About This Episode
In episode 7 of the PHW Podcast, host Dr. Kristen Marvin engages in an enlightening conversation with Joleen Zivnuska, APRN, a renowned women's health nurse practitioner. The episode delves deep into the topic of breast health, a timely discussion with October being Breast Cancer Awareness Month. The conversation kicks off with a personal insight into Joleen’s journey in women's health, from her early beginnings in ICU nursing to her transition into functional medicine. She shares her unique approach to patient care, emphasizing the importance of understanding breast health through a holistic lens. Listeners are introduced to key concepts about breast cancer risk, including the role of metabolic processes and inflammation in cancer development, the common misconceptions around hormone-driven cancers, and the often misunderstood role of estrogen. With practical advice on how to maintain breast health, this episode also touches on lifestyle factors, including stress management, nutrition, and the importance of reducing chemical exposure in everyday products. It's an empowering discussion that encourages women to take an active role in their health through informed choices and preventative care.
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Episode Transcript
Auto-generated from the episode audio — may contain minor transcription errors.
I am not a fan of underwire bras, so we need to burn those guys. Interesting, tell us more, tell us why. Um, it causes a lot of, uh, decreased, uh, circulation, and so many times there's congestion at the bottom of the breast, and many times right where the underwire would be, that's where we see more fibrocystic changes, so it basically puts more compression around that area, decreases circulation. Your circulation, lymphatics, things can't flow. That's right. Yeah, and, like, probably don't sleep in a bra. Yeah, right, oh heavens, I tell them, whenever you can, don't wear one, you know, and if the Amazon man comes, well, you know, he's going to leave the package on the porch.
Hello everybody, and welcome to episode seven of the PHW podcast, I get to be the lucky host today, I'm Dr. Kristen Marvin, and I have the honor and privilege of interviewing my dear friend and colleague, Jolene, of Nusa Women's Health, nurse practitioner extraordinaire, like I know that any of our patients and your patients listening will agree with me 100% when I say that you are truly a gift to so many people, and you're just, like, you know, the number one advocate for women and their health. And so I'm super excited to, um, have you on the podcast today, we're talking about a really exciting topic, um, breast health, right, but before we get there, I know our listeners probably would love to hear just a little bit more personal stuff from you, so is there anything you want to share, just tell us a little bit more about your background, and, like, how you got into women's health.
Um, I grew up on a cattle ranch, um, around Manhattan, and always thought that I wanted to be a veterinarian, until I got to K-State and found out you had to be a senator's daughter at that time, so that didn't quite work out, um, and I thought I really didn't want to try to go to the physician route, and so nursing was kind of where I went, um, and in my undergrad rotations, when I was in the birth rooms and stuff, I just thought it was one of the most boring things ever, um, so when I was young, you know, it was kind of, I just jumped into the deep end and went into ICU, CCU, and thought that was a lot more action.
Yeah, a lot more action that way, um, and then I ended up — was in Houston working with, um, cancer patients, and was doing charge on the 12-hour nights, and had one of our fellows, was — gave me just a little taste of autonomy, and he said, you know, just write your own orders, I mean, obviously talk to me about the big stuff, but write your own orders, I'll co-sign them in the morning, and so I thought, well, this is really kind of fun, you know, I get to do what I want, you know, or stuff for patients that I think is best, and so that kind of gave me a taste, and I knew some other friends that were nurse practitioners, so I thought, okay, this is what I really want to do.
So I came back to Kansas, and I thought, you know, I need to probably pick up some women's health, cause I had that — before deciding what I wanted to do, and I actually hit Wesley right at the time when they were converting over to a tertiary care center, so many of the kind of normal vaginal delivery nurses were pretty nervous about having the sickest moms and babies west of Topeka, mhm, come to the birth rooms. Yeah, um, but me with Miss ICU, CCU, you know, you're like, bring it on, bring it all, and so they did.
Um, I was, you know, again, when I was working nights, and um, so they gave me kind of the most complex patients, which, you know, multiple IVs, monitors, that didn't — that didn't bother me, so that was kind of the beginning, so just right there at the birth rooms, and then, um, Dr. John Evans, high-risk OB, a perinatologist, asked me to come work with him, so then I got to see more with high-risk OB, and kind of what was that beginning of what led up to that, what led up to the processes that they were having problems with. Yeah, um, so I've kind of done everything in the GYN world except oncology, so mhm. Yeah, yeah, very good.
Well, you are certainly our go-to expert in the office for all things women's health and hormones and all that good stuff, how did you transition into more of the functional medicine side of things? So I was, um, working in a large OB-GYN office at that time, for 12 years, and was starting to see women that were on 10, 15 medications, and I just wanted to puke, I just thought, you know what, I'm not sure that it's really helping all that much, and I really got disillusioned with it, and I thought, I don't even want my name on this, so my plan was to just get out and show my horses, that's where I always headed.
Um, one of the compounding pharmacists heard about it in town, and so called me, and said, I think you're really looking for functional medicine, and I even — four years in, was working with the KU's OB-GYN residency program, I thought, you know, I kind of know OB-GYN, I have no idea what he's talking about with functional medicine, but he was, um, encouraged me to go with him to a conference in Denver that a GYN was putting on, on hormones, and my husband's like, well, you're getting out anyways, so what do you got to lose, you know, so it was — and um, Jan had done this with many other providers that he had kind of converted over to functional, so he had this down pat, and it was so amazing to be able to talk to him, um, at suppers every night about what I was hearing.
I was sitting in between a family doc and an OB-GYN, and when they were talking about cortisol, you know, we all kind of were like, you know, deer in the headlights, it's like, did you ever hear about this, Addison's and Cushing's, but that's it, right, it was really the beginning, but it was absolutely very exciting. And then, um, in the land of OB-GYN, we kind of have six to eight drugs, and then we get into surgeries, and if the drugs and the surgeries didn't help, well, then it's all in your head, I mean, there's kind of that natural progression, and so I was really thinking about some of these women as I was hearing all of this, as far as, oh, that's why she was responding that way, and so that really piqued my curiosity to definitely be learning more.
