if there's sort of one major takeaway, it's that when you're seeing a patient with a high-grade neuroendocrine carcinoma, the odds are that their tumor will express both of these proteins. And so that can sort of get your head thinking about what therapies they might be eligible for. And then we also did an analysis of some populations of interest. So for example, we know that non-neuroendocrine pathologies can transform into neuroendocrine tumors. And so we specifically looked at that subset of patients with transformed tumors, and those were also- the majority of them were positive, about three-quarters of them were positive for both of these two proteins. We looked at patients with brain met samples, again, about 70% were positive. And then I'd say the last sort of population of interest was we had a subset of 10 patients who had serial biopsies stained for either DLL3 or SEZ6 or both. In between the two samples, these patients were treated with chemotherapy. They were not treated with targeted therapy, but interestingly, in the majority of cases, the testing results were concordant, meaning if it was DLL3 positive to begin with, it tended to remain DLL3 positive after treatment. And so I think that's important as well as we think about, you know, a patient who maybe had DLL3 testing done before they received their induction chemo-IO, we can somewhat confidently say that they're probably still DLL3 positive after that treatment. And then finally, we did do a survival analysis among specifically the patients with lung neuroendocrine carcinomas. We looked at whether DLL3 expression affected progression-free survival on first-line platinum-etoposide, and then we looked at did it affect overall survival. And we found that it did not have an impact or the median progression-free survival was similar whether you were DLL3 positive or negative. But interestingly, with overall survival, we found that DLL3 positivity actually correlated with slightly improved overall survival. These were small numbers, and so, you know, I think we have to interpret this with caution, for sure, but it is interesting. I think there may be something to the fact that five of the patients who were DLL3 positive were treated with DLL3-targeting treatments. And so this made me think of, like in the breast cancer world, for example, if you have a patient with HER2-positive disease, it initially portended worse prognosis, more aggressive disease biology, but on the other hand, it opens the door for targeted treatments that actually now, at least with HER2-positive breast cancer, are associated with improved outcomes. And so I think that's one finding of interest as well. Dr. Rafeh Naqash: Definitely proof-of-concept findings here that you guys have in the manuscript. Alissa, if I may ask you, what is the next important step for a project like this in your mind? Dr. Alissa Cooper: Jesse has highlighted a couple of key findings that we hope to move forward with future investigative studies, not necessarily in a real-world setting, but maybe even in clinical trial settings or in collaboration with sponsors. Are these biomarkers predictive? Are they prognostic? You know, those are still- we have some nascent data, data has been brewing, but I think that we we still don't have the answers to those open questions, which I think are critically important for determining not only clinical treatment decision-making, but also our ability to understand sequencing of therapies, prioritization of therapies. I think a prospective, forward-looking project, piggybacking on that paired biopsy, you know, we had a very small subset of patients with paired biopsies, but a larger subset or cohort looking at paired biopsies where we can see is there evolution of these IHC expression, even mRNA expression, as you're saying, is there differential there? Are there selection pressures to targeted therapies? Is there upregulation or downregulation of targets in response not just to chemotherapy, but for example, for other sort of ADCs or bi-specific T-cell engagers? I think those are going to be critically important future studies which are going to be a bit challenging to do, but really important to figure out this key clinical question of sequencing, which we're all contemplating in our clinics day in and day out. If you have a patient, and these patients often can be sick quite quickly, they might have one shot of what's the next treatment that you're going to pick. We can't guarantee that every patient is going to get to see every therapy. How can you help to sort of answer the question of like what should you offer? So I think that's the key question sort of underlying any future work is how predictive or prognostic are these biomarkers? What translational or correlative studies can we do on the tissue to understand clinical treatment decision-making? I think those are the key things that will unfold in the next couple of years. Dr. Rafeh Naqash: The last question for you, Alissa, that I have is, you are fairly early in your career, and you've accomplished quite a lot. One of the most important things that comes out from this manuscript is your mentorship for somebody who is a fellow and who led this project. For other junior investigators, early-career investigators, how did you do this? How did you manage to do this, and how did you mentor Jessica on this project with some of the lessons that you learned along the way, the good and other things that would perhaps help other listeners as they try to mentor residents, trainees, which is one of the important things of what we do in our daily routine? Dr. Alissa Cooper: I appreciate you calling me accomplished. Um, I'm not sure how true that is, but I appreciate that. I didn't have to do a whole lot with this project because Jesse is an extraordinarily smart, driven, talented fellow who came up with a lot of the clinical questions and a lot of the research questions as well. And so this project was definitely a collaborative project on both of our ends. But I think what was helpful from both of our perspectives is from my perspective, I could kind of see that this was a gap in the literature that really, I think, from my work leading clinical trials and from treating patients with these kinds of cancers that I really hoped to answer. And so when I came to Jessica with this idea as sort of a project to complete, she was very eager to take it and run with it and also make it her own. You know, in terms of early mentorship, I have to admit this was the first project that I mentored, so it was a great learning experience for me as well because as an early-career clinician and researcher, you're used to having someone else looking over your shoulder to tell you, "Yes, this is a good journal target, here's what we can anticipate reviewers are going to say, here are other key collaborators we should include." Those kind of things about a project that don't always occur to you as you're sort of first starting out. And so all of that experience for me to be identifying those more upper-level management sort of questions was a really good learning experience for me. And of course, I was fantastically lucky to have a partner in Jesse, who is just a rising star. Dr. Jessica Ross: Thank you. Dr. Rafeh Naqash: Well, excellent. It sounds like the first of many other mentorship opportunities to come for you, Alissa. And Jessica, congratulations on your next step of joining and being faculty, hopefully, where you're training. Thank you again, both of you. This was very insightful. I definitely learned a lot after I reviewed the manuscript and read the manuscript. Hopefully, our listeners will feel the same. Perhaps we'll have more of your work being published in JCO PO subsequently. Dr. Alissa Cooper: Hope so. Thank you very much for the opportunity to chat today. Dr. Jessica Ross: Yes, thank you. This was great. Dr. Rafeh Naqash: Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so as you never miss an episode. You can find all ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Disclosures: Dr. Alissa Jamie Cooper Honoraria Company: MJH Life Scienes, Ideology Health, Intellisphere LLC, MedStar Health, Physician's Education Resource, LLC,  Gilead Sciences, Regeneron, Daiichi Sankyo/Astra Zeneca, Novartis,  Research Funding: Merck, Roche, Monte Rosa Therapeutics, Abbvie, Amgen, Daiichi Sankyo/Astra Zeneca Travel, Accommodations, Expenses: Gilead Sciences

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Ein Abend. 120 Minuten. 90 Frauen. Ein Gast. Und ein Thema, das endlich laut werden darf. Mit unserem carpe diem Live-Podcast vor Publikum haben wir das Museumsquartier Wien in einen Ort des Austauschs, der Aufklärung und des gemeinsamen Lachens verwandelt. Denn: Die Wechseljahre sind so viel mehr als Hitzewallungen, Schlafstörungen oder Stimmungsschwankungen. Sie sind eine Lebensphase im Wandel – mit Herausforderungen, aber auch mit echten Chancen. Zu Gast im Talk mit Host Niki Löwenstein ist der renommierte Frauenmediziner und Endokrinologe Univ.-Prof. DDr. Johannes Huber, der klar, holistisch und mit Leidenschaft über Hormone, Medizin und das Älterwerden spricht. Im Live-Talk erklärt Johannes Huber, was im Körper während der Wechseljahre wirklich passiert, warum jede Frau sie anders erlebt und wie man Symptome richtig einordnet. Denn oft ist es nicht einfach, neue körperliche und mentale Zustände richtig zu deuten, erklärt unser Talk-Gast: „Wenn man sich als Mediziner mit der Menopause beschäftigt, muss man den weißen Arztkittel ausziehen und den Rock des Kriminalinspektors anziehen.“ Außerdem sprechen wir über Ernährung, Lebensstil, medizinische Begleitung und natürlich über das große Thema „Hormone" – über Chancen, Risiken und Mythen, die sich hartnäckig halten. „Jedes Antibiotikum ist für den Körper künstlicher als eine Hormonersatztherapie“, erzählt Prof. Huber im Live-Podcast. Mit dabei: ein engagiertes Publikum, das live mit diskutiert, Fragen stellt und ganz persönliche Erfahrungen teilt – von Hitzewallungen bis Schlaflosigkeit, von Tabus bis zu neuen Perspektiven. Am Ende bleibt die Erkenntnis: Die Wechseljahre sind nicht das Ende, sondern ein Neubeginn. Ein Aufbruch in ein selbstbestimmtes, informiertes und gelasseneres Leben. Diese Live-Folge wurde am 8. Oktober 2025 im MuseumsQuartier Wien aufgezeichnet. Was wir außerdem aus dieser Episode mitnehmen: Warum Progesteron das Hormon der Weisheit und Östrogen das Hormon der Schönheit ist Wieso Hormone einen Schlüssel und ein Schlüsselloch brauchen Warum der Frauenkörper ein Wunderwerk ist Was wir von der Bibel für den nächsten Gynäkologie-Besuch lernen können Welches Gewürz die Libido ankurbelt Warum Hunger ein tolles Anti-Aging-Mittel ist Wie das Wundermittel Calcium und die weibliche Periode zusammenhängen Welche Mythen sich rund um Hormonersatztherapie ranken Viel Vergnügen mit dem Podcast! Mehr zu Prof. Johannes Huber erfährst du HIER. Follow us on ...   Apple Podcasts Spotify Instagram Homepage YouTube

Das Vorhaben für die Legalisierung von Schwangerschaftsabbrüchen ist kurz vor dem Ziel im Bundestag ausgebremst worden. In ihrem Buch plädiert Dr. med. Alicia Baier, Ärztin in der Gynäkologie und Gründerin von Doctors for Choice German für die körperliche Selbstbestimmung.

"Da müssen Sie halt durch!" Das ist leider immer noch ein Standardspruch von Gynäkolog:innen, wenn Frauen mit heftigen Wechseljahres-Beschwerden Lösungen erbitten, ggfs auch hormoneller Art. Seit einigen Tagen (Nov. 2025) ändert sich (hoffentlich) diese Arroganz, denn die Women's Health Initiative (WHI) unterstützt in Zusammenarbeit mit wichtigen Aufsichtsbehörden wie der US-amerikanischen FDA die Aufhebung der Warnhinweise für Hormonersatztherapieprodukte (HRT) zur Behandlung von Wechseljahresbeschwerden, basierend auf aktuellen wissenschaftlichen Studien und Expertenkonsens. Diese Änderung erfolgt nach mehr als zwei Jahrzehnten der Vorsicht im Anschluss an die ursprüngliche WHI-Studie aus dem Jahr 2002, die Bedenken hinsichtlich eines erhöhten Risikos für Herz-Kreislauf-Erkrankungen und Brustkrebs im Zusammenhang mit synthetischen (patentierbaren) Hormonen bei älteren Frauen aufkommen ließ.Unser Gast Heilpraktikerin und Sportwissenschaftlerin Nancy Bolmerg kennt durch ihre Hormonberatungen die Leiden von mindestens 1/3 der Frauen vor und nach der Menopause – nur 1/3 der Frauen haben keine nennenswerten Beschwerden.Nancy macht sich dafür stark, dass nach sorgfältigen Bluttests bioidentische Hormone verschrieben werden dürfen (Scherz am Rande: "derzeit sind harte Drogen leichter als diese erhältlich"). Sie erklärt uns den erheblichen Unterschied zwischen den "gefährlichen" und den Molekülen, die unser Körper bestens kennt.Diese innerhalb von 10 Jahren nach Beginn der Menopause (vor dem 60. Lebensjahr) anzuwenden kann mit einer Verringerung der Gesamtmortalität, von Knochenbrüchen, des Risikos für Herz-Kreislauf-Erkrankungen und Alzheimer verbunden sein. Wechseljahre sind Entzündungsjahre – und immerhin oft 1/3 eines Frauenlebens: Wir dürfen diese Zeit mit Sport, achtsamer Ernährung und eben mit passenden Hormonen begleiten! Denn wem ist bewusst, dass sogar trockene Augen, "quietschende" Gelenke, störrische Verdauung durch winzige Mengen an Estriol behandelt werden könnten?Konnten dir unsere Rezeptideen und Tipps bereits helfen?! Magst du uns zu mehr REICHWEITE verhelfen und empfiehlst unseren Podcast weiter? Danke für deine/Ihre Unterstützung durch den Kauf in unserem Shop oder über unsere Empfehlungs-Links, auch über eine kleine Spende "für einen Kaffee" freuen wir uns: Eliane und/oder Sabrina. Streicheleinheiten für die Hormon-Bändigerin Leber: LeberCare-Set Raumspray Weihnachts-Duft und Stöbern im Advents-Sortiment Tee AdventkalenderDufter Adventkalender (limitiert!)WeihnachtsduftGeschenk-Set Oh TannenbaumBaldini Mini-Duftset “Alles Liebe”Deutsche Pionierin der Aufklärung über bioidentische Hormone: Gynäkologin und Buchautorin Dr. med. Sheila de Liz, ihre Bücher bei uns im ShopForsthaus ApothekeArtikel von Eliane über Plastik im KörperHunger auf seriöses und firmenunabhängiges Wissen? Regelmäßige Informations-Häppchen – ohne Extra-Kosten – im neuen WhatsApp-Kanal oder in unserem Telegram-Kanal Über 800 Blog-Artikel von Eliane Zimmermann, insbesondere rund um Studien: AromapraxisÜber 400 Blog-Artikel von Sabrina Herber, ergänzt mit hunderten von Rezepturen: Vivere-AromapflegeAufzeichnungen unserer über 40 webSeminare:: HAFTUNGSAUSSCHLUSS :: Alle Informationen in unserem Podcast beruhen auf unserer langjährigen Erfahrung, auf traditionellen Anwendungen, sowie – sofern bereits durchgeführt – auf wissenschaftlichen Arbeiten. Unsere Tipps dienen ausschließlich Ihrer Information und ersetzen niemals eine gründliche Beratung, Untersuchung oder Diagnose bei einer gut ausgebildeten Heilpraktikerin oder beim qualifizierten Arzt. Ganzheitlich verstandene Aromatherapie berücksichtigt vorrangig individuellen Besonderheiten, dies ist nur in einem persönliche Gespräch möglich. Unsere zur Verfügung gestellten Inhalte können und dürfen nicht zur Erstellung eigenständiger Diagnosen verwendet werden. Das vollständige Impressum befindet sich jeweils auf den beiden Websites der Autorinnen, jede Haftung wird ausgeschlossen.

Weltweit steht das Recht auf körperliche Selbstbestimmung unter Beschuss. Auch in Deutschland. Denn rechts-konservative Kräfte versuchen seit Jahren, Einfluss auf die Rechtssprechung zu nehmen – immer wieder mit Erfolg.Laura spricht mit der Gynäkologin Alicia Baier darüber, warum Schwangerschaftsabbrüche in Deutschland im Strafgesetzbuch stehen, warum zwei Urteile des Bundesverfassungsgerichts zwar wegweisend, aber nicht demokratisch waren und wie die FDP im letzten Jahr einen wichtigen Schritt hin zu legalen Schwangerschaftsabbrüchen verhindert hat. Alicia Baier ist Autorin von „Das Patriarchat im Uterus“ und Teil des Vorstands von Doctors for Choice.Danke an alle, die den Lila Podcast unterstützenHelft uns, damit unsere Arbeit fair bezahlt werden kann! Alle Infos darüber, wie ihr den Lila Podcast supporten könnt, haben wir für euch hier gesammelt.Aktuelle Werbepartner und weitere Infos zum Podcast.Links und Hinweise„Das Patriarchat im Uterus“, Buch von Alicia BaierAussprache im Bundestag zum Entwurf (inkl. Zitat Beatrix von Storch)Phoenix: Pressekonferenz Merz/Dobrindt (inkl. Zitat Friedrich Merz)SWR: §219a - Infos über Abtreibung verboten? (inkl. Zitat Kristina Hänel)Politik mit Anne Will: Wird der Rechtsstaat zur Kampfzone? (inkl. Zitat Frauke Brosius-Gersdorf)ELSA-Studie AbschlussberichtThe Turnaway StudyWeitere Quelle findet ihr hierWeitere Lila-Folge zum ThemaAbtreibung im Fokus: Was wir aus Polen und aus der Geschichte lernen können (Live von der Dokumentale)Kenne deine (Menschen-)Rechte: Was die UN-Frauenrechtskonvention CEDAW bringtTranskriptWir freuen uns sehr, euch ein Transkript zur Sendung zur Verfügung stellen zu können. Es wurde automatisch erstellt. Ihr findet es auf unserer Website. Hosted on Acast. See acast.com/privacy for more information.

Well, from time to time we cover RANDOM tidbits of information which cover RANDOM questions and/or RANDOM patient care issues that we encounter. In this episode we will cover one OB issue related to recurrent pregnancy loss, one GYN issue related to unilateral breast swelling in a patient with SLE, and one RANDOM life perspective response from a mock interview that I participated in for a residency candidate. Listen in fordetails!1.     Viviana DO; Giugni, Claudio Schenone MD; Ros, Stephanie T. MD, MSCI. Factor V and recurrent pregnancy loss: de Assis, Evaluation of Recurrent Pregnancy Loss. Obstetrics & Gynecology 143(5):p 645-659, May 2024. | DOI: 10.1097/AOG.0000000000005498Unilateral Breast Swelling with SLE: 2.     Voizard B, Lalonde L, Sanchez LM, et al. LupusMastitis as a First Manifestation of Systemic Disease: About Two Cases With a Review of the Literature. European Journal of Radiology. 2017;92:124-131. doi:10.1016/j.ejrad.2017.04.023.3.     Kinonen C, Gattuso P, Reddy VB. Lupus Mastitis:An Uncommon Complication of Systemic or Discoid Lupus. The American Journal of Surgical Pathology. 2010;34(6):901-6. doi:10.1097/PAS.0b013e3181da00fb.4.      Summers TA, Lehman MB, Barner R, Royer MC. Lupus Mastitis: A Clinicopathologic Review and Addition of a Case. Advances in Anatomic Pathology.2009;16(1):56-61. doi:10.1097/PAP.0b013e3181915ff7.5.     Jiménez-Antón A, Jiménez-Gallo D,Millán-Cayetano JF, Navarro-Navarro I, Linares-Barrios M. Unilateral Lupus Mastitis.Lupus. 2023;32(3):438-440. doi:10.1177/09612033221151011.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

OBJECTIF SANTÉ Émission présentée par Catherine Lacrosnière qui reçoit le Docteur Pascale Sabban Serfati, Gynécologue et le Docteur Yves Otmezguine, oncologue Thème : le cancer du sein de la femme jeune, un combat particulier, un combat d'espoir

Operationen mit dem Roboter? In der Urologie ist das seit 25 Jahren nahezu Standard, in den USA werden längst 95 Prozent aller Prostatakrebs-Eingriffe mit dem Roboter durchgeführt. Auch an der Asklepios Klinik Altona assistiert bereits seit 2017 Kollege „Dr. Da Vinci“, wie das bekannteste Modell heißt, bei zahlreichen Operationen in den Bereichen Urologie, Chirurgie und Gynäkologie. Und es werden mehr.

Hey ihr Lieben!

