Deborah Copaken, author of “Ladyparts,” knows what it’s like to have your doctor ignore, downplay or shrug off your concerns — and to be blocked from crucial care because you don’t have the right health insurance. Dr. Mary O’Connor and Kanwal Haq wrote their book “Taking Care of You” for people like Deborah who need help accessing care.
We talked with:
- Deborah Copaken is the New York Times bestselling author of seven books, including “Shutterbabe,” “The Red Book,” “Between Here and April,” and “Ladyparts,” her most recent memoir of bodily destruction and resurrection during marital rupture.
- Mary I. O’Connor, M.D., is an orthopedic surgeon, health equity leader, health care entrepreneur and leader of the national nonprofit coalition Movement is Life.
- Kanwal L. Haq, M.S., is a medical anthropologist, community organizer and nonprofit consultant. She currently leads the NYC women’s health programs at the Arnhold Institute for Global Health at Mount Sinai’s Icahn School of Medicine.
We talked about:
In this episode, Dr. Millstine and her guests discuss:
- Not being believed. Have you ever brought up a health concern to a doctor and felt like they didn’t believe you or weren’t taking you seriously? Everyone on this episode can relate. If the last time you tried to get health care was a disaster, you’re more likely to try to “tough it out” the next time a health issue crops up.
- The lack of research. There are many gaps in research on women’s health issues, as well as health issues for gender and racially diverse people. One example: Women weren’t required by law to be part of National Institutes of Health clinical trials until 1994. These gaps can lead to subpar care.
- It‘s time for a change. For better health outcomes, systems — such as insurance and health care at large — need to change. But our guests argue that we can’t wait until that happens, because people are hurting and dying now. Instead, everyone needs to be educated and empowered in order to advocate for themselves in the doctor’s office.
Can’t get enough?
- Purchase the Mayo Clinic Press book “Taking Care of You.”
- Purchase Deborah’s book “Ladyparts.”
- From Bookshop.org
- From Amazon
- From Barnes & Noble
- Want to read more on the topic? Check out our blog:
Got feedback?
- If you’ve got ideas or book suggestions, email us at readtalkgrow@mayo.edu.
- We invite you to complete the following survey as part of a research study at Mayo Clinic. Your responses are anonymous. Your participation in this survey as well as its completion are voluntary.
Read the transcript:
Dr. Denise Millstine: Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. In the same way that books can transport us to a different time, place or culture, “Read.Talk. Grow.” demonstrates how books can also give a new appreciation for health experiences and provide a platform from which women’s health can be discussed. At “Read. Talk. Grow.” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives.
I’m your host, Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic in Arizona, where I practice women’s health, internal medicine and integrative medicine. I am always reading and I love discussing books with my patients, my professional colleagues, and now with you.
I am thrilled today to have an episode talking about general women’s health and our access to care and what happens to women as they try to access care for various reasons. My first guest is the amazing bestselling author Deborah Copaken. She’s a New York Times bestselling author of seven books, including “Shutter Babe,” “The Red Book,” “Between Here and April,” and the book we’ll be focusing on today, “Ladyparts,” which is her most recent memoir of bodily destruction and resurrection during marital rupture.
She’s been a contributing writer for The Atlantic, for Emmy and Golden Globe nominated hits like “Emily in Paris.” She’s been a performer and is an Emmy Award winning news producer and photojournalist. I’m thrilled to invite Deb Copaken to the show. My other two guests are health care professionals that I have had the honor of personally working with on their current book, “Taking Care of You.”
Dr. Mary O’Connor is an internationally recognized orthopedic surgeon, a pioneer of her own right as a woman in this typically male dominated field. But she takes it even further because she’s a health equity leader. She’s the co-founder and chief medical officer of Vori Health, which is a virtual musculoskeletal medical practice, delivering an innovative model of patient care to empower humanity to better health.
She’s recently partnered with Kanwal Haq, our other guest, in writing the book, “Taking Care of You.” Kanwal completed her Bachelors of Science in the biological sciences from the University of Missouri. Her Masters Degree in medical anthropology from Boston University’s School of Medicine, and worked at the Centre Hospitalier Universitaire de Kigali (CHUK), AmeriCorps, the United Nations and the Yale School of Medicine. She currently leads the New York City Women’s Health Programs at Mount Sinai Icahn School of Medicines Arnold Institute for Global Health. Mary and Kanwal, welcome to the show.