That's amazing, well, I know there's a lot of women out there, hundreds and hundreds of women that are like, let me find that person Jan and thank him for convincing you to stay, because you've obviously helped so many women, um, and bring so many sweet little babies into this world too, right. Yeah, um, okay, well, let's go ahead and transition then into the meat of our discussion, right, so, all things breast health, um, of course, as many of our listeners know, October is well known as Breast Cancer Awareness Month, right, um, anybody who's familiar with that has seen the little pink ribbon, knows kind of what that is, um, but I think what I'm most excited about today is to give our listeners, especially the women listening, um, you know, just some take-home actionable things that they can be thinking about when it really comes to supporting their breast health and their overall health, right, because it's all connected.
So um, when you're working with a woman in the office, and you know, maybe there is a family history or a concern for something like breast cancer, but even if there's not, like, what are some of the things that you first think about, like, what are some of the things that you're like, I'm going to teach this person this, when it comes to breast health? Um, just realizing that it is a metabolic process, so you know, many women, whether it's a mother, you know, when cancer is younger than 50, we think may have more genetic concerns, but again, we can have the genetics there, but we are not our mothers, you know, and so that doesn't mean that that's necessarily going to be there, in fact, 5 to 10% are genetic in nature.
Um, but we're not doomed with that, and the genes may be there, the propensity may be there, but they don't get turned on, maybe, unless there's more of a metabolic process from that. So it's just looking at all the other factors, as far as, like, what her insulin levels are, what is her weight, what is she moving, you know, all those pillars that we talked about, um, you know, because that's where cancers come from, that it's not hormones, we want to pick on the low-hanging fruit and villainize estrogen, and that's not where it's at, this is a metabolic process. Yeah, and especially in the United States right now, it is a disaster, I mean, it's really an epidemic of cancers.
Yeah, yeah, cancer and metabolic dysfunction, right, right, let's — for our listeners, because I know you and I, you know, we say metabolic dysfunction, and we know exactly what that means, but maybe a lot of our listeners are kind of like, well, I've heard that term before, but like, what does that really mean, like, maybe, because our listeners are familiar with the pillars, let's kind of go through maybe a few of those, and kind of point out some, you know, areas, cause you mentioned great things like insulin, and I love that point you made, of you know, cancers really being like just 5 to 10%, of, or I should say breast cancers, right, 5 to 10% are actually genetically driven.
That's right, and you know, I remember a very sweet rep that we had for a genetic testing company, right, that when she would come visit and we'd talk about those things, and you know, I think a lot of our listeners are probably familiar with, like, the BRCA genes, right, and I just always remember, like, it always bothered me that, you know, it was like, okay, it is arguably a very high percentage of women with a BRCA gene mutation that can go on to develop breast cancer, but it's not 100%. It's not, right, it's not, so yeah, so let's go back, like, what are some of the big areas that you see with the pillars?
So when we're looking at the pillars, um, it just kind of starts out with, trying to help ladies look at what is their purpose, and many times I truly believe women take care of the world and everything else in it, um, except themselves. Yeah, that's true, that's so true, ourselves are like — that's right, I have to preach on that part, I know, I'm like, I just had to dump that in there — yeah, it is, but it is true, that because of that, you know, we're the ones that's got, um, staying up with sick children, um, helping Aunt Martha, making birthdays, Christmas special, it's also why we have 80% of all the autoimmune diseases, and so just realizing kind of what comes with that.
So in looking at the pillars, it's trying to kind of make that segue to them, of their own individual health, so looking at, um, the idea of trying to — well, what's my purpose — for some, you know, that seems really pretty out there, um, but it actually helps us then to realize, this is to be more disciplined about trying to make changes, and actually to get their health in the best shape, and to model to their family too, that we take care of us, so trying to have that be an encouragement to them. Um, looking at just how we manage stress, yes, so we all have it, um, and again, it was realizing the detriment of cortisol, as far as the strongest hormone but also the most inflammatory hormone in the body, and how do we manage that, because most of us didn't grow up with parents who were therapists who could teach just how to manage stress, and so we, by hook or by crook, we just try to get through the day and our to-do list the best that we can.
Right, so trying, for some, maybe it is helping them learn other ways, better ways of coping, or what they can, uh, delegate out, or say no to, right, um, but realizing that cortisol, again, is that strongest hormone but also the most inflammatory, and so when we're looking at metabolic diseases, obesity and insulin resistance, um, you know, all those things are what is causing, you know, kind of our epidemic of cancers, and diabetes, and cardiovascular disease, and endometriosis, um, autoimmune diseases, you know, all of that is kind of — we're the basement of inflammation, right, going into the metabolic diseases.
Right, so how we manage stress, and how we look at cortisol, because again, knowing that that is also the strongest but the most inflammatory of all the hormones, and especially, with working with the sex hormones, they're the weakest. Yes, and so they can easily get obliterated by those stronger hormones, especially cortisol. Right, so it really is important for women to understand that that cortisol piece impacts, not just, you know, like, only certain areas of the body, it's like it can influence how you're metabolizing your hormones. Absolutely, and the breast tissue is hormone sensitive tissue. It is, very much so, very much so.
What about from a nutrition perspective, because that's certainly one of the pillars? Well, you know, we were meant to have whole foods, and in these days we have invented a lot of kind of the Frankenstein foods, and so again, chemically heavy, chemically laden, um, and our bodies were just not intended to digest that, um, and to be able to get the nutrients that it needs from it. So looking at not only how we're eating, but when we're eating, how much do we eat, right, all of that, in hoping to be able to get people back to eating whole foods again.
Yeah, yeah, so one of the many reasons why we recommend, if at all possible, try to choose organic, you know, food that hasn't maybe seen as many chemicals, because we know that they're hormone disruptors, right, endocrine disruptors, so that can absolutely affect our breast. Absolutely. Um, what's one of the most common, you know, technically food-related items that women might be addicted to first thing in the morning that could affect their breast health? It's a leading question, by the way. You talking about coffee? Yeah, I know this is like the most unpopular thing that I sometimes bring up, but I think you could probably speak to that with how you see it impact women's breast health, right.