Wie verändert Soziokratie den Klinikalltag und das Verständnis von Führung?Kathrin Hillewerth, Co-Klinikleiterin Chirurgie am Spital Zollikerberg, spricht über den Weg hin zu soziokratischen Strukturen, über Vertrauen, Mitbestimmung und die Kunst, in einem hochkomplexen Umfeld Orientierung zu geben. Ein ehrlicher Einblick in Führung, Verantwortung und Wandel im Gesundheitswesen. Über meine InterviewpartnerinKathrin Hillewerth ist Co-Klinikleiterin der Klinik für Chirurgie am Spital Zollikerberg, eine Funktion, die sie seit 2010 gemeinsam mit einem ärztlichen Kollegen wahrnimmt. Sie verbindet fundierte Pflegeexpertise mit langjähriger Führungserfahrung und einer ausgeprägten ethischen Haltung: Als Co-Leiterin des Ethik-Forums der Gesundheitswelt Zollikerberg prägt sie seit gut 20 Jahren die werteorientierte Entscheidungsfindung im Haus. Mit einem Master of Science in Nursing und einem MAS in Ethischer Entscheidungsfindung in Organisationen und Gesellschaft bringt sie wissenschaftliche Tiefe ebenso ein wie gelebte Praxis.Seit 2019 begleitet sie die Einführung soziokratischer Kreisstrukturen in der Klinik für Chirurgie mit dem Ziel, Verantwortung breiter zu verteilen, Mitbestimmung zu stärken und die Qualität der Zusammenarbeit weiterzuentwickeln. Über das UnternehmenDas Spital Zollikerberg ist Teil der Gesundheitswelt Zollikerberg der Stiftung Diakoniewerk Neumünster – Schweizerische Pflegerinnenschule.Als privates Akutspital mit öffentlichem Leistungsauftrag des Kantons Zürich steht es für moderne Medizin, menschliche Pflege und wertebasierte Gesundheitsarbeit. Mit 173 Betten, jährlich rund 11'000 stationären und 70'000 ambulanten Behandlungen sowie etwa 2'000 Geburten zählt das Spital zu den bedeutenden Gesundheitseinrichtungen der Region. Die Klinik für Chirurgie ist eines der zentralen Leistungszentren: Über 1'500 stationäre Eingriffe und 6'000 Notfallbehandlungen pro Jahr bilden ein breites Spektrum von Allgemeinchirurgie, Orthopädie, Wirbelsäulen- und Gynä­ko­logie ab.Besonders bemerkenswert: Seit 2019 arbeitet die Klinik für Chirurgie mit soziokratischen Kreisstrukturen, ein Modell, das Zusammenarbeit, Mitbestimmung und gemeinsame Verantwortung im Klinikalltag neu gestaltet.

Der 34-jährige Demokrat und Muslim Zohran Mamdani ist neuer Stadtpräsident von New York. Ganz zum Ärger von US-Präsident Donald Trump, der bereits im Vorfeld der Wahl angekündigt hat, Mamdani bekämpfen zu wollen. Das Gespräch mit USA-Experte Stephan Bierling. Weitere Themen: Der deutsche Innenminister Alexander Dobrindt hat den islamistischen Verein «Muslim Interaktiv» verboten. Der Verein sorgte im April 2024 mit einer Kundgebung in Hamburg bundesweit für Empörung. Nun hat das Innenministerium daraus die Konsequenz gezogen. Schweizer Ärzte und Ärztinnen müssen derzeit viel Geduld aufbringen, wenn es um ihren Facharzttitel geht. Gynäkologinnen, Psychiater, aber auch Anästhesisten warten monatelang auf die Anerkennung, weil das zuständige Institut, das die Titel herausgibt, überlastet ist. Woran liegt das?

Empfohlener Link: www.intumind.de/podcast-selbsttest In dieser neuen Podcastfolge erfährst du, wie du die hormonellen Veränderungen rund um die Wechseljahre verstehen – und vor allem gelassener damit umgehen kannst. Gemeinsam mit Gynäkologin Dr. Judith Bilder sprechen wir über Anzeichen, natürliche Wege zur Balance und wie du wieder Vertrauen in deinen Körper findest. Diese Folge macht Mut, klärt auf und zeigt: Du musst nicht leiden, wenn du weißt, was in deinem Körper passiert.

In der Diagnostik und Therapie der Endometriose hat sich in den letzten Jahren einiges getan. Die Aktualisierung der Leitlinie zeigt: moderne Endometriose-Versorgung muss mit überholten Vorstellungen aufräumen, Frauen in ihren Beschwerden ernst nehmen und individuell auf sie eingehen. PD Dr. med. Stefanie Burghaus, Gynäkologin und Leitlinien-Koordinatorin, erklärt im Podcast, was das für die Praxis bedeutet.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This Blog contains dialogue of a sexual nature In my 29-year history of practicing gynecology and 23 years of practicing hormone replacement medicine, there have always been a few questions that only the bravest and most comfortable patients would ask me during a well-woman visit or consultation. During the next few weeks, I will dedicate my blog to those usually unanswered questions, but most probably those questions that women are too embarrassed to ask. The first question is asked in many forms, but the general idea of the question is:” What should I do if I think my vaginal area smells weird?”  “Smelling weird” is a common description that can imply many things, so I will outline what I ask my patients to gather enough information to provide them with a medically relevant answer. What does it smell like? Yeasty, like baked bread? Sweaty-like body odor? Sour- like a towel that has been we too long? Musky – like the musk type of perfumes? Urine? everyone knows what that smells like Old people in a nursing home? OR “Like something is dead in there?” “Like Fish?” These are the actual descriptions that I have received in response to my question, and they all identify different. In case some of you are worriers, I will start with the fact that vaginal odors 1-6 are likely due to a minor infection, either an overgrowth of yeast, or the fact that you don't air out that area at night which makes yeast and bacteria grow in the warm environment between your legs or under the covers. Vaginal odors 7 and 8 are more serious and require treatment. I will first discuss the most important conditions based on their odors. These can be quite dangerous if ignored. Let me start by addressing odors 7 and 8. Odor # 7. If your vagina smells foul, like “something is dead in there,” you should probably make an appointment with your GYN. It could result from something as simple as a tampon that was “lost” in the vagina, leading to bacteria growing from menstrual blood and semen.  This is a common cause of such vaginal odor. The GYN will need to use an instrument to grasp the tampon and remove it. She will then prescribe an antibiotic to treat the infection that has developed. While there's no harm in removing it, leaving it in place can lead to a serious pelvic infection. If your doctor doesn't find a tampon and this odor is confirmed by her, then she will do bacterial cultures and a pap to look for cervical cancer or endometrial cancer. It is important that you don't ignore this odor.  It won't get better on its own. Odor #8. If your vagina smells like fish it is likely an infection with a bacteria called hemophilous vaginalis, or from Trichomonas (“Trick”). Hemophilus can be caused by wiping back to front (the wrong way), which allows rectal bacteria to enter the vagina. Additionally, Hemophilus can be introduced into the vagina during intercourse. In these two cases, it is not considered a venereal infection– NOT an infection you acquired from your sexual partner. However, Hemophilus can be a venereal infection that you contract from a sexual partner if he acquired it from someone else and transmitted it to you! The treatment is essentially the same: a medication called Flagyl or metronidazole, taken three times a day for 7-10 days. If your partner has it too, he needs to take the medication at the same time so you don‘t keep passing it to each other. These infections require examination and testing to receive an antibiotic. The last possible cause of a fishy-smelling vagina is Trichomonas, a parasite that produces a significant amount of thin, greenish discharge along with a fishy odor. It is sexually transmitted, and both partners should be treated.  He should also have his other contacts treated. The group of infections in #8 is treatable and curable with medical help. Another quality of Hemophilus and Trichomonas is that if you have nitrazine pH paper and test the discharge with it, it will turn the paper dark blue.  Dark blue means go to the GYN! We'll start back up at 1-6 discussing the causes of “funny smelling discharge. ” These are the least likely to be serious infections. I need to provide some initial information before I discuss the various reasons for vaginal odor. First, there is always a slight odor that is uniquely yours. You shouldn't try to eliminate all signs of vaginal odor because it results from a combination of yeast, good bacteria, estrogen, testosterone, and progesterone, which help protect your vagina and vulva, the area surrounding the vagina.  Changes in hormones such as pregnancy, menopause, hormone replacement therapy, diet, antibiotics, and dehydration can alter the vaginal smell and discharge. The yeasty odor that resembles baked bread comes from normal yeast present in the vagina. Some women naturally have this odor. It becomes a concern only when it is accompanied by itching and a significant amount of white discharge. These yeast infections can occur after taking antibiotics that eliminate good bacteria.  They may also arise when blood sugar levels are elevated, as seen in diabetics or prediabetics. The pH paper will not change color.  Treatment involves yeast medication, which can be either vaginal or oral, along with oral probiotics and sometimes vaginal probiotics to help restore the good bacteria. If you are diabetic, you may experience yeast infections until your blood glucose levels are normalized.   Sweaty-like body odor.The vagina can develop body odor from sweat that fosters the same bacteria found under your armpits.  This matter is simple.  Change out of wet swimsuits, wash gently with the same soap you use for the rest of your body, and allow your vagina to dry by sleeping without underwear.   Sour like a towel that has been wet too long. The ability to detect sour odors is genetically determined. You may not notice it, but your significant other might, or you may smell his clothes that have this odor, while he doesn't.  Either way, it is caused by bacteria from sweaty, damp clothes thrown into a hamper, allowing fungus and bacteria to grow. For some reason, you then wear these clothes, and your vagina ends up harboring the same jungle of bacteria and fungus.  This one is easy: air out clothes before wearing them, avoid putting on garments that are not clean, and wash these clothes in warm water to eliminate the microbes. You may need a doctor's visit for diagnosis and treatment.   Musky -you know, like the musk type of perfumes. A musky smell is the natural scent of fertile women with testosterone, especially when they are sexually stimulated. This is not an infection; it is the normal sexual scent of attraction. This odor usually diminishes with menopause or when you are on the pill and your testosterone levels decrease.   Like urine. The smell of urine is usually caused by leaking urine, poor wiping, or wearing a pad that absorbs leaking urine. It can precede a yeast infection because urine wetness encourages the growth of yeast. Treating urine leakage is imperative for resolving this issue. Options include surgery, Emsella magnetic pelvic floor strengthener, or a pessary. All of these can be discussed with your doctor when you inform them that you experience this odor consistently.   Like Elderly individuals in a nursing home? Sadly, nursing homes do have a characteristic odor; it is a combination of urine and cleaning chemicals, but there is something more. Elderly people who lack hormones have lost protective bacteria and exhibit a dominant odor of deterioration. This is what the vagina smells like without hormones and the beneficial bacteria they support. This is a smell that many women ask me about after menopause when they don't take hormones. The only way to return the odor to normal is to reinstate hormones.   If you have other vaginal odors I have not addressed, then send your email questions to podcast@biobalancehealth.com.  I pray you will trust your gynecologist enough to ask any questions you need to understand your own body. I hope I have provided you with some material to reflect on and compare to help answer your questions.

Ist Altern wirklich „die Mutter aller Krankheiten“? Oder ist es ein natürlicher Prozess, der dann aber typische Krankheiten mit sich bringt? Für den Gynäkologie Professor Bernd Kleine-Gunk aus Nürnberg gilt auf jeden Fall ersteres. „Krebs, Osteoporose, Demenz und viele weitere Krankheiten sind doch altersassoziiert“, sagt der Präsident der German Society of Anti-Aging Medicine (GSAAM) im „ÄrzteTag“-Podcast. Und: Der Wunsch vieler Menschen, gesund alt zu werden, sei doch nachvollziehbar. Im Gespräch wehrt sich der Mediziner, der die Anti-Aging-Medizin bereits seit 25 Jahren betreibt, auch gegen Vorwürfe, diese Medizinrichtung sei vor allem Industrie-getrieben und vor allem etwas für reiche Patienten. Das, was wirklich etabliert sei in der Longevity-Medizin, „kostet alles kein Geld“, so Kleine-Gunk: Rauchstopp, mehr Bewegung, die richtige Ernährung. Im Podcast erläutert er weiter, was darüber hinaus geht: Epigenetische Tests, die Forschungen, was Menschen altern lässt – und wie dies messbar gemacht werden kann, und im nächsten Schritt dann auch therapierbar. Diskutiert wird im Podcast auch, welche Evidenz die Longevity-Medizin bereits zu bieten habe, warum RCT-Studien, wenn es um Langlebigkeit geht, ihre Grenzen haben und welche Studien die Richtung besonders voranbringen könnten. Kleine-Gunk gibt zudem einen Überblick, wie niedergelassene Ärztinnen und Ärzte vorgehen können, die sich mit Longevity ein zusätzliches Standbein aufbauen wollen. Nicht zuletzt spricht er über Nahziele von Longevity – gesund 100 Jahre alt werden – sowie über langfristige Perspektiven und darüber, in welchem Alter Menschen in Zukunft vielleicht in Rente gehen werden.

Wie sagt man Menschen, dass sie Krebs haben, dass eine Krankheit nicht heilbar ist, dass die Medizin keine Lösung hat? Prof. Jalid Sehouli leitet die Gynäkologie der Berliner Charité und zeigt, wie das besser klappen könnte.

Heute spreche ich mit Professor Petra Stute, einer der führenden Expertinnen für Gynäkologische Endokrinologie und Reproduktionsmedizin am Inselspital in Bern. Sie ist Präsidentin der Europäischen Menopause- und Andropausegesellschaft (EMAS), ausgezeichnete Forscherin und leidenschaftliche Aufklärerin rund um das Thema weibliche Hormone. Gemeinsam tauchen wir in die spannenden Fragen der Menopause und Hormonersatztherapie ein: Wer profitiert, welche Risiken gilt es zu beachten und welche Alternativen gibt es? Außerdem sprechen wir über ihre aktuellen Studien, darunter die Menoflu-Studie, die den Zusammenhang zwischen Hormonen, Immunsystem und Alterung untersucht. Ein Gespräch voller Wissen, Klarheit und Orientierung. In dieser Folge sprechen wir u. a. über folgende Themen: - Sollte die Hormonersatztherapie allen Frauen in der Menopause empfohlen werden – oder nur bei Beschwerden? - Welche Alternativen zur Hormonersatztherapie gibt es, um Symptome und Alterskrankheiten vorzubeugen? - Können auch ältere Frauen nach Jahren der Menopause noch mit einer Hormontherapie beginnen? - Wie stark ist das Brustkrebsrisiko durch bioidentische Hormone wirklich erhöht? - Welche Kontraindikationen machen eine Hormonersatztherapie riskant oder unmöglich? - Warum nehmen Hitzewallungen Einfluss auf das Herz-Kreislauf-Risiko? - Welche Rolle spielen Wearables bei der Erkennung von Herzrisiken in der Menopause? - Können Hormone das Demenzrisiko senken – oder ist die Studienlage noch zu uneindeutig? - Wie stark schützt eine Hormonersatztherapie vor Diabetes, Osteoporose und Darmkrebs? - Wann ist der optimale Zeitpunkt für den Beginn einer Hormonersatztherapie? - Gibt es ein Alterslimit für die Anwendung von Hormonen – oder können sie lebenslang genommen werden? - Welche Rolle spielen Lebensstilfaktoren wie Ernährung, Schlaf und Bewegung im Zusammenspiel mit Hormonen? - Kann Yoga menopausale Beschwerden lindern und gleichzeitig Entzündungswerte sowie Herzrisiken senken? Weitere Informationen zu Prof. Petra Stute findest du hier: https://www.menoqueens.com/about Und hier geht´s zu ihrem Buch: https://www.amazon.de/Management-Menopause-medizinisches-Kochbuch-Wechseljahre/dp/3662704935/ref=sr_1_1?dib=eyJ2IjoiMSJ9.HOODuulF4wnSwm5zQiX7bLew3PBsbvHnPbNRLPb11__GjHj071QN20LucGBJIEps.dOPqTNukUPCdw-h9yjrcqiGrBKQB2ey1JjtXW_2R7Hg&dib_tag=se&qid=1753427146&refinements=p_27%3APetra+Stute&s=books&sr=1-1 Du interessierst dich für Gesunde Langlebigkeit (Longevity) und möchtest ein Leben lang gesund und fit bleiben, dann folge mir auch auf den sozialen Kanälen bei Instagram, TikTok, Facebook oder YouTube. https://www.instagram.com/nina.ruge.official https://www.tiktok.com/@nina.ruge.official https://www.facebook.com/NinaRugeOffiziell https://www.youtube.com/channel/UCOe2d1hLARB60z2hg039l9g Disclaimer: Ich bin keine Ärztin und meine Inhalte ersetzen keine medizinische Beratung. Bei gesundheitlichen Fragen wende dich bitte an deinen Arzt/deine Ärztin. STY-233

In der morgige Podcastfolge widmen wir uns dem spannenden Thema Menopause und Hormonersatztherapie. Gemeinsam mit Professor Petra Stute, stellvertretende Chefärztin für Gynäkologische Endokrinologie und Reproduktionsmedizin am Inselspital Bern und Präsidentin der Europäischen Menopause- und Andropausegesellschaft (EMAS), gehen wir den wichtigsten Fragen auf den Grund: Wer profitiert von Hormonen, welche Risiken gilt es zu beachten, und welche Alternativen gibt es? Wir sprechen über Brustkrebs, Herz-Kreislauf-Erkrankungen, Schlafprobleme, Demenz, Diabetes sowie aktuelle Studien wie die Menoflu-Studie. Ein Gespräch voller Klarheit, wissenschaftlicher Fakten und Orientierung für Frauen in der Lebensmitte. Du möchtest tiefer in das Thema einsteigen? Hier gehts zum Podcast-Interview mit Prof Petra Stute: https://link.stayoung.de/STY-233SpotifyEBDu interessierst dich für Gesunde Langlebigkeit (Longevity) und möchtest ein Leben lang gesund und fit bleiben, dann folge mir auch auf den sozialen Kanälen bei Instagram, TikTok, Facebook oder YouTube. https://www.instagram.com/nina.ruge.official https://www.tiktok.com/@nina.ruge.official https://www.facebook.com/NinaRugeOffiziell https://www.youtube.com/channel/UCOe2d1hLARB60z2hg039l9g Disclaimer:Ich bin keine Ärztin und meine Inhalte ersetzen keine medizinische Beratung. Bei gesundheitlichen Fragen wende dich bitte an deinen Arzt/deine Ärztin. STY-233

Endometriose, Lobbyismus und die Frage, warum Gynäkologie noch immer ein männlich dominiertes Feld ist: In dieser Folge sprechen Lenia und Luisa mit Dr. Mertcan Usluer – bekannt als Gynäkollege auf Instagram – über die blinden Flecken der Frauenmedizin. Zwischen persönlichen Erfahrungen, wissenschaftlichen Fakten und gesellschaftlichen Tabus wird deutlich, wie groß der Nachholbedarf ist. Im Fokus steht Endometriose: eine Erkrankung, die mit starken Schmerzen, chronischen Beschwerden, Schmerzen beim Sex oder unerfülltem Kinderwunsch verbunden sein kann. Der Weg zur Diagnose dauert meist viele Jahre, weil Symptome verharmlost oder falsch gedeutet werden. Lenia erzählt von ihrer eigenen Leidensgeschichte. Mertci erklärt, warum wirtschaftliche Interessen und Lobbyismus dazu führen, dass Krankheiten, die vor allem Frauen betreffen, bis heute zu wenig Beachtung finden. Das Gespräch öffnet auch den Blick fürs Grundsätzliche: Warum gilt in der Embryonalentwicklung zunächst jeder Mensch als weiblich? Weshalb war die Gynäkologie so lange von männlichen Blickwinkeln geprägt? Warum hat Mertci sich für diesen Fachbereich entschieden und mit welchen Standardfragen wird er konfrontiert, wenn er erzählt, dass er Gynäkologe ist? Zum Abschluss wird es persönlicher, denn Lenia und Luisa stellen ihm unerwartete „Random-Fragen“.

