Latest / The Dr Louise Newson Podcast / 14 - Breasts, bodies, and belonging: a conversation with Jean Hannah Edelstein

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14 - Breasts, bodies, and belonging: a conversation with Jean Hannah Edelstein · The Dr Louise Newson Podcast

• 0:03
  On the podcast today, I've got Jean Hannah Edelstein, who's
• 0:06
  written this book called Breasts.
• 0:08
  We do talk quite a lot about breasts in the podcast.
• 0:11
  We also talk about her having a bilateral mastectomy and also a
• 0:16
  hysterectomy and oophrectomy. The most important thing, I
• 0:19
  think, from the podcast is our conversation talking about how
• 0:22
  to be an advocate for yourself, choose the right doctor and
• 0:26
  choose the right treatment for you too.
• 0:28
  Super excited to have you on the podcast today, Dean.
• 0:31
  Thank you. I've got lots of 1 to talk
• 0:33
  about. But the first thing is about
• 0:35
  your book actually, and it's called breasts.
• 0:38
  Like I have never had a book called Breasts before in my
• 0:41
  hands and a relatively brief relationship.
• 0:45
  So I just thought we'd talk a bit about breasts initially
• 0:49
  because I'm relatively flat chested and I've spent my whole
• 0:53
  life wishing that I had bigger breasts.
• 0:56
  But I've had lots of patients who are really jealous of me
• 0:59
  being very flat chested. And we're all different.
• 1:01
  We're different shapes, we're different sizes.
• 1:03
  And certainly as a teenager, often we go through lots of body
• 1:08
  dysmorphosphere where we're really wanting to be something
• 1:10
  different. And it's taken me decades to
• 1:12
  realise this is me, this is my shape.
• 1:15
  Like, I'm never going to change the size of my, my breasts
• 1:18
  really. But breasts mean different
• 1:21
  things to different people, don't they?
• 1:23
  And different cultures as well, actually.
• 1:24
  So when we're talking, this is very general.
• 1:27
  This is just like our opinion. But could you just talk me
• 1:30
  through, like, we'll come on to your personal story, but like,
• 1:34
  what have your breasts meant to you from when you were a young
• 1:37
  age? Yeah, I mean, I think that's a
• 1:38
  really good question. I grew up in the US, as you can
• 1:42
  tell from my accent, but my mom is from Scotland, so I'm a dual
• 1:46
  citizen. So I did spend a lot of time in
• 1:48
  the UK when I was young as well. And I think, you know, I'm, I'm
• 1:54
  43, so I grew up in the 90s, which I think was like a
• 1:57
  particular time for girls where there was a lot of talk about
• 2:02
  women's bodies. Perhaps like, you know, she was
• 2:05
  like moving towards a world where there was less modesty.
• 2:07
  But there was at least in the US and in the UK to some extent as
• 2:11
  well. But there was also a lot of
• 2:13
  shame coupled with that. So I would say that I remember
• 2:17
  as a teenager growing breasts, being interested in them, but
• 2:22
  also being in shaped of them and being aware that dressing,
• 2:27
  dressing to cover them or conceal them felt important in
• 2:30
  order to avoid negative attention from men, boys, but
• 2:35
  also especially adult men. That, you know, As I went
• 2:38
  through puberty and, and had a visible more visibly like female
• 2:42
  adult body, even though it's far from being an adult, that I
• 2:44
  started to receive that kind of attention, which made me really
• 2:47
  uncomfortable. But I also felt very responsible
• 2:50
  for it. I sort of felt like a little
• 2:52
  bit, I would say, you know, that like it was a burden of being in
• 2:58
  a female body to receive this attention and I had to do my
• 3:01
  best to avoid it. But if I didn't avoid it, then I
• 3:04
  felt often guilt and shame around that.
• 3:07
  I mean, I think one thing that I, you know, I'm the same age as
• 3:10
  Britney Spears, approximately. And during her heyday, as she
• 3:14
  was emerging as this teen pop star, there was so much
• 3:17
  conversation specifically around her breasts and whether or not
• 3:21
  she'd had implants at, you know, and she was like 1516.
