Latest / Clearly Hormonal / Menopause Society Conference Recap: Why Midlife Care Must Be Individualized

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Menopause Society Conference Recap: Why Midlife Care Must Be Individualized · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society Certified Practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:48
  Dr. Komal Patil-Sisodia: A quick disclaimer.
• 0:49
  Dr. Komal Patil-Sisodia: I'm a physician, but this is education, not personalized medical advice.
• 0:53
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:03
  Dr. Komal Patil-Sisodia: This episode is a day late, and it's because I was trying to put my thoughts together about all of the stuff that I learned at the Menopause Society meeting last week in San Diego.
• 1:12
  Dr. Komal Patil-Sisodia: I wanted to share what I am bringing back to my clinic and to my patients.
• 1:16
  Dr. Komal Patil-Sisodia: But before we get into the science, I want to talk about the general atmosphere of the conference.
• 1:25
  Dr. Komal Patil-Sisodia: I think it's safe to say that women's health is having a moment.
• 1:28
  Dr. Komal Patil-Sisodia: It's been having a moment for the past five to six years, and in the resurgence of interest around women's health, there have been a lot of opposing viewpoints and polarization around what the next best step is for women.
• 1:47
  Dr. Komal Patil-Sisodia: And here are my thoughts as an endocrinologist, because I see this regularly in my patients.
• 1:52
  Dr. Komal Patil-Sisodia: I see it in the context of their metabolic disease.
• 1:56
  Dr. Komal Patil-Sisodia: There is no one-size-fits-all solution for all women.
• 2:01
  Dr. Komal Patil-Sisodia: We are going to have to have clinically nuanced discussions, meaning very individualized to you when you go in to see your doctor about what you may be going through in midlife.
• 2:12
  Dr. Komal Patil-Sisodia: My menopause will not look like your menopause, will not look like the menopause of the person walking down the street.
• 2:18
  Dr. Komal Patil-Sisodia: Now, the hard thing is when you go to a scientific conference, they are presenting the data that they have at this point in time.
• 2:25
  Dr. Komal Patil-Sisodia: And there is data that we see in studies, but there's also clinical nuance and understanding that we may not have data for some things yet, but we've seen patterns in the way that we practice, that with an appropriate conversation based on the data that we do have and somebody's personalized risk, we can make an individualized decision for them.
• 2:47
  Dr. Komal Patil-Sisodia: It was interesting to see the posts after the conference that were circulating on social media.
• 2:53
  Dr. Komal Patil-Sisodia: Some felt that there was no clinical nuance.
• 2:56
  Dr. Komal Patil-Sisodia: Some felt that there was not enough science.
• 2:59
  Dr. Komal Patil-Sisodia: Some felt that stages and platforms were being given to people who were pushing controversial ideas.
• 3:06
  Dr. Komal Patil-Sisodia: It was all over the place.
• 3:07
  Dr. Komal Patil-Sisodia: I think I saw somebody post, and I can't remember who it was but, they said on their social media post,"It was like being invited to somebody's awkward family dinner and not knowing any of the drama that went down." So what I will say is there was some good science at this meeting.
• 3:26
  Dr. Komal Patil-Sisodia: We still need to apply clinical nuance to every conversation we have with women around midlife health, and we need to look at symptoms and what the goals of care are going to be before we make a treatment decision.
• 3:37
  Dr. Komal Patil-Sisodia: It's never gonna be one size fits all.
• 3:39
  Dr. Komal Patil-Sisodia: So now let's get into what I heard at the conference.
• 3:42
  Dr. Komal Patil-Sisodia: There was a lot of discussion around hormones.
• 3:45
  Dr. Komal Patil-Sisodia: There was great discussion around heart health, and that made me really happy because it's one of the reasons why I started this podcast.
• 3:52
  Dr. Komal Patil-Sisodia: We talked about bone loss, sleep, mood, sexual health, and support women need to get care.
