Latest / The Menopause Disruptor Podcast / The Intersection Between Anesthesia, Menopause, and Oral Health with Dr. Sandra Bargeron

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The Intersection Between Anesthesia, Menopause, and Oral Health with Dr. Sandra Bargeron · The Menopause Disruptor Podcast

• 0:00
  Sandra Bargeron: If we talk about postmenopause, right, estrogen drives our neuroprotective and even the volume of our brain is impacted by declining progesterone.
• 0:09
  Sandra Bargeron: We scan the brains of a postmenopausal woman who has never been on hormones, they are going to have, they have shown them to have smaller brains.
• 0:17
  Sandra Bargeron: The brain shrinks with declining estrogen.
• 0:20
  Sandra Bargeron: And so if it does that like on a volume size, you know it's doing that on a neuronal level, which means it's not going to handle the stress of surgery as well.
• 0:28
  Sandra Bargeron: Anything we bring into surgery creates stress, is going to cause more impact on the brain.
• 0:33
  Mary Lee: Welcome back to the menopause disruptor podcast.
• 0:36
  Mary Lee: We are going to talk about a really rare, never thought-of topic with menopause, and that is preparing for surgery.
• 0:46
  Mary Lee: Let me pose this question.
• 0:48
  Mary Lee: What if preparing for surgery meant more than fasting, arranging a ride home, and getting your paperwork in order?
• 0:56
  Mary Lee: What if one of the most important things you could prepare for was your brain?
• 1:01
  Mary Lee: We tend to think of anesthesia as simply being put to sleep.
• 1:06
  Mary Lee: But anesthesia isn't sleep, it is a carefully controlled alteration of consciousness, and surgery itself places an enormous physiological demand on the body and the nervous system.
• 1:20
  Mary Lee: And here's where today's conversation gets particularly interesting for women in midlife.
• 1:26
  Mary Lee: Because the brain you bring into the operating room matters.
• 1:31
  Mary Lee: Your sleep, your metabolic health, your medications, your stress load, your physical fitness, your previous neurological history, and potentially where you are in your hormonal journey.
• 1:44
  Mary Lee: And for women navigating perimenopause and menopause, this raises some fascinating questions.
• 1:50
  Mary Lee: Could fluctuating hormones influence how our brains respond to anesthesia?
• 1:56
  Mary Lee: And why do some women wake up feeling relatively clear while others experience prolonged brain fog, nausea, fatigue, or cognitive changes?
• 2:06
  Mary Lee: And what happens when we add a history of concussion, chronic sleep disruption, neurodivergence, or other neurological vulnerabilities to the equation?
• 2:16
  Mary Lee: My guest today has spent more than two decades at the head of the operating table, Sandra Bergeron.
• 2:23
  Mary Lee: She is a certified anesthesiologist assistant with more than 22 years in medicine and more than 10,000 anesthesia cases under her belt.
• 2:34
  Mary Lee: And after years of watching patients respond very differently to what might appear to be the same surgical experience, she began asking a bigger question.
• 2:43
  Mary Lee: How much neurological resilience does a person actually have before they go into surgery?
• 2:50
  Mary Lee: That question became the foundation of her work at Beyond Brain Health.
• 2:55
  Mary Lee: Her neurological stress and recovery index, NSRI, and her book, Breakthrough Anesthesia Fog, Protect Your Brain and Heal Faster After Surgery.
• 3:06
  Mary Lee: Sandra's approach challenges us to think differently about surgical readiness.
• 3:11
  Mary Lee: Not just am I medically cleared, but how prepared is my brain and my nervous system for this stress?
• 3:19
  Mary Lee: And I particularly wanted to have this conversation because we recently explored on this podcast what happens when concussion collides with menopause.
• 3:28
  Mary Lee: And today we're addressing another piece to that puzzle, anesthesia and surgical stress.
• 3:34
  Mary Lee: So whether you have a surgery coming up, have experienced that frustrating post-surgical brain fog, or you're simply interested in understanding how we can build greater neurological resilience as we move through midlife, I think that you're going to find this conversation absolutely fascinating, mind-blowing, pun intended.
• 3:54
  Mary Lee: Please join me in welcoming Sandra Bergeron to the Menopause Disruptor Podcast.
• 4:00
  Mary Lee: Welcome, Dr.
• 4:01
  Mary Lee: Bergeron.
• 4:02
  Mary Lee: I'm so happy to have you here because we are going to talk about one of my primary focuses for many reasons, and that is brain health, but very new ones.
• 4:10
  Mary Lee: First of all, so glad to have you here.
• 4:13
  Sandra Bargeron: Well, thanks for having me.
• 4:14
  Sandra Bargeron: I can definitely talk on this topic a lot.
• 4:17
  Sandra Bargeron: I have a lot of passion behind it.
• 4:18
  Sandra Bargeron: So I'm happy to be here.
• 4:20
  Sandra Bargeron: Okay.
• 4:21
  Sandra Bargeron: So do you like to go by Dr.
• 4:23
  Sandra Bargeron: Bergeron?
• 4:24
  Sandra Bargeron: I like to go by Sandra.
• 4:25
  Sandra Bargeron: It's confusing because I have a PhD and I don't want any medical doctor to think I'm calling myself a medical doctor because I'm not a medical doctor.
• 4:34
  Sandra Bargeron: I am a double-boarded practitioner.
• 4:37
  Sandra Bargeron: I have two separate degrees.
• 4:38
  Sandra Bargeron: Um a physician assistant, general practice physician assistant, got that degree in 2004.
• 4:45
  Sandra Bargeron: I graduated in 2004.
• 4:46
  Sandra Bargeron: So I practiced in the OR primarily.
• 4:49
  Sandra Bargeron: I was a first assistant in the OR, so I scrubbed in and operated on all kinds of things.
• 4:54
  Sandra Bargeron: I also did a little bit of emergency room, moonlighting, and then outpatient care and type things like that.
• 5:00
  Sandra Bargeron: I didn't love medicine.
• 5:02
  Sandra Bargeron: So I actually was going to go to medical school.
• 5:05
  Sandra Bargeron: But my father-in-law was a retiree, he was retiring from orthopedic surgery, and he said, the direction medicine is going, you're really not gonna like it.
• 5:14
  Sandra Bargeron: Just go be a PA and then you can have better life work-life balance.
• 5:18
  Sandra Bargeron: And you know, it's not the marathon of the degree.
• 5:22
  Sandra Bargeron: He may have been right in the sense that, like when it comes to research, I'm definitely a high-level thinker.
• 5:27
  Sandra Bargeron: So I don't know, maybe it would have been good to go to medical school just to have that as a something to piggyback on for research.
• 5:33
  Sandra Bargeron: As it is, I do research without the degree, but I learned it was a good thing.
• 5:38
  Sandra Bargeron: I learned early that oh boy, I don't like this.
• 5:41
  Sandra Bargeron: I don't like so I'm glad I didn't go, right?
• 5:44
  Sandra Bargeron: I don't like band-aiding medication, like people with medications or like the two options were operate or give a medication.
• 5:52
  Sandra Bargeron: The medication always had a side effect, which led to more medications.
• 5:54
  Sandra Bargeron: I'm like, this is is this really what we do in medicine?
• 5:57
  Sandra Bargeron: So it was like it wasn't very long into my career that I had this like existential crisis, and I was like, what am I supposed to do with this?
• 6:04
  Sandra Bargeron: I don't like this.
• 6:05
  Sandra Bargeron: I really didn't like it.
• 6:06
  Sandra Bargeron: And because I was in the operating room, I was introduced to the profession of anesthesia in a non-medical doctor realm, which because yes, I could have gone back to medical school and all that, but again, I had this like, I don't really like this the way we do medicine.
• 6:22
  Sandra Bargeron: So, like, what what can I do that will give me the opportunity to practice the art of medicine, to use medications in a way that are limited and providing like good relief for human suffering.
• 6:38
  Sandra Bargeron: Anesthesia makes sense, right?
• 6:40
  Sandra Bargeron: You put people to sleep with a medication, they don't go home on it.
• 6:43
  Sandra Bargeron: It's a compassionate and uh safety-oriented job, and it takes a lot of brain power and it's critical thinking and all the things that I'd like to do.
• 6:50
  Sandra Bargeron: So I went back and got my anesthesia degree, which is two separate degrees.
• 6:54
  Sandra Bargeron: So two two two and a half year degrees basically, five years combined.
• 6:58
  Sandra Bargeron: Wow.
• 6:59
  Sandra Bargeron: And so I graduated in 2010 and I took two boards.
• 7:02
  Sandra Bargeron: I took my PA boards and my anesthesia boards and started practicing.
• 7:06
  Sandra Bargeron: So I've been practicing anesthesia since 2010, medicine since 2004, and I've seen this gamut because I was as a PA, I was writing prescriptions and assisting.
• 7:18
  Sandra Bargeron: I've seen the perspective from all aspects of surgery and anesthesia and medicine, even in the urgent emergency care kind of realm.
• 7:26
  Sandra Bargeron: So I really got a good view of the system in medicine, the things I don't like about it, the what areas we could strengthen it, some things that are good about it.
• 7:35
  Sandra Bargeron: But, you know, I have a good view of that.
• 7:38
  Sandra Bargeron: It wasn't until after anesthesia school that my own health journey, my son's health journey all led to further education, which led to my PhD.
• 7:48
  Sandra Bargeron: And that is where I got functional medicine training, and that's where we are now.
• 7:53
  Sandra Bargeron: That's how we landed in the space where I'm doing brain health from like protecting the brain around anesthesia and offering solutions in that realm because it wasn't without that education, there wasn't a real direction to do that that thing.
• 8:08
  Sandra Bargeron: So that's my background.
• 8:10
  Mary Lee: That's incredible.
• 8:11
  Mary Lee: Wow, and what a nuanced, unique niche area of brain health, anesthesia.
• 8:19
  Mary Lee: A real fun time talking about anesthesia.
• 8:22
  Mary Lee: And and it's not an easy word to say, it's very Latin.
• 8:26
  Mary Lee: And today I just seem to be tongue-tied.
• 8:28
  Mary Lee: But so, and the menopause and anesthesia connection.
• 8:32
  Mary Lee: I mean, that is something we just don't hear about.