• 3:26
  And it was totally, I was both sort of fascinated and horrified
• 3:31
  by it because it was like this media narrative was telling me
• 3:35
  that the my body or the body of someone my age was sort of up
• 3:39
  for public consumption and discussion.
• 3:42
  And then at the same time, there was this huge emphasis,
• 3:45
  certainly within the US and this narrative that she was a virgin,
• 3:48
  you know, that she had never had sex and that she was saving
• 3:51
  herself for marriage. So that was very confusing as
• 3:53
  well because it was this presentation of this teenage
• 3:56
  girl, same age as me as an object, as a sex object, as a
• 4:01
  body to be analyzed and discussed by other people, but
• 4:04
  also a pure body. And that, I think, was, you
• 4:08
  know, just a very kind of strange dichotomy that was just
• 4:13
  sort of omnipresent in the way that I thought about bodies and
• 4:17
  I thought about sex and I thought about my body and my
• 4:19
  breasts and my friends, I think to greater or lesser extents,
• 4:24
  did too. So yeah.
• 4:26
  It's, it's really interesting, isn't it?
• 4:28
  I've got three daughters and I think I'm more protective
• 4:33
  because of them really. And some of the things that
• 4:35
  they've had to endure or comments that people have made
• 4:38
  to them. It was one thing, people making
• 4:40
  comments to me when I was growing up, but somehow it's a
• 4:42
  whole new level when it's my children that people have
• 4:45
  commented on them. And it's, it's really like, I
• 4:51
  don't know, maybe 'cause I'm a doctor.
• 4:53
  People are like anatomical bodies in my mind.
• 4:55
  You know, it's, yeah, it's really, I don't judge people by
• 4:58
  the size of shape what they are, but actually people do.
• 5:03
  And it there's a lot of pressure on society.
• 5:07
  I think sometimes if you haven't got the right breast size or
• 5:10
  whatever. And I know just recently
• 5:13
  transfer eyebrow and realising that they're so much bigger than
• 5:16
  they were when I was younger and people are bigger breasted than
• 5:20
  they used to be. Whether that's a good thing or a
• 5:23
  bad thing or why it is, is a whole different conversation.
• 5:25
  But it's how people feel. And I know my children have gone
• 5:28
  from ridiculous push up bras with the most padding to try and
• 5:32
  get the biggest cleavage. And now they don't actually wear
• 5:34
  bras. It's completely opposite
• 5:38
  directions actually. And I don't know whether that's
• 5:40
  just because they feel freer with their bodies.
• 5:44
  You know, lots of their friends don't wear bras.
• 5:46
  It's we're not, we're not changing the shape of our our
• 5:49
  breasts for other people to comment or trying to be
• 5:53
  something we're not. I don't know what it's like in
• 5:55
  the US. Yeah, I mean, obviously can't
• 5:57
  speak to your daughter specifically, but I do think
• 5:59
  it's interesting that breasts are seen as almost sort of
• 6:02
  separate from the body in a like as if that they can the way that
• 6:06
  they the way that they're worn, let's say changes according to
• 6:09
  fashion. And I think, you know, I
• 6:10
  remember from a young age seeing Vogue every now and then would
• 6:15
  have a story which was like, pressed her in and then, you
• 6:18
  know, the next season pressed her out and thinking like, well,
• 6:22
  you know, I still have them. So yeah.
• 6:25
  What does that all mean? And so, yeah, to some extent,
• 6:28
  certainly, like, the 90s were the Wonder Bra era.
• 6:31
  And so everyone was trying to push them.
• 6:34
  Well, not everyone. But then, you know, in the US,
• 6:36
  Victoria's Secret, I remember, you know, as a teenager going
• 6:41
  towards my late teens, starting to shop in Victoria's Secret
• 6:44
  with friends. It was very clearly, in
• 6:46
  retrospect, clearly being marketed to teenage girls, like
• 6:49
  they knew what they were doing. So, you know, and I think it's
• 6:52
  because when you're, when you're born, you don't like, obviously
• 6:55
  you have the, you know, the anatomical configuration that
• 6:59
  will cause you to grow breasts, but you don't have the breasts
• 7:02
  and they're the only body part that kind of emerge like that
• 7:06
  and change your body dramatically.