• 3:59
  Dr. Komal Patil-Sisodia: And those conversations all went really well.
• 4:01
  Dr. Komal Patil-Sisodia: I thought it was great that we talked about so many different things at the conference because all of those conversations belong together.
• 4:08
  Dr. Komal Patil-Sisodia: If you are tired, waking up through the night, and struggling to feel like yourself, one symptom can affect the next and a treatment plan that you develop with your healthcare team has to account for all of that.
• 4:19
  Dr. Komal Patil-Sisodia: And as a hormone specialist, I pay attention to what changes during the menopause transition, as do so many of my colleagues.
• 4:26
  Dr. Komal Patil-Sisodia: As an obesity medicine specialist, I'm also thinking about muscle and body fat and blood sugar and long-term health.
• 4:33
  Dr. Komal Patil-Sisodia: And then as a menopause practitioner, I want to know what all of this means for the person that's sitting in front of me, what is affecting her life, what can we actually treat safely, and what do we need to look into further?
• 4:44
  Dr. Komal Patil-Sisodia: So today, I'm going to walk through the different themes of the conference that stood out to me.
• 4:49
  Dr. Komal Patil-Sisodia: I'll try and explain where the evidence is strong, where it's still developing and we still need to do more research, and then what questions you can bring to your own visit when you meet with your doctor.
• 5:02
  Dr. Komal Patil-Sisodia: One point before we start, though.
• 5:04
  Dr. Komal Patil-Sisodia: A talk at a medical meeting can include new research, established guidelines, and the speaker's own ideas and thoughts about how menopausal care should be, and those are all different kinds of information.
• 5:17
  Dr. Komal Patil-Sisodia: And I will keep those differences as clear as possible as we go along because there was a good mix of all three when people were up on that stage.
• 5:26
  Dr. Komal Patil-Sisodia: And this episode is for education, so I want you all to remember that your own treatment choices will depend on your health history, your symptoms, and your goals.
• 5:36
  Dr. Komal Patil-Sisodia: Let's start with a common concern.
• 5:38
  Dr. Komal Patil-Sisodia: My body feels different, and I don't understand why.
• 5:41
  Dr. Komal Patil-Sisodia: Maybe your clothes fit differently even though your weight has barely changed, or the scale's gone up and you're wondering what happened.
• 5:48
  Dr. Komal Patil-Sisodia: When that happens, I want to understand more than just your number on the scale.
• 5:52
  Dr. Komal Patil-Sisodia: I want to know what is changing in your body, how you feel, and what you are able to do.
• 5:58
  Dr. Komal Patil-Sisodia: One of the talks at the conference reviewed SWAN, which is the study of women's health across the nation.
• 6:04
  Dr. Komal Patil-Sisodia: This study follows women through midlife and has taught us a lot about the menopause transition.
• 6:10
  Dr. Komal Patil-Sisodia: Researchers found that body fat can increase while lean tissue, like muscle, decreases.
• 6:16
  Dr. Komal Patil-Sisodia: Where we store fat changes, too, and these shifts can be bigger than the change that we see on the scale.
• 6:22
  Dr. Komal Patil-Sisodia: These are patterns that we see across groups of women, but it does not mean that everyone will have the same experience.
• 6:28
  Dr. Komal Patil-Sisodia: The patterns can also change depending on what type of racial or ethnic group you come from.
• 6:33
  Dr. Komal Patil-Sisodia: So if your body weight has barely moved, this does not rule out changes in your body composition, And knowing those changes can happen doesn't tell us exactly what is happening in your body.
• 6:45
  Dr. Komal Patil-Sisodia: We still need to listen and assess your situation, and that includes asking about strength and daily function.
• 6:51
  Dr. Komal Patil-Sisodia: Can you climb stairs comfortably?
• 6:54
  Dr. Komal Patil-Sisodia: Can you carry what you need to carry?
• 6:56
  Dr. Komal Patil-Sisodia: Can you get up from a chair?
