Latest / The Dr Louise Newson Podcast / 29 - Hysterectomy: surgery, recovery and hormones

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29 - Hysterectomy: surgery, recovery and hormones · The Dr Louise Newson Podcast

0:00
I'm really excited because on the 19th of October I'm going to
0:04
be at the Rose Theatre in Kingston with Emma Barnett.
0:07
There's a few seats left so I hope some of you will be able to
0:11
join me there. We're going to be doing AQ and A
0:14
where Emma will be questioning me and then I'll be answering as
0:18
many questions as possible from the audience.
0:21
It's going to be a fun and enjoyable evening, so hope some
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of you can come the Today. Camila Phillips is my guest.
0:31
She's a doctor. She's an obstetrician and
0:33
gynecologist in New York. She runs Cala Health, and she's
0:37
also the author of the Empowered Hysterectomy.
0:40
So we talk a lot about hysterectomy, what it means
0:44
well, how we should prepare ourselves before the operation.
0:47
We talk a bit about how hard it can be for women to be listened
0:50
to and about how medicine is broken in certain ways.
0:55
It's a really great and very uplifting conversation, which I
0:59
hope you enjoy. So great to finally have you
1:04
here in the podcast studio. Even though it's remote, you're,
1:08
I know you're busy working as an of OBGYNI should say over in the
1:14
UK, it's a obstetrician or gynecologist.
1:17
And so your work is really inspiring.
1:20
And I'm not a gynecologist, and people sometimes find that quite
1:25
confusing when I'm a hormone specialist because for many
1:30
decades people have just thought about hormones, progesterone,
1:34
Easter style, a bit about testosterone, thinking they're
1:37
just ovarian hormones. It's just about our periods.
1:40
It's about our womb, it's about our fertility.
1:42
And when I start talking about the role of hormones in our
1:45
brain and our bones, people get a bit confused.
1:49
But you're you. You obviously focus on the
1:53
pelvic organs, but you think of the woman as an entire person,
1:56
which is just wonderful. I appreciate that.
2:00
Yes, I appreciate that. And it's so interesting you say
2:03
that because I wish in our medical training we had more of
2:08
a holistic approach in that sense in particular because, you
2:13
know, I come across orthopedist and they are well should be
2:19
hormone specialists, right? Because they're dealing with
2:22
women and broken bones and that cascade is so dependent on
2:27
hormones. So there really isn't a field in
2:29
medicine that you shouldn't to some degree be a hormone
2:33
specialist. I totally agree.
2:36
I used to say it was only maybe people who are pediatricians but
2:40
then the youngest patient I've I've met was like 12 because her
2:44
periods didn't develop, she had streak ovaries.
2:46
So everybody needs to know about hormones.
2:51
Absolutely. I had a 13 year old here
2:53
yesterday and that typically is like here the pediatricians kind
2:58
of wheelhouse. But no, when it comes to
3:00
puberty, Oh my gosh, the changing brain, even as
3:06
brothers, sisters, caregivers, if you have anyone in your life
3:09
who's going through puberty, you're a hormone specialist now,
3:13
because the changes that the brain experiences are
3:16
miraculous. So really, everyone is a hormone
3:19
specialist as far as I'm concerned.
3:22
I totally agree. But you know what, I shudder
3:24
when I look back at my medical training because I did a lot of
3:27
different hospital specialties because I was a general
3:30
physician in hospital before I changed into being a family
3:33
physician and I never thought once about hormones and then I
3:39
became a family physician. I had to do 6 months of Zengyne
3:43
and I saw these women coming in with heavy bleeding and it was
3:47
just around the time that Marina Coyle started to take off.
3:50
So a lot of women were coming in for hysterectomies because of
3:53
their bleeding. Now, a lot of these women were
3:55
in their late 40s, so they would have been perimenopausal.
4:00
They probably didn't necessarily need a hysterectomy because if,
4:05
if they'd had the right balance of hormones, natural hormones,
4:09
especially progesterone, they probably would have been fine.
4:12
But I never even thought to ask them.
4:14
But the other thing is they usually have their ovaries taken
4:17
out the same time regardless. It was like we're, we're down
4:21
there anyway. If we take your ovaries out,
4:23
then you won't get ovarian cancer.
4:25
And, and I sort of look back and I, I don't remember giving them
4:29
hormones even after their ovaries were removed.