Dr. Mary O’Connor: Delighted to be with you all today. Very excited about this podcast.
Dr. Denise Millstine: So Deb, let’s start with you. “Ladyparts” is a whirlwind tour through what looks like a butchered woman and is focused on various organ systems, really highlighting your experience of accessing care as a woman who is a famous writer but hasn’t consistently had access to medical insurance. Tell us about the process of writing this book.
Deborah Copaken: I think the process of writing this book was an exorcism of sorts because, yes, I’m a well-known writer, bestselling author, all that stuff that you said in my bio, but that means that I don’t have access to health care. Why? Because I’m not working within a corporate structure. I am a freelance writer who has had to find work and find jobs that come with health insurance at critical moments.
Like when I got breast cancer, like when I had to get an MRI, like when I had to get my cervix removed, and so my work is actually affected by the lack of care. Now, one of the reasons I wrote this book is because I couldn’t believe the hoops I had to jump through just to get health care.
I couldn’t believe the number of times that a doctor didn’t believe me. One insane, off the cuff moment of that was when I was in the midst of having appendicitis, I went to a doctor and said I have a stomach ache, and he said: “It’s gas.”
I said, “I don’t think it’s gas. I don’t usually go to the doctor for gas. I literally, as I was paying the bill, collapsed in his waiting room. The nurse went and got him. He stood over me, with his legs over my body, literally over my prone body saying, “Oh, come on, I can’t be that bad.”
When I begged for somebody to help me outside, he said: “You can make it. You’re fine.” I had to beg a person in the street to get a taxi for me. I got to the hospital, and I had a ruptured appendix. That’s a crazy example of it, but I have tons of other examples like adenomyosis. It took 16 years to diagnose. Why? I was seeing an OBGYN.
Guess who diagnosed my adenomyosis? My primary care physician when he saw that my hemoglobin was a seven. I wanted to write this because I also couldn’t believe that I was the only one going through this.
Dr. Denise Millstine: For sure you’re not the only one going through this. That’s why I think it’s so important that you put this work into the world. The story I thought you were going to tell, the one that gives me chest pain, is when you’ve just had surgery and you went to the emergency department, with pelvic pain, and they didn’t even do a pelvic exam. Subsequently, you had a major complication and almost died.
Deborah Copaken: I think it’s telling that I didn’t tell you that story. I think what happens in trauma is that we want to forget it. Like, yeah, that happened and I can’t believe I left it out. But I also absolutely can believe I left it out because it really is, when I do remember that moment, and just for people that don’t know the story, what happened is I had my uterus out.
They told me to keep the cervix, which was bad medicine. The cervix, five years later, got diseased. I had it out in another eight hour surgery, robotic surgery, and a little over a week after that surgery, I went to the emergency room complaining of intense inner pain, inside pain. Not outside pain. They said, “Oh, maybe it’s just an infection.”
They gave me an antibiotic and sent me home. I said: “Somebody look inside me with the speculum!” They said: “Oh, we don’t have a speculum in the emergency room.” Now, come on. What? No speculum in a major emergency room in New York City? And nobody to look inside it? The problem was what I was having was a rare complication of vaginal surgery called vaginal cuff dehiscence, which was basically, post surgery, vagina, with the cervix present, and they close it up. The stitches then come undone and you are open to the world and your viscera falls out. My apartment looked like a crime scene. My poor daughter had just flown in from Israel and was fast asleep, and I’m rumbling around in the kitchen for glass Tupperware to put these giant blood clots in them, because I don’t know if they’re my organs or not.
I don’t know what’s coming out of me. Intestines are coming out of me. Everything is coming out of me. The worst part of all of this, because we’re in America and not anywhere else, is when my daughter, who’s now in med school, I think a lot because of this, said, “We have to call 911,” and I said, “Don’t you dare! I don’t know what that ambulance is going to cost, and I have no wiggle room in my budget right now!”