• 7:07
  And so I, I understand why both people feel we, you know,
• 7:11
  certain level of detachment from them that they don't, from an
• 7:14
  arm or a leg. And also that way that society
• 7:17
  views them as kind of malleable in a way that other body parts
• 7:22
  are not. And I mean, I remember thinking
• 7:24
  as I got into like my, you know, university years and then into
• 7:27
  my early 20s and I did have quite large breasts thinking,
• 7:32
  which I got, you know, both positive and negative attention
• 7:34
  for. And thinking like, oh, I wish I
• 7:36
  could just kind of like swap them occasionally for a smaller
• 7:39
  set so that when I go to the gym or don't want this attention,
• 7:43
  then I can do that. And then because that was kind
• 7:45
  of how like the cultural discourse of the fashion
• 7:48
  discourse talked about brass. But the reality was, of course,
• 7:51
  I couldn't trade them in or I could, but then it would have,
• 7:54
  you know, required a lot of plastic surgery.
• 7:56
  And then I think what was interesting, I moved to London
• 7:59
  in 2003 to go to Graduate School, and that was very much
• 8:03
  the heyday of a particular kind of media narrative around
• 8:06
  plastic surgery. Glamour models like Jordan and
• 8:10
  Jodie Marsh were very prominent, and there was constant
• 8:15
  discussion about the breast size of various celebrities
• 8:19
  magazines. I'm trying to remember like
• 8:21
  Closer where they would run paparazzi photos of, of female
• 8:27
  celebrities and like circle, you know, like what size their
• 8:30
  breasts were. Did they look bigger this week?
• 8:31
  Did they have a boob job? Lots of, you know, just tabling
• 8:35
  journalism around, you know, specifically focused around the
• 8:38
  size of women's breasts. It's really interesting and so
• 8:42
  moving forwards. Obviously you've written your
• 8:45
  book called Breasts. It's not just about you and your
• 8:49
  breast size and how you had various experiences.
• 8:52
  Tell me what happened. So when I was 41, so a couple
• 8:57
  years ago, I was diagnosed with early breast cancer, Stage 0
• 9:02
  DCIS, doctoral carcinoma in situ.
• 9:05
  You can correct me if I'm pronouncing.
• 9:07
  That exactly right. And that is that really a stage
• 9:11
  of detectable breast cancer I live in.
• 9:14
  So I was in London for nine years and then I live in the
• 9:16
  United States now. And so here, because I work for
• 9:20
  a large corporation, I do have very good health insurance.
• 9:23
  And because of that, I was getting regular screening for
• 9:26
  breast cancer because I was considered high risk because I
• 9:29
  have a genetic syndrome called Lynch syndrome, which increases
• 9:34
  risk of a lot of different types of cancer.
• 9:36
  So I went for my normal mammogram, as I said, when I was
• 9:40
  41, really just expecting it to be the usual.
• 9:43
  And that was when they diagnosed me with this early breast
• 9:46
  cancer. And then I was quite quickly
• 9:49
  told that the solution to that would be to have a mastectomy.
• 9:53
  And so the book is called Breasts, a Relatively Brief
• 9:55
  Relationship, because in the end I only had breasts for about 30
• 10:00
  years and then I had mastectomy in February of 2023.
• 10:06
  So you had both your breasts removed.
• 10:08
  That's correct. So I had the cancer was found in
• 10:12
  on the right side and it was quite widespread.
• 10:15
  So a lumpectomy was not an option because it was just
• 10:18
  throughout the breast. We just I had the option of
• 10:23
  keeping the left breast, but because of my elevated risk, my
• 10:27
  surgeon was sort of inclined towards me having it, having it
• 10:32
  removed as a preventive measure. Also because I did by then, this
• 10:36
  was post breastfeeding two children.
• 10:38
  I had very large breasts. I think I was a 30F or G at that
• 10:44
  point and so I can't remember, maybe 32.