4:32
No, I mean I didn't either, right?
4:34
That wasn't our training. And I, I think we're similar
4:37
age. We grew up in this time where we
4:41
literally were scared to death of hormones.
4:44
We, at least my training and I had very good training and I
4:48
think it was all very well meaning at the time because that
4:52
is the information we had to work with.
4:55
We, we didn't consider the ramifications of taking out the
5:03
ovaries, denying women hormones, how it affected their sexual
5:08
health, their mental health, their bone structures, their
5:11
cardiovascular health. We had no idea.
5:14
So IA 100% know at the beginning of my career in doing
5:18
hysterectomies or seeing this, these women, you know, you'll,
5:22
it's a phase, you'll get through it.
5:24
Like let's just treat the symptoms, but really not
5:27
treating the whole person. So I think, you know, we're all
5:30
kind of guilty of that because that's the information we had at
5:33
that time. But now we know better.
5:36
Right now we know better. My mother had a hysterectomy 1
5:40
without telling me and two had her ovaries removed.
5:43
And I could have never been so upset, never been so upset.
5:47
But This is why we're doing better.
5:50
Now we have to. Yeah, we are and we're not
5:53
really. So we did an audit.
5:55
We looked at 3 teaching hospitals in London, I won't
5:59
tell you their names, but three big hospitals in London, and
6:02
looked at young women who'd had their ovaries removed for benign
6:05
reasons, so this wasn't cancer related, and looked to see how
6:09
many of these women had been offered or prescribed HRT
6:13
following their ovaries being removed.
6:16
And it was about 5% had been offered or given HRT and it was
6:22
0% that had been prescribed testosterone.
6:25
I got goosebumps. I wish you could.
6:27
Touch my arm right now I have goosebumps.
6:31
Wow 5%. So the offering of HRTI think is
6:38
probably, I wish I had my own studies, probably a little
6:41
different than the United States.
6:42
I can't say it's astronomical by any means.
6:45
I do not want to pretend that we are having this huge hormone
6:49
revolution. I think we're experiencing it
6:51
with everyone else. Testosterone, however, I agree
6:56
100%. I cannot tell you like the
7:00
pushback I get from pharmacists, insurance companies and even
7:06
patients themselves when I'm like, OK, so let's add on this
7:10
next thing. And well, I don't make
7:12
testosterone. That's a that's the male
7:14
hormone. Only men do that.
7:17
And so the amount of education that has to go along with the
7:21
prescription is tremendous because it is entirely novel to
7:26
people that, yes, women make and need testosterone.
7:31
And, you know, I was looking at a study recently from the 1980s,
7:35
so many years ago, showing that when women had their, yeah, when
7:39
they had their ovaries removed and they had, they had estrogen,
7:42
they felt better. But when they had testosterone
7:45
added to it, a lot of their symptoms, including well-being,
7:48
improved. And I don't think it's bad.
7:51
Is it as a doctor if we improve someone's well-being?
7:54
Right. And you know what, it's
7:56
interesting. So I personally do use
7:58
testosterone. And so part of my education is a
8:02
is a bit of that disclosure to humanize.
8:05
You know, I still look like a woman, I still sound like a
8:09
woman, like all of those quote UN quote ideas of femininity and
8:13
women are still there. So I use that as part of my
8:17
disclosure to help them understand this concept of
8:23
well-being. And it's, it's sort of
8:25
intangible, right? Like what is well-being.
8:28
But when I explain, like, I sleep better, my body moves
8:32
better, my workouts are better, my mood, you know, really
8:37
helping them understand what I mean by well-being is
8:40
tremendous. Yeah, I totally agree.
8:43
And, and you know, I've been open about it before.
8:45
I've been taking testosterone for about 9 years now and I do
8:49
not shave every morning. I haven't got a beard, you know,
8:53
and, and I still think I look like a woman, but I often say to
8:59
people it's really trivial, but lots of women get it.
9:02
Like when I when the dishwasher needs emptying, I just go, OK,
9:06
I'll empty it. Whereas before testosterone, I'm
9:09
like, I can't, that's another thing to do.