I was a single parent. I had just lost my job. I didn’t have $4,000 or $5000 or $8,000 to pay for an ambulance that I wasn’t sure was going to be covered, because did they call the right ambulance company? Was it part of my insurance? Was it part of somebody else’s insurance? Did they drop me off at the hospital? I was in no state to do this. So we took UberPool. Not just Uber. UberPool to the emergency room because that was the bloodless state of my mind at that moment. I was completely out of it, losing it, but cogent enough to say no ambulance.
Dr. Denise Millstine: So, Mary and Kanwal you are nodding along, because as upsetting and disturbing as these stories are, they are unfortunately not unique, and stories like this are what brought you to write “Taking Care of You.”
Dr. Mary O’Connor: That’s right. Deb, I was just cringing listening to this story. I think that all of us have some kind of similar story to us or a loved one. I won’t even go into details on that. But the reason why Kanwal and I wrote this book was exactly to try and help women be empowered to be better advocates for their own health.
Your story of essentially the physician not listening to you, totally marginalizing your symptoms and your concerns, is unfortunately so common. I would see it in my orthopedic surgery practice all the time; women coming in, they’ve seen other surgeons, and I’ll translate that. That means almost always white male surgeons, because orthopedics remains a very white male profession.
It’s not that I think that my colleagues are trying to mistreat women. There are communication style differences. There are biases that we carry into the patient physician interaction, and all of this comes into play with an end result of too many women not having their voices heard. If we can empower the everyday woman, which is the person we wrote this book for, to be more comfortable asking the right questions, to have more knowledge, then I believe that they’re going to be able to receive better care because they’re simply going to be better engaged patients.
Deborah Copaken: I’m going to give you an example of an orthopedic mistake. My sister, Laura is an orthopedic surgeon herself, one of the rare women in orthopedic surgery. She needed spine surgery. I think she’s been hunched over doing surgery for so long that the ergonomics of surgery are pretty bad on the back. She’s a pediatric orthopedic surgeon, so her patients are tiny.
She needed spine surgery and she got spine surgery where she lives in Maryland. When she got out of that spine surgery, there were more problems, her right arm, she had to hold it over her head if she were to have comfort. Something went wrong. She told the male white doctor: “Something’s wrong. This is not right. I don’t feel right. I’m an orthopedic surgeon myself. I know something’s wrong.” He kept saying: “You’re fine, you’re fine. This is normal. This is normal.” Well, that was seven months ago. This week she’s literally up at Columbia, at Weill Cornell, on the Upper East Side, in my city, in New York. She got a revision surgery and they have to go in the front and in the back this time; the front to fix what was broken and the back to sort of get the nerves on pinched because there were nerves that had been pinched from the surgery that had been incorrectly done. It’s just this week that this happened! Just this week.
Dr. Mary O’Connor: I know. I mean, it’s painful. It’s so painful. We see it all the time. I don’t know another way to distill it except to say that physicians do not listen to women like they listen to men. Medical errors occur for men, too. We all know that there’s opportunity for us to do much better in medicine, but there is just this inherent bias that women are not reporting their symptoms or believed when they’re reporting their symptoms, that they’re as bad as they are. It’s just that simple. That’s a problem. That’s a huge, huge problem.
Deborah Copaken: Or we’re giving bad information because we’re not studied. For example, up until very recently, medical schools did not teach about menopause. Up until very recently, we thought that the cervix played a role in sexual pleasure. That turned out to be bunk, and is the reason my hysterectomy was only a supracervical hysterectomy. They didn’t take the cervix out because when I was asked, after an adenomyosis diagnosis, “What kind of hysterectomy do you want?”
I was like, “I don’t know! It’s not a menu! This is not a restaurant! I’m not like choosing the crab over the halibut! You tell me!” The reason they couldn’t tell me and I had to make this decision on my own is because there wasn’t any science. There wasn’t any study.
We didn’t we didn’t 3D map the clitoris until 2016. That is the problem too. I would add that it’s not just medical doctors not believing women, it is the entire United States system. It is the insurance system. I don’t know if you can see this, but I’m wearing hearing aids right now. Why? Because in June I had a COVID infection, and I went deaf. I went to an EMT and they cut holes in my eardrums to try to relieve the pressure. It didn’t work.