• 8:35
  Mary Lee: But it's very important.
• 8:36
  Mary Lee: And you started noticing that in the operating room that made you realize that we weren't paying enough attention to what actually happens to the brain during and after anesthesia.
• 8:47
  Mary Lee: Anesthesia.
• 8:48
  Mary Lee: Anesthesia.
• 8:50
  Mary Lee: Let's talk about that.
• 9:01
  Sandra Bargeron: Well, let's let me give you a little background.
• 9:04
  Sandra Bargeron: So, my my mother-in-law, two family members in my career or my life impacted the trajectory of how I viewed this because in medicine, especially in anesthesia, we do learn about cognitive decline risks with anesthesia in our training.
• 9:21
  Sandra Bargeron: But anesthesia is a critical care specialty.
• 9:24
  Sandra Bargeron: What that means is our primary priority is that you manage to get through surgery safely.
• 9:29
  Sandra Bargeron: You don't have a heart attack, you don't have a stroke, you don't die.
• 9:32
  Sandra Bargeron: Okay.
• 9:32
  Sandra Bargeron: That is our number one priority that you are safe through surgery.
• 9:38
  Sandra Bargeron: And surgery is a situation where we put you in a position where it's life-threatening, like you're being operating around.
• 9:46
  Sandra Bargeron: It's a very stressful event to the body.
• 9:48
  Sandra Bargeron: So it's not like sitting on cruise control.
• 9:51
  Sandra Bargeron: There's a reason we focus on those areas.
• 9:53
  Sandra Bargeron: That said, when we learn about cognitive decline in medicine, and this is true for it doesn't matter if you're a CRNA, an AA, or an anesthesiologist, you learn about the link to certain populations are at more risk for cognitive decline.
• 10:08
  Sandra Bargeron: And what our perspective in medicine is, well, what can we do medically to change that outcome right now, right?
• 10:16
  Sandra Bargeron: Anesthesia's critical care.
• 10:18
  Sandra Bargeron: So there's no pre, there's no post, you're not going to see your anesthesiologist in this wide spectrum of two a month before, two months after.
• 10:25
  Sandra Bargeron: You get them now.
• 10:25
  Sandra Bargeron: So what can we do right now?
• 10:27
  Sandra Bargeron: So we make decisions about spinals versus general.
• 10:30
  Sandra Bargeron: Do we maybe limit these drugs or you know, and we might make those decisions.
• 10:34
  Sandra Bargeron: We kind of talk about that.
• 10:35
  Sandra Bargeron: That's a lot in the literature of what we talk about in medicine, but it's not really designed to follow up with you and ideally optimize you.
• 10:45
  Sandra Bargeron: Like the profession isn't designed like that.
• 10:48
  Sandra Bargeron: Okay.
• 10:48
  Sandra Bargeron: Now, my mother-in-law, when she was in her 40s, she had the classic picture that I think so many people resonate with.
• 10:55
  Sandra Bargeron: And I promise this to tie it all again.
• 10:57
  Sandra Bargeron: She was in her mid 40s, late 40s, got diagnosed with chronic fatigue syndrome, and it was really profound.
• 11:04
  Sandra Bargeron: Anybody else relate to that in perimenopause?
• 11:07
  Sandra Bargeron: Like, I mean, right?
• 11:09
  Sandra Bargeron: It's like, oh, I'm in perimenopause now.
• 11:11
  Sandra Bargeron: I know because I ain't got no energy.
• 11:14
  Sandra Bargeron: So no memories.
• 11:16
  Sandra Bargeron: Memory, yeah.
• 11:17
  Sandra Bargeron: And just can't.
• 11:18
  Sandra Bargeron: Some days you're just like, I don't, I can't function.
• 11:21
  Sandra Bargeron: So of course she went through that.
• 11:23
  Sandra Bargeron: And when I met her and married her son, you know, she was a decade beyond that, but she still had like brain fog, memory, you know, just little, she called herself brain barts.
• 11:33
  Sandra Bargeron: You know, I just literally brain marts, it's okay.
• 11:35
  Sandra Bargeron: And then around 68, she had to have sudden open heart surgery.
• 11:40
  Sandra Bargeron: And unfortunately, that is one of the highest risk surgery for cognitive decline postoperatively, which I didn't know at the time I was a PA.
• 11:49
  Sandra Bargeron: I didn't know.
• 11:49
  Sandra Bargeron: I just knew that's a very dangerous surgery, and we want to make sure that everything is she makes it through safely.
• 11:55
  Sandra Bargeron: She doesn't die, you know.
• 11:57
  Sandra Bargeron: But afterwards, we saw a rapid change in personality, a big change in her memory, just major changes that were major, but they weren't dementia.
• 12:08
  Sandra Bargeron: They were just major to those who knew her.
• 12:10
  Sandra Bargeron: Do you know what I mean?
• 12:11
  Sandra Bargeron: Like her personality and all these things.
• 12:13
  Sandra Bargeron: So it followed her for another, you know, decade and she died of dementia.
• 12:17
  Sandra Bargeron: I mean, it's just a rapid decline.
• 12:18
  Mary Lee: Oh my goodness.
• 12:19
  Mary Lee: My goodness.
• 12:20
  Sandra Bargeron: So, in the midst of all that, my son developed Lyme disease.
• 12:25
  Sandra Bargeron: So, in the midst of her decline, I'm watching this, I'm trying to help her.
• 12:29
  Sandra Bargeron: I don't really know what to do.
• 12:31
  Sandra Bargeron: But my son gets sick with Lyme disease, and that kind of propelled me into functional medicine because there wasn't what are we going to do for Lyme disease, except antibiotics.
• 12:40
  Sandra Bargeron: And I wasn't willing to do that.
• 12:41
  Sandra Bargeron: I'd had enough understanding by that point to go, okay, I need real help with this.
• 12:46
  Sandra Bargeron: Like I couldn't find good help, like, I couldn't find a practice that really took the whole person into perspective.
• 12:52
  Sandra Bargeron: So that's what threw me into functional medicine and learning it for myself and figuring it out.
• 12:58
  Sandra Bargeron: And so that's when I started to look at her decline, the literature in medicine that we talked about.
• 13:04
  Sandra Bargeron: I we talk about it in our degree, right?
• 13:07
  Sandra Bargeron: I started to look at it with different eyes.
• 13:09
  Sandra Bargeron: I'm like, okay, but so wait, anesthesia is a stressful event.
• 13:14
  Sandra Bargeron: Surgery is a stressor.
• 13:16
  Sandra Bargeron: It's a toxic event, it's an inflammatory event, it's an immune stressor, it causes all these disruptions of the human body.
• 13:24
  Sandra Bargeron: Why don't we prepare for it?
• 13:25
  Sandra Bargeron: Or why don't we have some kind of plan to recover afterwards?
• 13:28
  Sandra Bargeron: Like, who's doing that?
• 13:29
  Sandra Bargeron: Nobody was doing that.
• 13:31
  Sandra Bargeron: Now, the interesting thing was is the literature was starting to pick up on like, here's the factor that we identify as consistently the factor that matters the most.
• 13:43
  Sandra Bargeron: And so in the anesthesia literature, what started to emerge was this pattern of it's not the drug.
• 13:49
  Sandra Bargeron: Like we looked at propofol, we looked at gas, we looked at general anesthesia, we looked at regional anesthesia.
• 13:54
  Sandra Bargeron: We look all the things that people ask me on my on my page, they're like, Well, what should I get a spinal?
• 13:59
  Sandra Bargeron: Should I, you know, like, is it worse with this drug?
• 14:01
  Sandra Bargeron: Is it worth we looked at that, we have been looking at that for 30 years.
• 14:05
  Sandra Bargeron: But what was emerging was it's the patient, it's the patient's resilience and their cognitive baseline.
• 14:12
  Sandra Bargeron: So even the medical literature was starting to say cognitive, like your cognitive baseline is more of a predictor of your outcomes than any of the drugs or even the surgery that you go through.
• 14:25
  Sandra Bargeron: So the difference between what the way I look at it and the way medicine looks at it is they look at it as a predictive model.
• 14:32
  Sandra Bargeron: So you can go get a cognitive test at your doctor's office.
• 14:35
  Sandra Bargeron: If you're in primary care, go see them, and they can refer you to a neuropsychologist or somebody, and they'll give you a cognitive assessment.
• 14:42
  Sandra Bargeron: Cognitive assessment is a measure of function and where you are now.
• 14:47
  Sandra Bargeron: Okay, you know, and it says, okay, well, because you're here, you're likely to have an outcome that's not so good.
• 14:53
  Sandra Bargeron: Okay.
• 14:54
  Sandra Bargeron: It doesn't tell us how to change anything.
• 14:57
  Sandra Bargeron: Cognitive is function is function.
• 14:59
  Sandra Bargeron: Resilience, and this will piggyback, I promise, into what you asked me about with the hormones.
• 15:05
  Sandra Bargeron: Resilience is a different animal.
• 15:07
  Sandra Bargeron: Resilience is how much capacity do you have to manage stress and how can we modify it?
• 15:14
  Sandra Bargeron: So when I started looking at this, you know, I started writing my book, I started realizing this was the problem.
• 15:21
  Sandra Bargeron: The literature is pointing to this.
• 15:23
  Sandra Bargeron: I was like, we need a measurement of resilience.
• 15:26
  Sandra Bargeron: Now, some groups were starting to look at those, and there was enough literature to pull from that.
• 15:31
  Sandra Bargeron: I had about like 130 different peer-reviewed studies to build what is now the NSRI, the neurologic stress and recovery index.
• 15:40
  Sandra Bargeron: And it looks at five separate domains that determine your neurologic resilience.
• 15:45
  Sandra Bargeron: One of them is hormones, so it's metabolic health.
• 15:48
  Sandra Bargeron: Hormones fall into that.
• 15:49
  Sandra Bargeron: Yeah.
• 15:49
  Sandra Bargeron: And so from there, we can look at, okay, these are the factors, these are the areas you're weak in, and those determine your neurological neurologic resilience.
• 15:59
  Sandra Bargeron: So maybe you're only weak in metabolic health and medication burden.
• 16:03
  Sandra Bargeron: Okay, those are two areas.