9:11
You know, it was sort of or emptying the washing or like
9:15
looking at the laundry basket and thinking, oh, I leave it
9:17
till tomorrow. And then the next day it's even
9:18
bigger. And I'm like, I can't sort out
9:20
the lights and darks. I'm just like, my brain doesn't
9:22
function. And now it's like, OK, I'll just
9:25
do it. And it, you know, it's those
9:26
little things and it's very hard.
9:28
How do you measure that in a study?
9:30
You're never going to do a study looking at whether women can
9:32
sort out the washing or not. It's like, but actually
9:35
day-to-day that makes a massive impact.
9:38
And, and I think it's very hard as doctors, isn't it?
9:41
Because we, we're used to looking at numbers and figures
9:43
like someone's hemoglobin level or their iron level or their
9:47
blood pressure or what their scan shows.
9:49
Whereas when we're talking about feelings and emotions and
9:53
happiness, it's quite difficult, isn't it, to measure.
9:56
Right. And I, I do love that though
10:00
there is a big drive here and maybe not there, but people want
10:07
to measure their hormones. I want to know where I'm at.
10:10
You know, they come in all that I need to check my hormones
10:13
because I need to know where I'm at.
10:15
OK, I don't even argue anymore. Let's do it.
10:18
Let's do it really as an exercise to help you understand
10:22
how sometimes these numbers are not reflective of how you feel,
10:28
how you're functioning, how you're sleeping, how you're
10:30
thinking, all of those things. So I love numbers sometimes for
10:34
from that perspective because it helps drive home the point that
10:39
do I not treat you because your number says?
10:43
Not to. Treat you.
10:45
So if I do love numbers from that perspective, and then it's
10:49
probably the last time in their treatment we ever, you know,
10:52
check numbers again. Well, it's interesting, isn't
10:55
it? I think you know any, any
10:57
numbers that we do like any blood tests, it's in context.
11:01
We wouldn't just treat someone in isolation, isolation.
11:05
And I think there's always this big debate how useful or not
11:08
useful our hormone levels and they are a guide.
11:12
But I wouldn't change someone's treatment if I'd never spoken to
11:15
them. I wouldn't just look at their
11:16
numbers. You know, I think, I mean, I did
11:20
have my testosterone never done before I started testosterone
11:23
and it was 0 point nothing. It was really low.
11:26
And I was actually quite reassured.
11:28
It was like, oh, that's a bit of validation.
11:30
And then I could see it improve and so, but it wouldn't have
11:34
made any difference. I knew I had like I was 45.
11:37
I had like all the symptoms. The tank was empty.
11:41
Yeah, Yeah, yeah. That's, that's exactly right.
11:43
But, but talking about personal experience, I think you do learn
11:46
a lot in medicine. And a few years ago I had a
11:50
hysterectomy and I, I underestimated actually the
11:55
recovery. I, I know it's really hard when
11:58
you're a doctor because people treat you differently.
12:01
And so I had a great surgeon. I chose my surgeon.
12:04
Of course I was very lucky, I had a good anaesthetist, but no
12:07
one really gave me any education and I didn't know whether it was
12:11
because I should know everything or whether they would just, you
12:15
know, treat me or that's maybe how they do.
12:17
So I'm having, I had this hysterectomy and then I had a
12:21
few complications. I went into retention.
12:23
I couldn't empty my bladder. I had to have a catheter and the
12:29
nurse put in the catheter and I knew she wasn't going to do it
12:32
very well because she was really fumbling and fiddle faffing
12:34
around. And then she inflated the
12:36
balloon in my urethra, which was incredibly painful and I knew it
12:42
was. And she walked out of the room
12:43
and told me to stop making a first.
12:45
And I called the band, I called the pan.
12:46
I said just give me a syringe, I'll deflate the balloon myself.
12:50
And my husband is a urologist, so he was pretty annoyed by this
12:52
stage. And, and I felt really degraded
12:56
as a woman because it took them a long time to even put the
12:59
Catherine because they kept saying, oh, just tickle your
13:01
back, Just relax, go to the toilet, play some music.
13:04
You're just a bit. And I was like, no, my, I can't
13:07
feel anything, but I'm now a bit uncomfortable and I'm getting
13:09
some kidney pain and, you know, and then I had an indwelling
13:13
catheter for about four to five weeks afterwards.
13:16
So I had to have a leg bag and I had to, and, and every time I
13:20
tried to have my catheter removed, I went into retention.