What do you look for when selecting a personal doctor? Years of experience? Hospital affiliation? Expertise and specialty? Martha's latest guest began her journey into medicine as a young student with a passion for science, biology, and the deep desire to impact the lives of others. With more than 40 years in practice and medical research, Dr. Carin Behar is changing the way women look at health and wellness. As a general internist and the medical director of the Joan Tisch Center for Women's Health, Dr. Behar treats a wide variety of conditions, with a focus on preventive care and health maintenance. She caters to the unique needs of women, consolidating annual medical and GYN exams, mammograms, bone density, medical subspecialties, women's orthopedics, dermatology, and cancer risk, all in one place. In this podcast, Dr. Behar talks to Martha about her approach to women's care, the latest advice on women's imaging and testing, the importance of mental health, and what she wishes all her female patients to know as they enter their later years. Be sure to listen. See omnystudio.com/listener for privacy information.

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

In this eye-opening episode, I explain why conventional period advice is outdated, dismissive, and flat-out wrong for high-achieving women like YOU. You'll learn: ✔️ The 3 lies most women are told about their period ✔️ Why birth control is NOT a fix for hormone chaos ✔️ What your period is actually trying to tell you ✔️ How to start a hormone rhythm reset Whether you're struggling with cramps, mood swings, or mid-cycle crashes — this episode will shift how you see your cycle forever. Vitality Health Rx: Daily Greens powder & Optimal Probiotic – https://shopvrx.com/collections/all-products Use code: FEELGREAT15 for 15% off your first order.  

Today, I am honored to connect with Rachel Frankenthal, a board-certified physician assistant with a master's degree in public health, specializing in gynecologic oncology. Rachel is on the staff at UCLA Health, where she treats women with gynecologic cancers and women at high risk for uterine or ovarian cancer due to genetic mutations or a strong family history.  In our discussion, we unpack GYN oncology, covering the five GYN cancers, why ovarian cancer is the silent killer, and the labs and ultrasounds to help screen for ovarian cancer. We dive into genetics, including BRCA mutations and Lynch syndrome, appropriate genetic counseling, and what Rachel considers when dealing with younger patients still at peak fertility versus older patients. We explore the importance of HRT utilization for cancer previvors, the effects of pelvic radiation, vaginal and sexual health, and what thriving looks like after cancer. Rachel shares her stepwise approach to hot flashes, and we also discuss the importance of lifestyle, bone health, and specific research on the benefits of GLP-1s for women with ovarian and endometrial cancer.  This conversation is especially relevant as we are in GYN and Ovarian Cancer Awareness Month. I look forward to having Rachel back again, hopefully later this fall, to discuss the use of hormone replacement therapy with GYN oncology survivors. IN THIS EPISODE, YOU WILL LEARN: How the lack of effective screening makes ovarian cancer hard to detect due to  How BRCA and Lynch syndrome influence cancer risk and treatment choices The benefits of HRT for cancer previvors Risks that arise from surgical menopause without sufficient or properly dosed HRT Why less than 50% of eligible women actually receive hormone therapy How pelvic radiation impacts menopause, vaginal tissue, bladder, and GI health The support that is crucial for cancer survivors after pelvic radiation Lifestyle factors to improve cancer treatment outcomes   Rachel shares her stepwise approach to managing hot flashes  What GLP-1 research reveals about reducing ovarian cancer mortality and endometrial cancer risk Bio: Rachel Frankenthal Rachel Frankenthal is a board-certified and licensed Physician Associate and Menopause Society Certified Practitioner with a Master's in Public Health. She specializes in gynecologic oncology, treating women with gynecologic cancers as well as women at high risk for uterine or ovarian cancer due to genetic mutations. Rachel has a special passion for menopause and midlife women's healthcare. She developed the menopause clinic for gynecologic cancer survivors and previvors at UCLA and has played an integral role in developing the GYN cancer survivorship program, where she teaches the weekly yoga and meditation class. Rachel lectures at UCLA and across the country on the importance of comprehensive menopause care in cancer survivorship and has created a course on hormone therapy for gynecologic cancer survivors through the Heather Hirsch Academy. In addition to being a medical practitioner, Rachel is a certified yoga and Pilates instructor, a prior Broadway performer, and an advocate for integrative, holistic health. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Rachel Frankenthal On Instagram

In this interview, Andrea Donsky, nutritionist, menopause educator, and published menopause researcher and co-founder of WeAreMorphus.com, discusses how hormonal birth control can mask where you are in the menopausal transition, what labs help, and how to talk to your doctor about safer options. Elizabeth Katzman specializes in Functional Diagnostic Nutrition for women in perimenopause and menopause. She'll help you connect the dots if you've taken the pill in the past or are on the pill now. Topic Covered: What the pill does (synthetic estrogen + progestin), why the “period” on it is a withdrawal bleed, and how it can hide your true perimenopause status.Why progestins can raise anxiety/depression risk, and how bioidentical progesterone supports sleep, mood, bones, and thyroid.Thyroid connection: How the pill can deplete nutrients and interfere with T4→T3 conversion, and raise hypothyroid risk when midlife thyroid issues already spike.Leaky gut, depleted lacto/bifido, and why protecting your mucosal lining matters for autoimmune risk.Testing that helps (and when): Why FSH/E2/Progesterone timing matters off the pill, plus affordable bloodwork that gives clues even when hormones fluctuate.How to think about nutrient repletion (methylated B's, magnesium, zinc, selenium) and why an IUD or mini-pill (progestin-only) isn't automatically a better choice.Topical/oral/vaginal progesterone options, DHEA and pregnenolone basics, and why “fit + formulation + timing” often matter more than the dose.Red meat, ferritin, and genetics: Why iron can climb post-menopause, when to watch ferritin, and how genetics (MTHFR, APOE) affect it.When your long-time GYN isn't the right HRT partner, and how to add a practitioner who actually understands midlife hormones.Links From The Show:Perimenopause, Menopause & Pelvic Health SurveyDNA CompanyWhy You Should Test Your Iron Levels in Menopause with Dr. Christy SuttonDr. Thomas Perls on Longevity Tips from Studying CentenariansUnderstanding Bio-Send us a text ✅ Fill out our surveys: https://bit.ly/4jcVuLh

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

Die Pille galt in Deutschland jahrzehntelang als die beliebteste Verhütungsmethode. Seit 2023 aber ist das vorbei. Da wurde sie erstmals vom Kondom als Nummer eins der beliebtesten Verhütungsmittel abgelöst. Tendenz steigend: Vor allem immer weniger junge Frauen verhüten mit der Pille. Was aber ist dran am schlechten Image der Pille? Und wie wirkt sich die Pille eigentlich auf das Gehirn aus? Das untersuchen zwei Neurowissenschaftlerinnen: Dr. Belinda Pletzer führt an der Universität Salzburg eine ERC Starting Grant finanzierte Probandinnenstudie, Carina Heller hat ihr Gehirn im Selbstexperiment untersucht. Erste Ergebnisse zum Einfluss der Pille auf das Gehirn präsentieren sie im Podcast. Außerdem ordnet die Gynäkologin Dr. Christine Adler Chancen und Risiken der Anti-Baby-Pille ein. Hier geht es zur Folge "Hormonfrei verhüten: Was Kupferspirale und Kupferkette wirklich leisten": https://open.spotify.com/episode/7xuzgXQ5WQnA64I2bNK0fa "Aha! Zehn Minuten Alltags-Wissen" ist der Wissenschafts-Podcast von WELT. Wir freuen uns über Feedback an wissen@welt.de. Produktion: Serdar Deniz Redaktion: Sophia Häglsperger Impressum: https://www.welt.de/services/article7893735/Impressum.html Datenschutz: https://www.welt.de/services/article157550705/Datenschutzerklaerung-WELT-DIGITAL.html

Persistent Genital Arousal Disorder (PGAD) is a rare and often misunderstood condition that involves unwanted, persistent genital sensations that don't resolve with one or more orgasms. Left untreated, PGAD can deeply affect mental health, body wellness, and quality of life.On this episode of Sky Women's Health Podcast, I'm joined by Dr. Sameena Rahman, founder of the GYN and Sexual Medicine Collective and host of Gyno Girl Presents: SEX, DRUGS & HORMONES, to explore:How PGAD is defined and diagnosedThe workup for underlying causesMultidisciplinary treatment optionsHow sexual wellness, hormones, and mental health intersectDr. Sameena Rahman:

Gibt es den berüchtigten „Husband Stitch“ wirklich? Wie verändern sich Brüste während der Schwangerschaft? Und was finden wir bei Frauen eigentlich wirklich erregend? In dieser Folge sprechen wir mit Chefärztin, Fünffach-Mama und Gynäkologie-Expertin Dr. Mandy Mangler über Schönheitsideale nach der Geburt, was sich hinter dem Begriff „Mommy Makeover” verbirgt und welche Rolle Partner:innen beim Schönheitsdruck spielen. Sie verrät außerdem, wie lange der After-Baby-Body für die Rückbildung braucht, warum das Familienbett für viele mehr ist als nur eine Schlaflösung – und warum sie manchmal mit Vollbart joggen geht. Hier findet ihr Mandy bei Instagram https://www.instagram.com/mandy_mangler/?hl=de Und hier geht's zu„Das große Gyn-Buch” und zum „Gyncast": https://www.suhrkamp.de/das-grosse-gynbuch-von-prof-dr-mandy-mangler-s-1520 https://open.spotify.com/show/5emE9WkGJD5rEzrWW3UfQF Sichert euch jetzt Karten für die 10 Jahre Beste Freundinnen Tour unter https://www.bestefreundinnen.de/ Oder besucht Jakobs Tour in Hamburg: PsychoSpiele - LUKAS KLASCHINSKI https://shop.myticket.de/selection/event/seat?perfId=10229380009532&table=false&choiceSelectionDone=false&productId=10229380009398&tourId=10229359365800 Du möchtest mehr über unsere Werbepartner erfahren? Hier findest du alle Infos & Rabatte: https://linktr.ee/beste_vaterfreuden Du möchtest Werbung in diesem Podcast schalten? Dann erfahre hier mehr über die Werbemöglichkeiten bei Seven.One Audio: https://www.seven.one/portfolio/sevenone-audio

Habt Ihr mal die Diagnose Polyzystisches Syndrom (PCOS) bekommen, habt oder hattet Ihr PMS (das Prämenstruelle Syndrom) oder während der Schwangerschaft einen Diabetes oder eine so genannte Präeklampsie mit hohem Blutdruck usw.? Dann hört unbedingt rein in diese Folge. Denn diese Krankheiten sind so genannte Marker-Erkrankungen, die einem zurufen: "Achtung, ich kann dir nochmal Ärger machen, du solltest besonders gut auf dich achten, wenn du gesund alt werden willst!" Diana im Gespräch mit Gynäkologie-Professorin Dr. Annette Hasenburg von der Universität Mainz über solche 'metabolic signposts', das riesige Ärgernis, dass diese Erkrankungen im regulären dreijährlichen Check-up überhaupt keine Rolle spielen und wie Frauen auf sich selbst acht geben können.INFOS ZUR FOLGE:Hier geht es zu Prof. Dr. Annette Hasenburg im Internet.Hier geht es zu Prof. Dr. Annette Hasenburg auf Insta.Hier geht es zur MENO AN MICH-Folge "Hormone und der Stoffwechsel: Insulinresistenz" mit Dr. Katrin Schaudig (vom 30. Mai 2024).Hier ist Diana auf Prof. Hasenburg aufmerksam geworden (Podcast "ne Dosis Wissen" zum Thema Frauengesundheit vom März 2025)-Hier geht es zum Newsletter "Saisonwechsel" von der BRIGITTE.Hier geht es zum meno_brigitte-Insta-Account.Hier geht es zu Dianas Instagram.Hier geht es zu Julias Instagram.+++ Weitere Infos zu unseren Werbepartnern findet Ihr hier: https://linktr.ee/menoanmich +++WEITERE ANGEBOTE aus der BRIGITTE Redaktion:Masterclass Finanzen (aus unserer Eigenwerbung in dieser Folge, der Early Bird Rabatt gilt bis zum 8. September): academy.brigitte.de/masterclass?utm_source=menoanmich&utm_medium=podcast&utm_campaign=mcf-premium-kh11&utm_term=shopSkin-Code-Kurs mit Dermatologin Dr. Yael Adler: brigitte.de/meno-skinKrafttraining 50 plus: Forever Fit On Demand Kurs von BRIGITTE ACADEMYOn Demand Video-Kurs "Wechseljahre: Wissen, was hilft": https://academy.brigitte.de/course/wechseljahre?utm_source=podcast&utm_medium=meno&utm_campaign=wechseljahreKostenloses Webinar Rentenlücke berechnen: https://academy.brigitte.de/webinar-aufzeichnung-rentenluecke-berechnenETF Kurs: https://academy.brigitte.de/course/etf-kurs?utm_source=menoanmich&utm_medium=podcast&utm_campaign=etf-kurs-mEs gibt auch einen MENO AN MICH-Rabattcode, MENO15 (gilt für viele BRIGITTE-Angebote).Ihr habt Anregungen, wollt uns Eure Geschichte erzählen oder selbst bei uns zu Gast im Podcast sein? Dann schreibt uns beiden persönlich, worüber Ihr gern mehr wissen würdet, was Euch bewegt, rührt, entsetzt und Freude macht an podcast@brigitte.de. Wir freuen uns auf Euch! Und bewertet und abonniert unseren Podcast gerne auch auf Spotify, iTunes, Amazon Music oder Audio Now. Noch mehr spannende Beiträge findet Ihr zudem auf Brigitte.de sowie dem Instagram- oder Facebook-Account von BRIGITTE –schaut vorbei! +++Unsere allgemeinen Datenschutzrichtlinien finden Sie unter https://datenschutz.ad-alliance.de/podcast.html +++Wir verarbeiten im Zusammenhang mit dem Angebot unserer Podcasts Daten. Wenn Sie der automatischen Übermittlung der Daten widersprechen wollen, klicken Sie hier: https://datenschutz.ad-alliance.de/podcast.htmlUnsere allgemeinen Datenschutzrichtlinien finden Sie unter https://art19.com/privacy. Die Datenschutzrichtlinien für Kalifornien sind unter https://art19.com/privacy#do-not-sell-my-info abrufbar.

Ist die Pille wirklich so problematisch? Wie verlässlich ist Coitus interruptus – oder eben nicht? Und warum sind Frauen nicht immer super gut drauf? Der weibliche Zyklus gilt für viele Männer als einziges Mysterium, deswegen sagen wir als eure zwei Lieblingsmänner: Schluss damit! Gemeinsam mit Chefärztin Dr. Mandy Mangler tauchen wir ganz tief ein in die Welt der Gynäkologie und sprechen darüber, wie der Zyklus wirklich funktioniert, was Frauen in der zweiten Hälfte besonders brauchen und wann Lust und Libido ihren Höhepunkt haben. Mandy verrät außerdem, wann Frauen ihr Gehalt verhandeln sollten, warum sich der Männergeschmack während der Periode vielleicht ändern kann und warum ein großer Penis beim Sex gar nicht mal so optimal ist. Hier findet ihr Mandy bei Instagram https://www.instagram.com/mandy_mangler/?hl=de Und hier geht's zu„Das große Gyn-Buch” und zum „Gyncast": https://www.suhrkamp.de/das-grosse-gynbuch-von-prof-dr-mandy-mangler-s-1520 https://open.spotify.com/show/5emE9WkGJD5rEzrWW3UfQF Sichert euch jetzt Karten für die 10 Jahre Beste Freundinnen Tour unter https://www.bestefreundinnen.de/ Oder besucht Jakobs Tour in Hamburg: PsychoSpiele - LUKAS KLASCHINSKI https://shop.myticket.de/selection/event/seat?perfId=10229380009532&table=false&choiceSelectionDone=false&productId=10229380009398&tourId=10229359365800 Du möchtest mehr über unsere Werbepartner erfahren? Hier findest du alle Infos & Rabatte: https://linktr.ee/beste_freundinnen Du möchtest Werbung in diesem Podcast schalten? Dann erfahre hier mehr über die Werbemöglichkeiten bei Seven.One Audio: https://www.seven.one/portfolio/sevenone-audio

This episode of Perimenopause: Head to Toe features Dr. Sameena Rahman, an OB-GYN and specialist in sexual medicine and menopause. She is also the founder of the GYN and Sexual Medicine CollectiveDr. Rahman highlights that women in their mid-40s often experience confusing bodily changes. Symptoms include: Menstrual Changes: Unpredictable periods, with some becoming heavier or stopping for months. Physical & Emotional Symptoms: Intimate dryness, reduced libido, sleep issues, hot flashes, brain fog, and irritability.Systemic Issues in Women's HealthcareThe conversation addresses challenges within the medical system. A Patriarchal System: The doctors agree that the healthcare system is historically patriarchal, resulting in a lack of research and understanding of women's health. Medical Training Gap: The doctors note that medical school training often overlooks the significant emotional and cognitive effects of perimenopause, focusing instead on hot flashes and irregular periods. The "Double Whammy": They point out that because the OB-GYN field is largely female, there's an unspoken expectation to manage all aspects of women's health with limited resources, leading to provider burnout and inadequate patient care.Cultural Differences and BiasDr. Rahman, who is South Asian, discusses unique challenges for women of color. Earlier Onset: Women of color, including Black and South Asian women, often experience perimenopause and menopause earlier. This is linked to allostatic load, the cumulative "wear and tear" from chronic stress. Stigma: Cultural factors like stoicism and taboos around sex lead to a reluctance to seek medical help. Health Disparities: The episode notes higher rates of heart disease and diabetes in the South Asian population.About Dr. Rahman's Practice and BookDr. Sameena Rahman is a board-certified OB/GYN, sex-med gynecologist, menopause specialist and a clinical assistant professor of OB/GYN at the Northwestern Feinberg School of Medicine. She is the founder of the Gyn & Sexual Medicine Collective, a successful concierge practice that emphasizes evidence-based medicine and an affiliate of Ms. Medicine. Dr. Rahman is dedicated to evaluating and treating each patient with compassion, trauma-informed care, and an awareness of personal bias. Additionally, she hosts the podcast Gyno Girl Presents: Sex, Drugs & Hormones.Her upcoming book, "Brown Girls Disease? A Guide to Sexual Health and Empowerment Through a South Asian Lens," explores sexual health issues from a unique cultural and religious perspective.