• 6:57
  Dr. Komal Patil-Sisodia: Your answers matter alongside your weight, your symptoms, and your health measures.
• 7:01
  Dr. Komal Patil-Sisodia: And if weight loss is a part of your care, I generally recommend that that plan supports muscle and bone too.
• 7:09
  Dr. Komal Patil-Sisodia: We should discuss nutrition and strength from the start, and then follow along how you're doing.
• 7:14
  Dr. Komal Patil-Sisodia: Losing weight is only one part of the goal.
• 7:17
  Dr. Komal Patil-Sisodia: Bone is a part of the same conversation because bone loss can speed up before your last menstrual period In the SWAN presentation, the fastest bone loss happened from about one year before the final menstrual periods to two years after it.
• 7:32
  Dr. Komal Patil-Sisodia: Both lower bone density and faster bone loss were linked to fractures later in life.
• 7:37
  Dr. Komal Patil-Sisodia: And that tells me we should be discussing bone health during the transition rather than waiting for a fracture to start the conversation.
• 7:44
  Dr. Komal Patil-Sisodia: As an endocrinologist, this hits home for me.
• 7:46
  Dr. Komal Patil-Sisodia: I have seen several women in my practice who have their final menstrual period somewhere in the 40s, and the current guidelines by the USPSTF don't recommend getting a bone density scan until 65.
• 8:00
  Dr. Komal Patil-Sisodia: That's 20 some odd years of waiting for osteoporosis to develop and worsen.
• 8:05
  Dr. Komal Patil-Sisodia: And a lot of women that I proactively screen who are postmenopausal in their 40s already have osteopenia or osteoporosis at that time.
• 8:15
  Dr. Komal Patil-Sisodia: So we can start that conversation a lot earlier.
• 8:18
  Dr. Komal Patil-Sisodia: There were exercise talks at the conference that helped connect those findings to how we should implement them into daily care.
• 8:25
  Dr. Komal Patil-Sisodia: Strength training can help build strength, aerobic exercise support your fitness, balance work and activities that are safely loading your bones will also have a role.
• 8:35
  Dr. Komal Patil-Sisodia: And we can choose activities based on your symptoms, your current fitness level, and your bone health in mind.
• 8:41
  Dr. Komal Patil-Sisodia: We have to be really careful, about giving somebody a one size fits all recommendation when everybody's bodies are built slightly differently.
• 8:49
  Dr. Komal Patil-Sisodia: If you are just starting out, the right program will depend on what your current ability is, what types of health conditions you have, and what your fracture risk is.
• 8:59
  Dr. Komal Patil-Sisodia: If you've never worked out, we're not gonna send you to CrossFit.
• 9:02
  Dr. Komal Patil-Sisodia: We're gonna recommend that maybe you strength train a few times a week, start with walking, and then slowly incorporate more activity as you're able to.
• 9:11
  Dr. Komal Patil-Sisodia: If sleep or pain are getting in the way, we also need to address that.
• 9:15
  Dr. Komal Patil-Sisodia: So where do hormones fit into this?
• 9:16
  Dr. Komal Patil-Sisodia: Hormone therapy can help protect bone in appropriate patients.
• 9:21
  Dr. Komal Patil-Sisodia: It's not a main treatment for weight loss, and a speaker's proposal to give every woman a bone scan during perimenopause is not an established screening rule.
• 9:30
  Dr. Komal Patil-Sisodia: That was said on stage, and I had some issues with that.
• 9:33
  Dr. Komal Patil-Sisodia: Each part of the plan needs a clear reason, and I gave you my rationale for when I check a bone density scan.
• 9:39
  Dr. Komal Patil-Sisodia: At follow-up, I want to know more than whether the scale has changed.
• 9:43
  Dr. Komal Patil-Sisodia: So how is your strength?
• 9:44
  Dr. Komal Patil-Sisodia: Are you eating enough to support your needs?