13:23
But I felt really like devalued as a person.
13:26
I, I don't know whether that's easy to say, but I just, I felt
13:30
like it's really horrible having a catheter written.
13:33
I, I, my husband was great because he knew like how to look
13:36
after it, but it was like it was sort of left and lost and didn't
13:40
really know if my bladder would ever work again.
13:42
I, I then had awful urinary tract infections afterwards,
13:46
once with pyelonephritis. And again, I wasn't really, I
13:51
was sort of taught a bit about Samantha Bositz.
13:53
No one really talked to me about vaginal hormones.
13:56
And I sort of thought, gosh, like if I wasn't who I am and
14:01
have the knowledge that I have, it would be really different.
14:05
But you know, you must hear story.
14:07
I hear stories all the time of women just being sort of left
14:10
and presumed that we can just, and it's only a hysterectomy.
14:13
We know the womb's really small. It's a minor operation, but for
14:17
me, it was a really major operation.
14:18
And I was quite like shocked how big an operation it really was
14:22
for me. I think we do absolutely.
14:25
Despite how we approach the hysterectomy, vaginal,
14:29
laparoscopic open incisions, I think that we often
14:35
underestimate the impact that any surgery or trauma to your
14:40
body can potentially have. And I, I really do find that
14:44
some physicians, not all, but don't take the time or even I
14:49
will say in the US system have the time.
14:51
We have these 15 minute very crazy intervals to talk about,
14:57
hey, these are potential complications.
15:00
Let's talk about them now in the setting of you being calm, being
15:04
able to understand and digest and Mull over the information in
15:09
the event that they actually happen.
15:12
And that was part of the impetus of writing this book, the
15:16
understanding that I had people come in and they didn't really
15:21
actually even know what was removed.
15:23
If you can imagine not knowing, you know, the difference between
15:29
their cervix or the actual body of the uterus.
15:32
And were the tubes out? But maybe they left them.
15:34
Was it the right ovary, the left?
15:36
And yes, there's a degree of just recall in memory, but also
15:40
a degree of information prior to the surgery that is critical
15:44
prior to the surgery and even post, right that is critical to
15:48
feeling empowered about this journey, even if there is a
15:52
complication. Yeah, and I think This is why
15:55
your book, The Empowered Hysterectomy, you've actually
15:58
called it your complete handbook.
16:00
And I like the word handbook to diagnose this decision and
16:03
treatment and decision is really important because it's got to be
16:07
a joint decision. And you know, my knowledge of
16:10
anatomy is is pretty good. But there is still women that
16:13
think that, wow, if they have their cervix and their womb
16:16
removed, everything's going to Ford out and there's going to be
16:19
a real problem. But also, you know, I had a bit
16:23
of physio afterwards, but straight afterwards I couldn't
16:26
feel my pelvic floor at all. So there was no point doing
16:28
pelvic floor exercises. Everything was numb, of course,
16:32
and it took me weeks to get my pelvic floor, my core strength
16:34
back. But I, I knew what to do and I
16:37
knew how to limit myself. But limiting yourself and being
16:41
very gradual is really important as well.
16:43
And your book is really detailed, but actually, like,
16:48
I've never read such a detailed book, but that's great because
16:50
people often don't know where to go to get really detailed
16:53
advice, do they? Yeah, and I was hoping to strike
16:57
a fine chord between very common everyday language because I feel
17:04
like in medicine, everything can be explained at a 6th grade
17:08
level. And that is not to assume you
17:12
can't understand or, you know, dumb things down.
17:15
But it doesn't need to be that technical, right?
17:18
We can explain these things in very simple terms.
17:21
But then on the flip side, if you want to elevate the
17:24
conversation and have the advanced understanding of what
17:29
is happening, that that is there for you to should you choose to
17:33
engage in these conversations. So I'm glad that you, you
17:37
experience the technicality without sort of being
17:40
overwhelmed by it because it's already overwhelming, right?
17:45
You're going in my body, something's coming out.
17:47
I have this recovery, but the anxiety and the we can decrease
17:53
with knowledge and managing expectations.
17:56
And everyone deserves to enter this decision making process
18:01
knowledgeable, in unison and in concert with their doctor,
18:06
aligned with their values. And there's a way we can do
18:10
that. And this hopes to revolutionize
18:13
how we approach the surgery. It's so important and I think,
18:19
you know, one of the things that people often too scared to ask,
18:24
they've got so much going on, they don't know who to ask.