They looked through my eustachian tube. They found it was completely shut from COVID inflammation, and there was an easy fix, and that was a balloon eustachian tube dilation surgery. It’s been used for 11 years, 96.2% efficacy. I went to the hospital, I’m scrubbed in. I have the line in my arm, my surgeon is there.
The surgery’s scheduled for 3 p.m. at 2:58 p.m. he comes in and he says: “United has denied your care. UnitedHealthcare has denied your care.” You were here in the hospital ready to go and you can’t get the care that you need. Then they won’t upload it into the system so that he can do an immediate peer to peer appeal.
Then we appealed the first time, we appealed the second time, we appealed to the state, I lost my UnitedHealthcare and I just decided I’m going on Fidelis because maybe Fidelis will cover it. But that was June. We’re now about to be in October. I’m deaf if I take my hearing aides out, I hear nothing.
Nothing. I don’t need to be deaf. I don’t need to be deaf if they open my eustachian tubes, I could live like everybody else. What I’ve been living with is as if you were in an airplane and your ears never popped for four months. That’s insane. That’s UnitedHealthcare’s fault.
Dr. Denise Millstine: I can’t stand that feeling for a day. I can’t imagine living with that. Kanwal, you’ve really been focusing your career on this question of access and health equity, give us your thoughts about this.
Kanwal Haq: First, Deb I just wanted to say I’m so sorry for everything that you’ve had to experience. Part of what led me to reach out to Mary and collaborate on this was my own experiences and not being believed. I won’t go too much into that, but I can very much relate. As Mary and I started talking about how screwed up the system is and how it doesn’t care for women, you’re like: “What could we do right now? What could we do today that could help women get better care and advocate for themselves?”
I think the first thing was, one, empowering women with knowledge of what is actually going on. Because I didn’t know until I started doing this research that it wasn’t until 1994 that women were even required to be included in clinical trials.
Then for clinical trials, before you get to that step, you have to do the lab studies, you’ve got to do the animal studies, and it wasn’t until 2016 that we were like: “Oh, wait, we should take a step back and maybe do the animal studies and make sure that females are included in that step.”
This is why 80% of the drugs that are taken off the market are because they have adverse side effects in women. There’s just so much of this bias that’s ingrained within the system that we keep seeing. When we started out, we asked our friends, we asked our family members to share their stories with us.
My work is really focused on community engagement, grounded in community. How can I work with the communities that I’m a part of and really feel like, what are they experiencing and how can we bring light to this issue and not going in as a researcher and being like, “You know, this is what you need.” It’s more, “Tell us what can we do.”
After we got this information, we got quote unquote, this data of what women were experiencing saying, we were like, “What can we do right now?” That is how “Taking Care Of You” came to be because we were like, “This is literally a tool we can put in the hands of women. You can take this. There’s questions in here that are written by medical experts, by women who are neurologists, cardiologists, orthopedic surgeons, and they’ve all contributed their guidance because they’re in medicine for the right reasons and they really want to help women get that care.
We hope that this will be a tool that is going to be used like that. Very much you can flip to the chapter that you’re interested in and read that you don’t have to read the full book cover to cover, although we hope that you will. But someone had a great idea of how to use this book, which was read the first section that explains the landscape of what is women’s health.
It’s not just reproductive sexual maternal health. While that really, really matters, and that’s really important, when we talk about women’s health, we tend to limit our focus on those areas.
Well, what about all of the other conditions that impact women? They impact women a lot differently than men. For example, when you have a heart attack, you’re not going to have that feeling of an elephant sitting on your chest.
You might feel some discomfort, and as a woman, we tend to be like: “Oh, it’ll be okay.” You might not recognize that you need to go and seek care for this. That’s why this is pounds and it’s still not long enough for all of the topics that we wanted to cover. But that’s how we got started and this is really a direct labor of love and our way of trying to make a dent in the system.
Deborah Copaken: I’m very grateful for that, and I hope one of the answers is if your doctor isn’t listening to you switch doctors, because that has been my experience. I went in for migraines and I said to my female doctor: “You know, I’m going through perimenopause right now. Could this be hormonal?” She rolled her eyes and I thought: “That’s not the doctor for me. No doctor rolls their eyes at an idea.” I went to a male doctor, who I actually really love, and he said: “Yeah. Could be menopausal. Your migraines that have come on post-menopause, and you had them as a child before you got your period, makes a lot of sense.”