Right, well, all the caffeine, so if it's coffee, if it's tea, if it's, you know, some chocolates, even, although there's good things, there's great antioxidants with a higher percentage, good chocolates, right, but of definitely getting in the caffeine, which many times will stimulate fibrocystic cysts, and, um, maybe part of — we're still trying to unravel density, what's all going on with that, but part of that as well. Yeah, and we'll definitely talk more about that later, for sure, but um, okay, what about a few other pillars maybe we haven't touched on? Actually, with detox, this kind of fits under detox, and we kind of alluded to this with the nutrition piece, but what are other ways that women expose themselves to chemicals, maybe, that you see?
Um, well, just in our, um, health care products, you know, our cleaning products, um, all of that, how we even warm our food, you know, if we're microwaving in plastic, you know, that it's coming in, um, all of those things, of just looking at the house, and then uh, many times our makeup, and especially, for the United States, Europe has done such a nice job, a much better job of, um, outlawing a lot of our problems that are unfortunately allowed in our cleaning products or personal products, and so it really is kind of a buyer beware, you know, kind of the best thing we got for us in the United States is looking at how California banned it, right, I mean, that's kind of the only thing California gets right, yeah, that's right, that's right, so I mean, they are a little bit more out there than I think the majority of the rest of us in doing that.
So but if we have a bunch of inflammation from cortisol, then many times the gut is not working as well as it should, it may not be trying to detox and get, um, these aberrant chemicals out, right, um, many ladies, I think honestly, just don't take the time to go to the bathroom, so they end up with problems with constipation, which then they're reabsorbing all those toxins that their body had gathered up and was trying to get rid of, and hormones — hormones, yes, the estrone, all those harmful hormones too, um, they just reabsorb them again, right, um, and so definitely that can be, you know, a big part of the inflammation with it.
Absolutely, absolutely, yeah, one big thing I often see with women, is women love to smell nice and smell pretty, and so it kind of goes back to that, like, perfume is a beauty product that is a huge endocrine disruptor, and there's some natural options out there that women can look for, um, it's not like you have to go totally without, but even just being mindful of those things, and you know, where do you spray your perfume, yeah, right, over your thyroid and the breast. Yeah, so I think it's important for women to, you know, recognize some of those things too, because it really does play a big difference, right, plays a big role, anyways.
So um, what about — are there certain, you know, I think it's super important, right, that we touch on the pillars, we always want to focus on pillars first, and especially sleep too, sleep — yes, I was going to say, do you want to touch on sleep? Well, and I think, because as women who are trying to crank everything they can out of a 24-hour window, it seems like then, meantime, sleep may be one of those things that gets kind of lopped off, right, but it's during that sleep, as when we are restoring our immune system, uh, 70% which is in the gut, we are also, uh, creating our neurotransmitters, again, in the gut, majority of them in the gut, and so if — and we wash out beta-amyloid plaque from our brains, so if women are not getting enough sleep, then many times that's when they're going to catch all the viruses, or whatever that's going on emotionally, they may not be in the middle of the road either, because their neurotransmitters are not where they should be.
Also, yeah, so it's again, that just restorative time, you know, and when we are under the control, again, of cortisol, and maybe not getting the sleep that we need, you know, this body was intended to be, 80% of the time, in parasympathetic nervous system, of that rest and digest, but unfortunately that's kind of not how we live our lives, we are kind of in the opposite, to where we are 80% sympathetic, of being able to just fight, flight, or freeze even, sometimes, and so the detriment, again, of that strongest hormone, most inflammatory hormone, then for many women, they just have a hard time even shutting their brains off at night to be able to get into that good sleep.
Right, so of helping them use some supplements, many times I use supplements to, um, help a body learn a new way, you know, and then seeing what they're — having them describe kind of their routine, what their bedroom's like, you know, all that, if there's TVs in the bedroom, and right, but looking at brainstorming what their sleep patterns are like, to try to help them learn a new way. Good, good, yeah, that makes a lot of sense, so essentially I think the big takeaway there, with the pillars, is that, you know, there's things that we have control over, some things we don't, right, like, I can't control that my neighbor sprays his lawn, or you know, I can't always control, technically, like, you know, everything that maybe gets contaminated on foods, or you know, I can do my best, right, but those things 100% influence breast health, a lot of times through, like you said, inflammation with cortisol, not metabolizing our hormones well, right, um, you know, our gut not working well, we're not detoxing well, um, and then, yeah, sometimes just those things that we don't really think about, that are exposures, like perfumes or beauty products, or those types of things, right.
So um, and this body was really meant to move too, yeah, exercise, we almost forgot exercise, and so of being able to realize that it even helps us to be able to sleep, um, it's just kind of Mother Nature's natural way of a de-stressor for us, and that may look different for each one of us, whether it's a walk with the dog, or whether it's, you know, doing a more concerted effort of, you know, CrossFit or something else like that. That's right, but we definitely, as we age, many women end up with little twigs as legs, and then the next thing is going to be a cane, and then a walker, and then a wheelchair, and assisted living, so I'm going to try and do everything that I can to make sure that ladies don't get down that road, and we definitely need to make sure that we are keeping that muscle mass and keeping building it, which is harder to do as we age, we have to work even harder at it.
Right, um, are there any other tools in the office sometimes that you'll use, I know you kind of briefly mentioned, like, certain supplementation to try to help support, do you have any favorites that you want to share with patients? Um, you know, when it comes to helping regulate cycles, um, Femibalance is just one of my — I mean, I'm kind of basically really a Debbie Downer, you kind of have to prove it to me, cause there's just so much bad stuff out there, and um, but when we first brought that in, my gosh, it went through five nationwide shortages, I had women crying because they couldn't get it, because it'll knock out PMS in about a month and a half, right, um, it's good for even the teenagers, with their heavy cycles and their emotions, and even before, you know, when they have two years of anovulatory cycles and those high estrogens.
Yeah, oh my gosh, Femibalance, you get your daughter back, you know, and so that one definitely helps me, with having ladies who are — have irregular cycles, and to try to get back into regular cycles again, um, very helpful, as far as women who are trying to get pregnant, and then um, the sulforaphane that are in there, the calcium D-glucarate, are definitely helping the pathways to prevent the estrogen-fed cancers, both breast and uterine cancers. Yeah, yeah, so obviously it's really through that hormone metabolism support where you can really see how it can positively impact the breast tissue, being hormone sensitive. Right, so that makes sense, um, one area I thought our listeners would find really interesting, that you've kind of shared with me a little bit about, is just how our oral health maybe plays into this, so can you share a little bit more about that?