• 16:04
  Sandra Bargeron: Well, we can talk to your doctor, we can address this medication burden as a concern before surgery.
• 16:10
  Sandra Bargeron: And what about metabolic health?
• 16:12
  Sandra Bargeron: Can we do something with metabolic health?
• 16:13
  Sandra Bargeron: Can we get you moving?
• 16:14
  Sandra Bargeron: Can we get you on some biodentical hormones?
• 16:16
  Sandra Bargeron: What do we need to do here to improve your metabolic health so that you have more resilience going into surgery?
• 16:23
  Sandra Bargeron: Okay.
• 16:23
  Sandra Bargeron: That's the question that we built.
• 16:25
  Sandra Bargeron: That was a lot of information, but there you go.
• 16:28
  Mary Lee: That's incredible.
• 16:29
  Mary Lee: So just building metabolic health.
• 16:31
  Mary Lee: And if someone whose resilience is indicator is quite low, they have a low baseline.
• 16:37
  Mary Lee: Uh, how do you and you've got a set date for surgery?
• 16:40
  Mary Lee: How do you get prepared in a fixed amount of time?
• 16:43
  Mary Lee: And that could be very short.
• 16:44
  Mary Lee: Sometimes you're on waiting list and all of a sudden they say, Okay, it's go time.
• 16:47
  Mary Lee: How do you prepare?
• 16:49
  Sandra Bargeron: And is just a little bit of effort enough to say they're resilient, they have a better outcome from the surgery in the a little bit of effort is still worth a million pounds.
• 17:00
  Sandra Bargeron: So your question, I'll answer it directly, and then I want to give a little bit of context.
• 17:04
  Sandra Bargeron: Um, what do we do?
• 17:06
  Sandra Bargeron: So the reason the neurologic resilience, neurologic stress and recovery index is built around five domains is because if you have a short period of time to optimize, we need to know which domain is the weakest, right?
• 17:17
  Sandra Bargeron: We could throw a spaghetti at the wall and kind of try to optimize everything, but do you know what you're optimizing?
• 17:22
  Sandra Bargeron: I mean, are you getting sunlight?
• 17:23
  Sandra Bargeron: Okay, great.
• 17:24
  Sandra Bargeron: Are you eating nutritiously?
• 17:25
  Sandra Bargeron: What does that mean?
• 17:25
  Sandra Bargeron: Like, are we deficient?
• 17:27
  Sandra Bargeron: Are we on meds that are depleting things?
• 17:29
  Sandra Bargeron: I don't, you know, so the the tool actually gives a little bit of a structure to identify where to put your effort into in the in the four to five weeks you might have before surgery.
• 17:39
  Sandra Bargeron: You know, maybe maybe you just need to get outside and walk every day.
• 17:43
  Sandra Bargeron: Maybe you haven't been moving, and that little bit does build BDNF, right?
• 17:48
  Sandra Bargeron: So moving is a huge uh brain-drive neurotrophic factor stimulator.
• 17:54
  Sandra Bargeron: You can't actually supplement and you there are no supplements that quantify and build BDNF as much as movement does, right?
• 18:04
  Sandra Bargeron: So, right.
• 18:05
  Sandra Bargeron: So if we identify that's a vulnerability and you have a very sedentary lifestyle and you have six weeks to prepare, well, you're gonna prioritize.
• 18:12
  Sandra Bargeron: I want you to prioritize your movement.
• 18:14
  Sandra Bargeron: Get out there and walk outside.
• 18:16
  Sandra Bargeron: I don't care if it's 10 minutes, you're making a difference on neurologic health because it's it's a it's validated in the research.
• 18:24
  Sandra Bargeron: Um, can we improve sleep quality?
• 18:27
  Sandra Bargeron: Is there is are you inadvertently uh, you know, changing staying up too late, leave leaving blue lights on, screen time before bed?
• 18:36
  Sandra Bargeron: Are you doing that and not even noticing?
• 18:38
  Sandra Bargeron: And then you're completely disrupted all through the night.
• 18:41
  Sandra Bargeron: Well, that's where we consolidate all of our day, where we detox everything.
• 18:45
  Sandra Bargeron: And so if your body's coming into surgery with a whole lot of metabolic neurologic trash, well, then you're gonna have a harder time moving the increased burden of you know, neurotoxins out of the brain after surgery.
• 19:00
  Sandra Bargeron: So we can identify if sleep is something we need to focus on and we kind of get directions in that way.
• 19:05
  Sandra Bargeron: So that that's the concept behind the neurologic resilience.
• 19:09
  Sandra Bargeron: And I want to just kind of give a little context about why I built it out and brought it to the public because there are, I would be remiss to say that they aren't studying this kind of stuff.
• 19:18
  Sandra Bargeron: In fact, they were studying this 30 years ago.
• 19:23
  Sandra Bargeron: In 1999, this is before 2000, there was actually a study done by Yale.
• 19:30
  Sandra Bargeron: And it didn't even look at pre-operative optimization, it just looked at post-operative inpatient modifications to things.
• 19:38
  Sandra Bargeron: And that's part of what I teach in the book.
• 19:40
  Sandra Bargeron: Like, here's what we need to do before, here's what you do during, here's what you do after.
• 19:44
  Sandra Bargeron: Like the whole framework is in my book between all of that.
• 19:48
  Sandra Bargeron: But the cool thing was that they like they just did post-operative.
• 19:52
  Sandra Bargeron: All they did was like, hey, get them in front of the sun, don't interrupt their sleep, give them their hearing aids, make sure they had their glasses.
• 19:58
  Sandra Bargeron: Just simple, simple modifications, but very intentional.
• 20:02
  Sandra Bargeron: And they did that, and they actually reduced delirium by 40% just by doing those things inpatient.
• 20:09
  Sandra Bargeron: Then the hospitals that adopted that they saved accumulative like $7.3 million back in the 90s in cost to the hospital because they implemented such simple things.
• 20:20
  Sandra Bargeron: Now they did it as a trial, and the problem was is that the system, remember, I said I didn't like the system, medical system, the system is limited in being able to implement it.
• 20:33
  Sandra Bargeron: The hospital benefits from this, but insurance companies don't.
• 20:36
  Sandra Bargeron: There's no coding, there's nobody to own the job of managing this.
• 20:40
  Sandra Bargeron: Anesthesia's not, they're not a long-term follow-up.
• 20:43
  Sandra Bargeron: Hospitalists, well, hospitalists are generalists, they're not trained to do this.
• 20:48
  Sandra Bargeron: So are you gonna apply this to a hospitalist?
• 20:50
  Sandra Bargeron: You have to create a whole arm.
• 20:51
  Sandra Bargeron: Then can they even bill for this kind of service?
• 20:54
  Sandra Bargeron: No.
• 20:54
  Sandra Bargeron: So there are all these system failures for this to be able to become something that is nationwide, even though they proved that it worked and it reduced delirium by 40%.
• 21:05
  Mary Lee: Significant.
• 21:06
  Sandra Bargeron: So, and that's 30 years ago, right?
• 21:08
  Sandra Bargeron: So the reality is that we know that these are things you can do, but we have no way inside the hospital system inside the medical system to like create a way for us to consistently offer it to patients and be the ones in medicine to drive it forward.
• 21:25
  Sandra Bargeron: So, though we are studying it, how do we make a difference for the patient right now?
• 21:30
  Sandra Bargeron: So, my approach was to go, look, it's been 30 years and they still haven't figured it out.
• 21:35
  Sandra Bargeron: So let's go and just bring this to the public.
• 21:38
  Sandra Bargeron: And this is why my whole page is about that, is and why I wrote the book and why I created the NSRIs like, hey, I'm gonna bring it to you.
• 21:45
  Sandra Bargeron: And you, the one with the skin in the game, the one that's gonna deal with the cognitive decline for the next decade.
• 21:52
  Sandra Bargeron: Yeah, you get to have the power to do the things that are modifiable and can improve your cognitive recovery, like huge.
• 21:59
  Sandra Bargeron: So that's the context I wanted to give.
• 22:02
  Mary Lee: It's shocking, it's eye opening.
• 22:04
  Mary Lee: Again, it's something that we would never think about in the context.
• 22:08
  Mary Lee: Context of managing menopause and what happens to our brain when we're in surgery, particularly the brain that has outside of being a sedate lifestyle, but just the role that estrogen plays as a neuroprotector in our brain health alone.
• 22:24
  Mary Lee: If we were to take a relatively fit woman who's been managing her all her lifestyle markers, you know, her nutrition is fairly strong or decent.
• 22:35
  Mary Lee: Exercise, you know, it's there.
• 22:36
  Mary Lee: Maybe she does a little bit of resistance training.
• 22:39
  Mary Lee: And sleep is pretty well managed.
• 22:42
  Mary Lee: Stressors, okay.
• 22:43
  Mary Lee: Menopause in itself is a stressor on the border.
• 22:46
  Mary Lee: Rising cortisol.
• 22:48
  Mary Lee: So just that factor alone, rising cortisol or declining estrogen.
• 22:53
  Mary Lee: How much does that put a menopausal woman at risk if she does have to go in for surgery?
• 22:58
  Mary Lee: Maybe even it's just simple day surgery, but she's still going under anesthetic.
• 23:04
  Sandra Bargeron: Yes.
• 23:04
  Sandra Bargeron: I consider I consider that population a understudied, underrecognized population.
• 23:11
  Sandra Bargeron: I know everybody on this podcast probably shocked that women aren't getting studied properly.
• 23:16
  Sandra Bargeron: Hello, that's the story of medical research, right?
• 23:19
  Sandra Bargeron: But the reality, so I can't quantify, I can't give you a statistic because we aren't well studied in that area.
• 23:24
  Sandra Bargeron: But I can tell you this everything you mentioned is accurate.
• 23:29
  Sandra Bargeron: Like there's a rise in cortisol.
• 23:31
  Sandra Bargeron: And there's a difference between perimenopause and postmenopause, right?
• 23:34
  Sandra Bargeron: Because in perimenopause, we have these wild swings of our estrogen, up, down, up, down.
• 23:39
  Sandra Bargeron: We're excess estrogen one day, we're a lipoestrogenemic the next day.