• 9:46
  Dr. Komal Patil-Sisodia: Are symptoms making it difficult for you to stay active?
• 9:50
  Dr. Komal Patil-Sisodia: Those questions will help us adjust your plan as a whole.
• 9:54
  Dr. Komal Patil-Sisodia: That brings us to a question I hear often.
• 9:56
  Dr. Komal Patil-Sisodia: Would hormone therapy help me?
• 9:58
  Dr. Komal Patil-Sisodia: And to answer it, we need to put symptoms, bone health, medical history, and treatment goals all into the same conversation.
• 10:06
  Dr. Komal Patil-Sisodia: That's really hard to do in a 15-minute visit.
• 10:10
  Dr. Komal Patil-Sisodia: The FDA presentation looked at changes to menopause hormone therapy labels.
• 10:15
  Dr. Komal Patil-Sisodia: Some language about heart disease, breast cancer, and dementia was removed from the black box warning, which is the most prominent warning label on a drug.
• 10:24
  Dr. Komal Patil-Sisodia: Information about heart disease and breast cancer risk still appears somewhere else on the labels for treatments.
• 10:30
  Dr. Komal Patil-Sisodia: A change in the warning language doesn't mean that all of the risks of hormone therapy have disappeared, and I think this was a big concern for everybody who was at the conference or speaking at the conference.
• 10:41
  Dr. Komal Patil-Sisodia: It should help us have clearer conversations about risks and benefits, but should not be used as a blanket statement that hormones are safe for everyone.
• 10:49
  Dr. Komal Patil-Sisodia: Hormone therapy can actually be a very useful option for symptoms like hot flashes.
• 10:54
  Dr. Komal Patil-Sisodia: It can also help protect bone in certain patients, but the decision to use it depends on your age, your health history, your symptoms, and the time it's been since menopause.
• 11:05
  Dr. Komal Patil-Sisodia: We also need to be clear about what types of treatments exist.
• 11:08
  Dr. Komal Patil-Sisodia: Hormones that act through the body, which we call systemic, are different from low dose vaginal estrogen, which is just used for local symptoms like vaginal dryness and pelvic floor.
• 11:21
  Dr. Komal Patil-Sisodia: The risks and the uses are not identical, even though the hormones may be similar, because there are different doses and different ways that they affect your body And the question is, what are we hoping this treatment will help you do or feel?
• 11:36
  Dr. Komal Patil-Sisodia: Maybe you want fewer night sweats so you can sleep.
• 11:39
  Dr. Komal Patil-Sisodia: Maybe dryness is making sex super painful.
• 11:42
  Dr. Komal Patil-Sisodia: Those concerns deserve specific treatment choices, and we should be honest about the limits of treatment.
• 11:48
  Dr. Komal Patil-Sisodia: Hormone therapy, is not a main treatment for weight loss, and evidence that it relieves symptoms does not mean that it prevents heart disease or dementia.
• 11:57
  Dr. Komal Patil-Sisodia: Your history can change the advice, however.
• 12:00
  Dr. Komal Patil-Sisodia: Losing your ovarian function very early in life is very different than reaching menopause at the usual age.
• 12:06
  Dr. Komal Patil-Sisodia: And a history of breast cancer can change your treatment choices too.
• 12:10
  Dr. Komal Patil-Sisodia: So if you're looking online and you're seeing all these broad sweeping claims, that's not individualized to you, and we need to be sure that you're not missing the details of your own health when you're making a treatment decision with your doctor.
• 12:25
  Dr. Komal Patil-Sisodia: If hormones aren't a good fit for you or you prefer another option because you don't want to take hormones, there are treatments that are non-hormonal for hot flashes.
• 12:33
  Dr. Komal Patil-Sisodia: There are some newer medications that work on the brain's temperature control regulation, and they have their own risks and may need some blood tests and monitoring for liver function.
• 12:45
  Dr. Komal Patil-Sisodia: But having more options is useful, and choosing among them should be a conversation with room for whatever your questions are and what your preferences are going to be Sleep came up a lot through the meeting, and for good reason.