Kanwal Haq: That’s actually chapter six. Finding the right clinician.
Dr. Denise Millstine: We’re doing an episode on Perimenopause. I don’t know if you’re familiar with the book: “What Fresh Hell Is This?” by Heather Corinna. They wrote a book about a similar experience to health care and not having the people that she saw the health care professionals that she saw recognized how connected their symptoms were to her perimenopausal stage.
You’re absolutely right, except you said they didn’t teach menopause in medical school and residencies. I think that is still pretty much true. I am biased because I work in women’s health with menopause experts. I think everybody knows this, but you step just a little outside this office space and recognize how little the importance of hormones, hormonal transitions are incorporated into the care of middle-aged women.
I want to jump back to talking about the science not being there. The doctors probably often don’t listen. There’s also a tendency among women to minimize. You’re having a literal medical emergency and you’ve walked to the hospital to save the fare for an Uber or a subway, because as women we’ve culturally been told, “I can do this,” “I got this.” Also “I got this by myself.” “I don’t need anybody’s help.” Could you all talk a little bit about that?
Dr. Mary O’Connor: Well, Denise, I’ll make a comment. I’m sure we all have comments on this. The first thing is, I agree that we’ve been enculturated to do that, but we’re also conditioned to do it. We’re conditioned to do it because of the experiences that Deb and Kanwal have referred to, where we’re not going to be heard, no one’s going to take what we’re saying seriously, and so we delay because we’re now looking for additional data points so that when we go when someone really believes what we have to say.
This is all part of the systemic discrimination and bias that women experience. Then if you enlarge that conversation to the intersection of race and ethnicity, as well as gender, it gets even worse. One of the things that we focused on in our book, in our clinical conditions chapter, in the middle section, 55 common clinical conditions that women experience. Each chapter is divided into “What is the condition?” “What causes it?” “How is it treated?” and “Why does this matter to women?” That’s where we pulled in information that was available regarding sex and gender differences or race and ethnic differences.
I was surprised because I’m an orthopedic surgeon. I don’t have clinical expertise in all these other areas. That’s why we have 111 healthcare professionals, all women who contributed to this book. Pulling that information in, I was surprised at how much sexual differences there are in so many conditions. Then we have a section on questions to ask your doctor or health care provider and pearls of wisdom from the experts. They’re really designed to be a concise way to give good, useful information, because we need to decondition ourselves, so to speak. We can’t wait for the system to change because women are being hurt. Women are dying. I lost my sister-in-law because nobody listened to her.
At a great medical institution, it was just catastrophic. It’s too painful for me to even tell the story. We can’t wait for these changes to occur on a systemic level. We need to work towards those changes, but we need to do something now that’s going to help now.
Deborah Copaken: This is also happening on a person-to-person level, I’ve noticed amongst women. I’ll give you a perfect example. I’ve been having UTIs. I wrote a story about getting COVID in March of 2020 because I went to get an antibiotic for the UTI. The person at the clinic gave me Keflex.I said: “No, I need Cipro. I know that I need Cipro.” Gave me the wrong one. I had to go back on March 18th, 2020 to a room with nobody wearing masks and everybody coughing in an urgent care, and I caught COVID there because my UTI wasn’t treated, but I had a urologist reach out to me over Twitter.
Dr. Rachel Rubin reached out to me over Twitter and said: “You’re UTIs, could be solved by vaginal estrogen” and I was like: “What, what? How do I learn this over Twitter? Why am I learning this over Twitter?” Well, thank God she’s an advocate. There’s a bunch of them writing DM’s to people saying here’s how you can solve this problem. But that shouldn’t be what we’re dealing with. We shouldn’t have to learn that vaginal estrogen, which, by the way, has solved my UTIs forever. I haven’t had one since I went on it. We shouldn’t have to learn that on Twitter.
Dr. Denise Millstine: I’ll just make a comment from a women’s health standpoint for that. I think a lot of what happens with vaginal estrogen and women who have a history of breast cancer is that doctors and health care professionals feel nervous about using vaginal estrogen. But our years of experience have shown that topical vaginal estrogen in a woman at risk, or who has a history of breast cancer is absolutely an option to consider.