• 23:43
  Sandra Bargeron: We're boom, boom, boom, boom as we drift our way down.
• 23:46
  Sandra Bargeron: Overall, we're low, but we still have these wild swings, which makes us feel crazy, right?
• 23:51
  Sandra Bargeron: Terrible.
• 23:52
  Sandra Bargeron: But those shifts have impacts on everything: your microbiome, your gallbladder, and the bile that you produce, and your all those things determine how well you detox from anesthesia, like how much you clear those anesthetic drugs, how much you manage the physiologic burden, how well you manage the inflammatory response.
• 24:11
  Sandra Bargeron: So, like, and we're just talking about estrogen.
• 24:14
  Sandra Bargeron: We haven't even talked about progesterone.
• 24:16
  Sandra Bargeron: Like progesterone alone is a key to driving cellular detoxification, being able to put yourself into rest and digest mode after a stressful response.
• 24:26
  Sandra Bargeron: So, as we have not just declining and swinging estrogens, we have declining progesterone, which means that less of a stressful the same stressor at 30 creates a profound stress response at 40 because of our progesterone declining and our likelihood to swing into fight or flight being higher, right?
• 24:47
  Sandra Bargeron: We don't calibrate as well because progesterone has declined and it drives parasympathetic response.
• 24:53
  Sandra Bargeron: So we have a lot of factors involved there.
• 24:56
  Sandra Bargeron: On top of that, now if we talk about postmenopause, right, estrogen drives our neuroprotective and even the volume of our brain is impacted by declining progesterone.
• 25:07
  Sandra Bargeron: We scan the brains of a postmenopausal woman who has never been on hormones, they are going to have, they have shown them to have smaller brains.
• 25:14
  Sandra Bargeron: The brain shrinks with declining estrogen.
• 25:17
  Sandra Bargeron: And so that if it does that like on a volume size, you know it's doing that on a neuronal level, which means it's not going to handle the stress of surgery as well.
• 25:26
  Sandra Bargeron: Does that make sense?
• 25:27
  Sandra Bargeron: Anything we bring into surgery creates stress, is going to cause more impact on the brain.
• 25:33
  Sandra Bargeron: So huge and but you don't detox as well, you don't stress response doesn't recover as well.
• 25:38
  Sandra Bargeron: You see the cortisol goes up, but also the parasympathetic response doesn't swing back to back baseline as easily.
• 25:44
  Sandra Bargeron: Your microbiome, your methylation, right?
• 25:48
  Sandra Bargeron: It's a big conversation right now about methylation.
• 25:50
  Sandra Bargeron: Well, why is it that it's so common after maybe let's just say 36, 40 for women to start experiencing the symptoms of their methylation dysfunction, right?
• 25:59
  Sandra Bargeron: They had the genetic propensity, they didn't really notice early on, but they really notice it.
• 26:06
  Sandra Bargeron: And they're going to the doctor and they're getting tested and they're finding out they have MTHFR.
• 26:10
  Sandra Bargeron: Well, they have it the whole time.
• 26:12
  Sandra Bargeron: It's just that the hormones impact the expression of your genes.
• 26:18
  Sandra Bargeron: So while estrogen and progesterone protect the expression of methylation, you know, maybe you have a genetic mutation.
• 26:25
  Sandra Bargeron: Even there, you can kind of make up for if you have healthy hormones.
• 26:29
  Sandra Bargeron: I'm really simplifying the signs here, but but you know, but once that protective activation of those methylation genes is declining, now you have MTFHFR expression.
• 26:41
  Sandra Bargeron: Do you know what I mean?
• 26:42
  Sandra Bargeron: So you don't you don't absorb your B vitamins as well.
• 26:45
  Sandra Bargeron: And on now you're becoming nutritional deficient.
• 26:47
  Sandra Bargeron: Now you get brain fog.
• 26:48
  Sandra Bargeron: Now you get, does that make sense?
• 26:50
  Mary Lee: Yeah.
• 26:50
  Mary Lee: Well, let's just take it back one more step for the lay person.
• 26:53
  Mary Lee: And not all listeners are going to understand methylation.
• 26:56
  Mary Lee: Let's just bring it back to the bare bones, methylation, its role in the body.
• 27:00
  Mary Lee: And yeah, let's just go right into that.
• 27:03
  Sandra Bargeron: Yeah, methylation.
• 27:04
  Sandra Bargeron: So methylation is uh it's an intracellular, well, it's a cellular process by which we manage certain cellular processes and and basically absorb certain nutrients.
• 27:15
  Sandra Bargeron: So I'll just keep it super simple.
• 27:18
  Sandra Bargeron: The big thing is it is involved in the metabolism of your B vitamins.
• 27:23
  Sandra Bargeron: So your B12, your folate, and things like that.
• 27:26
  Sandra Bargeron: And so when you don't methylate well, you don't absorb the certain types of B vitamins very well.
• 27:32
  Sandra Bargeron: You really need methylated B vitamins in order to be able to absorb them.
• 27:36
  Sandra Bargeron: So your cyanocobamelin, which is your non-methylated B12, it will actually become toxic in the body if you don't methylate well.
• 27:46
  Sandra Bargeron: And so a lot of times people take supplements and they don't know which type of methylated, what type of B vitamin, what kind of vitamin they're taking.
• 27:53
  Sandra Bargeron: It's very often the cheaper cyanocobamelin, which is actually causing more problems for people who have methylation problems.
• 28:01
  Sandra Bargeron: And here's the thing 66.7% of the population has methylation dysfunction.
• 28:06
  Sandra Bargeron: So is that right?
• 28:07
  Sandra Bargeron: Two thirds.
• 28:08
  Sandra Bargeron: Yeah.
• 28:08
  Sandra Bargeron: So, and we're not talking about two alleles, we're talking about at least one gene, one from your parent is off.
• 28:16
  Sandra Bargeron: And so you're undermethylating.
• 28:18
  Sandra Bargeron: But methylation is really important because if you undermethylate, it also impacts cellular inflammation and atherosclerosis.
• 28:26
  Sandra Bargeron: So you can develop coronary artery disease more like you're more likely to develop that if you have undermethylation.
• 28:33
  Sandra Bargeron: So it impacts a lot of things.
• 28:34
  Sandra Bargeron: Poor methylation early in life can influence your fertility.
• 28:39
  Sandra Bargeron: So if you have poor methylation early in life, you might struggle with infertility.
• 28:44
  Sandra Bargeron: It's linked to some things like PCOS and certainly.
• 28:48
  Mary Lee: Yeah, of course.
• 28:49
  Sandra Bargeron: And then certainly in the postmenopausal person, it becomes a lot more of an expression.
• 28:54
  Sandra Bargeron: We lose our resilience on every level as estrogen declines.
• 28:59
  Sandra Bargeron: So that's a DNA level.
• 29:01
  Sandra Bargeron: You know, we're talking about DNA there when we're talking about methylation.
• 29:05
  Sandra Bargeron: We lose our resilience in our brain, we lose our cardiovascular resilience.
• 29:09
  Sandra Bargeron: You'll see your HRV changes, like you know, hormones impact all systems that impact your overall resilience, which is why it's so important to talk about and why it influences anesthesia.
• 29:24
  Sandra Bargeron: So I now a little bit into the scientific explanation there.
• 29:28
  Sandra Bargeron: But the science is all we have is mechanistic or explanations on a mechanical level.
• 29:33
  Sandra Bargeron: Like we can explain the physiology because we don't haven't studied women properly.
• 29:39
  Sandra Bargeron: But what the point of it is, is that women and perimenopause are often overlooked in their recovery period because they're like, well, they're young and healthy.
• 29:48
  Sandra Bargeron: They're 40.
• 29:49
  Sandra Bargeron: When I see a 40-year-old in my OR table, I'm like, well, it's young and healthy.
• 29:53
  Sandra Bargeron: Thank God she's not 80, you know.
• 29:55
  Sandra Bargeron: But post-operatively, they're going to be resilient and they're not going to have a huge swing in their blood pressure.
• 30:01
  Sandra Bargeron: They're going to tolerate the anesthetic really well, is what we care about.
• 30:04
  Sandra Bargeron: But post-operatively, the ability to bounce back after surgery is certainly dropped drastically in that period of time.
• 30:13
  Sandra Bargeron: And for a woman who's in perimenopause and menopause, that 40-year-old woman, the thing about us is that we're dealing with our children and often aging parents.
• 30:24
  Sandra Bargeron: We're kind of the sandwich community, right?
• 30:26
  Sandra Bargeron: And we're working and we're trying to be a good spouse.
• 30:29
  Sandra Bargeron: And so when we experience the symptoms, they're not dementia, but they're post-operative cognitive dysfunction, which is what the name that the American Society of Anesthesiologists gives this.
• 30:42
  Sandra Bargeron: When there's this transient change in cognitive function, emotional health and stability, these types of things, that's got a name, the diagnosed, like an actual name.
• 30:52
  Sandra Bargeron: And when we experience it in our 40s while we're trying to do everything for everyone, those small changes make a big difference.
• 31:01
  Mary Lee: Just like you were saying with your mother-in-law, just did not feel herself or an act herself to those who knew her more up close and personally that something had shifted.
• 31:13
  Sandra Bargeron: Huge change.
• 31:14
  Sandra Bargeron: Personality.
• 31:15
  Sandra Bargeron: Personality was huge change.
• 31:17
  Sandra Bargeron: And that makes relationships harder.
• 31:20
  Sandra Bargeron: It strains relationships.
• 31:21
  Sandra Bargeron: It makes it harder to just keep your job.
• 31:25
  Sandra Bargeron: You know what I mean?
• 31:26
  Sandra Bargeron: Like it's significant.
• 31:29
  Sandra Bargeron: So it's an underlooked thing.
• 31:31
  Sandra Bargeron: So, you know, though we're not looking, we're not saying, hey, you know, the 40-year-old woman's gonna have dementia after surgery.
• 31:37
  Sandra Bargeron: We're not saying that.
• 31:39
  Sandra Bargeron: But her cognition is impacted.
• 31:40
  Sandra Bargeron: And the problem is if she mentions that she's not feeling right, who's listening to that?
• 31:47
  Sandra Bargeron: Is there anybody listening and validating her and saying that makes sense?