• 10:47
  Anyway, in order to have a single mastectomy and then a
• 10:52
  reconstruction, I was going to have to have significant surgery
• 10:55
  to the left side anyway because reconstructing a breast of that
• 11:00
  size was just not feasible. So I thought about it and it
• 11:04
  seemed very clear to me I didn't want to have and I didn't want
• 11:07
  to go through any more of this. I didn't want to have this
• 11:09
  concern again. And also a relative of mine had
• 11:12
  had the only one side done and was pretty unhappy with the
• 11:15
  results. So that also influenced my
• 11:17
  decision. So you have subsequently had
• 11:21
  reconstruction, but that wasn't initially, was it?
• 11:23
  So initially you went from having breasts to no.
• 11:27
  Breasts, that's correct. So yeah, it all felt, you know,
• 11:30
  it was very swift. I had the diagnosis at the end
• 11:33
  of December. I had the surgery in mid
• 11:36
  February. So it was about 7 weeks, I think
• 11:39
  7 or 8 weeks between diagnosis and surgery.
• 11:42
  And you know, and I'm sure there will be folks listening to this
• 11:46
  who've gone through mastectomy as well.
• 11:48
  It's very shocked thinking it's an amputation.
• 11:50
  And of course, I also know that I was fortunate compared to many
• 11:56
  breast cancer patients and that the surgery was sufficient.
• 11:59
  I didn't have to go through further treatment.
• 12:01
  But nonetheless, it's just very shocking to have this part of
• 12:03
  your body cut off. And I think particularly because
• 12:07
  I had had this kind of complex relationship with my breasts.
• 12:11
  And it has been interesting, since publishing the book, I
• 12:13
  have, of course, you know, had the privilege of speaking to a
• 12:17
  lot of women about their breasts and how they feel about them.
• 12:20
  And there's a hugely diverse range of opinions and
• 12:24
  experiences. But for me, I think I had spent
• 12:28
  this time feeling sometimes tortured by them because of the
• 12:31
  negative attention I received. But I had come to terms with
• 12:34
  them over the years. And I was in an, you know, I was
• 12:37
  in a good place with my body and my breasts.
• 12:39
  I had breastfed my children. That was in itself sometimes a
• 12:42
  difficult experience. But ultimately, when I was glad
• 12:45
  that I had and, yeah, I had this, like, feeling of, like,
• 12:48
  ease and happiness in my body. And so it was it.
• 12:50
  I just felt very angry to be told that I now had to have them
• 12:54
  removed. So I went and I went and I had
• 12:56
  the mastectomy and partially because they wanted to ensure,
• 12:59
  you know, though they didn't believe that the cancer had
• 13:01
  spread, they wanted to be absolutely sure of that from the
• 13:04
  pathology from the surgery before doing reconstruction.
• 13:08
  Also, because my breasts were so large, I think doing
• 13:10
  reconstruction in one surgery with a mastectomy wasn't really
• 13:14
  sort of technically that feasible.
• 13:16
  So, yeah, so I had expanders which are placed in the area
• 13:22
  where the where the reconstruction is happening,
• 13:24
  which are essentially temporary implants that are kind of like a
• 13:27
  balloon where they start at very small.
• 13:31
  And then over time, you go back to your surgeon's office and
• 13:34
  they inject saline into them to make them slightly larger.
• 13:37
  I mean, it's a very strange. It's so strange, you know, I'm
• 13:41
  sure you're familiar with this, but like for someone I'm, you
• 13:44
  know, not a physician, I don't work in the healthcare industry.
• 13:47
  So you go in and they literally inflate you and then they say,
• 13:51
  well, how does that look? And then at some point you say,
• 13:54
  OK, that seems fine. And then they you go for a
• 13:58
  second surgery where they replace the temporary expander
• 14:01
  with a permanent implant. So it's kind of like having a,
• 14:05
  having a dress made, I guess. But I mean, that's the closest
• 14:09
  thing I would describe it to like going to a tailor and be
• 14:12
  like, can you have that a little bit more?
• 14:14
  But it's just such a strange and kind of disembodying experience.
• 14:18
  And did you feel well supported throughout that process?
• 14:21
  Yeah, I mean, I would say a mixture.