We have to get our minds wrapped around whether it’s estradiol that’s being systemically absorbed through the whole body, or estradiol that is just in the vaginal canal, in which case you can counteract recurrent UTI and vaginal pain and dryness and help women have more rewarding and less painful sexual health as well. All of those things are really important.
Deborah Copaken: Well, that’s because of the Women’s Health Initiative, which was a billion dollar study. There’s a little bit of higher risk with estrogen, but it’s a much higher risk being an airline stewardess. With being an airline stewardess your risk of breast cancer is so much higher than if you have a little Divigel on your thigh every morning and a little estrogen inside your vagina every day, and by the way, vaginal estrogen is not systemic. It’s not dangerous.
I have zero breast cancer. I am happy to be taking it. We don’t have that information out there because the studies haven’t been done. Mary, you’re an orthopedic surgeon. You know that if I get a knee replaced, it’s a male knee that’s going into my knee. They don’t make female knees. They make one brand of knee for men.
Dr. Mary O’Connor: Just for the broader listenership, there was a company that came out with a quote, female knee. A great company, very innovative, but there are differences. Should we be surprised that a woman’s bones are shaped differently than men’s bones? We shouldn’t be surprised.
So it’s all about the ratio of the front to back, to the side, to the side width, so they increase their ratio size options and then did, what I think was a brilliant marketing move, saying this is the female knee, although lots and lots of research shows that it’s really not. You have to pick the implant that’s the right match for the individual patient, and so they come in all different sizes.
Now orthopedic surgeons can actually have an implant that’s custom made for an individual knee, which completely addresses that question, although I would say that’s not embraced broadly yet and could certainly be something for women to ask about. But again, if we go to total knee, which is one of the things I’ve done, I’ve done thousands of knee replacements, women don’t do as well as men.
They are more symptomatic, they have more pain and they have more functional limitations. We can translate that to broad terms. They wait longer to have the surgery. They get as much improvement in general as men, but because they started off worse, they actually don’t end up in the same place.
So the question is where is that sweet spot where I as an orthopedic surgeon could confidently tell you: “Listen, Deb, if you wait longer there could be some negative impact on your final outcome, and we don’t know.” Now. Personally, I think that we know that there’s inappropriate surgeries that are done.
My broad statement is that the healthcare system is driven by needing to be profitable — which I’m not criticizing — everyone needs to make a profit so you can keep your doors open, but we should be keeping our doors open so we can serve our communities. There is this pressure for doing activities that are more financially rewarding to a system like surgery. Advanced imaging and procedures.
If we focused on community efforts like Kanwal’s doing, and we went more upstream and we were able to better engage communities, and in particular women because they drive health in the family and in the community, to embrace healthier lifestyles, to address the obesity epidemic that’s in this country, to improve levels of physical activity, nutrition, address, food deserts.
All of these issues, that many times are rooted in systemic problems, then we would be better. We wouldn’t have seen the impact of COVID in marginalized communities. Why? Because they don’t have access to health care to the same degree as others, and they have lots of other health challenges, comorbidities that are much more predominant.
I could go on and on. I’ll mention this one story just because the stories are so good. So my nonprofit health equity group that I chair called Movement It’s Life, and we have a program called Operation Change. We go into communities. We take 40 women with knee pain and co-morbidities like obesity, hypertension, diabetes, 18-week program, 3 hours a week.
One of those hours is some kind of learning session, like we’re going to talk about nutrition or arthritis or depression. Why? Because all these women are also depressed. That’s another thing. Orthopedic surgeons typically don’t want to even look at or address the fact that a lot of patients, particularly women with bad arthritis and obesity and other comorbidities, are also depressed, which is going to impact the likelihood of them being happy and satisfied with their surgery.
We go into communities, we teach women, we do it in a culturally aligned way. So we have cohorts that are Latinas, African-Americans. We’ve done it in rural white communities for rural white women. Why? So we can culturally align the sessions. Let’s learn about foods that you cook that ethnically align with you.