• 31:53
  Sandra Bargeron: Or is she going to her doctor and hearing, well, I don't know, you should be fine by now.
• 31:58
  Sandra Bargeron: Surgery went fine.
• 32:00
  Sandra Bargeron: I would say be, like most of the time.
• 32:03
  Sandra Bargeron: And it's a form of inadvertent gaslighting.
• 32:05
  Sandra Bargeron: It's not that the the practitioners over here, you know, they know and they're just pretending they don't, you know, they don't know.
• 32:12
  Sandra Bargeron: They don't realize that this is a significant challenge for a 40-year-old to 50-year-old and beyond woman.
• 32:20
  Sandra Bargeron: And they don't really have anything to offer.
• 32:23
  Sandra Bargeron: So even if they did know, what would they do?
• 32:25
  Sandra Bargeron: That's the next question.
• 32:27
  Sandra Bargeron: You know what I mean?
• 32:27
  Sandra Bargeron: So they the problem is this population gets overlooked a lot and almost gasped inadvertently, like I said, you know, and left going, well, I don't know.
• 32:38
  Sandra Bargeron: I guess just got grit my teeth and get through this, right?
• 32:41
  Sandra Bargeron: And meanwhile, their relationships are struggling and they're struggling at work, and maybe they're a business owner, you know, and they can't even keep the dynamics of their job intact, right?
• 32:51
  Sandra Bargeron: So it's a really important topic for quality of life for a woman going through perimenopause.
• 32:58
  Sandra Bargeron: And I would call perimenopause anything from 35 to 55.
• 33:03
  Sandra Bargeron: Yeah.
• 33:07
  Mary Lee: Yeah.
• 33:08
  Mary Lee: A third to a quarter of your life, a quarter to a third of your life for some.
• 33:12
  Sandra Bargeron: Yeah.
• 33:12
  Sandra Bargeron: That's and this isn't to scare people, it's just to actually to empower them, right?
• 33:17
  Sandra Bargeron: Disrupt to empower is how I yeah.
• 33:21
  Mary Lee: Cause a little bit of a ripple in the way women's health and medical science treats women because the lived experience is outweighing any data that we can collect.
• 33:32
  Mary Lee: But there's no money to invest in women's health.
• 33:35
  Mary Lee: And oftentimes pharmaceutical companies don't really benefit from investing in the research unless they have something to gain.
• 33:44
  Sandra Bargeron: What is the financial benefit to a pharmaceutical company in this realm?
• 33:48
  Sandra Bargeron: There isn't.
• 33:50
  Sandra Bargeron: If you're leaning on insurance and medicine to give you quality of life, you've drunk the wrong Kool-Aid.
• 34:00
  Sandra Bargeron: Yeah.
• 34:01
  Sandra Bargeron: This is not a critique.
• 34:03
  Sandra Bargeron: It has a role to play.
• 34:04
  Sandra Bargeron: And its job is to fix crucial and critical health crises, right?
• 34:11
  Sandra Bargeron: Even your primary care doctor, when they don't they look at you and they look at your labs and you're 35 years old and they're like, You look good, blood pressure's good, weight's good, everything's good, good job, keep going.
• 34:22
  Sandra Bargeron: You know, that's not optimizing health.
• 34:24
  Sandra Bargeron: That's like just keep doing what you're doing, you know, until your LDLs are a certain number and you try glycerizer through the roof and and you're you're like gaining a little weight, then they're like, you know, let's get you on some medicines, you know, but still not optimizing your health.
• 34:40
  Sandra Bargeron: So, you know, if you're the person that has the most skin in the game is also the person who has the most power to change the outcome, which is you, which is you.
• 34:51
  Mary Lee: Exactly.
• 34:52
  Mary Lee: That's the whole point is that you must take agency and be in control or advocate for your own health.
• 34:59
  Mary Lee: But that taking agency and implementing those lifestyle changes basically begins day one.
• 35:06
  Mary Lee: Uh, and even those lifestyle choices we make prior to perimenopause, carrying our stress load or just the bad eating habits.
• 35:13
  Mary Lee: Like I said, our nutrition might look good on paper, but in fact, it's horrible.
• 35:19
  Mary Lee: And that's gonna speak to gut health because we're slowly introducing toxins into the body that eventually it just erodes away at the gut, the leaky gut, it gets those toxins get into the system, and we have that gut-brain barrier.
• 35:33
  Mary Lee: So then that's gonna or the gut brain axis, and that ends up impacting brain health and impacts detoxification, hormone regulation, insulin resistance.
• 35:44
  Sandra Bargeron: Yes, like your gut influences all of that.
• 35:48
  Sandra Bargeron: So, like, you know, the one thing I say in my book, I have two chapters on diet, and the first rule is processed food.
• 35:55
  Sandra Bargeron: No, limit, you know, good, better, best.
• 35:59
  Sandra Bargeron: Of course, you know, if you're coming from eating McDonald's every night, then me saying don't eat any processed food, you'll be like, and I give up, you know, like, okay, well, it's good, better, best.
• 36:08
  Sandra Bargeron: Let's cut out the fast food and start cooking at home, even if that looks like ragu, right?
• 36:14
  Sandra Bargeron: It's not the best, but it's good.
• 36:16
  Sandra Bargeron: You're not doing McDonald's.
• 36:18
  Sandra Bargeron: You know, best looks like you actually, you know, process your own food.
• 36:23
  Sandra Bargeron: You get the raw vegetables, you make your own pot pie.
• 36:26
  Sandra Bargeron: You know what I mean?
• 36:27
  Sandra Bargeron: Like you cook from scratch, and and that does actually play a role because the enzymes in the food influence the enzymes in the gut.
• 36:36
  Sandra Bargeron: And that translates to hormone balance.
• 36:39
  Sandra Bargeron: It really goes sequentially that way.
• 36:41
  Sandra Bargeron: So, gut health and the brain, I mean, that is a well-established phenomenon.
• 36:46
  Sandra Bargeron: When your gut is a mess, so is your brain.
• 36:48
  Sandra Bargeron: It's the number one place where we start with gut with brain repair in my practice.
• 36:54
  Mary Lee: Okay.
• 36:54
  Mary Lee: You're very interesting.
• 36:55
  Mary Lee: Well, let's talk about your practice and exactly how you are well, your clientele.
• 37:01
  Mary Lee: I'm sure menopausal women are very much part of that, your clientele.
• 37:05
  Mary Lee: And exactly how you get them onto a lifestyle regime that is going to set them up for success, whether it's just continue on in quality of life, or in the off chance they need to go into surgery.
• 37:18
  Mary Lee: And sometimes that surgery is simple, like somebody needs to get a tooth extracted, but are horrified with dentists and want to go general anesthetic.
• 37:27
  Mary Lee: And that's my case in point too.
• 37:29
  Mary Lee: Luckily, I came out the other end relatively unscathed, but would I have ever thought about the risks?
• 37:35
  Mary Lee: No.
• 37:36
  Sandra Bargeron: You know, that's an interesting example to give because there are a couple of surgeries that I consider from a functional medicine perspective, like viewing it as a whole person, the microbiome, the level of stress on the cellular level, and how those impact the brain.
• 37:58
  Sandra Bargeron: There are a few surgeries that I consider shockingly risky for the brain.
• 38:04
  Sandra Bargeron: People, every all the studies show, you know, the obvious, like major surgery, open heart surgery and thoracic surgery, these types of things where we're actually controlling, like we're opening your chest.
• 38:14
  Sandra Bargeron: Of course, that's a high risk.
• 38:16
  Sandra Bargeron: But the dental, your oral microbiome influences your brain more than you know massively.
• 38:24
  Sandra Bargeron: Been hearing this lately.
• 38:25
  Sandra Bargeron: So when you have a disruption, you're maybe you have a cavity, maybe there's infection in the jaw, maybe there's some periodontal disease, and they go in and they start cleaning that up and showering the body with those bacteria, the brain takes a hit with that.
• 38:43
  Sandra Bargeron: And if it's under general anesthesia, it's double hit.
• 38:45
  Sandra Bargeron: Now we've got an infection hit, now we've got the immune disruption, now we got general anesthesia, medical pharmaceutical toxins or environmental stressures, you know, plus just the response.
• 38:57
  Sandra Bargeron: That bacterial load coming from the tooth is a big deal to the brain.
• 39:01
  Sandra Bargeron: The other one that's in the same because of the same reason is like kidney stones.
• 39:07
  Sandra Bargeron: How many old people do you know go in for kidney stones?
• 39:12
  Sandra Bargeron: I mean, our cystodase and anesthesia are stacked.
• 39:16
  Sandra Bargeron: We get 12 12 cases in a day.
• 39:18
  Mary Lee: Bam, bam, bam, bam, bam.
• 39:20
  Sandra Bargeron: Because they're stones or prostates or just fast cases, and most of them are stones.
• 39:25
  Sandra Bargeron: Well, the bacteria, and I've actually looked at this independently.
• 39:28
  Sandra Bargeron: This didn't make it my book because it's too nuanced, but I looked at the bacteria most commonly found and released during stone surgery, like kidney stone surgery.
• 39:38
  Sandra Bargeron: And they those bacteria independently cause cognitive dysfunction in the body by themselves.
• 39:44
  Sandra Bargeron: So now we're just go lasering them and just releasing them all over the body under general anesthesia.
• 39:50
  Sandra Bargeron: That's a actually a pretty significant event, not discussed well because why would we?
• 39:56
  Sandra Bargeron: We're not talking about open heart surgery, anesthesia's looking at critical care.
• 40:00
  Sandra Bargeron: But from a functional perspective, those two are underrecognized as kind of risky to the brain, surprisingly risky.
• 40:08
  Sandra Bargeron: But what was you had a question that I kind of piggybacked off of?
• 40:12
  Sandra Bargeron: I can't remember now, because I zeroed in on your oral surgery.
• 40:17
  Mary Lee: So when you when your clients come in and you start to work with them, well, first of all, would they come to see you for functional health medicine or pre-surgery preparation, or do you cover sort of the whole gamut?
• 41:16
  Sandra Bargeron: Yeah, so I do have a clinic.
• 41:17
  Sandra Bargeron: You know, we're trying to build out more systems of like programs and things so that it can access more people can have access faster.