• 14:24
  I was very well supported by my family and my friends.
• 14:27
  My husband lost his mother to breast cancer before I met him,
• 14:31
  and that was a very traumatic episode in his life.
• 14:34
  And so I think the impact on him of hearing my diagnosis was very
• 14:38
  hard, but he was incredibly stalwart and supportive
• 14:41
  throughout the whole process. I mean, I think I don't really
• 14:43
  like to talk about my sex life, but obviously like that was
• 14:46
  something that came into it was how that would affect that part
• 14:48
  of our lives. And should I be concerned about
• 14:52
  should my thoughts around reconstruction or mastectomy
• 14:55
  concern like how he would feel? And, you know, it was quickly,
• 15:00
  he just was going to support whatever choices that I made and
• 15:03
  has never made me feel any different in that way.
• 15:05
  And so that was really important.
• 15:08
  My, my family was also very helpful in terms of, you know,
• 15:12
  coming in and helping with the kids when I was going to the
• 15:15
  surgery and so forth. In terms of the healthcare
• 15:19
  providers I worked with, I would say it was somewhat mixed.
• 15:23
  The surgeon who diagnosed me was amazing.
• 15:27
  When you have a mastectomy with reconstruction, at least here in
• 15:30
  the US, you work with both a breast surgeon and a plastic
• 15:33
  surgeon. They work as a team.
• 15:35
  After I met with the breast surgeon, I then went on what I
• 15:38
  would describe as kind of like a Goldilocks like shopping trip
• 15:42
  for a plastic surgeon to find the one that felt right for me
• 15:47
  and what I wanted. And the first one I met with, I
• 15:50
  found terrible. His approach seemed to be very,
• 15:54
  he was just very negative about what I could expect.
• 15:58
  And also just kind of, I just felt very dismissed by him, sort
• 16:04
  of like no acknowledgement of like what I was actually no
• 16:07
  acknowledgement. He was clear that he had a
• 16:09
  cosmetic practice in his surgery as well.
• 16:11
  But like no acknowledgement. That was not why I was there.
• 16:13
  I was not there with, you know, a sense of excitement about
• 16:16
  having the surgery. I was like very unhappy about
• 16:18
  it. And so he was definitely not the
• 16:20
  right person. He also had me watch a video,
• 16:24
  which is one of the craziest things I've ever seen, which
• 16:28
  was, you know, before he even came in, his assistant was like,
• 16:30
  oh, watch this video. And the video was just felt very
• 16:33
  a very sort of like preachy video to women about like, now
• 16:38
  you're going to have a breast reconstruction and you should
• 16:42
  just be accepting of what happens and you'll be happy at
• 16:45
  the end. And there was like a scene of a
• 16:46
  woman being spoken to by a male doctor.
• 16:51
  And she was just, you know, just nodding and he, you know, And
• 16:55
  then the final scene was a woman who I would estimate, estimate
• 17:01
  was in her late 60s, early 70s, washing a dog in a garden with a
• 17:06
  home with a voice over about like, you know, your life will
• 17:11
  return to normal and you'll be so happy.
• 17:13
  And I was just kind of like, what?
• 17:17
  Whose idea was this? And I think a lot of healthcare
• 17:20
  providers, especially surgeons to an extent, they're so
• 17:24
  technically excellent, but they don't necessarily have a lot of
• 17:27
  space in their brains to also think about the people who
• 17:30
  they're performing the surgery on.
• 17:32
  And ultimately, you know, I thought about it a lot and I was
• 17:35
  like, I would rather the person doing the surgery be great at
• 17:37
  surgery. They'd be someone I want to hang
• 17:39
  out with. That's OK.
• 17:40
  We don't have to be best friends, but I just do need them
• 17:43
  to see me like, as a person. The second plastic surgeon.
• 17:46
  So I rejected that one. The second one I went to see.