That's right, you know, it really is one of those things that, um, I think that we — we even have meridians from our teeth to the heart and breast, yeah, to, like, certain organs in the body, right. Yes, yes, and so, um, dentists have said that they have found cavitations, which is like, maybe at the bottom of a root canal, where there may be an infection there, but it's not painful, so ladies don't know it's there, but it's an infection that can be there, and then many times they may see issues, like, with the breast on that same side, so the lymphatics actually drain out of that area down into the breast.
Yeah, and so connections of seeing things like that in the breast — in the mouth — but then going to breast as well, um, I think there's the, um, biologic dentists, I — they're saying that, you know, the information that we got on fluoride was probably about 75 years old, and so, of more concerns with neurotoxicity that may be there with it, again, it's a metal that would normally be there, um, mercury amalgams, again, if we see that there's heavy metals in the body, then many times that can be sources of issues for people, um, so it is one of those things where it's looking at getting toothpaste, maybe, that has, um, things that will actually help us to remineralize teeth instead of tearing it down, not using the alcohol mouthwashes, but more friendly versions, and trying to keep our mouths basically in an alkaline state.
So yeah, like oral health, I mean, people have probably been learning more about, like, the mouth has a microbiome, so some of those same principles can apply with the gut, when we really think about it, you know, with the gut, and if you think about it, your mouth is technically an extension of your digestive tract. It definitely is, um, but I think it's fascinating, right, that these certain, you know, the teeth that we have, the individual teeth, can actually correspond strongly with these organs that we have in the body, right, so um, and I remember years ago I pulled up some research for a patient who had a history of breast cancer, who had mercury amalgam, you know, metal amalgam fillings in the mouth, and believe it or not, there is some published research out there that shows that strong connection of something like breast cancer, and having these things.
And you know, I mean, when I share this with patients, and I'm sure some listeners are going to go — I mean, a lot of people do — and I think it's definitely one thing you can always bring up with your health care provider, especially your more functional-medicine-minded health care providers, um, because there's still a lot of dentists out there that are like, don't mess with that, that's fine, you know, but like you mentioned, you know, we know that some of those toxic metals are definitely, you know, associated with inflammation, and brain health, and obviously breast health too, right. Absolutely, yes, absolutely.
Um, well, let's transition a little bit into talking about, like, what are some of the findings, or just things that women should pay attention to with their breasts, you know, when it comes to — that's probably a first step, right, like helping women understand, like, what is my breast tissue, where is my breast tissue exactly, and what am I looking for, you know, those types of things. So well, part of, um, in fact this just absolutely amazes me, ACOG has come out and said that they're not recommending self-breast exams and clinical exams anymore. Interesting, and that just blows my mind, I mean, I personally have found so many breast cancers.
I can imagine, and them saying not a clinical exam, yeah, that is interesting, so um, I spend quite a bit of time in a well-woman exam, teaching ladies how to do a breast exam, so um, because most cancers feel like a rock, they're kind — they're firm, they many times don't move, they're jagged, like you would think a rock would be, um, and what's kind of dangerous about them is they don't hurt, and so many times they go undetected until maybe a lady sees an asymmetry, you know, and it's like, well, what's this, yeah, whereas if we have the little fibrocystic breasts, which are kind of like the little water balloons, um, those guys are tender, you know, if somebody gets us an elbow, it's like, ow, you know, we know that.
Yeah, and so if you weren't being intentional as far as doing the self-breast exams, many times you wouldn't know that the cancer was there until much, much later. ACOG says that the reason that they're doing that is because it was producing too much anxiety for women, and I'm like, if a lady says, I don't feel anything, I can't do this, and it's like, okay, do you have a partner, you know, um, and someone who can do that, or else, you know, be able to come in a couple times a year or something, so they all know that if they do feel something, then, you know what your next step is, get an appointment, you know, and let us feel that with you.
Yeah, so um, being able to kind of know what they're feeling, if it's the fibrocystic — those guys are probably more responding to the caffeine, things like that — um, fibroadenomas can be like a marble, they can be firm too, they're benign, um, but anything that's really firm, fixed, I mean, it needs some more imaging, it needs — yeah, if people are just listening to the podcast, when you mentioned that ACOG said that, you know, they don't recommend those self-exams anymore because it causes too much anxiety, my face was that of great annoyance and skepticism. Mine too, mine too, because I'm like, well, maybe some of that anxiety is actually coming from just the unknown, because women haven't been taught, like, who's teaching women how to do this, you know?
That's right, and so I'm going to just put on the record that I respectfully disagree with — yeah, that's both of us — yeah, that's both of us. Yeah, and I teach lymphatic breast massage, and so it's being able to try to help them learn how they can maybe get some of those fibrocystic cysts to go away, you know, that as well. So yeah, so that they are checking, I think that that's important, um, and for most of them it gives them empowerment, that they know that there is something that they can do. Mhm, right, I am not a fan of underwire bras, so we need to burn those guys — interesting, tell us more, tell us why — um, it causes a lot of, uh, decreased, uh, circulation, and so many times there's congestion at the bottom of the breast, and many times right where the underwire would be, that's where we see more fibrocystic changes, so it basically puts more compression around that area, circulation — your circulation, lymphatics, things can't flow — that's right, yeah, and, like, probably don't sleep in a bra — right, oh heavens, I tell them, whenever you can, don't wear one, you know, and if the Amazon man comes, well, you know, he's going to leave the package on the porch.
So and if — yeah, so, but if you can do it without it, then that's even better. Okay, so, okay, that makes a lot of sense, um, yeah, those are good points for women, what — is there anything else that women should be aware of, as far as just their breast, you know, like discharge or any other skin changes or things to look for? One of, um, definitely, you know, up to a year after stopping breastfeeding, ladies can have discharge, and that's totally normal, but if it's two years out, or something like that, or beyond that, then that needs to be investigated as well.