18:26
Do they ask the nurse? Do they ask the junior Doctor
18:29
Who's who's admitting someone? Do they ask the senior Doctor
18:32
Who may just maybe do the operation?
18:34
And then like you say, everything's so quick and rushed
18:36
and you don't always think about the consequences or or you might
18:40
think afterwards. So actually to be, if you can be
18:43
prepared, it's really important having that list of questions.
18:46
I think it's crucially important, but there's a lot of
18:49
people who have a hysterectomy and have their ovaries removed,
18:54
remaining in so they don't have their ovaries removed.
18:58
And then they're told, well, you won't be menopausal because
19:00
you've still got your ovaries. And that's like, just wrong as
19:05
well, isn't it? That's just wrong.
19:08
It's wrong. You know, we spend a lot of time
19:13
emphasizing the period, right, as the hallmark of menopause,
19:17
which is quite helpful until you no longer have a uterus.
19:21
And so we have to educate and expand the definition of what
19:27
this transition could look like for you if you don't have a
19:30
uterus, and understand that the symptoms may manifest in your
19:35
sleep, may manifest in your mood, may manifest in how you
19:39
feel or experience your body, your joints, your workout, how
19:42
you experience intercourse. And so, yeah, I do get that a
19:46
lot because again, an understanding of the body might
19:50
be off. And so we have to revisit that.
19:52
But really, making sure women understand that the menopausal
19:57
transition is still in their future and that there are ways
20:01
to mitigate those symptoms in a way that will allow them to
20:05
enjoy the transition. It doesn't have to be it.
20:08
It's not, you know, lost on them just because they've had this
20:12
procedure. So my my mother-in-law, who's
20:16
now 89, she's very inspirational.
20:19
When she was about 36, she had her womb removed and she had I
20:27
think one of her ovaries removed.
20:29
But anyway, she didn't know anything about hormones then.
20:31
It was a long time ago. And she, she was talking about
20:35
it to my husband the day before yesterday actually, because he
20:38
was just saying what we're sure. What was it like?
20:40
Well, when you, you know, you started to have symptoms and she
20:43
got very tearful actually, and started crying because she's a
20:46
very upbeat, very positive person.
20:49
And she said it was just like a black cloud over her.
20:52
And my husband is now 56. And so he was about two or
20:57
three. So it was, you know, 50 plus
20:59
years ago. And she had this black cloud
21:02
over her. She felt joyless.
21:03
She felt very sad and she didn't really know what was going on.
21:07
And then after a few months, she read a book, Feminine Forever,
21:11
which I'm sure you know, the book by Robert Wilson.
21:14
And her husband, who was AGP, came home and she said, Alec, I
21:18
need some estrogen. And he said, what?
21:20
What's he talking about? He said, I've read this book and
21:23
I I just know that I need estrogen.
21:25
So he referred her to a gynecologist and she had
21:28
estrogen. And within days, literally, she
21:30
felt better. But but yeah.
21:33
And she's still on HRT now, of course.
21:36
But what's really sad is that she had a sister who was 18
21:40
months younger than her and had it was quite a different
21:43
personality. She was sort of larger than
21:45
knife, quite party animal, and she had a quite a horrible
21:49
boyfriend at the time. But she had a hysterectomy for I
21:52
don't know of some reason and didn't talk about anything, but
21:57
no one prepared. So no one talked to her about
21:59
the possibility of any symptoms after her surgery.
22:02
And she became very dark very quickly and she took her life
22:06
and and died by suicide one New Year's Eve.
22:09
And everyone blamed the partner because he was quite
22:12
argumentative. But my mother-in-law, like now
22:16
like looks back so much. And just as I wonder whether
22:20
Barbara would be here if she'd had hormones, and of course we
22:23
don't know, I can guess what the answer would be.
22:27
But you know what? Every day in my clinic, I speak
22:30
to women who have had suicidal thoughts, and a lot of them are
22:35
related to their hormones. But it can be quite hard to
22:38
diagnose if, if symptoms come on insidiously and somebody who's
22:42
in their 30s or 40s. But if someone's had surgery,
22:46
we've got to be thinking more quickly really about hormonal
22:50
changes, haven't we? Yeah, absolutely.