• 41:25
  Sandra Bargeron: For me, I'm the bottleneck.
• 41:26
  Sandra Bargeron: Like I have a limited schedule and I only see certain people, but I'm a consultant, health consultant is what I call myself.
• 41:32
  Sandra Bargeron: So I basically see everything.
• 41:35
  Sandra Bargeron: It started with Lyme because my son, I got referred for for complex Lyme, horribly sick Lyme people, often hitting their getting hit hard when they hit perimenopause because now the reserve has gone down.
• 41:48
  Sandra Bargeron: So they've been fighting Lyme disease for 20 years and now their reserve is gone and now they can't get out of bed, right?
• 41:54
  Sandra Bargeron: And oh surprise, they had Lyme and they've had it for 20 years, you know, that kind of thing.
• 41:59
  Sandra Bargeron: But I've I take care of kind of anything that's related to cognitive brain health.
• 42:04
  Sandra Bargeron: So I've dealt with a lot of TBI, it's usually neurologic Lyme or even some early cognitive decline in older patients.
• 42:11
  Sandra Bargeron: So I have a kind of a big spectrum and then perioperative brain optimization and recovery.
• 42:18
  Sandra Bargeron: So I kind of cover all that.
• 42:20
  Sandra Bargeron: Okay.
• 42:21
  Mary Lee: So it obviously what you were seeing in the operating room in your clinic, this is what was the impetus to your book, Breakthrough Anesthesia Fog.
• 42:30
  Mary Lee: And you've shared a lot of the impetus to why you needed to get this information out.
• 42:36
  Mary Lee: And you've talked about neurological reserve.
• 42:38
  Mary Lee: Let's go back just to explain that to everyday language in the context of can uh perimenopause and menopausal women have any control over their neurological reserve?
• 42:51
  Sandra Bargeron: Absolutely.
• 42:52
  Sandra Bargeron: That's a great question.
• 42:53
  Sandra Bargeron: I think that's the most important question you can ask because it's physiologically what okay, let's let's just talk about what's reserve, an example somebody could take into account.
• 43:06
  Sandra Bargeron: How long does it take you to recover from an emotionally draining conversation?
• 43:13
  Sandra Bargeron: That's a good question, right?
• 43:15
  Sandra Bargeron: So you have a really big kind of emotionally intense conversation with someone, maybe your argument, maybe disagreement, maybe you know, but it's really important to you and it's a really intense conversation.
• 43:28
  Sandra Bargeron: How long does it take you to recover from that?
• 43:31
  Sandra Bargeron: If you miss a night of sleep, how long does it take you to recover from that feeling of death getting in sleep?
• 43:41
  Sandra Bargeron: If you drink alcohol, how long does it take you to recover from that?
• 43:47
  Sandra Bargeron: See what I'm saying?
• 43:48
  Sandra Bargeron: So these are like everyday stressors that we can encounter.
• 43:51
  Sandra Bargeron: Does it knock you off your feet?
• 43:52
  Sandra Bargeron: Do you bounce right back and have no problem?
• 43:55
  Sandra Bargeron: Like, answer that question, then that gives you kind of a concept of what's my reserve like?
• 44:01
  Sandra Bargeron: Does a lot of people, a lot of conversation, like too many people, too much noise, too much conversation, too much stimulation in the environment.
• 44:09
  Sandra Bargeron: Does it make you exhausted and have to go like go to your little happy place somewhere else?
• 44:15
  Sandra Bargeron: You know, that's also reserve.
• 44:17
  Sandra Bargeron: Like, that's how much how much capacity do you have to handle a whole lot of stimulation at one time?
• 44:23
  Sandra Bargeron: That is a picture of what neurologic reserve looks like on an everyday level.
• 44:28
  Sandra Bargeron: And so, yeah.
• 44:30
  Sandra Bargeron: So when we those give you insights into the fact that hi, when I was 20, I could go party at the club until 3 a.m., drink all night with all that noise and all those people.
• 44:41
  Sandra Bargeron: And the next day I'm asleep till seven, then I'm up and I'm going to the, I'm gonna go sightseeing.
• 44:46
  Sandra Bargeron: Like a 20 year old has a lot of reserve.
• 44:49
  Sandra Bargeron: I can't do that at 47 years old.
• 44:52
  Sandra Bargeron: Do you know what I mean?
• 44:53
  Sandra Bargeron: So there's obvious that's an awesome Obvious evidence of reserve, but reserve determines your ability to handle stressors.
• 45:02
  Sandra Bargeron: And if those are small stressors, and I consider anesthesia one of the strongest neurological stressors, then you can have a clue that, okay, I'm struggling with these little things.
• 45:13
  Sandra Bargeron: If I go under anesthesia, and it is the neurological stress test, then I could expect that I'm going to need some time for cognitive recovery.
• 45:24
  Sandra Bargeron: And how do we build that?
• 45:26
  Sandra Bargeron: Well, that has a lot to do with lifestyle diet.
• 45:29
  Sandra Bargeron: And again, it goes back to the NSRI.
• 45:31
  Sandra Bargeron: Where are you deficient?
• 45:33
  Sandra Bargeron: Are you on meds that are wiping out your vitamins?
• 45:37
  Sandra Bargeron: Because a lot of them, let's just list a couple, like you know, your antidepressants, they wipe out your B vitamins constantly, along with magnesia, a large percentage of them, and some more specifically.
• 45:47
  Sandra Bargeron: If you're on metformin for PCOS or insulin resistance, the first drug they usually give you, B12 is gone.
• 45:56
  Sandra Bargeron: CoQ10 is wiped out.
• 45:58
  Sandra Bargeron: Those things drive cellular energy and wipe those out long enough.
• 46:02
  Sandra Bargeron: You aren't methylating.
• 46:04
  Sandra Bargeron: Now we're cycling into a spiral down into poor resilience on a cellular level, DNA level, and on.
• 46:10
  Sandra Bargeron: Okay.
• 46:11
  Sandra Bargeron: So this is just talking about medications.
• 46:13
  Sandra Bargeron: What about your diet?
• 46:14
  Sandra Bargeron: Is your gut trashed?
• 46:16
  Sandra Bargeron: Are you even absorbing from your food?
• 46:19
  Sandra Bargeron: Are you eating foods that actually contain nutrients?
• 46:22
  Sandra Bargeron: Your processed foods are often depleted and don't contain what they should.
• 46:26
  Sandra Bargeron: Are you getting selenium so that your thyroid can work real well and it's protected through surgery?
• 46:32
  Sandra Bargeron: Right?
• 46:33
  Sandra Bargeron: Are you these are the questions that we ask and they become more important as we age because we can deal with nutritional deficiency for a while, but eventually it causes cellular dysfunction, which leads to disease.
• 46:47
  Sandra Bargeron: So that's where we're at when we hit perimenopause usually.
• 46:52
  Mary Lee: Okay, fantastic explanation.
• 46:54
  Mary Lee: This is information that needs to be in the hands of all surgeons, all medical clinics, even your GP, uh women.
• 47:03
  Mary Lee: Apart from podcasts like this one, and writing your book and having your programs in your clinic, how are you getting this information in front of the change makers or those who are in those positions of power that need to be able to first of all understand it, take it seriously, and then consult wisely with their patients of some of the uh implications or things to think about.
• 47:30
  Sandra Bargeron: Great question.
• 47:31
  Sandra Bargeron: Uh really to do to be able to do that, research is the key here.
• 47:35
  Sandra Bargeron: And and that's one of the it is the mission that drives Beyond Brain Health, which is separate from my practice, a different different business.
• 47:43
  Sandra Bargeron: Beyond Brain Health is what's building out everything else.
• 47:46
  Sandra Bargeron: My practice is an independent consulting practice.
• 47:49
  Sandra Bargeron: But what the mission of Beyond Brain Health is to change the infrastructure to support patients around surgery from all levels and ideally get them into this place where you're going to see the practitioners where the hospitals are engaging with this.
• 48:05
  Sandra Bargeron: But to do that, you have to have good research.
• 48:07
  Sandra Bargeron: So, what we actually were able to do was amazing.
• 48:10
  Sandra Bargeron: It was amazing.
• 48:11
  Sandra Bargeron: In March, end of February, for three weeks, I released the NSRI as a research window to kind of test the prototype and build it out and strengthen, catch things, engage the populate, engage the public with did these questions even make sense to you?
• 48:27
  Sandra Bargeron: Like, can you answer this really?
• 48:29
  Sandra Bargeron: How was that?
• 48:30
  Sandra Bargeron: I had like 2200 people fill out the NSRI in three weeks.
• 48:35
  Sandra Bargeron: It was amazing.
• 48:36
  Sandra Bargeron: And great feedback that I took back and we strengthened the tool and built, we actually added in about 16 more studies.
• 48:45
  Sandra Bargeron: From the feedback I got back, I got 60 more studies and backing the tool and strengthened it, captured more things, neuroinflammant inflammation like Lyme.
• 48:55
  Sandra Bargeron: I don't know how I missed that one of some with Lyme.
• 48:57
  Sandra Bargeron: I didn't ask those questions.
• 48:58
  Sandra Bargeron: Like, have you ever had Lyme disease?
• 49:00
  Sandra Bargeron: That would be important to you right now.
• 49:01
  Sandra Bargeron: But things like that.
• 49:03
  Sandra Bargeron: So we built that out and added all those additional studies.
• 49:07
  Sandra Bargeron: And right now it's continuing on as a data capture, but we took, we closed out the data aggregate for a study at almost 3,000 people.
• 49:20
  Sandra Bargeron: And that we closed it out beginning of July.
• 49:22
  Sandra Bargeron: So I took that cohort.
• 49:24
  Sandra Bargeron: We're still capturing data, and we're people are still have access to the NSRI and can do them anytime.
• 49:28
  Sandra Bargeron: But I took that cohort and basically have written a white paper and I've got some anesthesiologists, neuropsychologists, surgeons even reviewing all that data.
• 49:38
  Sandra Bargeron: So we have a proof of concept that's going to be published here very shortly.
• 49:42
  Sandra Bargeron: September is the goal.
• 49:43
  Sandra Bargeron: So that's our first stage.