Um, inflammatory breast cancer is always almost an emergency, that's a very fast-growing cancer, majority of all breast cancers have been there for 2 to 10 years, they're very slow growing, usually, um, but not that one, and it would be unusual, they would notice a redness, you know, red skin, yeah, um, and almost like a sunburn appearance, um, but that hadn't been there before, they definitely need to get in and be seen. Yeah, yeah, yeah, um, well, maybe just for women out there who haven't really been taught how to examine their breasts, could you just give a few important pointers for women, you know, of things like — is there an important time of when to check your breast tissue, especially if somebody's premenopausal, like they're still having periods, um, you know, stuff like that, like, what are just some of the basic tips that you teach women?
Well, the breast, and go, changes with hormones, just like our uterus does, and so, um, it's preparing for that pregnancy, again, so usually I encourage ladies to do it after their periods, okay, um, they're not going to be as tender, and the hormones are low, so that stimulation isn't there. Um, and the perimenopausal ladies, you know, I mean, they're kind of having periods every now and then, so it's kind of like, pick the beginning of the month, you know, I mean, it's going to be hard for them to know, but it's one of those things that women are the ones who know their breast the best, and so again, the idea of saying not to do that just is nuts to me.
Um, and so many times I have them feel what I'm feeling, um, and so that they know what to look for, and if they feel like that area is getting larger or something, then they know that I definitely want to be there to investigate it further. Yeah, yeah, that makes sense, those are good tips. Well, I feel like this is a really good — excuse me — transition into maybe, really, because I feel like we could go pretty deep, on what are some of the just available and recommended screening tools that we have, you know, I think, like we were kind of talking about earlier, one of my big annoyances with the whole pink ribbon breast cancer awareness thing is that they kind of just emphasize that, instead of all those wonderful things you just kind of talked through for us.
Um, so let's kind of go into all those different options, and help women really understand, like, what is out there, what maybe makes the most sense, so that they can make an informed decision about how they want to screen. Okay, um, I think that for years we have been told that mammograms save lives, and statistics are kind of, uh, walking back on that a little bit now, and so it is — the concerns that we have with mammograms is that the compression, and it's really interesting, in the show notes, um, I'm going to — there is a, um, I'm going to be talking about a documentary that, um, Megan Smith, and she's a journalist, she was a lobbyist on the Capitol, and she went after this, you know, of what was going on with mammograms, and so she even came up with some things that I'd never heard of.
Oh, like what, and um, and she has — yeah, so give us a preview so we get excited to go watch the documentary. How, you know, how we all kind of dread that compression, squeezing the breast, yeah, how many pounds of pressure do you think that is that's applied to the breast? I have no idea, my hope is that it would be as little as possible. She says 45 pounds. 45 pounds? Yes, I mean, in that breast compression, I struggle to pick up a 40 pound dumbbell, and so five more pounds to that is what's added to the breast to compress it, right, and that's why women with implants, you know, are discouraged from getting them, they want to burst the implant — exactly, exactly — but it's kind of like, why do we want to do that to normal tissue as well, you know.
Yeah, and then so it's kind of trauma to the tissue, it's not — kind of, it is trauma — yeah, but then we add radiation as we're kind of traumatizing the tissue. Yes, and so in doing that too, she — I mean, she's a little forensic, I mean, she's a go-getter, yeah, I'm excited, I ordered this, it's on Amazon, and so, you know, we can, to be able to — but just as she was describing some of the things that she found, by really pursuing it, and that many radiologists didn't really even realize the amount of radiation that has been given to the breast, and they had to go check with their radiology physicist to find out, and the physicist was saying, no, she's right, that's how much it is.
Well, because I think so many women have just been blown off when they bring that up as a concern, they're like, well, it's not that much radiation, it's like getting on an airplane, or some of these other things, and I mean, while some of that may be true, in the context of just how much — yeah — it's like, well, but does it really make sense, right, that we're compressing, traumatizing that tissue, and then giving — like, we're intentionally giving that radiation — when we've also kind of been told that radiation causes cancer, that's — that's so true, that's so true.
There was — she also talks about, um, Otis Brawley, who — he's a medical oncologist, and he was in charge of — he was the head of, um, the American Cancer Society for a while, he's moved on from that now, but while he was there, he was even saying that the concerns with mammograms, and we've got to find a better way. Yeah, so he was even acknowledging that as well. Yeah, which is pretty exciting, I think, that that's there, and you're right, it is exciting, it's exciting to kind of hear people, not just, I mean, you know, waking up a little bit, but then, like, asking those tough questions and demanding better answers.
Yes, that's how we make meaningful change. Well, you know, and it's just, honestly, you know, how long do you think that we would use mammograms if they were given to men on some of their tender parts, you know, that compression. That's a very good question, yeah, it would be gone, right, Capitol Hill would have it out of the way, there would be funding like you wouldn't believe. I'm laughing, but it's true, unfortunately, I mean, it's — yeah, but we think that we're doing our duty, that, you know, that's how we're monitoring our health, we're trying to prevent cancer, when actually, again, it's the pillars, it's the metabolic, it's those choices.
And you know, and there's — I'm going to digress just a second, because there's one other big piece, I think, that, you know, getting cancer is many times the lifestyle choices that we make, but sometimes it's life events as well. Oh yes, and so um, with that, what I'm talking about is traumas, whether it's big-T or little-t traumas that are there, and I'm so thankful for the mind body therapists who really are experts with trauma, to understand this, and many times I see that coming in with women who, you know, when I'm asking them about their stressors, I'm trying to see, do they have anxiety, things like this, and they're telling me everything's wonderful, you know, I'm doing great, I don't have any problems, but yet I'm looking at biological markers, like reverse T3, like oxidative stress, um, things like that, that are telling me the opposite.
And so those things are going to go elevated when there is a lot of anxiety, um, or inflammation, basically. Mhm, and so of being able to, again, try to help them learn a different way. Absolutely, um, and many women don't even realize that they have trauma, but their bodies are telling me they do, they have really heavy cycles, it is never normal to have heavy cycles, we want to rationalize that away, but it is never normal, right, um, and I can tell you all the physiology behind it, but that's where many times being able to show women those independent markers is how I can get them to see that maybe there's something different here, because the body is still going to respond to that trauma, even though they may have disassociated from it, they may have swept it under the rug, their body's still responding to that.