22:53
I mean, without a doubt that story is is heartbreaking.
22:56
And we don't know. However, we do know that she
23:01
should have been offered hormones, you know, as just the
23:04
standard of care. I think some of my most
23:08
rewarding visits and I still do obstetric.
23:11
So I love the babies, but really some of my most rewarding visits
23:16
are the the visits, not the day I start the hormones, right.
23:19
It's the follow up visit. It's a.
23:22
Follow up visit when she comes in and has lipstick on and her
23:28
hair is done and the clothes are coordinated and there is a, a
23:33
life that was not there just a few weeks ago.
23:38
And I think the the the magical thing, which is just so, Oh my
23:45
God, I can't think of just mesmerizing almost maybe about
23:49
the human body specifically the brain is.
23:52
The impacts. How quickly our brains respond
23:58
to estrogen. And again, I, I, it boggles my
24:02
mind a little bit why it's so weird.
24:05
But we all went through puberty, right?
24:07
And that's a little bit of insanity, why our hormones are
24:12
all over the place. So why is it any different than
24:15
in pregnancy? Our hormones are all over the
24:18
place. Then we wouldn't make those same
24:21
associations with midlife. Of course, you know, of course.
24:25
And so that story is heartbreaking.
24:28
And it reminds all of us that our brains are so dependent on
24:35
our hormones. Estrogen is a gift, and it is
24:39
something that I encourage people to discuss with their
24:43
physicians. Now I start talking to my female
24:45
patients about hormones at their 35 year old visit.
24:49
I really do. Because, you know, you always
24:52
have these outliers of women who yeah, right, those outlets you
24:56
never for me, want to miss those people who have that very early
25:01
perimenopausal transition. You want to capture them.
25:04
And so some of them, when I bring it up in one ear and out
25:07
the other, OK, fine, fine. But I planted the seed for
25:12
future conversations about how we're going to take care of you
25:16
during this transition to make sure your whole person stays
25:20
intact with the use of hormones. Yeah, it's so important because
25:26
also, I feel, you know, we can educate others through our
25:29
patients as well. So even if some of my patients
25:33
don't have mental health symptoms, they might have more
25:35
physical symptoms. If they know those are potential
25:38
symptoms, they'll recognize them in their friends as well.
25:42
So one of the things I've earmarked in this book because I
25:45
really agree with you and I feel it's really sad and like, my
25:48
work is full of frustrations. You know, even the story about
25:51
my mother-in-law, like it hasn't moved on.
25:53
This is over 50 years ago. Things are still bad.
25:56
But you've written here. It's quite early on in the book
25:58
that medicine is broken. We all know it.
26:02
You've said and you know, it's really sad.
26:05
We're both doctors. We're both proud to be but
26:07
doctors, we love our jobs. But the system is failing
26:12
people, especially women, isn't it?
26:14
It is. OK, this is where I show my bias
26:18
towards women because especially in the United States and I touch
26:24
on it in the book. The.
26:26
Women's Health, women's healthcare, the phases of our
26:30
lives truly used to be quote UN quote woman's work, right?
26:35
And no one wanted to do that woman's work.
26:38
So we did it for ourselves and we did an amazing job and we
26:44
took care of our bodies and we use herbs and we use midwifery
26:48
and we use these practices that really elevated Women's Health.
26:52
And then at least in the United States, the introduction of
26:58
capitalism, you know, enslaved people needing to breed humans
27:04
introduced this practice that men got involved.
27:09
And I really think that the movement to move the women's
27:15
body away from care directed by and for women to a more male
27:22
sort of dominated space and way of thinking and even
27:26
capitalistic manhandling has hurt us.
27:30
It has hurt us. And I see it in a lot of my
27:33
patients who are transitioning a majority of their care to female
27:38
doctors. And we have the research to
27:40
support that, right? Women who have female surgeons
27:44
have fewer complications. We stay in the hospital longer.
27:47
We feel listened to, our outcomes are overall better.
27:50
And so, yes, I am clearly biased.
27:54
It teaches us that we have some work to do in the medical
27:59
training of our male counterparts, how to listen, how
28:03
to communicate, how to care, and in a way that innately many
28:08
women just learn by the fact of being a woman in this world that
28:13
that needs to be readdressed and founded.