• 17:49
  That was kind of funny because he was much warmer and
• 17:52
  friendlier. But then he started telling me
• 17:55
  that he would give me some free liposuction while I had the
• 17:58
  procedure done. And that was very funny because
• 18:01
  he was so with reconstruction, you have that implant put in and
• 18:05
  then many women have a fat transfer, which is when they do
• 18:09
  some liposuction, another part of your body to get some fat,
• 18:12
  which they then place sort of above the implant to fill it out
• 18:14
  and make it look more natural because you don't because you no
• 18:17
  longer have breast tissue can sometimes see the the outlines
• 18:19
  of the implant. So that itself is very normal.
• 18:22
  And I expected it, but he was sort of describing, he was like,
• 18:24
  and, you know, I can take some extra and just like, throw it
• 18:28
  away. And I remember my husband and I
• 18:30
  were just kind of like staring at him, like what?
• 18:32
  What? And he said it like two or three
• 18:35
  times. And he's like, you know, I'll
• 18:36
  charge it to your insurance because it, you know, because
• 18:40
  this is a cancer surgery, insurance would pay for it, but
• 18:42
  a cosmetic surgery they wouldn't pay for.
• 18:44
  And I was just like, totally bewildered.
• 18:47
  And then I thought, oh, he's trying to cheer me up with by
• 18:51
  offering some free cosmetic surgery, but he doesn't know
• 18:53
  anything about me. Like I don't want cosmetic, you
• 18:56
  know, like I would not choose to do.
• 18:57
  It judgmental, isn't it? It was very judgmental and it
• 19:01
  just felt quite sort of, you know, a little bit, you know,
• 19:05
  just making the assumption while women, all women want to be
• 19:08
  thinner. So this woman will also want to
• 19:12
  have liposuction, you know, and I'm a very, let's say average
• 19:15
  size person. But like, no, I didn't and there
• 19:18
  wasn't, you know. So again, I just felt like this,
• 19:20
  this person does not see me as a person.
• 19:23
  The third surgeon who I found, you know, both did excellent
• 19:27
  work and I felt he was at least making an effort to get to know
• 19:30
  me. And so I felt comfortable
• 19:32
  working with him. And that is really important.
• 19:34
  You know, as a doctor, I really keen for patients to feel that
• 19:39
  their whole person, their mind and their body and all their
• 19:43
  organs are looked after. And so much in medicine it
• 19:46
  becomes very siloed. And that's very difficult for
• 19:49
  that person because you do want to be treated as an individual.
• 19:53
  And that's crucially important. Anything we do, whether it's a
• 19:56
  surgery or medicine we're giving or or making a diagnosis or what
• 19:59
  have you. But since you've had the
• 20:01
  mastectomy, you've also had two other big surgeries as well,
• 20:05
  haven't you? That's true.
• 20:07
  So actually in the week that a few days before the book came
• 20:11
  out, I had a hysterectomy including and I can never
• 20:14
  pronounce this ovarectomy Ovarian.
• 20:17
  Yes, had had my ovaries removed as well.
• 20:20
  So Lynch syndrome is interesting because it's, first of all, not
• 20:23
  that well known, even though it's actually very common.
• 20:26
  I think it's about one in 300 people have one form of Lynch
• 20:29
  syndrome. It's primarily associated with
• 20:32
  colon cancer. And having this surgery was
• 20:35
  something that I was told when I was first diagnosed with Lynch
• 20:39
  in 2014 that I should have. And I was 33 at the time.
• 20:42
  And I remember, you know, going in for this meeting with a
• 20:47
  geneticist and it just feeling like it accelerated from zero to
• 20:51
  100 kilometers an hour from, oh, you have Lynch syndrome to you
• 20:55
  should have a hysterectomy. And I just, you know, it was
• 20:57
  completely overwhelmed. Couldn't believe it.
• 20:59
  I pushed back and I was able to, for many years, get some testing
• 21:03
  done to, you know, to see if I had any signs of early cancer,
• 21:08
  but was frequently reminded that the tests that are done for
• 21:12
  ovarian and uterine cancer are not that effective.
• 21:15
  And especially ovarian cancers usually only detected when it's
• 21:19
  very far along. And so because of that, this
• 21:22
  surgery was recommended whenever I completed my family.
• 21:25
  So yeah, so this April, late March was when I finally decided
• 21:31
  to do it. Yeah, which which is a big
• 21:34
  decision, especially when people have preventative surgery.