The body doesn't lie. It doesn't, it doesn't, it keeps score, once you know — once you know how to listen. Right, right, once you know how to listen, but many times we don't, you know, we're busy, we — you know, it's like, we got a migraine, we don't wonder why we have a migraine, we just take a pill, take a pill, and we keep going. Right, so that is, um, and I personally have found probably what I would say were five, either breast cancers or uterine cancers that I feel like were caused by trauma. Yeah, and so, I mean, if I'm seeing that, I mean, yeah, it's definitely out there, and I think that that's just a whole other source of when we look at some of the things that can cause cancer.
Absolutely, and all of our metabolic — GOP that we are into these days — we're seeing cancers in much younger, in teenagers and in the 20s, it's not just the elderly and ladies in their 60s anymore, so of being aware of how this is, you know, all affecting it. Yeah, and we've had some other, uh, maybe immune system disruptors in the last several years that may have added to some of this as well, but it is the fact of it, is that we truly do have an epidemic with metabolic issues, and cancer is right in there with that. Right, right, so yeah, it's not just physical trauma to the breast that unfortunately happens with a mammogram, but it can also be, like you said, big-T and little-t traumas too.
Absolutely, the emotional part, that, you know, we call emotional, is very much a piece of our whole system. Yeah, and so when we are truly taking a holistic, a whole-person approach, we 100% have to take those things into consideration. Right, right, okay, so I can already hear several of our listeners going, ah, mammograms, maybe these aren't the greatest thing, maybe I shouldn't be doing this — um, what — I mean, surely there's other tools women can consider, so let's kind of talk through, you know, what are some of those things that are available, what are some of the obstacles, what are maybe some of the, you know, both pros and cons, because no test is perfect, right.
Right, right, not yet — not yet, not yet, not yet — um, so in the works, okay, but not yet, we'll get to that, um, and so it is — when we look at thermography, yes, um, it is detecting heat, mm, which is usually inflammation, temperature, right, measuring temperature, and so realizing what that is looking at, so that's why you have to go in and — you have, if it's cold outside, you have to warm up, and sometimes they have you put your hands in water and all this kind of stuff, um, but a concern I have with that too is just the penetrance of it, so if you have a smaller breast, that's probably going to be okay, but I question the depth that that can really go in detecting heat.
Um, uh, Dr. Jenn Simmons is, uh — she was a prior breast surgeon, um, went back and got her functional certification through IFM, and she is now a breast oncologist, and she's written a book, "The Smart Woman's Guide to Breast Cancer," and all these things are going to be in the show notes, but she also has a podcast called "Keeping Abreast," which I have just lived on, I mean, it's really just an amazing resource that we have, and especially an oncologist that's specializing with breast, that's just so exciting to me. Oh, very exciting, she's the one that says that she does not believe that thermography should be done by itself, but it should be done also with ultrasound, so putting those two together, right, gives you a little bit better idea.
Ultrasound is really good, as far as being able to show us whether a mass is cystic or solid, but again, not all solid ones are cancer, the adenomas — you know, I mean, those guys, they're like little marbles, but they're not cancer — but it, and so there can always be, um, shadows, or finding things that, you know, don't pan out, or, you know, some of the — that of where we can overall — things, whether it's mammograms, ultrasounds, uh, MRIs, breast MRIs do as well, you know, which I've always thought of those as, okay, it's going to — that's where we go to see if it's invasive or not, or if there's metastasis, and but yet it really has limitations as well, it's no radiation, but um, it uses gadolinium dye, which is a heavy metal that is accumulating in the body, especially — they're watching it accumulating in the brain — the studies so far have seen not to see that it's causing problems, but it's a little bit unnerving, you know, that we're putting a heavy metal in the body.
Yes, that we really can't get out, there's detox protocols for anyone who needs, like, CAT scans, or um, even mammogram, so, you know, those are things we have at the office, if anybody's ever interested in that, because especially if you do have a cancer diagnosis, there's going to be probably a lot of those studies, but it's things that we can do even prior to, and then after, to try to help with the detox part of that, to support. Right, good, well, let's summarize that a little bit for our listeners, because I feel like there was a lot of really good information in there, so and we could even like present it as kind of a story, like the typical timeline, right, that a woman might go through.
You know, I think you know this better than I do off the top of your head, but I think still the general recommendation for screening starts at age as early as age 40, for just general — we're not talking about women that have a strong family history or anything like that, right — but at least sometime in that 40s decade, to get at least a baseline, right, right, so women would maybe go as early as 40 to get a mammogram, and they get a mammogram, and we kind of summarized, you know, some of the potential pros, although not many of the pros really stick out at the top of my mind, but with that being said, I mean, the cons would be, like you said, we're compressing tissue, and we're not just squeezing it, we are compressing with 45 pounds even of pressure, and then we're radiating the tissue.
And my understanding, too, with the mammogram, where it's one of the potential downsides of where it's lacking, and we're trying to image the breast, right, and talk a little bit maybe about, how, like, the densities — like we mentioned it before — but like, how common are densities for women? So again, um, some are saying that it's up to 50% in women who are greater than 40 years of age. Okay, um, when you look at a mammogram with a woman with dense breast, it's a whiteout, and so I had a radiologist explain it to me as, like, looking for a snowball in a snow field, and that's why mammograms miss 30% of all cancers in dense breast.
Um, and so again, looking for some other kind of way, another method of being able to image breast, that is going to be able to not have the negativity to that, and be able to actually try to see it, to image it. Yeah, yeah, I had a radiologist once tell me that really a mammogram only sees well in women that just arguably have very fatty breast tissue. True, right, they're black — a mammogram on those breasts is just pitch black. Yeah, so then, like, maybe an abnormal density might show up, or you could see that better, right, but if — like you said — up to maybe 50% of women 40 and older, which those are predominantly the women getting mammograms, right, right, have dense breast tissue, then the mammograms are having a hard time even seeing through that.