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Depuis 2018, le Sénégal a intégré la vaccination contre le papillomavirus dans son programme de vaccination de routine. Cette vaccination gratuite représente un outil essentiel dans la lutte contre le cancer du col de l'utérus, qui constitue la première cause de mortalité par cancer chez les femmes, dans le pays, et qui est souvent transmis lors des premières relations sexuelles. Les séances de vaccination (qui ciblent les filles de 9 à 15 ans) sont organisées dans des structures de santé ou dans des écoles. C'est dans un établissement scolaire que se rend Priorité Santé, pour discuter avec des soignants et des jeunes, du déroulé de cette campagne mais aussi de son impact sur la santé des femmes et leur ressenti. Emission délocalisée en Casamance « Parler du cancer du col de l'utérus est important parce que c'est un problème de santé publique qui est majeur. » Dr Abdoulaye Barry, Gynécologue-obstétricien, Spécialiste en colposcopie et pathologie cervico-vaginale et chef du service de la maternité du centre de santé de Ziguinchor « hôpital silence »   (Rediffusion) Retrouvez l'émission en entier ici :Casamance: campagne de vaccination aux infections à papillomavirus humain en milieu scolaire

Ist es ein Burnout… oder sind es „nur“ die Wechseljahre? Tatsächlich steckt hinter mancher Burnout-Diagnose, hinter Wesensveränderungen und mentalen Problemen mittelalter Frauen auch die hormonelle Umstellung in der Lebensmitte. Nur hat das kaum jemand auf dem Zettel. Diana spricht mit der Gynäkologin und Präsidentin der Deutschen Menopause Gesellschaft Dr. Katrin Schaudig und ihrer Patientin Annette über das hammerharte Jahr, das hinter Annette liegt. Das mit Schulterschmerzen anfing und über Erschöpfung und Heulattacken in eine mehrmonatige unfreiwillige berufliche Auszeit führte. Und darüber, wie Annette wieder rausgekommen ist aus dem Tief (Spoiler: Hormone waren beteiligt).Diese Folge wurde erstmals am 13. Oktober 2023 gesendet.INFOS ZUR FOLGE:Hier und hier geht es zu Dr. Katrin Schaudig im Internet.Hier geht es zur im Gespräch erwähnten MENO AN MICH Folge mit Dr. Anneliese Schwenkhagen und Dr. Andrea Krüger: "Hormone und Stimmung: Bin ich depressiv, sind das die Wechseljahre... oder ist es einfach das Leben?"Hier geht es zu Katrin Schaudigs neuem Buch: "Hot stuff – Wechseljahrewissen to go" (dtv, erscheint am 14. August 2025)Hier geht es zum Newsletter "Saisonwechsel" von der BRIGITTE.Hier geht es zum meno_brigitte-Insta-Account.Hier geht es zu Dianas Instagram.Hier geht es zu Julias Instagram.+++ Weitere Infos zu unseren Werbepartnern findet Ihr hier: https://linktr.ee/menoanmich +++WEITERE ANGEBOTE aus der BRIGITTE Redaktion:Skin-Code-Kurs mit Dermatologin Dr. Yael Adler: brigitte.de/meno-skinKrafttraining 50 plus: Forever Fit On Demand Kurs von BRIGITTE ACADEMYOn Demand Video-Kurs "Wechseljahre: Wissen, was hilft": https://academy.brigitte.de/course/wechseljahre?utm_source=podcast&utm_medium=meno&utm_campaign=wechseljahreMasterclass Finanzen Basic: https://academy.brigitte.de/course/masterclass-finanzen-basic?utm_source=menoanmich&utm_medium=podcast&utm_campaign=mcf-basicKostenloses Webinar Rentenlücke berechnen: https://academy.brigitte.de/webinar-aufzeichnung-rentenluecke-berechnenETF Kurs: https://academy.brigitte.de/course/etf-kurs?utm_source=menoanmich&utm_medium=podcast&utm_campaign=etf-kurs-mEs gibt auch einen MENO AN MICH-Rabattcode, MENO15 (gilt für viele BRIGITTE-Angebote).Ihr habt Anregungen, wollt uns Eure Geschichte erzählen oder selbst bei uns zu Gast im Podcast sein? Dann schreibt uns beiden persönlich, worüber Ihr gern mehr wissen würdet, was Euch bewegt, rührt, entsetzt und Freude macht an podcast@brigitte.de. Wir freuen uns auf Euch! Und bewertet und abonniert unseren Podcast gerne auch auf Spotify, iTunes, Amazon Music oder Audio Now. Noch mehr spannende Beiträge findet Ihr zudem auf Brigitte.de sowie dem Instagram- oder Facebook-Account von BRIGITTE –schaut vorbei! +++Unsere allgemeinen Datenschutzrichtlinien finden Sie unter https://datenschutz.ad-alliance.de/podcast.html +++Wir verarbeiten im Zusammenhang mit dem Angebot unserer Podcasts Daten. Wenn Sie der automatischen Übermittlung der Daten widersprechen wollen, klicken Sie hier: https://datenschutz.ad-alliance.de/podcast.htmlUnsere allgemeinen Datenschutzrichtlinien finden Sie unter https://art19.com/privacy. Die Datenschutzrichtlinien für Kalifornien sind unter https://art19.com/privacy#do-not-sell-my-info abrufbar.

Dr. Monica Prasad-Hayes explains GYN oncology, or treatment of gynecologic cancers. Dr. Hayes is an associate professor of OB-GYN, director of the GYN oncology fellowship at Mount Sinai Hospital, and a practicing GYN oncologist. She explains testing, treatment, and symptoms of ovarian cancer, cervical cancer, and more.