28:17
It teaches us that we have to address how capitalism and the
28:21
and the need to make money in this system.
28:24
You can be in medicine and make money.
28:26
It's possible and it is also possible to take excellent care
28:30
of patients. And in I guess my final point,
28:34
and particularly in the United States are desire for primary
28:39
care is, I mean, I was talking to a patient today and I don't
28:44
know if you are familiar with these brands, you know
28:46
McDonald's, but she was talking about how we have a donut brand
28:51
here called Krispy Kreme and that's enough.
28:54
That's all you need to know. Krispy Kreme, right, is now
28:57
doing a collaboration with McDonald's where they have
29:01
Donuts on either side where the bun was and then you have the
29:05
sandwich inside. Are we, are you serious?
29:09
Like, what are we, what are we doing?
29:11
And so in the United States in particular, our complete
29:16
disrespect for primary care and prevention permeates these
29:24
issues that contribute to medicine just being broken.
29:27
And so I think we both struggle with that everyday, right?
29:32
And we just spend our, our nine to five trying to fix, trying to
29:39
make better the people and the situation in front of us.
29:43
But certainly on a global well, city, county, state, nationwide
29:49
level, we we need rehab. We need we need help.
29:53
I totally agree. And I think you know, a lot of
29:56
workers doctors is also as educators and actually giving
29:59
women choices, empowering them and also to listen to them.
30:04
And it's one of the big thank yous that I get in the clinic is
30:07
in the first consultation. People just say thank you
30:10
because you've listened like that's before giving any
30:12
treatment, talking about treatment.
30:14
And that is nice, but it's sad because it's sad because they've
30:18
not been listened to before when or they've been judged in the
30:21
wrong way. So we've got a really long way
30:24
to go, but certainly, you know, your work is, is, is amazing.
30:29
And I, this book's so good, but I always end with three take
30:33
home tips. So, OK, the women who are
30:37
considering having a hysterectomy for whatever
30:40
reason, or maybe they've had a hysterectomy and they feel that
30:43
they haven't had the right post, you know, treatment.
30:47
What are the three things that you think people should be
30:50
asking their doctors, their team, that looking after them
30:54
about hysterectomy? So one thing I do and I
30:58
encourage people to do, whether it applies to them or not, I
31:01
always ask my healthcare team, have we gone through all the
31:05
options, whether they apply to me or not?
31:08
I think it's very important for people to understand that there
31:13
are many options. And in knowing those options,
31:17
again, whether they apply to you or not, it helps strengthen the
31:21
the doctor patient relationship in that we are thinking
31:25
holistically about my care. And I know that given all the
31:28
options available in the world, I'm making the decision that's
31:32
best for me. So making sure you know all your
31:34
options. Secondly, I would say, and I'm
31:39
going to try and do this like beginning, middle, end.
31:42
What do I need to know about my recovery this middle space?
31:46
How what do I do now? My surgery is 3 months away.
31:50
How do I optimize my success for recovery, minimizing
31:55
complications? How do I use my family, my
31:57
friends, my loved ones to support me during this time?
32:01
So although the component, for example, of urinary retention or
32:06
potential infection or these things are there, how do I
32:09
optimize to minimize my risk should I decide to move forward
32:12
with hysterectomy? And then finally, how do I get
32:18
back to myself? How do I get back to myself?
32:21
How do I, outside of not having a womb, realize the fabulous
32:29
person that I am? Because we've removed something,
32:32
right? But you are still the same
32:35
vibrant, amazing, intellectual, interesting, outgoing person
32:41
that you were before you entered the operating room.
32:44
I would think about what are my steps to make sure that I regain
32:47
the life and that I'm living it even better because now I've
32:51
eliminated this issue that was causing me trouble for so long.
32:56
How do I get my sex back? How do I regain my orgasm?
32:59
How do I, you know, resolve the anemia that was plaguing me so
33:05
much? So my beginning, so my
33:08
beginning, middle and end would be those three questions.
33:11
So that at the end of the journey, when you look back,
33:13
you're like, OK, I handled that. I did that right.
33:17
Yeah, that's such great advice. I love the positivity and the
33:20
the way you think about it. So thank you so much for joining
33:23
me today. I've really enjoyed it.
33:25
Thank you for having me, I will always come back.
33:27
This has been a pleasure.