I love that analogy, looking for a snowball in a snowstorm, that'd be very difficult to do, right. Yeah, so so then, you know, I think that probably contributes then to the data that we have out there that's been published, that shows, you know, that women, when it comes to mammogram, what they may do is actually overdiagnose women, compared to actually helping a woman, like, with something like an actual true breast cancer diagnosis. Yeah, so then, okay, what's — you know, they're going through this mammogram, let's say it's — you know, it's up to 50%, so maybe one and two chance that you're that woman who has breast densities, and the mammogram maybe sees something, so the next recommendation is, well, then, many times they may bring her back for a 3D, which is even a higher radiation.
Higher radiation, yeah, and so of being able to see, again, can they get a differentiation on that, um, then many times of going to ultrasound, but here's kind of a kicker with density — so I always hate it when the experts don't agree, you know, I want to know black and white, it's just easier on my brain — easier that way, isn't it — it is, so um, ACOG says that if you have density, it doesn't matter, you don't need any more imaging, you're done. I'm disagreeing a lot with ACOG on this episode. Well, you know, it's kind of interesting, um, they are the one discipline that is sued the most often, unfortunately, you know, if you've got a bad baby, it's watch out, you know, that type of thing, whether she's on crack or cane or not, so there's — it's fraught with that.
But they, so I think, frankly, I think it's a CYA thing on their part, um, other entities have said, no, we need to look further, we need to try to see what else we can find. Um, usually anybody with dense breast is going to end up with an ultrasound as well, um, there's disagreement on what causes dense breast, um, and so some have said, you're just born with it, there's nothing you can do about it, and when I think about that one, um, my mom had breast cancer at 37, so I started having mammograms at 30, and I already had dense breast, I wasn't on birth control pills, didn't have any higher estrogens, was average weight, you know, all of that, but I had dense breast, so I thought, well, you know, that seems to fit, you know, and I've been watching that with ladies who have mothers with breast cancer, and it is true, many of them do have dense breasts.
So my whole thing though is, you know, and others have said, okay, it's estrogen dominance is what causes that, um, so again, the Femibalance, the detox, and if they're on hormone replacement, of keeping that, you know, in the middle of the road, we're not going too high, too low, or, yeah, we're trying to manage that well, of being able to not cause more problems, but the one thing that frustrates me is when they're saying there's nothing you can do, so I'm kind of using myself as a guinea pig on this one, and for all the ladies that I've seen, I'm keeping track, if they have, um, heterogeneously dense breast, or category five, the worst, is extremely dense breast, and I'm writing down when they had their mammogram, how old they were, you know, all that kind of stuff, and one of the things that I'm questioning is whether iodine could be a part of this.
And so, of being able to, um, use some iodine and castor oil, using it topically, so I've got my iodine level and all this, and so I'm kind of just marching on to see what's going to happen, and I've, um, signed up for our HerScan ultrasound in November, and um, seeing if maybe they can see a difference in where I've always been, but you know, but just to see, I'm not satisfied with just saying there's nothing we can do. Yeah, I don't like that answer either, yeah, I think it's a lazy answer, and there's some things with iodine with fibrocystic, but nobody's looked at density, um, so this is just kind of our own little in-house research experiment.
Yes, to see if maybe we can make things better. I love it, well, I think back to ultrasound, you know, when — if a woman gets to that point, likely because of a density, or sometimes some type of abnormal mass, um, the frustration of sorts is that, you know, especially for those women that come in and they're like, I feel something, and it's right here, you know, um, where women — if I understand this correctly — still, women over the age of 30 cannot just go in for, like, a diagnostic sonogram, the facilities, at least in our area, the outpatient imaging facilities, all require a woman in that scenario to have a diagnostic mammogram first, and then they almost always end up doing the sonogram anyway.
Yeah, it's honestly the American College of Radiology that set that standard, I still have yet to hear, though, a good explanation for why that is, just the way we do things, you know, younger breasts are more dense, yeah, and so I think they know what they're up against, and it's like, uh, no, we're not going to go down that road if we have to. What I'm frustrated with is, um, had a lady with no known dense breast, and so I called out to see, couldn't I just send her automatically just a mammogram and an ultrasound, and I was told no, that she had to have a mammogram first, and then the radiologist would determine whether she needed an ultrasound.
And to myself I'm like, but it misses 30% of the cancers, why are you even medically-legally putting yourself in that position, you know, but um, there are other options, as far as some practices in town that are having ultrasounds, and so we could do that with our patients, to go to another place's option. Yeah, this facility is kind of doing some remodeling right now, they don't have to be a patient there to do it, so we could do that in the future. In the future, and like you mentioned, coming up this November, we're going to be the host site for a company called HerScan, you can learn more information on their website, herscan.com, and even find scheduling options for the days that we are hosting, they have — it's an independent — not an independent radiologist, but an independent sonographer coming in, everything is through them, it gets read by a certified radiologist, you get the report, and it can be, um, it's actually considered just a screening sonogram, um, which again, I think — well, we can certainly admit, just like mammograms, you know, as far as sonograms aren't perfect either.
Right, right, so no such thing as a perfect test, but I am thankful that at least some options do exist out there that women can think about, you know, cause some women, frankly, and I don't blame them, they're just like, I'm not going to do that, so then they just don't get any screening at all, frankly, and I don't know if that's necessarily the best. I'm thankful then, um, and then yeah, you also mentioned the MRI, so sometimes I think — my understanding is, and you definitely correct me if I'm wrong here — but an MRI is usually a next step if there is maybe something more serious going on, and like you mentioned, while MRI is positive, in the context of no radiation, they unfortunately have to use a contrast dye agent, the gadolinium, which is, like you said, a heavy metal that accumulates, and we may find that that probably isn't a great thing for the body either, so kind of the pros and cons of all those things, but I don't think — I'm not familiar with a lot of women really trying to just seek that out as just a basic screening.
No, I think in May I had an hour-long conversation with one of the radiologists, um, from a facility locally, and you know, asking, what's the plan for density, you know, what are you guys going to offer, and she was saying that probably it was going to be either — ladies can choose between an ultrasound or an MRI, right, obviously there's a big financial difference in those, and so I think most women are probably going to opt for the ultrasounds. Yeah, yeah, and then maybe you kind of dropped a little hint about maybe some technology that might be close to the perfect — what are just a few maybe hints you can share, just given that that's probably not an option available for most women, especially our listeners in our area, um, what little hints can you share, what might that look like?