• 21:37
  It's almost harder sometimes to make that decision and it and it
• 21:42
  is very individual, but obviously having your ovaries
• 21:45
  removed at a younger age also means that many of your hormones
• 21:48
  have been removed as well. So, so you, you are taking some
• 21:54
  hormones, aren't you? Yeah.
• 21:56
  And I mean, I will say I was very scared of the ovarian
• 21:59
  removal. You know, I think it was
• 22:02
  presented to me originally all those years ago.
• 22:05
  It's just kind of like a quick and easy solution to this
• 22:07
  situation, you know, to this risk.
• 22:09
  And it really weighed very heavily on me because I knew
• 22:13
  what the actual implications of early menopause would be.
• 22:16
  Then when I had the breast cancer, there was some concern
• 22:18
  whether I would be able to go on on HRT.
• 22:21
  But fortunately I was able to connect with an excellent Doctor
• 22:25
  Who for people with the kind of early stage breast cancer I had,
• 22:28
  the risk of increased risk of a recurrence is really it's is not
• 22:34
  significantly increased by hormones.
• 22:37
  And as she said, she was more concerned about the implications
• 22:40
  for my my cardiac health, my bone health than she would be
• 22:44
  for recurrence of of the breast cancer.
• 22:47
  So. And it's so important to have
• 22:50
  that conversation, it really, especially as you're young as
• 22:53
  well. And certainly in many countries,
• 22:56
  US and the UK, we know that a lot of young women who have
• 23:00
  their ovaries removed are not offered HRT.
• 23:03
  They're not offered estrogen, they're not offered
• 23:06
  testosterone, they're not offered progesterone.
• 23:08
  Yet we've known for decades that there are benefits to health,
• 23:12
  but also to well-being and symptom control as well,
• 23:17
  especially for young women. So it's really important because
• 23:22
  a lot of women even now have their ovaries removed and don't
• 23:25
  realize that they're going to be menopausal.
• 23:28
  I mean, it's obvious when you know it, but if you don't know
• 23:30
  it, people don't always stay. The dots exactly that
• 23:34
  conversation actually, because I have some friends who are
• 23:36
  physicians, girls who I grew up with who are now, you know,
• 23:39
  women who have been doctors for many years.
• 23:41
  And I mentioned that to them and they said yes, absolutely.
• 23:44
  And I have to say I was frustrated because I, I had to
• 23:50
  initiate the conversation about HRT and I really had to make
• 23:54
  several phone calls, send messages before I was able to
• 23:58
  get this consultation with this Doctor Who works within this
• 24:03
  leading world leading hospital where I received my treatment.
• 24:06
  It's amazing. I'm in, you know, very lucky to
• 24:08
  receive, you know, care from them.
• 24:10
  But I was kind of shocked, to be honest, that I felt like it
• 24:13
  should have just been part of the pathway there that if
• 24:15
  someone is having their ovaries removed, then of course they
• 24:18
  need to have this consultation. But I really had to get a lot of
• 24:21
  back and forth, including me saying, OK, I just won't do the
• 24:25
  ovaries in the surgery. I'll delay that for more years
• 24:28
  before they were able to sort of like connect the dots and say,
• 24:32
  OK, well, you can, you can speak to this doctor.
• 24:34
  I would describe myself as someone who, as I said, I have
• 24:38
  these friends who are physicians.
• 24:39
  I would say I'm more sort of like comfortable in a hospital
• 24:42
  environment than a lot of people are.
• 24:44
  And I'm well educated in my condition.
• 24:47
  And still I had to fight for it that much.
• 24:50
  And so it makes me feel really concerned about other women, to
• 24:54
  your point, who don't even know that they're about to go into
• 24:56
  menopause. They don't know what to ask for.
• 24:59
  And I'm, I'm, I'm so glad that you use your platform to talk
• 25:02
  about it because I think we just need to talk about it more.