In this episode of 'Don't Cut Your Own Bangs,' host Danielle Ireland introduces John Kippen, a resilience and empowerment coach, magician, and motivational speaker. John shares his incredible journey of overcoming a life-threatening brain tumor and how it transformed his life and career.  Throughout the episode, John discusses his healing journey, the power of vulnerability, and the importance of facing one's limiting beliefs. He also reveals the origins of his unique phrase 'impossible really means I am possible' and offers a special gift to listeners. Tune in to uncover valuable wisdom nuggets and be inspired by John's story of triumph over adversity.   00:00 Introduction to the Episode 00:40 Meet John Kippen: A Multihyphenate Talent 01:23 John's Life-Altering Diagnosis 05:46 The Surgery and Its Aftermath 08:04 The Road to Recovery 13:30 Embracing the New Normal 17:29 The Power of Truth and Magic 29:14 The Power of Magic and Connection 29:31 Introducing Treasured: A Journal for Self-Discovery 30:44 The Magic of Personal Connection 32:59 Overcoming Personal Struggles Through Magic 34:38 The Journey to Self-Acceptance 35:42 The Importance of Asking and Vulnerability 50:24 The TED Talk Experience 54:34 Final Thoughts and Encouragement   RATE, REVIEW, SUBSCRIBE TO “DON'T CUT YOUR OWN BANGS”  Like your favorite recipe or song, the best things in life are shared. When you rate, review, and subscribe to this podcast, your engagement helps me connect  with other listeners just like you. Plus, subscriptions just make life easier for everybody. It's one less thing for you to think about and you can easily keep up to date on everything that's new. So, please rate, review, and subscribe today.    DANIELLE IRELAND, LCSW I greatly appreciate your support and engagement as part of the Don't Cut Your Own Bangs community. Feel free to reach out with questions, comments, or anything you'd like to share. You can connect with me at any of the links below.   JOHN KIPPEN: https://www.ted.com/talks/john_kippen_being_different_is_my_super_power_magic_saved_my_life   https://www.johnkippen.com   DANIELLE IRELAND, LCSW Website: https://danielleireland.com/ The Treasured Journal: https://danielleireland.com/journal Instagram: https://www.instagram.com/danielleireland_lcsw TikTok: https://www.tiktok.com/@dontcutyourownbangspod?_t=ZP-8yFHmVNPKtq&_r=1 Transcript:   John Kippen Edited Interview [00:00:00] [00:00:07] Hello. Hello, this is Danielle Ireland and you are catching an episode of Don't Cut Your Own Bangs. And today I have the great pleasure of introducing you to someone I can now call a new friend John Kippen. John is a multihyphenate. He has had quite a life and he's an excellent storyteller. So this episode you're gonna wanna buckle up. [00:00:31] It is so good. Get those AirPods in, go on your walk, get safely in your car, get ready to listen because this is just an absolutely beautiful episode. But let me tell you a little bit about John. John is a resilience and empowerment coach. He was and is the CEO of a very successful IT company. [00:00:49] He was a main stage performer at the Magic Castle in Los Angeles, so if that just gives you a little insight, is the level of his magic. He is a motivational speaker. He's a life coach, and. He has a TED talk that has received over a million views. And the heartbeat of this TED talk is how he triumphs over tragedy with a diagnosis of a tumor the size of a golf ball that is separating his brainstem and the procedure he needed to save his life, changed his life forever. [00:01:23] Doing the work of healing does not come easily to anyone, but as John so beautifully puts in this episode, if John can do it, you can do it. He's using his stories, his vulnerable and raw experiences, and talking about not only what happened to him, but how he moved through the impossible. [00:01:45] He actually coins a phrase that I love and I'm going to keep. Which is that impossible really means I am possible. So the ultimate magic trick, the ultimate illusion is what your limiting beliefs are about yourself, and how do you use facing those fears and those limiting beliefs to transform your life. [00:02:08] And in John's case, he takes that healing and offers it as a gift to us. As listeners to his clients and his coaching practice to the readers of his book, he has authored a book The Forward by None other than the Jamie Lee Curtis from all of the places. You know her most recently. The Bear where she won an Emmy, but everything everywhere, all at once. [00:02:32] She and John are buds, and she believes in him and believes in his work, and as a champion of that work, it just adds a little extra sparkle and fairy dust to the beautiful work that he's already doing to say that he's been vetted by someone who is so sparkly and magnetic and also deeply entrenched in holding space for the truth and honoring the truth. [00:02:52] This is a heartfelt episode, so what I would recommend. If you're in a place to do so is you might wanna jot some notes down because John drops some beautiful wisdom nuggets in this episode. And the book that he authored is playing The Hand You're Dealt. And what I wanna share too, we talk about it in the episode, but I wanna highlight this 'cause it's really important. [00:03:12] John is giving everyone who listens to the episode a free gift, but it is not linked in the show notes. It is only available to those of you who listen. It's a special little surprise embedded in the episode that you have to listen to find, but it is a free gift from him to you. So without further ado, get ready to sit back, relax, and enjoy the beautiful wisdom of John Kippen. [00:03:35] ​ [00:03:36] Kippen, multihyphenate resilience and empowerment, coach magician, keynote speaker, author, and all around. Nice guy. Thank you for joining me today on the Don't Cut Your Own Bangs podcast. [00:03:47] Danielle: Hollywood legend wrote the forward of his beautiful book, playing the Hand You're Dealt Forward by the one and Only Take It Away, John, Jamie [00:03:58] John: Lee Curtis. [00:03:59] Danielle: Jamie Lee Curtis. Yes. So you have to stay and listen to the entire episode because he's going to tease out a special little giveaway that will only be revealed in the audio. [00:04:10] So you gotta listen. It's not gonna be linked in the show notes, folks. So buckle up, sit down. This is gonna be a great episode with a fun gift for you, a special little dose of magic hidden inside. So, John, you, I mean, all the different fun things that we listed about what you do. You're a magician, you're a motivational speaker, you're a coach. [00:04:30] What I know doing the work I do as a therapist is the skills and trade that you're building your life on. Those were skills that they were. Hard one, like nobody chooses, in my opinion and in my experience, no one chooses to go into a helping profession that hasn't needed help in their life. It's like the, our healing becomes our medicine. [00:04:54] And I really wanna learn about not just what you offer, but your healing journey that put you in the unique position you're in to do the work you do. So, welcome and I'd love to hear from you. [00:05:05] John: So just quickly, the Reader's Digest version of my backstory. Grew up Los Angeles, middle class family, two great parents loving, no sisters or brothers, had everything I needed. [00:05:18] They sent me to a nice school and, I got into theater, started doing theater, in college. I studied theater and became the big man on campus because pretty much I grabbed every opportunity that presented itself. Started a computer company out of college. 'cause I'm a creative problem solver. [00:05:38] That's the thread that goes through everything I do in my life. [00:05:42] Mm-hmm. [00:05:42] John: I look at a problem, I say, how am I gonna solve that? [00:05:45] Mm-hmm. [00:05:46] John: And then in June of July of 2002, I was diagnosed with a four half centimeter brain tumor called an acoustic neuroma. [00:05:55] Danielle: Yes. And this was, so it was slowly severing your brainstem? Correct. [00:05:59] John: It was displacing the brainstem. Causing not only hearing issues, but dizziness upon standing or walking. [00:06:07] Mm-hmm. [00:06:08] John: I had to have something done with it. I would not have survived. [00:06:12] Mm-hmm. [00:06:14] John: And. It was a whirlwind , I went and saw the doctor who finally diagnosed it after seeing him the MRI films, and he, he had no bedside manner. [00:06:25] I remember sitting on the examining room table, right. And the, the tissue paper is crinkling under my butt. Mm-hmm. I could feel the, I could sense the temperature. I'm heightened sensitivity. [00:06:37] And he looks up at the MRI after talking to a neurosurgeon, and he turns around and says, John, you have a four and a half centimeter brain tumor. [00:06:46] It's killing you. We're operating you on Friday. You're gonna go deaf in your left ear, and there's a possibility for some facial weakness. We're gonna do everything we can to prevent that. And he left [00:07:01] Danielle: the room. So he knew, and in his own. Brash in abrupt way, essentially prepared you for the outcome and challenges that would come assuming the surgery was a success? [00:07:17] John: Yeah. He is a world renowned acoustic neuroma surgeon. He's one of the guys you go to, when you have this kind of tumor and that's all he does. Wow. But he literally left the room and I'm sitting there and I didn't bring anybody in and [00:07:31] yeah. [00:07:32] John: A tip to anyone who's potentially going in for a serious diagnosis. [00:07:36] Yeah. [00:07:37] John: Bring a friend or a family member. [00:07:39] Because it goes in one ear and out the other, you're in shock. Right. Right. When you get home and you say, wait a minute, he said that surgery gonna be four hours or 14 hours or 20. How, how long ago and you have all these questions. Yeah. And you know, getting ahold of the doctor to ask them again is just not the way our medical system works. [00:08:01] He's back to back, to back to back patients. [00:08:04] So, I checked in the night before, they did blood tests and I tried to get an hour or two sleep, 6:00 AM my clockwork the orderly came in and said, okay, get naked, get on this cold gurney. What a sheet over you and we're going take you to the operating room. [00:08:21] Danielle: I wanna pause your story for a moment. 'cause there's a couple things that I, I wanna tease out a little. So one is you, the way that you tell your story, so well probably because you've told it on stages, you've shared it with others, you've written about it. There is something about a trauma. [00:08:37] That really marks the sort of BCAD of life. And the way you shared, I felt like I was in the room with you when you were getting this bomb of news dropped on you so you were theater trained, theater kid, a creative person, a creative problem solver, and a business owner. [00:08:57] Like I, I think about that often when people are experiencing trauma. What, what was life sort of the, the illusion of normalcy. The, the, you know, the predictability of this is my life and this is my to-do list and this is my calendar. So before that moment, you were just a guy on the west coast running a business. [00:09:17] Is that right? [00:09:18] John: Very successful business. [00:09:19] Danielle: And I, I just wanna share briefly too, I haven't met too many other only children. Theater background 'cause that's me too. [00:09:30] John: Oh, really? [00:09:31] Danielle: I'm an only child and I was a theater major and started acting when I was 13, so before. But, the creative problem solver, God, my theater background has paid dividends in ways I didn't know at the time. [00:09:42] I didn't know that when I was preparing for this interview, but now that you've said that, it's like that thing that I couldn't put my finger on has clicked into place. [00:09:49] John: I love doing improv. [00:09:51] Improv is the, you know, everybody talks about being in the moment. [00:09:57] Yeah. [00:09:57] John: What does that really mean, being in the moment? [00:10:00] When you do improv, you have to be in the moment. Otherwise you fall flat. And everybody, you're doing improv looks at you going. Well, it's your turn. [00:10:10] Danielle: You've tapped in. Now you've gotta say something. How are you gonna move the story forward? [00:10:14] Exactly. I feel most alive when I'm engaged in moments like that. And I, it's, I'm not a, a adrenaline junkie, but I would say that's my high, it's the, rush of connecting with somebody like that. So you were running a very successful business. This bomb has dropped. [00:10:32] You can barely remember what you were told and what your life is likely going to be. Assuming everything goes well, what is going to happen when you wake up off your op? And how long was your operation? [00:10:46] John: 15 hours. [00:10:48] Danielle: And the surgery was a success. They were able to remove the golf ice tumor. [00:10:52] Yeah. So they removed the fall sized tumor. [00:10:54] John: I didn't have time to think, you know, I got one of my guys who worked for me told him that he was gonna be running the company for a month or two. He agreed. [00:11:05] Mm-hmm. [00:11:05] John: Had to shovel up some more money to get him to do it, but, you know, it is what it is. You do what you have to do. [00:11:11] Yeah. And then,, I just tried to think positively, hope for the best. Plan for the worst. You know, I had someone gonna stay with me the first week, make food because I just wanted to recover and I didn't know what it was gonna be like. [00:11:27] Danielle: Yeah. You're like, I just need a week to recover, and then I'm just gonna hop back into life, hopefully. [00:11:31] John: Rolling the gurney into the surgical, prep area. [00:11:35] The nurse saying, Hey John, you know, we know we have to shape after your head. You want me to do it now or after you're under. [00:11:42] Danielle: So you didn't even know that they were gonna shave your head. Well, I didn't think about it. [00:11:48] John: I mean, if I had thought about it, I got a shaved part of my head. [00:11:51] Danielle: Right. [00:11:52] John: I said to her, please. [00:11:56] Danielle: Yeah. [00:11:58] John: And so, they roll me into the operating room. You got these really bright lights, , blinding you, and you're laying there and they're like, okay, you're gonna count back toward five. [00:12:09] The next thing I know, I hear faint voices and it was like I was 30 meters deep in a pool. Struggling to get to the surface. And I remember this like it was yesterday, literally trying to swim to the service to regain consciousness. [00:12:26] And finally when I got enough, I realized that my dad was sitting on the edge of my bed holding my hand, [00:12:34] and [00:12:34] John: he was smiling at me, but I didn't see my mom. [00:12:40] So I asked my dad for my glasses and he handed me the glasses. And I remember trying to put the, and then I realized my head's bandage. [00:12:48] Danielle: Oh, right. [00:12:50] John: So I had to figure out how to get the glasses in Cockeye to get 'em on my face, right? [00:12:55] And the look on her face was one of horror. What did these butchers do to my son's face? And at that point, I didn't know my face was paralyzed. Because I have full feeling, I just can't move it. [00:13:10] Danielle: So you currently, you still have full feeling in your face. You just lost mobility, [00:13:14] John: so I didn't really understand what that look was. [00:13:18] Danielle: Right. How could you? [00:13:19] John: And then my mom handed me her compact makeup. [00:13:22] And I opened it up and I'm like, holy crap. And then, I'm still getting [00:13:30] accustomed to, the one thing I noticed is leading into surgery, I was constantly dizzy and that dizziness was gone. [00:13:38] Danielle: Wow. [00:13:39] John: And that was like, oh my God, what a relief. [00:13:42] Mm-hmm. [00:13:43] John: So the doctor finally made his way in and I was like, so when's my face gonna move? And he said, John, we were, successful. [00:13:50] The tumors removed. Right when we were close the incision, your face stopped moving. But we think it's just to do the swelling, and once the swelling goes down, your face should start moving again. So I'm like, okay. I can handle that. That's a, it's not a permanent thing. I can deal with it. [00:14:05] So I'm in the hospital a week and, they're like, when you can do three laps around the hospital floor, without a walker, we'll send you home. [00:14:16] So that became my goal. I remember getting outta bed and then they said, no, no, no. Wait for the, I said, no. The doctor said that I need to rock three laps around. [00:14:26] I want to get the hell out of here [00:14:28] Five days I got home. My dad drove me home and I sat on my couch and now I'm like, okay, I can start healing and check email here and there. And I was taking lots of naps. And then I coughed and I touched the back of my neck and it was wet. [00:14:45] Mm. [00:14:47] John: Oh, it was a spinal fluid leak on the base of the incision. [00:14:51] Whew. [00:14:53] John: So immediately I called the doctor's office and the said, oh, get your ass back here. And I went back to the hospital three times with them to redo the bandaging to try to prevent the leak. [00:15:05] Danielle: Wait, you call the hospital. Hey, their spinal fluid leaking out of my surgical incision. And they're like, yeah, you should get in a car and drive yourself to the hospital. [00:15:16] John: They didn't say how I should get to the hospital. [00:15:19] Danielle: Okay. Fair, fair. But that, [00:15:22] okay. Wow. ' [00:15:24] John: cause that's not good. [00:15:25] And there was potential for getting, spinal meningitis in that. From what I understand is one of the most extreme pains out there. [00:15:35] Okay. [00:15:35] John: I went back and forth three different times over that week. [00:15:39] They tried to, it was just as right behind my ear, right at the base of the incision. So, there was no way that they were going to be able to, put a pressure manage to keep that and so it could start healing. [00:15:51] Danielle: Mm-hmm. [00:15:52] John: So they finally said, all right, tomorrow you're gonna come in and we're gonna, redo the incision and pull more belly fat outta your belly to fill the hole. [00:16:01] And Yeah. This time they used staples, man, thick Frankenstein. [00:16:07] All the way up. [00:16:08] But then I'm like, I was only in the hospital for a day. And then, and I'm like, okay, I can relax. I remember getting up and brushing my teeth, you know, and I'm looking at the mirror and God, , I don't recognize that guy. [00:16:24] Yeah. And I got rid of all the mirrors in my house. [00:16:30] I didn't want a constant reminder. [00:16:33] My face was screwed up. [00:16:34] Danielle: I, there's so much specificity to what is uniquely your story. [00:16:46] Mm-hmm. [00:16:47] Danielle: But what I have found is when people. Are able to share elements of their experience. It's when you go into the specificity of what you experienced. I can see myself in so many elements of your story in my own, like when we get in deeper, it becomes somehow more accessible and universal. [00:17:16] And in that way, you're not alone, even though it happened to you and that detail about your removing the mirrors from your home. It, it brings me to something I really wanted to ask you about. You share by saying, and then also , by, actually demonstrating in your TED talk that, once you began the healing process of really addressing your depression after your operation, that, the story, it led you to magic, literally. And I also think in a more magical way, beyond performing an illusion. And I know not to call it a trick, I learned that from arrested development. [00:18:03] But, there's something you said that I wanted to quote that it's amazing how accepting kids are of the truth. You open up your TED talk, which I will link in the show notes so people can see. But that you mentioned that this in a way that your permission and your humor and your honesty, it created levity and lightness. [00:18:27] For something that would be considered maybe so precious and heavy. And what I wanna speak to, and open up a question if that's okay, is, I'm curious what your relationship with the truth is because I think humor in its highest expression is allowing us to laugh at something that we see the truth in. [00:18:49] And yet it's this razor's edge between laughing at someone or laughing at something versus inviting us to laugh at the, the human experience that we maybe don't know how to name or express in another way. But I wanna know personally for you, what your relationship is with the truth and the value of embracing it. [00:19:13] And then in your line of work as a coach, where do you see people struggle with it? [00:19:19] John: Truth is an illusion. [00:19:21] Danielle: Ooh, tell me more. That just, that was a zingy response that you popped right out. Please tell me more. [00:19:28] John: Yeah. Truth. Everybody has their own truth. [00:19:31] Danielle: Oh, well there you go. [00:19:32] John: Their own perspective, [00:19:34] Danielle: uhhuh, [00:19:35] John: And the truth is formed out of your limiting beliefs. [00:19:41] Danielle: So the truth is formed out of your limited beliefs, [00:19:44] John: your limiting beliefs. [00:19:45] Danielle: Limiting beliefs. Okay. [00:19:47] John: Yeah. [00:19:48] I just wanted to take a slight step back. [00:19:50] Danielle: Mm-hmm. [00:19:51] John: I told you this was gonna be the Reader's Digest version. [00:19:54] Danielle: Yes. [00:19:54] John: But it took me 12 years [00:19:57] To come out of that hiding. Wow. 12 years. [00:20:02] Danielle: How old were you when you had your operation? [00:20:05] John: 33. [00:20:06] Danielle: 33. Okay. [00:20:08] John: And fortunately for me, I could work from home. But I miss so many celebrations with friends and family. 'cause I just didn't want to have to explain it. I didn't want to have to deal with the looks, , and I tell this story on my TED Talk and in my book. You know, at a restaurant I wanted to get a burger at Tony Aroma's. And I'm sitting there by myself and in a booth, and there's a booth right in front of me and there's a family with a kid, two parents and a kid. And the kid's squirming and gets up and turns around and is now on his knees on the bench and looking at me. [00:20:44] And he gets up and he comes over and he says, Mr, what's wrong with your face? And in that moment, I didn't want to have a five or 6-year-old come over and Right. And I'm like, okay, I had the strength to come out and go to a restaurant. I have to deal with this. So I started talking to this little boy [00:21:06] Danielle: Mm. [00:21:07] John: And saying, I had a medical procedure that caused me not to with my face before I could continue his mom grabbing him [00:21:16] mm-hmm. [00:21:17] John: The arm and drug him back and said, don't bother him. The nice man, he has enough troubles already. And I couldn't leave it there. [00:21:25] Mm-hmm. [00:21:27] John: So I had to go to the little boy and I knelt down and I got eye level and I said, I love my new face because it's different. [00:21:34] It's different just like yours. And I remember it like it was yesterday, he took his fingers and he tried to distort his face to be crooked like mine. And he turned to his mom and said, look, mom, I could do that too. And then he went back to eating his meal. His question was answered. [00:21:56] He had no judgment. And his parents were like, holy crap, did we just learn a lesson? How to raise our child? [00:22:03] They whispered, thank you on their way out. [00:22:07] Danielle: But there is something I, there, there's something to that woman's response to you that really resonated with me. [00:22:14] And it also, highlights the point you made so well about the, essentially the truth being relative. Because she projected onto you what her perception of your life was. Don't bother the nice man one, she didn't know you were nice, though. You are. But she didn't know that. Right. And she also didn't know what your troubles were or weren't, and she assumed that. [00:22:39] John: But I always wonder what her motives were. [00:22:41] Danielle: Right. [00:22:42] John: was it to make me comfortable or was it to make her and her son comfortable [00:22:48] Danielle: it for her? I think so. [00:22:50] John: And that's how I took it. [00:22:51] Danielle: I remember. So I have two children and I was pregnant once before and lost that pregnancy. [00:22:57] 12 weeks in. And I haven't thought about this in a very long time, but I remember going into, a annual doctor's appointment and she saw on the chart that I was listed as pregnant and clearly now was not. And it was in her own discomfort of not, she was asking me about the baby thinking, 'cause she was not my ob, GYN it was a different type of doctor. [00:23:20] And, she caught. Oh, and then I had sort of explained to her what that meant, and then she said, well, I'm sure, you blame yourself and I want you to know it's not your fault. Like she took her discomfort and tried to turn it into, she positioned herself above as someone who knew what he was experiencing and wanted to offer me this sympathy that was, one, she was wrong. [00:23:45] I totally misplaced. Yeah. I didn't blame myself. And it, that, that moment was such an extension of her own inability to hold the moment and the discomfort of the moment, and, tried to offer it up as a gift for me, which that's, yeah. [00:24:03] John: It's your perception of how you deal with that. [00:24:06] Danielle: Mm-hmm. [00:24:07] John: Losing a child can be. Empowering because you know that you can try again and get a child that is not gonna have any kind of defects and is gonna have a good life. And you know whether or not you believe in God or not. [00:24:24] Danielle: Yeah. [00:24:25] John: Things happen for a reason and we don't always understand the reason for them. [00:24:30] Danielle: I don't know if it, what the reason was, but I can say a gift from that was that somebody who lived with a very active monkey mind and a lot of head trash and some anxiety in the experience of the early grief, not for very long, but there was a moment in time where my mind was quiet, not numb, but quiet. [00:24:55] And it helped me realize, oh, there's the observer within me. Then there are the different conversations that are happening in my head that aren't me, which are maybe the perceptions that I call truth sometimes I wanna bring that same question of truth, which you had an answer I was not expecting, which I love when I never see it coming, so thank you. [00:25:18] Where do you see your clients? Because you're a coach, right? You are taking your healing and offering it as medicine to people that are trying to make a connection in their own life. So where do you see people that you work with? Struggle with the truth? [00:25:36] John: Everybody's hiding from someone something in their life. [00:25:40] They have buried something so deep and it keeps them from moving forward in their lives. 'cause it erodes their self-confidence. [00:25:50] That's what I learned through my love for performing magic. [00:25:58] Going to the magic castle, sitting at a table with a paralyzed face. [00:26:03] Yeah. I'm this overweight guy with balding, balding with a paralyzed face. And I could sit at a table and have people come to me. I tell this story sometimes, that the Magic Castle is a place where you have to get dressed up to the nines, you know? And women love to get dressed up [00:26:22] Danielle: That's true. [00:26:23] John: They're wearing their best outfits, right? And all of a sudden I'd have five or six women sitting at the table, and their reactions are very guarded. [00:26:34] Hmm. [00:26:36] John: You know, they're sitting there with their legs and arms crossed. [00:26:39] Hmm [00:26:40] John: they're leaning back. They have a smile that's just more of a grin. [00:26:45] Mm-hmm. ' [00:26:47] John: cause I don't know what I'm about. Sure. They don't know if I'm gonna be inappropriate, if I'm gonna come onto them, if I'm what it is. So they have no expectations other than they're gonna see some magic. [00:26:58] Mm-hmm. [00:26:59] John: So I start my act saying, hi guys. My name is John and I'm doing magic all my life. [00:27:05] But in 2 0 2 I had a brain tumor. And when they cut over my head, they traumatized medication, nerve offense, a paralyzed face. But something happened to me on that talk table that day, Danielle. [00:27:16] Mm-hmm. [00:27:17] John: I'm not sure what it was because I was unconscious. All I know is I recovered. I realized I had acquired some new skills and I pause. [00:27:29] Yeah. And I wait for everybody to get on the edge of their seat. Like, what happened, John, what? Skills. Skills I could acquire. I'm having brain surgery. [00:27:40] Mm-hmm. I [00:27:41] John: looked to my right and I looked to my left like it's the biggest secret. [00:27:45] Lean in and I whisper in a loud voice as I am able to visualize people's thoughts. And then I do some mental magic mentalism. Love it. And what I just did was I turned my biggest challenge into a superpower. [00:28:07] Danielle: Yes, you did. And I wanna pause you because when you said that in your talk, have, have you read Elizabeth Gilbert's book, big Magic? [00:28:15] Yes. [00:28:15] Danielle: When she talks about trickster energy, I was like, John Kippen is a freaking trickster. [00:28:22] That is trickster energy that you can shift. Before someone's very eyes. It's like you are performing magic and you are performing magic. You shifted before them and you invited them, your audience to see beyond their own limiting beliefs, their own projected truth. [00:28:47] John: They were distracted. They wanted to know why it was paralyzed, but they couldn't ask, did he have a stroke? Did he have be palsy? What was the reason? So I found them being distracted when I was performing. So I got that outta way in the first two minutes. [00:29:00] Mm-hmm. [00:29:01] John: I explained why my face is paralyzed. [00:29:03] And now I treat it as the experience is now I'm able to do superhuman things. [00:29:10] And now they're like, okay, cool. So as I perform [00:29:16] I focus on the spectator. Magic happens in your mind as a spectator. [00:29:22] Danielle: Oh, I love that magic happens in your mind [00:29:26] ​ [00:29:31] If you've ever wanted to start a journaling practice but didn't know where to start, or if you've been journaling off and on your whole life, but you're like, I wanna take this work deeper, I've got you covered. I've written a journal called Treasured, a Journal for unearthing you. It's broken down into seven key areas of your life, filled with stories, sentence stems, prompts, questions, and exercises. [00:29:51] All rooted in the work that I do with actual clients in my therapy sessions. I have given these examples to clients in sessions as homework, and they come back with insights that allow us to do such incredible work. This is something you can do in the privacy of your own home, whether you're in therapy or not. [00:30:10] It has context, it has guides. And hopefully some safety bumpers to help digging a little deeper feel possible, accessible and safe. You don't have to do this alone. And there's also a guided treasured meditation series that accompanies each section in the journal to help ease you into the processing state. [00:30:29] So my hope is to help guide you into feeling more secure with the most important relationship in your life, the one between you and you. Hop on over to the show notes and grab your copy today. And now back to the episode.​ [00:30:44] John: Magic is what you see in your mind or someone else sees in their mind. [00:30:49] Magic is that thing that immediately makes you present. [00:30:56] Danielle: Yeah. [00:30:57] John: And your, all of your sensors are now in a heightened state , whether it's a sunset or a beautiful beach or a beautiful woman or a magic trick or whatever it is, there's that sense of awe and wonder. [00:31:15] So as I would start to take each spectator, I would learn their names. [00:31:19] And I would use their names throughout the show. [00:31:22] Danielle: People love that. [00:31:23] John: People, I ask them, the one word in everybody's language that they love to hear the most is their own name . and so I use that as a way of engaging the audience. [00:31:33] They start leaning in and now they've got real smiles on their face [00:31:37] and I can literally see this wall that women in today's society are forced to put up as a self-protection mechanism. [00:31:45] Yeah. [00:31:46] John: I see this wall start to grow as they start to identify with me and they're like, I'm okay being myself. [00:31:54] And then the end of this [00:31:56] they're asking permission to hug me. [00:31:58] And , having a creative mind, I wanted to understand. What that is. What that, what was going on. [00:32:06] Danielle: You also, not only through performing magic, inviting the curiosity you could see in other people's faces into your opening act essentially, or your sleight of hand. [00:32:17] I'm gonna show you this over here so that you can not see what's coming here. Vulnerability in its purest form is magic because it's the one thing sharing the story you feel like you couldn't share. Letting somebody see the one part of you that you would never let anybody see 'cause you were so utterly convinced you would be outed or you would be cast out by exposing that vulnerability is the birthplace of true connection. [00:32:47] Yeah. Which is the ultimate magic trick. It's, it's like what they say in nightmares, if you stop and face the thing that's chasing you, it, it can't chase you anymore in the dream. And so you spent a decade, did I remember that correctly, you wanted to be a main stage performer at the Magic Castle? [00:33:06] It took you about 10 years and you did it. [00:33:08] John: I did. [00:33:09] Yeah. [00:33:09] Danielle: 10 years. [00:33:11] John: Yeah. [00:33:12] Danielle: 10 years. [00:33:13] John: It was my creative coping mechanism. I had hit rock bottom, was I suicidal? No, not really. But I was unhappy. [00:33:25] Danielle: Yeah. [00:33:26] John: I was, my girlfriend left me, and, fortunately I had a job that I could focus on. But I needed something more. And through sharing something so personal and tying magic into it and making it a positive instead of a negative [00:33:45] people are attracted to it. [00:33:49] Danielle: Yeah. Well, because you're holding fire in your hand. Yeah. You're not just saying it's possible, but you're living. You're turning it into a performance, which I think for an artist is one of the most selfless, beautiful acts. [00:34:11] John: It's what separates great artists from mediocre artists. What is he giving me to care about? [00:34:18] Danielle: I never thought about that with magic. What are they giving me to care about? [00:34:22] John: Yeah. What do I want them to think when they leave the theater? [00:34:27] Ability to put your own life in perspective. If John can, so can I. [00:34:33] That's my true message. [00:34:36] Any different is your superpower. [00:34:38] Now, my facial paralysis does not have to define me if I don't let it. [00:34:44] You know, Danielle I live my life that it's better to ask for forgiveness than permission. [00:34:51] And that's bit me in the butt numerous times. [00:34:54] Danielle: I can also say the opposite, can bite you in the butt. I think I waited probably too long, many times for permission that wasn't really coming because no one can ultimately grant it. Right? Like, if there's a path you wanna carve, like the job that you built, all of the different things that you've done, there's no resume posted on LinkedIn. [00:35:15] No one's hot. Like that's an empowerment coach slash magician slash keynote speaker, slash documentarian like that. You have to get curious and still, and listen to that little voice inside and follow that curiosity to a path that may not make sense for anyone for a really long time. And I didn't do that. [00:35:40] And that can bite you in the butt too. 'cause regret's hard to hold. [00:35:42] John: Alex SBE came out on national television [00:35:45] to his fans, to the world and said, I'm scared. I am fighting the battle of my life and I'm gonna ask for everyone's good thoughts and prayers . of what I'm going through. I reached out to Nikki Trebek, Alex's daughter and I said, Nikki, I need to perform for your dad . we're having a 75th birthday party and we don't have any entertainment. [00:36:13] So if you wanna be the entertainment, and I was like. Damn. Yes. [00:36:18] Danielle: Well, yeah. I will go to his house and perform magic for him. a [00:36:22] John: restaurant, but [00:36:23] Danielle: Oh, a restaurant. Okay. [00:36:23] John: Wrote a unique magic show [00:36:25] With Jeopardy themes and the whole nine yards and he was actually at the table as one of my assistants. [00:36:33] Oh. Along with his daughter. so he was this, he needed to understand how things worked. [00:36:39] Was a genius. And so he was constantly looking at me like, wait a minute. That's not possible. Just embrace it, Alex. You're not gonna figure it out. Just enjoy it. [00:36:52] Danielle: That's awesome. [00:36:54] John: And there's, on my website, john kipp.com. There are some magic videos and there are two videos of me performing for Alex , sat with him, and I said, Alex, I need to share something with you that, when you came out so publicly about your diagnosis [00:37:10] I asked for everybody's support and love and prayers that resonated with me. I am here to give to you. You've been a part of my life and the lives of millions of people. [00:37:27] And your life's work is meaningful. [00:37:30] I just wanted to tell you that, 'cause I had a feeling that no one ever takes the time to say thank you for your life's work. [00:37:37] And he immediately started welling up. [00:37:39] Danielle: Well, anybody who makes something look easy that we do take for granted. [00:37:45] And I think that, like I appreciate so much in the telling of your story, you share not just the struggles, but the time you had a vision of yourself. On the main stage performing at the Magic Castle, like the most elusive place where magic is. And you didn't just wanna get in, you didn't just wanna get an audition, you didn't wanna just like get to per perform an illusion, like main stage. [00:38:23] You didn't just have a goal. You had the goal and you did it, but you also say that it took you 10 years. And there's usually themes that run with anxiety, about not enoughness and the crunchiness of time. There's never enough time. I'm not enough and there's not enough time. And not being worthy. [00:38:42] Yes, yes, yes. One of my main motivations when I started this podcast originally several years ago, was I was. Starting to increasingly feel, trapped in this sort of, world of before and after story. And it was no longer feeling inspirational. It was just another measuring stick for how not enough. [00:39:03] Yeah. 'Cause it, it's great to see where somebody was and where they are, but when I'm knee deep in my own struggle when I'm the caterpillar goo and the chrysalis, and I'm not the shiny butterfly, but I'm also not the caterpillar anymore. What do I do when my life is literally a shitty pile of goo this is something that most clients don't come right out and ask me like in sessions one, two, and three. But it inevitably comes well, I've been doing this for, so many months. How much longer is it gonna take? How long is it gonna take? And I just always, I appreciate when people can acknowledge. [00:39:41] The time and consistency that goes into healing [00:39:47] John: joy is in the journey. [00:39:48] Danielle: Mm. [00:39:49] John: Not in the destination. [00:39:51] And that's the thing I really focus with my clients. [00:39:55] I have clients come to me because they're holding themselves back in their life. [00:39:59] And it's my job to get that out of them by asking open-ended questions, by building a rapport, I can trust this guy. [00:40:08] Danielle: Yeah. Would you say that's your superpower as a coach? [00:40:11] John: Through my journey of reverse engineering who I am and who I wanted to become. Coming out the other side immediately understood that it's not about me. [00:40:24] Danielle: Yes. It's only true every single time. [00:40:27] John: The joy comes from helping others get that realization, [00:40:32] That they understand they are truly powerful and have a chance to shape their destiny. [00:40:40] That's why I talk about limiting beliefs. [00:40:43] And we grow up with our parents or whoever raised us, those are our belief systems. [00:40:49] And so that's what forms who you are. You stop dreaming. [00:40:54] That's what midlife crisis is all about. [00:40:58] Danielle: Yeah. [00:40:59] John: We got educated, we got a job, we built a career. We have a family. [00:41:06] Danielle: It's, I think the version of that I hear in my sessions is essentially I did everything right. Shouldn't I be feeling better than I am? Yeah. Like, I followed all the rules. I'm winning. Why does it not feel like I'm winning? Yeah. And finding our way back to that. [00:41:29] The unlearning and the unraveling. That is a, it's a process. [00:41:34] John: I'll talk to a friend. How you doing? And so many people respond automatically living the dream. But is it your dream? You're living? [00:41:46] Whose dream are you living? Because you're wasting your life by living someone else's dream. And that's why you get to that point in life where it's not enough. [00:41:58] Cause it's not your dream. You just finished the last 30 years building. [00:42:03] Danielle: Yeah. And the joy really is in the process and there's no way to enjoy the process of fulfilling the wishes of somebody else because you, what you're constantly chasing is when I get there, then the relief will come and then you're there and you're like, well, where's my pot of gold? [00:42:22] John: Yeah. I had, I spent 20 years learning how not to hide my face. [00:42:28] And what happened in March in 2020? The pandemic hit [00:42:33] now covering your face with a mask, became not only politically correct. [00:42:41] But government mandated and I'm like sitting there thinking to myself, what do I do? So I found a company who prints things on masks and I sent them a picture of my face and a picture of the lower part of my job. [00:43:01] Danielle: Trickster energy, John Kippen trickster. That's the new hyphen to your list of all of your accomplishments. [00:43:08] John: I would walk around and strangers would look at it and not understand. [00:43:12] Danielle: Right, right. But people who knew me [00:43:15] John: would do a double take. [00:43:17] Danielle: I will not hide. [00:43:19] John: Refuses to hide. [00:43:20] Even through a global pandemic. [00:43:23] Yeah. [00:43:23] John: I'm gonna live my life [00:43:25] Danielle: mm-hmm. On [00:43:26] John: my own terms. [00:43:28] Danielle: Yeah. I work too hard, too long to get free and I will not hide for you. Wow. Wow. And [00:43:37] John: when I share that story, people like, wow, John's done some soul searching. [00:43:44] Danielle: Which is why your clients come to you. [00:43:46] John: Yeah. [00:43:46] Danielle: Yeah. I unfortunately have come across many. People in the helping profession that haven't started with their first client, which is themselves. I put myself in that camp. I've talked about it on the podcast before, but I didn't start seeing a therapist until I became one, which is probably not the right order, but I didn't realize until I was sitting there trying to help people. [00:44:09] And then my own stuff was getting activated in the session. It's called Counter Transference. And, yeah, I was like, oh shit, I gotta look at the mirror. I gotta do a little more digging. But I think a, what leads a lot of people into helping professions is its desire to heal. And it sounds like in your case you did the herculean task of lifting your own self up before you said, now what can I offer you? [00:44:39] I wanna ask, just a purely curious, selfish question before we get to the very end I wanna ask. In your book playing the Hand you're Dealt how did you connect with Jamie Lee Curtis? The same way you did Alex Trebek? Did you just find someone and you DMed them and [00:44:55] John: you're like, her assistant worked for a production company [00:45:00] in a previous job. [00:45:02] Danielle: Gotcha. [00:45:02] John: That I knew. [00:45:03] When Jamie was like, I need it. So help with my computer. Her assistant said, I've got the guy for you. And I remember being at Jamie's house. [00:45:15] She knew me before my facial surgery, and after. [00:45:18] Danielle: So you have a history then? [00:45:19] John: Oh yeah. We met in 2000. [00:45:21] Danielle: Oh, okay. [00:45:22] John: So she saw me before. [00:45:24] She saw the struggle. Sure, she has two. Great kids. [00:45:29] And she adopted me as her third child. Wow. She saw the ability to help me. And so I had a filmmaker friend of mine reach out and said, John, I'd love your story. [00:45:45] I want to film a documentary on you. And I'm like, cool. So I realized I'm paying for the damn documentary. [00:45:51] Danielle: Oh. So I wanna offer you this gift, and by the way, here's the bill. [00:45:55] John: Yes, exactly. But at that point, I'm all in and I'm like, what do I have to lose? I'm a risk taker. I can afford it. [00:46:01] I've got money in the bank. [00:46:03] Let's make sure we stay on budget or close to budget, so there I am working on Jamie's computer and I'm staring at the screen and I'm summoning the courage. Ask Jamie. So I'm telling her the story. My friend Ryan's gonna direct this documentary about my life and my journey, and then I pause and I'm just staring at the screen. [00:46:23] I feel these eyes burning into the side of my head. [00:46:26] Mm-hmm. [00:46:28] John: And Jamie says, and [00:46:32] Danielle: I love that she didn't do it for you, but she made you do it. [00:46:36] John: And then at that point, I realized what the question was. I said, Jamie, will you be in my documentary? [00:46:44] And she goes, fuck yes, I will. [00:46:48] Danielle: Yeah. [00:46:49] John: She gets it. [00:46:50] Yeah. [00:46:51] John: Going through her sobriety, she wears her sobriety on her. Shoulder as a badge of honor. [00:47:00] And that is her message. [00:47:02] Yeah. [00:47:03] John: If she can get people to stop drinking by showing up for people. That's her ultimate goal in life. And so, she saw in me what I didn't see, [00:47:18] Danielle: and you asked the question. I think it's a lesson that I feel like I'm eternally playing a game of peekaboo with where I forget, and then I remember and then I forget and then I remember. But like the opportunities that you're asking for, you have to ask. [00:47:39] Yes. You have to say the thing. Right. Which is so brave and so vulnerable. But then the magic is sometimes when you ask, someone will say Yes. Now, in your case, she was essentially lovingly poking you until you, [00:47:55] John: asked. There was a point where I was debating plastic surgery. [00:48:00] Did I want to try to fix my face? Because at the end of the day, I wanted symmetry at rest. I wanted to be able to get rid of the droopiness and just, have a symmetrical base. That's all I really wanted. Sure. And because I would say, I hit my smile. And I've had friends come up and say, John, your first smile, we love your smile. [00:48:23] But I didn't love my smile. And until I, not up here, not in my head, but in my heart, accepted my smile. I couldn't move forward. I couldn't heal. And once I accepted my new smile, I found joy. I found that I could love myself. [00:48:46] And what's funny is when you get to that point, [00:48:49] yeah. [00:48:50] John: You overcome whatever that thing is that's holding you back. [00:48:53] Yeah. [00:48:54] John: And you want to share it with every person you come in contact with. [00:49:00] Danielle: Yeah. You are the love you're seeking. [00:49:02] John: Yes. Yes. And you are your acceptance. [00:49:05] Danielle: It reminds me of, something. He said in an interview, in, A New Earth, but author Eckert Tolle said that right before his essential death of the, he called it the death of his ego, but we could call it enlightenment or rebirth. [00:49:19] But he remembers the last thing he said before he went to sleep was, I can't live with myself anymore. And it wasn't about in the interpretation , of , taking one's own life . but what he realized is that he couldn't live with the self that was hating him. He couldn't live with that self. [00:49:40] And that self never woke up. But he did. [00:49:45] John: Through my journey [00:49:46] Of coming to accept myself for who I am. I immediately see others. [00:49:53] Yeah. [00:49:53] John: How they're hiding. [00:49:54] Before they recognize it. And so my coaching is all about not saying, this is why you're hiding. [00:50:03] That's what's holding you back. [00:50:06] Danielle: What you said about once you, you see somebody's wall so clearly because you understand your own so well. My less eloquent way of saying that to clients, it's once you smell bullshit, you can't unm it. It's the scent in the air and you're like, huh, what am I smelling? [00:50:23] Oh, it's bullshit. Well, John, I would love to know your, don't cut your own bang moment. [00:50:30] John: I'm backstage. There are a thousand people in the audience and I had theatrical training I had a talk memorized. It had to be 12 minutes long. [00:50:39] I'm doing a magic trick with other people that are coming up stage. I needed to control that. I got there early the morning of the TED Talk and helped the guys focus the lights so that it looked better. I'm all in. I want to shine in this TED Talk. , I remember I'm going up on stage and I'm saying, to the cherry picker operator, can I give you a hand? Because I have lighting experience. And I expected the presenter come and say, no, John, you're the actor. Go in your, the green room and there's some donuts and coffee , and we'll call you already, but you didn't. She knew that I was there to make the entire event better. And she let me do it, [00:51:18] That's awesome. [00:51:19] John: This is my first real speech. Okay, in front of a thousand people. And I knew that I had a limited time to get the audience on my side. [00:51:30] Get the audience engaged. How was I gonna be able to break their, going through their phone, talking to a neighbor, drinking, eating, snacking in a full day of speech? [00:51:41] Yeah. [00:51:43] John: So I said, I wanna go first. And everybody has said, great, but we don't, you can go first. And right before the mc went on stage to introduce me. I did a magic trick war. I turned Monopoly money into real money and then back again. [00:52:00] So as a magician, everything was possible. I turned monopoly into real money, but then I realized that's actually called counterfeiting he stays out for like seven seconds. I did that to the mc and now he just saw a miracle happen. [00:52:16] So he turns around and walks on stage beaming, and he told that story to the audience and said, Hey guys, your next speaker just did a miracle. He turned monopoly money into real money in front of my eyes. Pay attention to this cat. [00:52:37] Yeah. [00:52:38] John: So I walked on that stage. I had the love of everybody in the audience that everybody wanted to see what I was gonna do. [00:52:46] Everybody wanted to hear what I was gonna say, so I didn't have to warm up the audience. I got the mc to do it for me. Genius. And I do that every time I speak because it works but anyway, three quarters of the speech, I'm standing on my red circle and I'm delivering my talk. [00:53:08] And the front lights go out. [00:53:10] Danielle: Wait, you were three fours of the way done when they went out. [00:53:13] John: I'm standing in shadows. And my first reaction was, whoa. That Whoa. Got the lighting guy to realize, holy shit, I hit the wrong button, and he brought the lights slowly back up. [00:53:27] As the lights went back up, I went magic [00:53:32] and so I got an amazing laugh from the audience. [00:53:36] Because I cut the tension, I was doing improv. [00:53:38] I remember walking off stage and the producer of the event said, John, don't worry about, we'll edit that part out. And I said, don't you dare. That was my finest moment. Don't you dare edit that out. [00:53:54] I want that in the video. [00:53:57] She just smiled as I went back to the dressing room and sat down and then the adrenaline was like, whew. Walking out into the audience after the event and having strangers just come up to me and wanna hug me and say, holy cow, I resonate with your message. [00:54:18] And my message on the TED Talk was, treat people are different with respect to compassion. [00:54:23] That's what TED talks are all about. You want one key message and that was my message. [00:54:27] You never know, you might be in their shoes in an instant. [00:54:34] Danielle: I wanna add to that, another way to speak to the value of doing some self investigation, whether that's through journaling, through therapy, or seeking out a coach from someone like yourself is, because that expression of, treat other people the way you would wanna be treated. [00:54:53] What I know is that we don't treat ourselves all that well. A lot of us, many of us don't treat ourselves well, which is why accessing the compassion. Of treating others kindly is sometimes harder for us to find, jumping to criticism or judgment, because there's something we are rejecting in us. [00:55:13] So I think a way to do the thing you're saying , that beautiful treat others with kindness and compassion. The best way to do that is to look within. And I invite anybody listening to go to the show notes, visit John's website, seek out a coaching call, grab a copy of his book. There are resources that can help you be kinder to yourself, to lowering the walls, to lifting the veil, to seeing yourself in a new way, to performing the ultimate illusion, which is [00:55:52] to love yourself more fully exactly as you are so that we can be kinder to each other. 'cause we need that, we need a lot more kindness. [00:56:00] Thank you, John. Do we have the information we need for our listeners to get the special code? [00:56:06] John: John kipping.com. [00:56:08] Slash free gift. [00:56:11] Danielle: Ooh, you heard it here. John kipping.com/free gift. And this is only the gift for those of you who have listened this far. [00:56:20] So if you listen to the beginning and you just try to skip to the show notes, sorry. You ain't getting a gift. Thank you, John. [00:56:28] Thank you so much for joining me on this incredible episode of Don't Cut Your Own Bangs. I hope that you love listening because I thoroughly enjoyed making it. My favorite episodes are the ones where I get to learn something too. I'm also a listener. And benefiting from the wisdom and insights of all of the experts, creatives, performers, adventurers seekers that I get an opportunity to meet in this podcast format. [00:56:56] Don't forget to check out the show notes and please before you sign off , always remember rate, review, subscribe to the podcast when you interact with the podcast. It just helps send it out like a rocket ship to other people that are looking for the same value that you are. And it also helps create a conversation where I can continue to develop and cultivate something that benefits you more and is more fun for you to listen to. Feedback is great, and also if you just wanna throw a compliment, that's sweet too. But thank you so much for being here. [00:57:26] Your intention, your time mean the absolute world to me, and I hope you continue to have an incredible day. [00:57:32] ​