Maria learns how to make some healthy dishes. She goes home to cook for her family and her husband is like: “I’m not eating any of that.” Maria’s making what she normally makes her husband and the children, and then she’s cooking another dish for her. Eventually the children start to eat what she’s eating, what she cooked for her, and the husband eventually starts eating. This is one woman who has now impacted the health of her entire family. To me, it’s like she is the pebble in the pond sending ripples of hope and improvement out to her family. If we can do that on a broader scale, we can improve health in communities and then in the country.
Deborah Copaken: That’s fantastic. I would even say that beyond the cultural issues and beyond poverty, there’s also the systemic issues in the United States of lack of child care, lack of affordable child care. If a woman needs to get care and she’s working a full-time job and she has to run and pick up that kid at daycare or she doesn’t have enough child care to actually even have a job.
She’s a full-time mother, how is she going to have time to go seek medical care? I’ll give you a perfect example. When I was pregnant with my third child — I got pregnant at 40. It was a surprise. My kids were 9 and 11, I decided to have the baby. That’s when my knee collapsed and I had a meniscus tear. I tore my meniscus because your joints are all gooey during pregnancy, I stepped off a curb in a weird way, my meniscus was torn. How many years do you think it took me to get that meniscus tear fixed? Eleven. Eleven years to finally get the surgery that I needed because I’m working, I don’t have enough child care. I’d become a single mother… All those things. The lack of a societal safety net in our country is also to blame for a lot of this. It’s not just the medical issues. It is a society that does not believe in caring for its citizens.
Dr. Mary O’Connor: I know Kanwal’s going to make a comment here, but I’ll just put in a quick plug. If I was redesigning the health care system, it would be a virtual first system. There’s no reason why you can’t interact with your doctor or nurse practitioner or whoever your health care provider is first, just like we’re doing now through Zoom, and then get it determined.
Do you actually need in-person care, which is what we’ve done with this company that I’ve co-founded, Vori Health, because there’s so much care for your spine, your neck, your lower back, your hip, knee, shoulder that can be delivered virtually and effectively and surround that patient with the care team. We use a bio psychosocial model. We know that our patients need more support than just what the doctor says you should do if we’re going to help them improve.
Kanwal Haq: Deb, I was just going to comment on what you’re talking about. The term that we use for that is social determinant of health. Social determinants of health are the conditions in which we work, live and play. These are really the non-medical factors that are influencing our health outcomes.
One thing about COVID has been that it’s really shown a light within the medical and public health community about social determinants of health and how much more we need to be paying attention to this. With the virus, we recognize that the virus doesn’t know boundaries. They don’t know one community from another. They don’t know those types of boundaries. We saw the virus spread and we saw how badly it impacted certain communities and some of these issues that propagated this forward. Social determinants of health, and that really influences our health.
Mary, what really contributes to our health? I just wanted you to comment a little bit on that.
Dr. Mary O’Connor: We have a chapter in the book on this because if you look at what contributes to health, medical access and medical care is only 11%. It’s shockingly low. Now that’s a critical 11% if you’re having a heart attack or you were in a car accident and fractured your femur or something like that. Then we have social determinants of health and the environment in which you live, which incorporates that and that’s around 24%. That’s an important factor.
Genetics, we can’t control our genetics, 22%. But the largest factor is our individual behavior at 36%. That’s why, for example, in movements like mine, the nonprofit health equity group I chair, that’s the whole point of our Operation Change program, is how can we go in right now to support women in making these behavior changes that are going to support their health?
Part of the reason why we wrote the book is because we still have a lot of ability to influence our health through our individual behavior. That doesn’t mean that we don’t need to address the systemic issues. Of course we do. We have a lot of opportunities to make it better.
Dr. Denise Millstine: Deb, I feel like you talk about this quite a bit in your brain section of “Ladyparts.” While you were working in the cognitive health space, you refer to some of the studies and the importance of some of the components covered in “Taking Care Of You Part Three” like sleep, exercise, diet. Can you talk a bit about your brain section?
Deborah Copaken: The brain section came about because I had this job at a company called Neuro Track, which was unlike most Alzheimer’s startups, which are trying to address plaque buildup and tau and tangles and try to fix that, it’s trying to address lifestyle changes before you’re ever diagnosed. So let’s say you have a genetic propensity to get Alzheimer’s because your grandmother had it and her grandmother, and her grandmother, and her grandma.