• 49:46
  Sandra Bargeron: Our second stage is going to be really, it's really exciting because we're going to do prospective research.
• 49:52
  Sandra Bargeron: So, and we're putting it into an app that's going to help people be able to guide themselves through preparation and recovery.
• 49:59
  Sandra Bargeron: So we get the capture your neurologic resilience to start.
• 50:02
  Sandra Bargeron: We kind of give you some feedback on like here's what you can do on how to surgery, prompts and things like that.
• 50:08
  Sandra Bargeron: So it's going to be an app designed for that.
• 50:10
  Sandra Bargeron: And then post-operatively, to do good research, we need people to fill out an assessment three times, right?
• 50:17
  Sandra Bargeron: Like a one week, one month, three months, and six months.
• 50:21
  Sandra Bargeron: Okay, four times.
• 50:22
  Sandra Bargeron: And that actually gives us real pre and post data that can be published and validated.
• 50:27
  Sandra Bargeron: And why that matters is because the institutions that matter when it comes to change making in the practitioner world, they need research.
• 50:36
  Sandra Bargeron: We need validation.
• 50:37
  Sandra Bargeron: Otherwise, I'm just speculating based on mechanistic things, which is a lot of what we do in longevity medicine, unfortunately.
• 50:44
  Sandra Bargeron: We do predictive models, but we don't have any way of like, well, we segmented these people and we post and pre-we don't have a way to do that in longevity, which is, and we trust longevity science, right?
• 50:56
  Sandra Bargeron: Like we listen to Dr.
• 50:58
  Sandra Bargeron: Huberman, right?
• 50:59
  Sandra Bargeron: Ms.
• 51:00
  Sandra Bargeron: Andrew Huberman.
• 51:01
  Sandra Bargeron: We think he's great.
• 51:02
  Sandra Bargeron: I mean, his research is really good, but he doesn't have studies like that to prove longevity narratives that he puts out.
• 51:09
  Sandra Bargeron: And so my goal is to rise a little bit above that and be able to really have pre- and post-research.
• 51:17
  Sandra Bargeron: Um, and then we can measure if you're really active, you're engaging in this app and where you're doing some of those things.
• 51:23
  Sandra Bargeron: We can see how much modifying those things impacts your outcomes, right?
• 51:29
  Sandra Bargeron: So that that will change a lot.
• 51:31
  Sandra Bargeron: And that's the first level is kind of really getting that research in.
• 51:35
  Sandra Bargeron: And then the next the big phase stage-wise, we're giving out, we're creating online group coaching courses so people can have access to the information and have the supplements that they need in the nutrition and the guidance, and even answer some of the questions around hey, is am I is this surgery something I need to pay attention to a little bit more?
• 51:56
  Sandra Bargeron: Like the mouth surgery and the bladder, you know, kidney stone surgeries that people don't maybe don't think about.
• 52:03
  Sandra Bargeron: Surgery plays a role.
• 52:04
  Sandra Bargeron: Like, are you having open heart surgery or you're having a toe bunion surgery?
• 52:08
  Sandra Bargeron: Like that's a big difference.
• 52:10
  Sandra Bargeron: So, you know, and then the long term is like getting some practitioners certified so they understand the concept and they have a resilience tool to use, they have a way to optimize before the stressful event, and they're ready and they're skilled and they have the knowledge to do it.
• 52:28
  Sandra Bargeron: Because right now that's a huge missing gap, right?
• 52:30
  Sandra Bargeron: Again, we inadvertently gaslight people because we don't know.
• 52:34
  Sandra Bargeron: You know, I I mean, I'm sure early on my career when I was seeing post-operative patients that I did that.
• 52:41
  Sandra Bargeron: I'm sure that I did.
• 52:43
  Sandra Bargeron: I'm sure that I was like, well, it's just the anesthesia, that'd be fine, yeah.
• 52:46
  Sandra Bargeron: You know, just dismissing what was actually a real thing that could have been optimized.
• 52:52
  Sandra Bargeron: Of course, I didn't have any formation back then.
• 52:54
  Sandra Bargeron: But so the goal is really empowering the patient, empowering the practitioner and changing the system.
• 53:00
  Sandra Bargeron: It's a big bold plan, but that's what we're doing.
• 53:04
  Mary Lee: Undertaking, huge undertaking, but it starts with one voice at a time, and somebody who's willing to put their hat in the ring and do that research and pursue this to get the answers, largely because it begins with a personal story, like you shared, your mother-in-law, the Lyme's disease with your son, and then just going through our own journey of menopause and saying, This just something's not right here, but I don't have the data to support it, but I've got the lived experience.
• 53:33
  Mary Lee: Thank goodness we live in a time where we can have podcasts like this to share that information.
• 53:38
  Mary Lee: Think about getting on the Huberman lab and just telling him Andrew.
• 53:41
  Mary Lee: Let's talk about your longevity hypothesis.
• 53:44
  Mary Lee: Have you actually proven it right or wrong?
• 53:47
  Sandra Bargeron: Yeah, right.
• 53:47
  Sandra Bargeron: Oh, I want to go against the guy who's like got a gazillion followers, but the reality is like science isn't bad, but it's not validated science, right?
• 53:56
  Sandra Bargeron: It's emerging, emerging science not doesn't mean it's wrong.
• 54:00
  Sandra Bargeron: Just it's just emerging where you know, when we have something like a stress event that we can measure against, so we know what your resilience is, we have a stress event, we can like really determine do these things that we actually do to our our health and lifestyle strengthen or help or hurt or do nothing, right?
• 54:20
  Mary Lee: Yeah.
• 54:21
  Mary Lee: What you just said it just made me think of a question I wanted to ask too, and which is one of the draws that brought you to this podcast.
• 54:30
  Mary Lee: And it was on my episode about concussion, and I've spoken a couple of times about the nuance between PTSD, concussions, brain health.
• 54:37
  Mary Lee: I can spend a long time talking to you about it.
• 54:39
  Sandra Bargeron: That trajectory is a huge thing.
• 54:41
  Mary Lee: A concussion, a brain injury, again, a stressor, one that cannot be controlled.
• 54:47
  Mary Lee: TBIs do not discriminate, it can happen to anybody.
• 54:51
  Mary Lee: Right.
• 54:51
  Mary Lee: So I'm sure that's on the the questionnaire for the neurological stress recovery index, your NSRI.
• 54:59
  Mary Lee: If we have just a little bit of time to address that.
• 55:03
  Sandra Bargeron: That's actually one of the groups that is near and dear to my heart because for two reasons.
• 55:10
  Sandra Bargeron: One, there are two types of traumatic brain injuries.
• 55:13
  Sandra Bargeron: One is a physical traumatic brain injury, a concussion.
• 55:18
  Sandra Bargeron: Acquired it's an acquired physical injury, or it's a traumatic physical injury.
• 55:25
  Sandra Bargeron: The other is an acquired, which is what you said.
• 55:28
  Sandra Bargeron: Acquired injury, which could be from being a meth addict or from repetitive abuse, like verbal, emotional abuse through childhood.
• 55:39
  Sandra Bargeron: That can actually change, change the brain.
• 55:42
  Sandra Bargeron: More definitively and more well-researched is like the chemical injuries, the chemical brain injuries.
• 55:48
  Sandra Bargeron: Those are acquired, they're considered acquired, but they cause similar changes in the brain as a literal concussion, that blackout concussion that is considered TBI.
• 55:58
  Sandra Bargeron: So we have a chemical and a traumatic brain injury.
• 56:03
  Sandra Bargeron: And anesthesia, kind of in that realm, because of what happens, because under surgery, it's chemical, and then all the immune shifts, all the hormone shifts that occur, not just the drug itself, pose itself, it is itself a chemical stress test, a chemical brain injury.
• 56:20
  Sandra Bargeron: It's actually why in the literature we quantify how many times somebody has had anesthesia.
• 56:27
  Sandra Bargeron: How many times they have it determines how likely they are to have risk for dementia.
• 56:31
  Sandra Bargeron: More and more surgery, higher risk for dementia, because it's like having multiple TBIs.
• 56:37
  Sandra Bargeron: So that's number one.
• 56:38
  Sandra Bargeron: And number two, to your point, yes, the traumatic brain injuries are actually, we specifically quantify even like, did you get hit from a surprise hit?
• 56:48
  Sandra Bargeron: Did you blackout?
• 56:49
  Sandra Bargeron: Like how severe we actually measure all that in the NSRI, because it creates sort of a bottleneck.
• 56:55
  Sandra Bargeron: If you know, I can't fix a scarred brain, but I can optimize all the domains extra.
• 57:02
  Sandra Bargeron: Like, so you've got a traumatic brain injury while your sleep and neural and your sleep, your medication burden, your metabolic health, your social health, your brain and social health.
• 57:11
  Sandra Bargeron: We, if we can get those as strong as we can before surgery protecting the brain.
• 57:17
  Sandra Bargeron: But why this is so important to me is because I have a dad who was in the military.
• 57:21
  Sandra Bargeron: He was a special forces guy.
• 57:23
  Sandra Bargeron: And in the military, there's two groups that really get double hits here: the military and contact sports, professional sports.
• 57:32
  Sandra Bargeron: Both of those populations, one have higher TBIs, and two have higher surgeries.
• 57:39
  Sandra Bargeron: Both get injured more often with their brain and both have to undergo surgery more because of the nature of their profession.
• 57:47
  Sandra Bargeron: You know, the athletes over here are getting tackled and he's ripping his ACL and he has to have surgery.
• 57:52
  Sandra Bargeron: And again, another surgery for realizing a meniscus, and then another surgery for a shoulder.
• 57:57
  Sandra Bargeron: And meanwhile, he's getting hit after hit after hit.
• 57:59
  Sandra Bargeron: Same thing with the military guy.
• 58:01
  Sandra Bargeron: They get blast concussions a lot.
• 58:03
  Sandra Bargeron: Maybe they don't get thrown off the, you know, the airplane or whatever.
• 58:09
  Sandra Bargeron: Maybe they don't get a major physical fall, but they get blast concussions, which are known to cause a similar type of injury.
• 58:16
  Sandra Bargeron: And then they have to have surgery because of the nature of their jet and wear and tear and all the things that soldiers go through.
• 58:22
  Sandra Bargeron: They end up having more surgery than most as well.