• 12:59
  Dr. Komal Patil-Sisodia: When you are waking up all night, it can be hard to think clearly or get through the day.
• 13:03
  Dr. Komal Patil-Sisodia: If hot flashes are waking you up, treating them may help, but we should not assume every sleep problem comes from menopause.
• 13:11
  Dr. Komal Patil-Sisodia: If you still can't sleep after the hot flashes improve, you need to take another look with your doctor.
• 13:16
  Dr. Komal Patil-Sisodia: So looking at ongoing insomnia or sleep apnea may need a sleep evaluation or a sleep study.
• 13:22
  Dr. Komal Patil-Sisodia: And sleep apnea is pretty common in women.
• 13:24
  Dr. Komal Patil-Sisodia: I think it's estimated that up to 80% of women who have sleep apnea don't know that they have it.
• 13:30
  Dr. Komal Patil-Sisodia: And it can show up as fatigue, morning headaches, difficulty concentrating, and snoring.
• 13:35
  Dr. Komal Patil-Sisodia: And some of these symptoms are similar to those of menopause, so it can be a little hard to dissect.
• 13:40
  Dr. Komal Patil-Sisodia: And this is why you want individualized care.
• 13:42
  Dr. Komal Patil-Sisodia: You want conversations with your doctor around what's working and what's not working For ongoing insomnia, there are treatments that teach skills to improve your sleep, and that's called cognitive behavioral therapy for insomnia.
• 13:57
  Dr. Komal Patil-Sisodia: Getting your basic sleep habits in check, like making sure you don't have a ton of screen time or stimulating activity before bed can be helpful, but a lot of people need more support than that because we get used to not sleeping, and then that requires some behavioral retraining.
• 14:15
  Dr. Komal Patil-Sisodia: When people are struggling with brain fog and mood, That deserves some attention too.
• 14:21
  Dr. Komal Patil-Sisodia: I want to know when the changes started, how they're affecting your life and your relationships, and what else is happening with your sleep and health.
• 14:28
  Dr. Komal Patil-Sisodia: Most women don't develop major depression during menopause.
• 14:33
  Dr. Komal Patil-Sisodia: Some are more vulnerable during this transition, and depression, if it's showing up, deserves assessment and treatment instead of being brushed off as something you just kind of have to tolerate.
• 14:45
  Dr. Komal Patil-Sisodia: When we choose a medication, we want to discuss how it's going to affect your other concerns, including weight and sexual function, and that's part of looking at the whole plan.
• 14:55
  Dr. Komal Patil-Sisodia: And when we talk about brain fog, we need to keep the evidence clear.
• 14:59
  Dr. Komal Patil-Sisodia: Helping you feel and function better matters.
• 15:02
  Dr. Komal Patil-Sisodia: It doesn't let us promise that a treatment that we're giving you is going to prevent dementia just because it cleared up your brain fog The next point I want to make is that feeling better and protecting your health go together.
• 15:14
  Dr. Komal Patil-Sisodia: Some changes are super easy to notice, and others, like high blood pressure or cholesterol, may not cause any symptoms.
• 15:21
  Dr. Komal Patil-Sisodia: And a visit for hot flashes or body changes is always a chance to review those health measures.
• 15:26
  Dr. Komal Patil-Sisodia: We should be doing that for women starting in their 20s regardless.
• 15:29
  Dr. Komal Patil-Sisodia: So depending on what your family history looks like, you should be screening for things that run in your family.
• 15:37
  Dr. Komal Patil-Sisodia: I think all women should be screened for blood sugar and cholesterol and blood pressure and have their health data looked at over time.
• 15:46
  Dr. Komal Patil-Sisodia: Your Pregnancy history matters too.
• 15:48
  Dr. Komal Patil-Sisodia: Diabetes or high blood pressure during a pregnancy can help us understand health risks later, including cardiovascular disease.