What can you do on a day-to-day basis? We broke it down into six categories, and of course, I’m speaking off the cuff and I’m going to forget them all, but I know one of them was exercise, and what we said in our language of the app was exercise doesn’t have to be going to the gym.
Exercise can be walking outside for 15 to 20 minutes. It really can. Or like starting with COVID, I had a seven-minute workout group that we did over Zoom and we still do it every day. It’s just seven minutes of this guy on YouTube telling us what to do and we do it, and then most of it is just chatting afterwards.
If you turn into a social situation, you’ll do it because we want to see each other and we’re spread out all over the country, in fact, in different countries as well. So exercise. Sleep is very important, and one of the things for sleep is to get that phone out of your bedroom. Just get the phone out of your bedroom. Put it somewhere else because the light from the phone is going to keep you awake.
We just offered little tips for getting it to sleep correctly. Now, one of the things that deafness has actually done for me is I can’t hear an alarm clock in the morning. I can’t tell you how amazing it is to wake up to a light every day. So I have this new alarm clock. It’s by Philips. I highly recommend it. You wake up to a sunrise, it starts with red and it goes brighter and brighter. And then that’s how you wake up and it doesn’t fail. I wake up every day and then there’s birdsong, which I don’t hear, but apparently once I put my hearing aids in, I can hear it.
So sleep is really important. Exercise, stress reduction. We do not talk enough in our country or in our world about the terrible effects of stress on the human body. I know it because I’ve been under stress and I know how I’ve dealt with stress and how stress affects my body and how you get sicker when you have stress.
Then there’s social relations. A lot of older people get Alzheimer’s because they’re just completely isolated. People who are deaf. If you have profound deafness, you’re five times more likely to get Alzheimer’s than if you have no deafness. If you’re just slightly deaf, like I am, you are twice as likely to get Alzheimer’s.
Dealing with isolation in terms of sound, in terms of human interaction, you want to get that person their hearing aids. You want to get them out into a social situation, make sure that they have friends. And that includes all of us in middle age as well. You want to have a social life. I can’t remember the other three.
They’re all these lifestyle changes that you can make. They’re teeny, tiny little things that are very easy. Nutrition is one of them. Obviously. A good diet. And mental engagement. I do “Wordle” with my mom everyday. Every morning we do “Wordle” together.
I wrote a piece about this for The Atlantic, how it sort of brought us together, actually. Gave us a diagram of overlap of what we’re interested in. But even in terms of the nutritional aspect, like add chia seeds into your smoothie and there you get amazing protein, the protein that we’ve been eating for generations and generations that you don’t have to go get that steak. You can just put some chia seeds in your smoothie and you’ve got excellent protein. Stuff like that.
Dr. Denise Millstine: Wonderful.
Dr. Mary O’Connor: I’m going to follow up on that because one of the chapters that we have in our book that I wrote is on being a health promoter. There’s a TEDx talk that I gave on this because what you’re doing is you are being a health promoter to your mother. You are supporting her in having a healthier behavior because you have this interaction with her that helps her mental acuity.
All of us can do this. We have the power, each of us, to go and promote better health with those around us, those that we love, those in our community. It can be something as simple as, when people were in the office and it was lunchtime, let’s just go out for a 10 minute walk after lunch or take the stairs, or I’m going to bring in fresh fruit or vegetables as a treat instead of donuts and a cake. There’s so many things that we can do and I think that we don’t recognize how much power we have to influence those around us in very positive ways. We call that being a health promoter and you definitely are a health promoter. Congratulations.
Deborah Copaken: Thank you so much. I didn’t know that. I would like to have that little award on my desk, please.
Dr. Denise Millstine: We’ll add it to your bio in the next introduction. I feel like we’ve really just spanned the spectrum talking about some really difficult experiences and outcomes and challenges, some systemic issues that still need to be addressed. But all three of you have really empowered women through telling your stories and writing your books, to think about the role they can play in their own health and educating themselves about health conditions to advocate for themselves and ask the right questions.
This is the power of books, and I really hope our listeners and people who are watching this podcast will pick up both “Ladyparts” and “Taking Care Of You” and become healthier because of it. Thank you all.
Deborah Copaken: Thank you.
Dr. Mary O’Connor: Thank you.
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