Was sind Kältewallungen und wofür sind die Eierstöcke gut, wenn die Eizellen verbraucht sind? Diana im Gespräch mit Gynäkologin Prof. Dr. Mandy Mangler über vereinzelte Zyklen, wenn man schon nicht mehr mit einer Blutung rechnet, die Wechseljahre als Verhütungsmethode und warum „Ich nehme Hormone, dann lebe ich länger“ zu einfach gedacht ist.Der Link zum kostenlosen Live-Webinar "Alte Glaubenssätze loslassen und selbstbewusst für die Altersvorsorge investieren!" aus unserer Eigenwerbung ist dieser: https://academy.brigitte.de/webinar-daniparthum?utm_source=menoanmich&utm_medium=podcast&utm_campaign=mcf-premium-kh11&utm_term=webinar-daniINFOS ZUR FOLGE:Hier geht es zu Mandys Buch: "Das große Gynbuch" (Insel Verlag, 2024)Hier geht es zu MENO AN MICH-Folge mit Mandy Manger "Gynäkologie, jetzt auch für Frauen" vom 13. Februar 2025.Hier geht es zu Mandys Podcast "Gyncast" (erscheint beim Tagesspiegel).Hier geht es zu Mandys Instagram.Hier geht es zu Mandy Mangler an ihrem Arbeitsplatz.Hier geht es zum Newsletter "Saisonwechsel" von der BRIGITTE.Hier geht es zum meno_brigitte-Insta-Account.Hier geht es zu Dianas Instagram.Hier geht es zu Julias Instagram.+++ Weitere Infos zu unseren Werbepartnern findet Ihr hier: https://linktr.ee/menoanmich +++WEITERE ANGEBOTE aus der BRIGITTE Redaktion:Skin-Code-Kurs mit Dermatologin Dr. Yael Adler: brigitte.de/meno-skinKrafttraining 50 plus: Forever Fit On Demand Kurs von BRIGITTE ACADEMYOn Demand Video-Kurs "Wechseljahre: Wissen, was hilft": https://academy.brigitte.de/course/wechseljahre?utm_source=podcast&utm_medium=meno&utm_campaign=wechseljahreMasterclass Finanzen Basic: https://academy.brigitte.de/course/masterclass-finanzen-basic?utm_source=menoanmich&utm_medium=podcast&utm_campaign=mcf-basicKostenloses Webinar Rentenlücke berechnen: https://academy.brigitte.de/webinar-aufzeichnung-rentenluecke-berechnenETF Kurs: https://academy.brigitte.de/course/etf-kurs?utm_source=menoanmich&utm_medium=podcast&utm_campaign=etf-kurs-mEs gibt auch einen MENO AN MICH-Rabattcode, MENO15 (gilt für viele BRIGITTE-Angebote).Ihr habt Anregungen, wollt uns Eure Geschichte erzählen oder selbst bei uns zu Gast im Podcast sein? Dann schreibt uns beiden persönlich, worüber Ihr gern mehr wissen würdet, was Euch bewegt, rührt, entsetzt und Freude macht an podcast@brigitte.de. Wir freuen uns auf Euch! Und bewertet und abonniert unseren Podcast gerne auch auf Spotify, iTunes, Amazon Music oder Audio Now. Noch mehr spannende Beiträge findet Ihr zudem auf Brigitte.de sowie dem Instagram- oder Facebook-Account von BRIGITTE –schaut vorbei! +++Unsere allgemeinen Datenschutzrichtlinien finden Sie unter https://datenschutz.ad-alliance.de/podcast.html +++Wir verarbeiten im Zusammenhang mit dem Angebot unserer Podcasts Daten. Wenn Sie der automatischen Übermittlung der Daten widersprechen wollen, klicken Sie hier: https://datenschutz.ad-alliance.de/podcast.htmlUnsere allgemeinen Datenschutzrichtlinien finden Sie unter https://art19.com/privacy. Die Datenschutzrichtlinien für Kalifornien sind unter https://art19.com/privacy#do-not-sell-my-info abrufbar.