• 25:06
  You're absolutely right. And I think, you know, we learn
• 25:08
  from others and that's why it's so important to share
• 25:11
  experiences. And I'm really grateful for you
• 25:13
  to being so open about many experiences that you've had, but
• 25:17
  also that you did say about, you know, choosing the right doctor
• 25:20
  for you. And I think that is also really
• 25:22
  important because a lot of women I consult with have often been
• 25:26
  really let down by the medical system and they've been given
• 25:29
  wrong information or information that's just not right for them
• 25:32
  or treatment choice choices that they don't want.
• 25:35
  So I think this is really important as we move forwards
• 25:38
  that people feel comfortable with the decisions that they're
• 25:40
  making and it's done at the right time because I think
• 25:43
  that's important. Everyone thinks that a treatment
• 25:45
  offered to them, they have to either take it now or not.
• 25:48
  And of course they can delay treatment choices.
• 25:50
  So it's great you're being so open.
• 25:53
  But just before I end, I'd really like 3 tips.
• 25:57
  And one of the things that comes through a lot from the book is
• 26:00
  you're a real advocate for yourself, and you're doing
• 26:02
  what's right for you, not for others.
• 26:05
  How do you think you know? What three things do you think
• 26:08
  would be really useful for people to learn from?
• 26:11
  Three messages so that we can all be advocates for ourselves,
• 26:14
  for our health. Oh, that's such a good question.
• 26:17
  Number one, take the tests that are offered to you.
• 26:22
  A lot of women are very afraid of mammograms, which I
• 26:25
  completely understand. They're really uncomfortable,
• 26:27
  they're unpleasant. They're they can feel violating,
• 26:32
  but nonetheless, if you were offered a mammogram, then do
• 26:35
  take it. And also if you were diagnosed
• 26:37
  with dense breasts, then ask for an ultrasound in addition to the
• 26:40
  mammogram. That's really important.
• 26:43
  And if you're not offered one, but you understand that you are
• 26:47
  of high risk because of your family history or a genetic
• 26:50
  history like mine, then ask for it.
• 26:53
  Ask for what you need. So I think that's number one.
• 26:56
  And if people hospitals say no to you, keep asking because
• 27:01
  actually I've often found, as I, you know, said with the example
• 27:04
  with HRT, repeated asking does get you what you want.
• 27:07
  You just have to pursue and not be told no.
• 27:10
  The second thing I would say is get a second opinion.
• 27:12
  I think we can feel very intimidated by healthcare
• 27:18
  providers or physicians who tell us things that are upsetting or
• 27:22
  frightening. You don't have to do anything
• 27:24
  that just one provider tells you to do For me with my diagnosis,
• 27:29
  of course, mastectomy felt very dramatic.
• 27:32
  So I went and got a second opinion encouraged by the
• 27:34
  surgeon who diagnosed me initially.
• 27:36
  And the second opinion was basically identical to the first
• 27:39
  opinion, which made me feel much better about the course of
• 27:41
  treatment. And I know some people feel like
• 27:44
  they're going to insult their doctors by ask, you know, going
• 27:46
  out and getting a second opinion.
• 27:48
  And I think a good physician will never be take it personally
• 27:52
  if you want to double check their their views with a, you
• 27:56
  know, one of their colleagues essentially.
• 28:00
  And then, you know, I think my third tip would be pay attention
• 28:06
  to how you feel emotionally and don't and pay attention to your
• 28:11
  intuition. Actually, a friend of mine
• 28:13
  recently wrote a really excellent book on intuition.
• 28:16
  And, you know, one of the points that she makes in that is that
• 28:19
  women are often sort of, you know, through our lives, told to
• 28:23
  doubt ourselves, told that we're being hysterical, told that
• 28:25
  we're being too sensitive and so forth.
• 28:28
  And I think through this whole process by learning more to
• 28:32
  listen to my intuition about how I feel.
• 28:36
  I haven't been able to control the process, but I have felt
• 28:38
  like more of an active participant in it rather than
• 28:44
  rather than an object in the process.
• 28:46
  So important, an active participant.
• 28:48
  I like that. Thank you ever so much, Jean.
• 28:51
  It's been really informative. So thanks for joining me today.
• 28:54
  Thank you so much, Louise. This is great.
• 28:58
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• 29:02
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