• 58:25
  Sandra Bargeron: So those two are actually in a very unique category of high risk.
• 58:29
  Sandra Bargeron: And why I really want this to be something that is implemented across those areas.
• 58:35
  Sandra Bargeron: Specifically, I know this is fall into the menopause, but they women are in the military too.
• 58:40
  Sandra Bargeron: You know, women's sports is a big deal too.
• 58:42
  Sandra Bargeron: So now you got a pair of menopause or woman playing soccer, you know.
• 58:46
  Sandra Bargeron: Oh my gosh.
• 58:47
  Mary Lee: So special ops woman in her 40s.
• 58:50
  Mary Lee: They happen, yeah.
• 58:51
  Mary Lee: But she's still going into on the front line.
• 58:55
  Sandra Bargeron: Correct.
• 58:55
  Sandra Bargeron: So, yeah, so this is certain certainly is its own category of high risk and one that deserves more research, which is why I look forward to the data that I can capture as people come through and do the full, you know, app and pre and post, and I can stratify it on these types of categories.
• 59:15
  Sandra Bargeron: Like, are you a person who's getting injured?
• 59:17
  Sandra Bargeron: Do you have a lot of traumatic brain injury?
• 59:18
  Sandra Bargeron: Like, what kind of sports do you?
• 59:19
  Sandra Bargeron: I can kind of do some moral research on that and fill in some of the research gaps there.
• 59:24
  Sandra Bargeron: And maybe there are special things we need to do to strengthen that.
• 59:28
  Sandra Bargeron: Right now, we're focused on overall neurologic resilience of neurologic.
• 59:31
  Sandra Bargeron: But maybe they need more, I don't know, something else, more hydration, more electrolytes, more minerals, more, you know, those types of things.
• 59:41
  Sandra Bargeron: Ketones, ketones.
• 59:44
  Mary Lee: Yeah.
• 59:44
  Mary Lee: Wow.
• 59:45
  Mary Lee: We could talk about things, factors that we can do to improve brain health in so many ways from our nutrition to supplements to exercise, resilience training.
• 59:53
  Mary Lee: I'm gonna bring you back.
• 59:54
  Mary Lee: I because when you crack that nut open with the concussions and brain injuries and go down that rabbit hole in the in the research, I would love, love, love to learn more and share that on this podcast.
• 1:00:07
  Mary Lee: For sure.
• 1:00:08
  Mary Lee: We've taken in a lot, a lot of science.
• 1:00:11
  Mary Lee: I love science, especially when it comes to the brain, because the fact that I have had three concussions when I was a child, and oral surgery when I was well about five years ago.
• 1:00:24
  Mary Lee: So I'm really getting a little bit worried for my brain health.
• 1:00:28
  Sandra Bargeron: Yeah.
• 1:00:28
  Sandra Bargeron: Well, the goal isn't worry.
• 1:00:30
  Sandra Bargeron: I think if you're doing those podcasts, you're already kind of doing more optimization than the average person because you have a little bit more knowledge.
• 1:00:37
  Sandra Bargeron: I mean, you're interviewing probably the experts here in a lot of fields, so I'm sure you're I'm sure you're doing a lot of the right things.
• 1:00:44
  Mary Lee: So yes, and you know, it is mentally stimulating to sit down with the experts in the field and then take in what they share.
• 1:00:52
  Mary Lee: And I feel my purpose, because I have science communication for so many years, is just to take in all of that from the experts and deliver it to the public and allow them to listen to it and see if it applies and exercise some discernment.
• 1:01:06
  Mary Lee: But most importantly, we've said this a few times, is that empowerment piece.
• 1:01:10
  Mary Lee: Don't wait for the research to back up your lived experience.
• 1:01:14
  Mary Lee: Go forth and start advocating and taking those lifestyle changes that put you back in a driver's seat and giving you that level of control so that you can have quality of life.
• 1:01:25
  Mary Lee: And what is quality of life?
• 1:01:27
  Sandra Bargeron: Whatever that looks like for you.
• 1:01:28
  Sandra Bargeron: Yeah.
• 1:01:28
  Sandra Bargeron: For you, yeah.
• 1:01:29
  Sandra Bargeron: You know, you I'm not going to spend too long, but you made a really great point.
• 1:01:33
  Sandra Bargeron: And it's actually a good thing to leave people with something actionable.
• 1:01:37
  Sandra Bargeron: And one of the things that you just said was that you're really, it's like really stimulating, neurologically stimulating for you to interview all these people and learn new information.
• 1:01:47
  Sandra Bargeron: It's actually a studied piece of the NSRI, it's in the in the domain of brain and social health.
• 1:01:53
  Sandra Bargeron: We ask, do you speak more than one language?
• 1:01:57
  Sandra Bargeron: Do you play an instrument?
• 1:01:58
  Sandra Bargeron: These things actually have an impact on neuroresilience.
• 1:02:02
  Sandra Bargeron: And I kind of make a joke in chapter three or four, I leave people with like a word search because really reading my book is challenging to people to challenge their paradigm, challenge their thinking, and it's learning something new.
• 1:02:17
  Sandra Bargeron: And learning something new builds new neurons.
• 1:02:20
  Sandra Bargeron: It really does.
• 1:02:21
  Sandra Bargeron: Doing something hard builds new neurons.
• 1:02:24
  Sandra Bargeron: It's a known fact function of neuroplasticity.
• 1:02:27
  Sandra Bargeron: So, you know, taking the effort to learn about your health at a deeper level is not only good to advocate for yourself, but it's actually neuroprotective.
• 1:02:39
  Sandra Bargeron: You're doing something hard, you're learning something new, you're building neuroplasticity in the process of doing that learning.
• 1:02:45
  Sandra Bargeron: So do that today.
• 1:02:47
  Sandra Bargeron: Like read read a new book.
• 1:02:49
  Sandra Bargeron: Don't scroll on Instagram in the evening.
• 1:02:51
  Sandra Bargeron: Do something that challenges you, whether it's read an article or you know, challenge your paradigm or learn how to play chess.
• 1:02:58
  Sandra Bargeron: You know.
• 1:03:01
  Mary Lee: Well, you've ended it on a great note about your book.
• 1:03:03
  Mary Lee: Go out and read Sandra's book, Dr.
• 1:03:05
  Mary Lee: Bergeron's book.
• 1:03:07
  Mary Lee: So let our listeners know where they can find your book and where they can find where you work.
• 1:03:13
  Mary Lee: All of the above.
• 1:03:14
  Sandra Bargeron: Yeah, so uh I'm at Beyond Brain Health on almost all platforms.
• 1:03:18
  Sandra Bargeron: I'm pretty sure it's even on Substack at Beyond Brain Health.
• 1:03:21
  Sandra Bargeron: So if you look at look at at Beyond Brain Health, you'll find me on YouTube, Instagram, Facebook, Substack, LinkedIn.
• 1:03:27
  Sandra Bargeron: I'm Sandra Bargeron.
• 1:03:29
  Sandra Bargeron: And my website's Beyond Brain Health.
• 1:03:31
  Sandra Bargeron: So it's super simple.
• 1:03:32
  Sandra Bargeron: Everything's Beyond Brain Health.
• 1:03:34
  Sandra Bargeron: And you can find a lot of research there.
• 1:03:36
  Sandra Bargeron: We do a weekly, you know, neuror resilience trust tip in our newsletter.
• 1:03:42
  Sandra Bargeron: So you can get plugged into that and get some actual action steps to strengthen your neurologic resilience and do that.
• 1:03:49
  Sandra Bargeron: But it's not a spammy email.
• 1:03:50
  Sandra Bargeron: It's really here's one thing you can do.
• 1:03:53
  Sandra Bargeron: You know, go forth and strengthen your brain, you know.
• 1:03:55
  Sandra Bargeron: But that that's where you can find me.
• 1:03:58
  Sandra Bargeron: And the book is on Amazon.
• 1:04:00
  Sandra Bargeron: I did self-publish, so you can find me at Beyond Brain Health, uh, or actually uh Breakthrough Anesthesia Fog is the name of the book.
• 1:04:09
  Sandra Bargeron: It will be available on audio uh books here in the next few weeks.
• 1:04:14
  Sandra Bargeron: I've been keep hearing it's gonna be next week, next week, but I'm pretty sure it's coming in the next two weeks.
• 1:04:19
  Sandra Bargeron: So I can Kindle, print, and audiobook.
• 1:04:23
  Sandra Bargeron: Oh my goodness.
• 1:04:24
  Sandra Bargeron: Are you the narrator of the book?
• 1:04:25
  Sandra Bargeron: I'm not, but I found somebody who sounds pretty close to me.
• 1:04:29
  Sandra Bargeron: So wonderful.
• 1:04:30
  Sandra Bargeron: Yeah, it was the bottleneck of time to get it done.
• 1:04:33
  Mary Lee: So I hired a voice actor.
• 1:04:36
  Mary Lee: That is so impressive.
• 1:04:37
  Mary Lee: Oh my goodness.
• 1:04:38
  Mary Lee: Well, we'll get all those links in the show notes below.
• 1:04:40
  Mary Lee: And also, I'm gonna have to pick your brain about self-publishing because I've got so many book ideas started, almost finished on the go.
• 1:04:49
  Mary Lee: And then it comes to that sharing to the public, and that that's what I find daunting.
• 1:04:53
  Mary Lee: Oh, it is daunting.
• 1:04:55
  Mary Lee: So thank you so much for sharing your expertise, your knowledge, your passion, and coming onto the show and just giving it another lens to which we should look at our health.
• 1:05:07
  Mary Lee: And the brain health being one thing, but just what happens to the brain when additional stressors are loading it, and then we have to go into a surgery of some of some sort.
• 1:05:18
  Mary Lee: Yeah.
• 1:05:18
  Mary Lee: What I learned is just forgive the pun, but it's intended, it blows my mind away.
• 1:05:23
  Mary Lee: It really does.
• 1:05:23
  Mary Lee: So I'm so yeah, so thank you.
• 1:05:27
  Sandra Bargeron: Awesome.
• 1:05:28
  Sandra Bargeron: Well, thanks for having me.
• 1:05:29
  Sandra Bargeron: I enjoyed the time.