Geneigte Gesellschaft, man sagt, sie sei eine Bad Mom – sie selbst sagt, sie sei fett. Und wir sagen: Sie ist absolut famos! In dieser ebenso schamlosen wie charmanten Folge bringt die kühne Lady Alina Friederichs ein Selbstvertrauen mit, das selbst gestählte Insta-Gemüter erröten lässt: Es geht um das Leben als Influencerin zwischen Reichweite und Realness, um das Fatshaming beim Frauenarzt, Internetmobbing von einer angeblichen Gynäkologin – und um die Entscheidung, nicht zu stillen, obwohl man weiß, was dann kommt. Alina Friederichs spricht über den Druck, perfekt zu performen – online wie offline. Über ihren Weg zur Selbstständigkeit, über ihren Körper, über das Wort „fett“ – und warum sie es selbstbewusst reclaimt. Und sie zeigt, wie man sich auch mit über 130 Kilo im Bikini zeigen kann, ohne sich vor den Blicken anderer kleinzumachen. Diese Folge strotzt vor subversivem Witz, echter Wut und genau dem Quäntchen Skandal, das man in feineren Kreisen natürlich nur unter vorgehaltener Hand feiert – und heimlich verschlingt. Herzlichst, Lady Leisadale Du möchtest mehr über unsere Werbepartner erfahren? Hier findest du alle Infos & Rabatte: https://linktr.ee/mama_leisa Du möchtest Werbung in diesem Podcast schalten? Dann erfahre hier mehr über die Werbemöglichkeiten bei Seven.One Audio: https://www.seven.one/portfolio/sevenone-audio

Maladie du système reproducteur masculin ou féminin, l'infertilité se définit par une impossibilité à concevoir après 12 mois ou plus de rapports sexuels réguliers non protégés. Les causes sont multiples et peuvent concerner l'homme, autant que la femme. À partir de quand s'inquiéter ? Quels sont les examens pouvant aider à définir la cause de l'infertilité ? Quels sont les recours possibles ?   Pr Michael Grynberg, chef de service de Médecine de la Reproduction & Préservation de la Fertilité à l'Hôpital Antoine Béclère, à Clamart, en région parisienne  Pr Ahmed Abdi, gynécologue et chef du service de Gynécologie obstétrique à l'Hôpital mère enfant de Nouakchott, en Mauritanie. Président de la société mauritanienne de gynécologie obstétrique. Chef du département mère enfant à la Faculté de Médecine.      Programmation musicale :  ► Q twins, DJ Tira – Hamba  ► 15 15 – Afa 

Maladie du système reproducteur masculin ou féminin, l'infertilité se définit par une impossibilité à concevoir après 12 mois ou plus de rapports sexuels réguliers non protégés. Les causes sont multiples et peuvent concerner l'homme, autant que la femme. À partir de quand s'inquiéter ? Quels sont les examens pouvant aider à définir la cause de l'infertilité ? Quels sont les recours possibles ?   Pr Michael Grynberg, chef de service de Médecine de la Reproduction & Préservation de la Fertilité à l'Hôpital Antoine Béclère, à Clamart, en région parisienne  Pr Ahmed Abdi, gynécologue et chef du service de Gynécologie obstétrique à l'Hôpital mère enfant de Nouakchott, en Mauritanie. Président de la société mauritanienne de gynécologie obstétrique. Chef du département mère enfant à la Faculté de Médecine.      Programmation musicale :  ► Q twins, DJ Tira – Hamba  ► 15 15 – Afa 

Wir haben es immer schon geahnt: Das Leben ist weder Ponyhof noch Kindergeburtstag. Sätze wie diese fallen ja immer dann, wenn etwas schief geht oder etwas Gravierendes passiert, Verlust, Trauer, Schmerz gehören für uns alle dazu, auch das ist bekannt. In diesen Momenten hoffen wir auf Beistand mit unserem ganz individuellen Leid, auf jemanden, der uns heilt und hilft. Wer aber schützt und stützt all die Menschen in den Regionen weltweit, in denen es zu Naturkatastrophen und Kriegen kommt? Wer fährt in die Krisengebiete und setzt dabei sein eigenes Leben auf das Spiel? Die ehrenamtlichen Mitarbeiter der medizinischen Hilfsorganisation "Ärzte ohne Grenzen" beispielsweise, deren Vorstandsvorsitzende Parnian Parvanta heute unser Gast ist. Sie kam 1982 in Kabul zur Welt, inmitten der Wirren des Afghanistankrieges, und hatte als 8jähriges Mädchen das Glück, mit ihrer Familie über Umwege nach Deutschland fliehen zu können. Immer schon wollte Parnian Parvanta Ärztin werden, sie wurde es, genauer: Fachärztin für Gynäkologie und Geburtshilfe. Nach Einsätzen z.B. in Indien, Nigeria und im Irak wurde sie 2023 zur Vorstandsvorsitzenden von "Ärzte ohne Grenzen" gewählt. Playlist: Shakira - Whenever wherever Grohe Baran - Kabul Jan Fettes Brot - Jein Freundeskreis - Mit Dir Ashiqi 2 - Tum Hi Ho Fairuz - Ya ana ya ana Shervin Hajipour - Barraye Rahat Fateh Ali Khan & Momina Mustehsan - Afareen Afareen Diese Podcast-Episode steht unter der Creative Commons Lizenz CC BY-NC-ND 4.0.

Warum menstruieren der Mensch und ein paar Tierarten, aber 97 Prozent der Säugetiere nicht? Es gibt überraschende Hinweise, warum sich die Menstruation im Laufe der Evolution entwickelt haben könnte. Die Forschung hofft dabei besonders auf Erkenntnisse von einem Tier: der Stachelmaus. Ein Podcast von Roana Brogsitter. Habt Ihr Feedback? Anregungen? Wir freuen uns, von Euch zu hören: WhatsApp (https://wa.me/491746744240) oder iq@br.de Credits Autorin: Roana Brogsitter SprecherInnen: Roana Brogsitter, Gudrun Skupin, Benjamin Stedler Produktion: Peter Riegel / mars13 Redaktion: Sarah Bioly Unsere Gesprächspartner: Dr. Christian Feregrino, Evolutionsbiologe Max-Planck-Institut für molekulare Genetik, Berlin https://www.molgen.mpg.de/person/131661

Dr. Lisa-Maria Wallwiener, Gynäkologin, und Hormonärztin, München
https://hormonaerztin.de/ Prof. Günther Wagner, Zoologe und Evolutionsbiologe Yale University, USA https://medicine.yale.edu/profile/gunter-wagner/ Zum Weiterschauen ARTE: Die Kraft des Zyklus https://www.youtube.com/watch?v=2Ipyp_7aI2Y Zum Weiterlesen Max Delbrück Center: Die Evolution der Menstruation erforschen https://www.mdc-berlin.de/de/news/news/die-evolution-der-menstruation-erforschen American Journal of Obstetrics & Gynecology: Menstruation: Wissenschaft und Gesellschaft https://www.ajog.org/article/S0002-9378(20)30619-0/fulltext IQ verpasst? Hier könnt ihr die letzten Folgen hören: https://www.ardaudiothek.de/sendung/iq-wissenschaft-und-forschung/5941402

Wir sollten über Abtreibungen so reden wie über Knie-OPs, findet der Gynäkologe Andreas Glasner. Im Podcast erklärt er, wie ein Schwangerschaftsabbruch typischerweise abläuft – und welche zwei medizinischen Methoden es gibt. Abtreibung, erklärt.