Yeah, well, um, thankfully there is emerging things out there, and of not having radiation, and not having compression, yeah, um, and so it's pretty exciting, you know, to be able to know that we have something that looks like it's going to be a lot of what we really want and need. Awesome, that's great, that's great, well, as we start to wrap up a little bit here, is there anything else — I know you always have so many wonderful things to share — yeah, definitely, throw that in there, if there's anything else you want to share, our excitement about is to see kind of this trend changing, um, as far as, historically, oncologists have just been dug in on, if you have especially estrogen-fed breast cancers, then there's no hormones for you, and you know, we're even seeing it in teenagers now, in 20-year-olds, in 40-year-olds, and I have seen a lady that was 40 who had a total hysterectomy, and I met up with her in her late 50s, and she had severe, severe osteoporosis, um, she was a Master Gardener, and I was like, don't you dare dig up your rose bush, don't fall over.
So we know what's going to happen if women don't have estrogen, and so um, that has been just kind of the rule of the land, and so it's been trying to help women with vaginal estrogens, of being able to help, sometimes even like with a Femibalance, because it does have plant-based estrogen progesterone, but it's more and more, um, I'm very thankful for providers who are willing to give back low-dose, um, add-back hormones, and so women can, you know, the just — the sexual dysfunction can be dealt with, there's always been the estradiol cream, way back in the day, that wasn't even something they wanted to use in town, and I — I did, hey, looking at levels, blood levels, to tell them, no, this is okay, you know, so then that got calmed down, we could use that, that was all right.
Um, but of actually being able to give them back hormones, of testosterone, um, and again, when you realize what cancer is, it's not estrogen, right, and we have villainized estrogen so much, it's the low-hanging fruit, you don't need to change your lifestyle, you just need to not have estrogen, you just need to avoid a hormone that basically is giving you life. That's right, that's right, I feel like we need to make T-shirts and bumper stickers that say, estrogen does not cause cancer. That's right, I would go for it, I would love it.
Well, and of course, you know, this could be a whole separate podcast in itself, but I think it's still worth mentioning briefly that probably a lot of that stemmed from the awful Women's Health Initiative study in the '90s. Oh yes, that — yes, that incorrectly demonized estrogen. Yes, it did, it did, and I lived through that. You did, I did, um, I was alive during that time too, I was just younger, it was a, uh, tsunami that hit our OB-GYN way in office, um, when — and it's really frustrating, because I've done a lot, I've been a coordinator of many clinical trial, FDA clinical trials, and um, the gentleman that ran that one really did have a vendetta, he told many people ahead of time, I'm going to stop that, he was a cardiologist, his belief was hormones were not good for women, and so he was like, I'm going to stop this hormone train.
Um, and so it — it's all been walked back now, but nobody heard that, nobody read that, they came out and they said, this was not — it was not true, um, worst hormones out there, as far as equine estrogens, 50% of that does look ours, but the other 50% of that is just equine — pregnant mares' urine — yeah, um, and then the worst progestin, um, Provera, right, so no wonder that we had some issues, and there were a lot of concerns with that study as well, but it got leaked out, which is what you never want in a clinical trial, but some people had intentions, and so then many, um, physicians really got scared, we were even asking the pharma rep, what is going on, she said, I can't even find out, and so it was just kind of a panic mode of cold-turkeying women off hormones, and I mean, they were flooding us with, can you help me, can you help me, you know, I mean, it was just really a very sad time.
Right, so it's — that has stuck, you know, all these many years later, and it's just — I still hear it, you know, that a lady will say, my doctor told me that I don't want hormones, because that's going to give me cancer, right, and so it's still being repeated, even today, so that's some of what we're up against, you know, with it, but thankfully, um, hopefully we can turn the tide on that, ladies who are estrogen receptor negative, it never was an issue for them, and when you understand what causes breast cancer, and you understand we've got to go after the metabolic processes that allowed this normal response to an abnormal metabolic condition, right, okay, we can do that, and she can have hormones.
So that's very exciting to me, I mean, it's just still kind of in its infancy, you know, stages, but um, you know, it is one of those things that, um, Avrum Bluming was a physician that wrote "Estrogen Matters," oh, ages ago, yes, um, and he was just saying, no, what we're doing to women, this is hideous, and he even had a daughter who had breast cancer, and he said, absolutely, I gave her estrogens, he's probably the only medical oncologist, you know, until Dr. Simmons, that I have heard, who has said that, but she's really campaigning hard for it, and um, on her podcast, "Keeping Abreast," she does interview other providers, and some of them do telehealth, and so um, if there's not somebody in your area that does it, you know, there are ways to get around that as well.
Yeah, there's ways to find that, right, access to that, which is so important. That's right, um, so that's an exciting thing, and they um — so it's also Megan Smith who did her documentary on the boobs, um, she also did another one on alternative cancer methods, so um, that's going to be in the show notes as well, it's currently on YouTube, never know when it may be taken down, but um, she went to Mexico and a lot of different other places to document that, of what people were doing that was working, you know, besides chemo and radiation.
Yeah, so amazing, amazing, well, what else — is there anything else you feel like you want to share for this episode? I think that's mostly it. Amazing, well, thank you so much for joining us. Absolutely, thank you, um, again, like, you are just a gift to our clinic and our patients, and so many women you've positively impacted, so many lives, and we're just so thankful for you, and so thankful for you to share your knowledge today with our listeners, and just to reassure our listeners, we'll definitely be having Jolene as a frequent flyer, repeat guest on the podcast, so don't worry, we'll come back with lots of other amazing women's health, hormone-related topics that we'll cover, but of course we thought breast health was very appropriate for the upcoming month of October, and I think we can arguably do it a lot better than that pink ribbon organization.
That's right, so thank you everybody again for listening, and don't forget to check us out on all of your podcast streaming apps, even on YouTube, and check out some of our other episodes, and we look forward to you guys joining us again soon. Thanks.