On this episode of The Wholesome Fertility Podcast, I am joined by Dr. Nirali Jain (eggspert_md), a board-certified OB/GYN and reproductive endocrinologist at Reproductive Medical Associates (RMA). Dr. Jain shares her expert insights on fertility preservation for individuals undergoing cancer treatment, a crucial yet often overlooked aspect of reproductive care. We explore what options are available for fertility preservation, including egg and sperm freezing, and why it's so important to initiate these discussions before starting chemotherapy or radiation. Dr. Jain also explains the difference between Letrozole and Clomid, the impact of estrogen-sensitive cancers on IVF treatments, and innovative approaches like random-start cycles and DuoStim protocols. Whether you're facing a cancer diagnosis or simply thinking proactively about your reproductive future, this conversation is filled with knowledge and reassurance. Key Takeaways: Why it's essential to discuss fertility before starting cancer treatment. The role of Letrozole in estrogen-sensitive cancers and fertility preservation. Differences between Letrozole and Clomid, and why Letrozole is often preferred. How new protocols like DuoStim and random-start cycles are improving outcomes. Why fertility preservation is important even for those without a cancer diagnosis. Guest Bio: Dr. Nirali Jain (@eggspert_md) is a board-certified OB/GYN and fertility specialist at Reproductive Medicine Associates (RMA) in Basking Ridge, New Jersey. She earned both her undergraduate degree in neurobiology (with a minor in dance!) and her medical degree from Northwestern University, before completing her residency at Weill Cornell/NYP, where she served as co-Chief Resident, and her fellowship in reproductive endocrinology and infertility at NYU Langone. Deeply passionate about women's health and fertility preservation, Dr. Jain blends the latest research and cutting-edge treatments with compassionate, patient-centered care. Her interests include third-party reproduction and oncofertility, and she is especially passionate about supporting patients navigating fertility preservation through a cancer diagnosis. Outside of the clinic, Dr. Jain is a trained dancer, a dedicated global traveler, and an adventurer working toward hiking all seven continents with her husband. Her diverse experiences, from international medical rotations to personal connections with friends and family navigating infertility, have shaped her into a warm, resourceful, and determined advocate for her patients. Links and Resources: Visit RMA websiteFollow Dr. Nirali Jain on Instagram For more information about Michelle, visit www.michelleoravitz.com To learn more about ancient wisdom and fertility, you can get Michelle's book at: https://www.michelleoravitz.com/thewayoffertility The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care. --  Transcript:   # TWF-Jain-Nirali (Video) ​[00:00:00]  **Michelle Oravitz:** Welcome to the podcast Jain.  **Dr. Nirali Jain:** Thanks so much for having me **Michelle Oravitz:** Yeah, so. **Michelle Oravitz:** I'm very excited to talk about this topic, which, um, actually you don't really hear a lot of people talking about, which is how to preserve your fertility if you're going through a cancer diagnosis and if you have to go through treatments. 'cause obviously that can impact a lot on fertility. **Michelle Oravitz:** I have, um, seen actually like a colleague of mine go through. And she also preserved her fertility and, and now she has a baby boy. so it's really nice. **Michelle Oravitz:** to **riverside_nirali_jain_raw-video-cfr_michelle_oravitz's _0181:** so nice. **Michelle Oravitz:** So I'd love for you first to introduce yourself and kind Of give us a background on how you got into this work. **Dr. Nirali Jain:** Of course. Um, so I am Dr. Narly Jane. I am, um, an OB GYN by training, and then I did an additional, after completing four years of residency in OB GYN and getting board certified in that, I did an additional training in reproductive endocrinology and [00:01:00] infertility or otherwise known as REI. So now I'm a fertility specialist. **Dr. Nirali Jain:** Um, I trained at Northwestern in Chicago, so I went to undergrad and medical school there. And then, um, home has always been New Jersey for me, so I moved back out east to New Jersey. Um, I did all my training actually in New York City at Cornell for residency and NYU for fellowship. Um, and then moved to the suburbs. **Dr. Nirali Jain:** Um, and now I'm a fertility specialist in, in Basking Ridge at Reproductive Medical Associates.  **Michelle Oravitz:** Very impressive background. That's awesome.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** I'd love to hear just really. About what your process is. If a person has been diagnosed with cancer, like what is the process? What are some of the things that you address if they are trying to preserve fertility, and what are some of the concerns going  **Dr. Nirali Jain:** yeah, yeah. All great questions. So, you know, there's a lot of us, uh, the Reis. Are a very small, [00:02:00] there's a very small number of us. So in terms of specializing in fertility preservation, technically we all are certified to treat patients with cancer and kind of move them through fertility preservation before starting chemotherapy. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, luckily we've been working closely with oncologists in the past several years just to establish some type of streamlined system because having a diagnosis of cancer and hearing all that information. Especially when you're young is so hard. So I think that's, that's where my interest started in terms of being able to speak to and counsel cancer patients. **Dr. Nirali Jain:** I think it is a very specific niche that you really have to be comfortable with in our field. Um, I. So I'll kind of walk you through, you know, what it, what does it look like, right? Um, you go into your oncologist's office suspecting that you have this, this lump. I'll take breast cancer, for example. It could really be any kind of cancer. **Dr. Nirali Jain:** Um, but breast cancer in a reproductive age patient or someone that's in those years where you're starting [00:03:00] to think about building a family, planning a family, um, or if you have kids at home, that's usually the type of patient that we see come in with a breast cancer diagnosis. So. Kinda just taking that, for example, um, the minute that you're diagnosed, it's really your oncologist's responsibility to counsel you on what treatment options are going to be offered to you. **Dr. Nirali Jain:** And then based off of the treatment options, it's important to know how that affects your reproduction. So how does it affect your ovaries in the short term, in the long term, um, in any way possible. So. Once a patient is initially referred from their oncologist to myself or any other fertility specialist, they come into my office and we just have a 30 minute conversation really talking about family planning goals. **Dr. Nirali Jain:** Any kids that they've had in the past either naturally conceived or through um, IVF, and then we talk about where they're at in their relationship. Are they married, are they not? Are they with a partner, [00:04:00] a male partner, a female partner, whatever it might be. It's important to know the social standpoint, um, especially in this sensitive phase of life. **Dr. Nirali Jain:** So patient patients usually spend anywhere from 30 minutes to an hour. Um, just kind of talking through where they're at, how they're feeling, what their ultimate childbearing goals are. And then from there we do an ultrasound and that's when I'm really able to see, you know, the, the reproductive status. **Dr. Nirali Jain:** So what do the ovaries look like? What does the uterus look like? Is there something that I need to be concerned about from a baseline GYN standpoint? Um, and all of those conversations are happening in real time. So. I think one of the things is patients come in and they're like, I'm already so overwhelmed with all this information from my oncologist, and now my fertility specialist is throwing all this information at me. **Dr. Nirali Jain:** Luckily, the way I like to frame it is you come in and you just let go. Like you let us do the work because in the background we're the ones talking to your oncologist. We're the [00:05:00] ones giving that feedback and creating a timeline with your oncologist. Um, and really I think just getting in the door is the hardest part. **Dr. Nirali Jain:** So once patients are here to see us, we go through the whole workup. We do anything that we would do for a normal patient that came in for fertility preservation. And then based off of where they're at in their journey, we talk about what makes sense for them, whether that means freezing embryos, freezing eggs, they're very similar in terms of the, the few weeks leading up to the egg retrievals. **Dr. Nirali Jain:** So I have that whole conversation just at the initial visit. And then from there we talk about the timeline behind the scenes and make sure that it works with their lives before moving forward. **Michelle Oravitz:** So for people listening to this, why, and this might be an obvious question, but to some it might not be,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** why would somebody want to preserve. eggs or sperm. 'cause I've had actually some couples  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** come to me where the husband preserved the sperm and they had to go through IVF just because he was going [00:06:00] through cancer treatments. So he had to preserve the sperm ahead of time.  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** people need to consider doing that before doing cancer treatments?  **Dr. Nirali Jain:** So there are certain cancer treatments that do affect the ovaries and the sperm health, and you know, for men and women, it affects your reproductive organs. In a similar way, um, depending on the type of chemotherapeutic agent, there are some that are more dangerous in terms of, um, being toxic to your ovaries or toxic to your sperm. **Dr. Nirali Jain:** And those are the instances where we are really thinking about what's the long-term impact because there's medications that oncologists do give patients, and our oncologists are amazing, the ones that we work with, Memorial Sloan Kettering from Reproductive Medical Associates through RMA, um, and. **Dr. Nirali Jain:** They're just so good at what they do and are so well-trained, so they know in the back of their mind, is this going to impact your ovaries or your sperm health or not? Um, and I [00:07:00] think that any chemotherapy, you know, your ovaries are these, these small organs that are constantly turning over follicles every month. **Dr. Nirali Jain:** So every month we're losing those eggs, and if they don't become. If an egg isn't ovulated, it doesn't become a baby, it's just gonna die off. So I counsel even patients that don't have cancer, I counsel them on fertility preservation as young as possible. You know, between the ages of 28 and 35, that's like the best time to preserve your fertility. **Dr. Nirali Jain:** So in cancer patients, there's an extra level added to that where even if they are a little bit younger, a little bit older. Your eggs are not gonna be the same quality. There's gonna be higher level of chromosomal errors, more DNA breakage, um, and, and bigger issues that lead to issues with conceiving naturally afterwards. **Dr. Nirali Jain:** So I think that it's important to consider how that chemotherapy is going to affect them or how surgery would affect them if it was, for example, a GYN cancer where [00:08:00] we're removing a whole ovary, you know, what, what do we have to do to preserve your fertility in that case? And those are important conversations to have. **Michelle Oravitz:** Yeah. for sure. I know that a lot of people are also concerned, you know, with going through the IVF process, you're taking in a lot of estrogen, a lot of hormones, and many cancers are actually estrogen sensitive. So I wanted to talk to you about that. 'cause I know that the data shows that it's. It's been fine, which some people might find surprising, but I wanted you to address that and just kind of **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** from your perspective.  **Dr. Nirali Jain:** That's so interesting that you asked that question because I actually, my whole I I graduated fellowship last year and my entire, like passion project in fellowship was looking at one of the drugs that we use to suppress the estrogen levels specifically in cancer patients. Um, and I had presented this at a few of our reproductive meetings. **Dr. Nirali Jain:** Um, A SRM is one of our annual meetings where all of the reiss get together. A lot of male fertility [00:09:00] specialists come and we kinda just talk about. Specific things and fertility preservation for cancer patients is, has been an ongoing topic of interest for all of us. Um, and it's important to know that there are different medications that we can offer. **Dr. Nirali Jain:** Letrozole is the one that I, um, have a particular love for and I, uh, you know, I use all the time for my patients, um, for different reasons, but it suppresses the exposure that your body has to estrogen. And there's mixed data, um, out there in terms of, you know, does Letrozole suppression actually impact, you know, does it help or. **Dr. Nirali Jain:** Or does it have no impact on your future risk of cancer after treatment? Um, and that honestly is still up for debate. But what we do know is that there's no increased risk of cancer recurrence in patients that have undergone fertility preservation with or without Letrozole. Um, Letrozole is one of those things that we can give, and the way it works is basically. **Dr. Nirali Jain:** It masks that [00:10:00] conversion. It, it doesn't allow for conversion from those androgens in the male hormones over to estrogen. Um, and so your body doesn't really see that estrogen exposure. It stays nice and low throughout your cycle, and it does help with actually ovarian maturation and getting mature eggs harvested and, um, helps a little bit with, with quality too. **Dr. Nirali Jain:** So I think that it's really nice in terms of having that available to us, but know that. It's not, it's not essential that you have it, really, the data showing plus minus. Um, but there are certain things that we can do to protect the ovaries, protect your exposure to estrogen. Um, and so that shouldn't be top of mind of concern when we're going through fertility preservation, even with an estrogen sensitive cancer. **Michelle Oravitz:** Actually, so, uh, on a different topic, kind of going back to that, so Letrozole versus Clomid, I, it's like a, the questions I personally feel just based on what I've heard and like my own research that Letrozole would be kind of like the more. [00:11:00] Um, the, it's, it's a little better, but I know that it really depends on the person as well.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** they might do better with Clom, but I'd love to hear your perspective and kind of pick your brain on this.  **Dr. Nirali Jain:** totally. You're choosing all the, all the right questions because these are all of my, my specific interests and niches. So  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** Letrozole is basically, you know, we use Letrozole and Clomid in. Patients that don't have cancer and patients that come in for an intrauterine insemination, that's kind of the most common scenario where we're thinking about, you know, which medication is better? **Dr. Nirali Jain:** Letrozole or Clomid and Clomid used to be the, the most common medication that we use, we dose patients, you know, have 50 milligrams of Clomid, give them five days of the medication. It's an oral pill. Feels really easy and. The way it works is really, it recruits more than one follicle, so it really helps with the release of, um, more than one follicle growing more than one follicle in the ovary. **Dr. Nirali Jain:** Um, but it has a little bit [00:12:00] higher of a risk of twins because that's exactly what it's good at. Um, Clomid, not so much in the cancer. In the cancer front, it's not really used there because it's considered, from a scientific perspective, it's considered like a selective estrogen receptor modulator. So it doesn't necessarily suppress your estrogen levels in the same way that Letrozole does versus. **Dr. Nirali Jain:** Letrozole is an aromatase inhibitor, so it really blocks the chemical conversion of one drug or one hormone to the other hormone. Um, the reason we love Letrozole so much, and I don't mean to like gush over Letrozole, but um, it's a mono follicular agent, so it works really well at recruiting one follicle  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** you know, every OB-GYN's nightmare in a way is having multiples when you didn't intend on having multiples at all. **Michelle Oravitz:** so  **Dr. Nirali Jain:** Um. **Michelle Oravitz:** were saying that, um, there's more of a chance of twins, it's Clomid, not letrozole.  **Dr. Nirali Jain:** Yes, there's a higher chance with Clomid versus Letrozole. And I mean, don't get me wrong, there's a chance of twins with [00:13:00] any type of assisted reproductive technology. Even when we're doing single embryo transfers, there's a chance that it's gonna split. So, um, the chance is always there just like it is in the natural world. **Dr. Nirali Jain:** But we know for a fact that. CLO is really good at recruiting many follicles. It's good for certain patients that don't respond well to Letrozole. Um, but Letrozole is kind of our, our go-to drug these days just because of all the benefits that we've seen.  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** These are all fun things to ask because I, I love talking to our eis 'cause there's so much information that I'm always  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** learn a lot from my patients in my own research, but it's really cool. Picking your guys' brains. So another question I have, and I have actually talked to Dr. Andrea Elli, he's been on,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** and he does a lot of endometriosis and, and immune related work as well,  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** so. I'd love to know just from your perspective. One thing that I do know from, based on what I've heard is that the, [00:14:00] guess like you were just saying, that breast cancer or estrogen sensitive breast cancer doesn't seem to be affected by IVF cycles, however, and endometriosis lesions do get affected.  **Dr. Nirali Jain:** Yeah. **Dr. Nirali Jain:** that's a great question. So, you know, every, there are so many complex G mind diagnoses that the, that our patients come in with. Um, and endometriosis is a big one because there is clear data that endometriosis is linked to infertility. So we think about, you know, when a patient comes in with endometriosis, we really do think about the different treatment options and what are the short-term and long-term impacts of the hormones that we're giving 'em. **Dr. Nirali Jain:** Um, these days, again, kind of going back to Letrozole, we, letrozole is something that I give all of my endometriosis patients because it helps suppress their estrogen because we know.  **Michelle Oravitz:** interesting.  **Dr. Nirali Jain:** is very responsive to estrogen and leads to this dysfunctional regulation of all the endometrial tissue that can really flare in a, [00:15:00] in a cycle, or shortly after a cycle. **Dr. Nirali Jain:** I. So we really, for endometriosis patients, the, the best treatment is being on birth control because we don't see that hormonal fluctuation. The up and down of the estrogen and the progesterone, that's what leads to those flares. Um, so I really, I watch patients closely after their cycles too, because you definitely can have an endometriosis flare and we say the best treatment for endometriosis is pregnancy, right? **Dr. Nirali Jain:** That's when you're suppressed, that's when you're at your lowest. Um, and patients, my endo patients feel so good in pregnancy because they have. Hormones that are nice in that baseline, they're not getting periods of course. Um, and that's truly, truly the best treatment.  **Michelle Oravitz:** That's interesting.  **Dr. Nirali Jain:** But it is important to consider when you're going through infertility treatments. **Dr. Nirali Jain:** How does my endometriosis affect the short and long-term effects of the fertility medications? And really not to, not to say that they're bad in any way. I think a lot of endometriosis patients go through IVF and have success and do really, really well, and that's kind of the push that they need. [00:16:00] Um, but it's important to be mindful of the bigger picture here. **Dr. Nirali Jain:** It's not just, you're not just a number of. A patient with endo coming in, getting the same protocol. It's really individualized to the extent of your lesions, what symptoms you're having, what grade of endometriosis, where your lesions are. So we're the RAs are thinking about everything before we actually start your protocol. **Michelle Oravitz:** It's crazy how in depth it is, and it's, it, there's just so, it's so multifaceted,  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** when it's females  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** are a little, I mean, they can, you know, there, there's definitely a number of things, but it's not as complicated and interconnected  **Dr. Nirali Jain:** Exactly. Exactly. That's so true. **Michelle Oravitz:** And so one question I actually have, this is kind of really off topic, but something that I was curious about. **Michelle Oravitz:** 'cause I heard about a while  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** a, a type of cancer treatment that was used. I'm not sure exactly what it was, but for some reason it actually caused follicles to grow, [00:17:00] or to multiply. And they were **Dr. Nirali Jain:** Interesting. **Michelle Oravitz:** this definitely. Puts, um, the whole idea of like a woman being born with all the follicles she'll ever have on its head, I thought that was really Interesting. **Michelle Oravitz:** Now I learned a little bit about it. I don't think it really went further than that,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** one of those things that they're like, Hmm, this is interesting. I don't know, it was kind of a random side effect of this chemo drug. I dunno if it was a chemo drug or a cancer drug.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** ever heard of that. **Michelle Oravitz:** So I was just **Dr. Nirali Jain:** I haven't, I mean, that's interesting. I feel like I'd have to look into that because that would be definitely a point of interest for a lot of Reis. But it kind of does go back to the point of, you know, women are really born with all the eggs we're ever gonna have. So it's about a million, and then it just goes down from there. **Dr. Nirali Jain:** And the, by the time you start having periods, I like to kind of show my patients a chart, but you have a couple hundred thousand eggs and you ovulate one egg a month. That's, you know. Able to [00:18:00] progress into a fertilized egg and then into a, an embryo into a baby, um, if that's your goal. But otherwise, patients that are having periods and not trying to actually get pregnant, we're losing hundreds of eggs a month. **Dr. Nirali Jain:** So.  **Michelle Oravitz:** Mm.  **Dr. Nirali Jain:** It's important to kind of think about that decline, and it's important to know that that rate can be faster in patients with cancer, patients with low ovarian reserve. And sometimes when you have the two compounded, that's when a fertility specialist is definitely, you know, in the queue to, to have a discussion with you in terms of what that means and how you can reach your family building goals despite being faced with that, with that challenge. **Michelle Oravitz:** Yeah. **Michelle Oravitz:** I mean, 'cause we know oxidative stress is one of the things that can cause, uh,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** quality eggs, but it's also can cause cancer. **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** um, similar, you know, like things that really deplete the body could definitely impact. Um, and then what are your thoughts? I know I'm asking you all kinds of random questions, **Dr. Nirali Jain:** I love it. **Michelle Oravitz:** are your thoughts about doing low simulation in certain [00:19:00] circumstances versus high stem? **Michelle Oravitz:** Sometimes people don't respond as well to higher stems.  **Dr. Nirali Jain:** Yeah, that's a great point. I think that it kind of all goes back to creating an individualized protocol. If. A patient's going to a practice and basically just getting a protocol saying, this is our standard. We start with our standard of, you know, I, I think about the standard, which is 300 of the FSH or that pen that you dial up, and then 150 units of that powder vial. **Dr. Nirali Jain:** And we have patients mixing powders all the time, and that's kind of our blanket protocol that we give patients. But that's not really what's happening behind the scenes. And if you're given a protocol that's, and being told, you know, this is kind of what we give to everyone, it's probably not the right fit for you. **Michelle Oravitz:** Yeah, I  **Dr. Nirali Jain:** Um, there are certain patients that respond to a much lower dose and do really, really well, and then some patients that need a much higher dose. Um, and I think it's, that's kind of like the fun part of being an REI of being able to individualize the [00:20:00] protocol to the patient. Um, and I know for a fact there are so many, luckily, you know, we have so many leaders in REI that have been. **Dr. Nirali Jain:** Have dedicated their entire careers to researching these different protocols and how they can help different patients. Um, patients with lower a MH, you know, might benefit from a duo stim protocol, for example. That's kind of the first one that comes to mind, but a protocol where we're using those follicles from the second half of a cycle. **Dr. Nirali Jain:** I would've never thought that those were the follicles that  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** would be better than the first half of the cycle,  **Michelle Oravitz:** Wait,  **Dr. Nirali Jain:** but, **Michelle Oravitz:** that. Explain that. Um, because I think that that's kind of a unique  **Dr. Nirali Jain:** mm-hmm.  **Michelle Oravitz:** that I haven't heard of.  **Dr. Nirali Jain:** Yeah, so there's this new day. It's still kind of developing, but um, kind of going back to, you know, what's an individualized protocol? Duo STEM is one of the newer protocols that we've started using. I, I've used it once or twice in patients. Um, but it goes back to the research that shows that you might actually have two different periods of time in a menstrual cycle where you could potentially recruit [00:21:00] follicles. **Dr. Nirali Jain:** You could have a follicular phase where there's a certain cohort of follicles recruited, and then you have a follicle that forms creates a corpus glut.  **Michelle Oravitz:** um, protocols  **Dr. Nirali Jain:** Yep. And then you basically go through the follicular protocol and then a few days after a retrieval, instead of waiting for a new follicular cohort or follicular recruitment from the first half of your menstrual cycle, you actually use the luteal phase and you recruit those follicles that would've actually died off or have been prematurely recruited in a prior cycle. **Dr. Nirali Jain:** So **Michelle Oravitz:** that's So  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** you just do a similar, I guess, um, medicine,  **Dr. Nirali Jain:** go right back into it.  **Michelle Oravitz:** do the same exact thing, but right after ovulation.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** Fascinating. That's really interesting.  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** has been your experience with that?  **Dr. Nirali Jain:** I think it's, honestly, it's mixed. Um, so far, you know, our data from fertility and sterility and A SRM, it, it shows support for these DUO STEM [00:22:00] protocols, saying that if patients don't have that great quality of eggs or if they have a very low number, maybe they'd benefit from starting the meds earlier and recruiting follicles. **Dr. Nirali Jain:** A little bit earlier. Um, so we've seen positive results so far. A lot of work to be done in terms of really understanding it. Um, and of course, as a new attending, I have a lot more experience to kind of build on. Um, but I, I have seen success from it. **Michelle Oravitz:** That's fascinating. Are there any other new technologies, like new add-ons, um, that you've seen, that you've found to be really cool or interesting?  **Dr. Nirali Jain:** I think the biggest thing, actually, kind of going back to our whole topic for today is fertility preservation cancer patients. One of the biggest things that I've learned recently is that we used to start fertility, um, patients. You know, only in the beginning of the cycle days, two or three is technically like when most. **Dr. Nirali Jain:** Most clinics, um, start patients, but for our cancer patients, sometimes you don't have that time. You don't wanna wait a full month to [00:23:00] restart, um, your, you know, your menstrual cycle and then do the fertility preservation and then delay chemotherapy a full month. So we started doing what we call random starts. **Dr. Nirali Jain:** So you basically start a patient whenever they come in. You know, it could be the day after your consultation, the day of your consultation. I've kind of seen all of the above. Um, and we've seen really good success with random starts, per se. Um, and we've been doing a lot more of that, where it's not as dependent on where you're at in your cycle. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, obviously there's a difference in outcomes. You might not be a great candidate for it, so definitely it's worth talking to your doctor about it. But it kind of gives relief to our cancer patients where if you have a new cancer diagnosis and you're like, oh, I just finished my period, like, I can't even start a cycle until next month. **Dr. Nirali Jain:** That's not always true. Um, so it's always worth it to go into see a fertility specialist and just get, you know, get the data that you need right away, and then you can make a decision later on. **Michelle Oravitz:** For sure. Um, Yeah. **Michelle Oravitz:** and I wanted to kind of cover a lot of different topics 'cause I know that [00:24:00] some people are gonna wanna hear what you have to say that don't necessarily, or, uh, have cancer. But it is important. I, I think that, you know, if you get to thirties and you haven't gotten married or you don't have a partner, I think it's really important to preserve your fertility in general.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** important thing. And then if you were going through a cancer diagnosis and you decided to preserve your fertility, um, guess more for women because they're eventually going to be thinking about transfers after they go through treatment. So what are some of the things that they would need to consider as far as that goes? **Michelle Oravitz:** Like after the  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** then they go through the cancer treatments. Um, and then what, how long should they  **Dr. Nirali Jain:** yeah. Like what does it look like? So I've had patients that come back, you know, in my fellowship training I did a, a couple research projects on patients that came back to pursue an embryo transfer, um, after chemotherapy agent. And basically compared them to how they did, um, [00:25:00] compared to patients that didn't have cancer and just froze their embryos or froze their eggs and then came back to pursue a transfer and. **Dr. Nirali Jain:** I think the, the most reassuring thing from the preliminary data that we have is saying that there's no difference in pregnancy rates and no difference in life birth,  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** of whether they had chemotherapy or not. After freezing those eggs and going through fertility preservation.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Um, in terms of where your body needs to be, I think the oncologist, we, we wait for their green light. **Dr. Nirali Jain:** We wait for their signal to say, you know, she's safe to carry a pregnancy.  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** And then once we do that, we basically treat you like any other patient. So if you're coming in for a cycle, if you're having periods, then it's reasonable to try a natural cycle protocol, wait for your body to naturally ovulate an egg. **Dr. Nirali Jain:** And instead of obviously hoping that egg will fertilize, we, um, use a corpus luteum. We use the progesterone from the corpus luteum to really support this embryo being implanted into the uterus. Um. Yeah. [00:26:00] And then there's also another side. I mean, some patients don't get their periods back and they always ask like, what if I never get my period back? **Dr. Nirali Jain:** What if I'm just like in menopause because of the chemotherapy agents? And for that, we can start you on a synthetic protocol or basically an estrogen dependent protocol where you take an estrogen pill for a certain number of days. We monitor your lining, then we start progesterone, um, to support your hormones from that perspective instead of relying on your ovaries to release the progesterone that they need, um, and then doing the embryo transfer a few, few days after progesterone starts. **Dr. Nirali Jain:** So there's definitely different protocols depending on where your menstrual health is at after the chemotherapy or after the cancer treatment. Um, but it's important to kind of just know that. That there's options. It doesn't mean that it's the end of the road if you all of a sudden stop getting your period. **Michelle Oravitz:** Yeah, for sure. I mean, 'cause you, technically speaking, you can really control a lot of that. More so for transfers  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** Retrievals really is kind of like what [00:27:00] eggs you have, what the quality is. But people can be in complete menopause and you guys can still control their cycles for transfer, which is kind of. A huge difference  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** in the  **Dr. Nirali Jain:** exactly. That's exactly right. Yeah. **Michelle Oravitz:** interesting. Any other, um, new, new things that you're, you guys are excited about? I always like to hear about like the new and upcoming things  **Dr. Nirali Jain:** Of course.  **Michelle Oravitz:** actually before, which I thought was fascinating. Yeah.  **Dr. Nirali Jain:** I feel like there's always like updates and, and new data and things like that coming out, but just know, I think it's important for patients to know, like we're constantly, we're, the reason I chose to even pursue this field was because it's new. Right. There's something that we are discovering every day, every year, and that's what makes our, our conferences so important to attend, um, to really just stay up to date. **Dr. Nirali Jain:** Um, but we are, uh, constantly updating our embryology standards, the way we thaw our eggs, and the success rate associated with a thaw and [00:28:00] how we treat our embryos and the media that we use, right? Like, so we're really thinking about the basic science perspective every single day, and that's what makes this field so unique. **Michelle Oravitz:** It is really awesome. And so do you guys specialize specifically on, um. Egg freezing and, and I mean specific fertility preservation in patients that do that have cancer that are going through treatments, do you guys specialize specifically in that? I mean, I know you do range  **Dr. Nirali Jain:** Yeah. Yeah, because it's such a small community, we all have our own niches and we all kind of have our own interests and  **Michelle Oravitz:** Yeah.  **Dr. Nirali Jain:** no like specific training. There are a couple courses that you take that I took in in training as well, just to kind of understand what it sounds like to, I. Council of fertility preservation, patient with and without cancer. **Dr. Nirali Jain:** Um, and then, you know, you kind of just learn by experience and you form a niche for something that you're passionate about. 'cause that's what makes you, you know, really thorough in, in your treatment. [00:29:00] So that's one of my interests. Um, and, but I would say,  **Michelle Oravitz:** training for that. It's just like  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** just know how to treat that in  **Dr. Nirali Jain:** exactly.  **Michelle Oravitz:** especially if you're interested in doing that.  **Dr. Nirali Jain:** Exactly. That's exactly right. It's kind of, it just comes with the experience comes with your mentors and who you're surrounded by, and everyone kind of helps each other get to that point. But there are several specialists in our practice at RMA that specialize specifically in fertility preservation in cancer patients. **Dr. Nirali Jain:** So we have a close communication with our oncologist and they know who to refer to within the practice because everyone has their own little interests.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** Um, definitely. I, like I said, I really enjoy picking your brain because it's a lot of fun for me. I, I do  **Dr. Nirali Jain:** Totally.  **Michelle Oravitz:** acupuncture, so  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** and I, I think that it's just so crazy that our fields don't work together. I mean, we kind of do, but I think, I just feel like it would be so great  **Dr. Nirali Jain:** exactly.[00:30:00]  **Michelle Oravitz:** the expertise because you guys have immense. Benefits like in, in, uh, technology and incredible innovations and, and then the natural aspect of really understanding the, the body. And I, I just think that it would work so amazing together if it was more of like a thing. 'cause it, I know in China they actually combine the two  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** eastern.  **Dr. Nirali Jain:** Yeah, I mean I think that that's so important and there is data that shows, you know, there's actually a recent study that came out just a few weeks ago on the benefits of acupuncture for fertility patients. And we know that, I mean, I recommend it to all of my patients, specifically the day of the embryo transfer. **Dr. Nirali Jain:** We, luckily, we offer it on site at RMA and we have acupuncturists that come in and, and do a session before and after the embryo transfer, and I think. A lot of that is targeted towards stress relief. But I also think that holistically it's important to feel at your best when we're doing something that's so crucial to your, to your health. **Dr. Nirali Jain:** So to really focus on the diet, focus on stress relief, [00:31:00] focus on meditation, yoga, whatever it takes to get to your best wellbeing when you're going through fertility treatments, um, is so important. So I appreciate  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** like you that really specialize in the other side of. Of this, because I do consider it still part of the holistic medicine that we need to really maximize success for our patients. **Michelle Oravitz:** Awesome. Well,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** Jane, this is such a pleasure Of talking to you. You've given us some, so much great information and we've definitely dived into a, do a topic that I don't typically, I haven't yet spoken about. But, um, that being said, it's such an important topic to talk about. And thank you so much for coming on today. **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** course. **Michelle Oravitz:** I get off, how can people find you?  **Dr. Nirali Jain:** That's a great question. So I have, um, a social media page. I, it's called Expert nc. So like EGG,  **Michelle Oravitz:** I  **Dr. Nirali Jain:** um, expert nc. Try, tried to make it a little bit humorous. Um, but I'm all over social [00:32:00] media and would love to hear from anyone that is listening. I, you know, every, every day I get different, um, dms and I'm happy to respond. **Dr. Nirali Jain:** I love hearing about everyone else's. Stories and things like that. Um, so that is kind of my main, main social media platform. Um, and then through like RMA and Reproductive Medical Associates, we also have a YouTube channel. We have an Instagram page, um, of our office available, um, as well that is public. **Dr. Nirali Jain:** So you can find us pretty easily if you just kind of hit Google. But um, yeah, I'm kind of developing my social media platform as the expert and I hope it grows.  **Michelle Oravitz:** Love it. Great.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** was such a pleasure talking to you. Thank you. so much **Dr. Nirali Jain:** Thank you. **Michelle Oravitz:** today.  **Dr. Nirali Jain:** Of course. Thank you so much for having me.  [00:33:00]   

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