• 15:55
  Dr. Komal Patil-Sisodia: And menopause that happens early can also increase the risk of cardiovascular disease later in life.
• 16:02
  Dr. Komal Patil-Sisodia: So you don't need every single test that was mentioned at a conference, but a useful test should answer a question that could change your care.
• 16:09
  Dr. Komal Patil-Sisodia: So if you're having symptoms like fatigue, I'm gonna ask you about thyroid, about whether you've ever had any iron deficiency, about whether you're vegetarian or vegan, and we need to consider checking a B12 level.
• 16:22
  Dr. Komal Patil-Sisodia: There are a lot of things that can play into certain symptoms in menopause, and we want to use tests that direct us to clearing up the mystery around those symptoms It's also really important to bring up concerns that often get left out.
• 16:38
  Dr. Komal Patil-Sisodia: The meeting covered sexual health, pelvic pain, hair loss, and skin changes.
• 16:43
  Dr. Komal Patil-Sisodia: A lot of these things are hard for women to talk about when they go into a doctor's office.
• 16:47
  Dr. Komal Patil-Sisodia: I remember the first time I saw my dermatologist.
• 16:50
  Dr. Komal Patil-Sisodia: It was actually for psoriasis, and we were finishing up the visit, and she looks at me and she goes,"We're gonna talk about the fact that your hair is thinning." And these concerns can affect your daily life, even when you don't think that they're important enough to bring up in a visit.
• 17:04
  Dr. Komal Patil-Sisodia: So if sex hurts, say so.
• 17:06
  Dr. Komal Patil-Sisodia: Dryness could be part of the problem, but tight pelvic muscles or a skin condition can also play a role, and the right treatment is gonna start with understanding what the cause is.
• 17:16
  Dr. Komal Patil-Sisodia: A change in desire deserves the same care.
• 17:18
  Dr. Komal Patil-Sisodia: There can be multiple things that contribute to desire: pain, mood, medications, the status of your relationship, stressors.
• 17:28
  Dr. Komal Patil-Sisodia: All of those things can be involved.
• 17:29
  Dr. Komal Patil-Sisodia: And a testosterone blood test does not really tell us the whole story or diagnose a low desire disorder.
• 17:36
  Dr. Komal Patil-Sisodia: Testosterone can be helpful in some women after menopause with a diagnosed desire disorder.
• 17:42
  Dr. Komal Patil-Sisodia: For other uses like energy, mood, or memory, the evidence isn't there yet.
• 17:45
  Dr. Komal Patil-Sisodia: Research is ongoing, but promising it now sets up people for false hope Hair loss also needs a closer look.
• 17:53
  Dr. Komal Patil-Sisodia: There are different causes that will call for different types of care, and we shouldn't assume that hormone therapy will fix it or that every skin symptom comes from low estrogen.
• 18:03
  Dr. Komal Patil-Sisodia: There can be scarring conditions of the scalp that contribute to hair loss.
• 18:07
  Dr. Komal Patil-Sisodia: There can be vitamin deficiencies.
• 18:09
  Dr. Komal Patil-Sisodia: There can be thyroid issues.
• 18:11
  Dr. Komal Patil-Sisodia: There can be female pattern baldness, which is genetic.
• 18:14
  Dr. Komal Patil-Sisodia: So it is important to have a very nuanced conversation around that And when I'm seeing you in the office, I also want to know about supplements, so bring a list of what you take sometimes there's a clear need when you have a nutrient deficiency, like a B12 deficiency or a D deficiency, but a product marketed for hormone balance still needs evidence that it actually does what it says it's gonna do and a review of the possible side effects or interactions.
• 18:41
  Dr. Komal Patil-Sisodia: And unfortunately, supplements in this country are not subject to the same degree of scrutiny as are FDA-approved drugs.
• 18:48
  Dr. Komal Patil-Sisodia: There's one symptom that I want to make sure that you all bring up regardless, and that's bleeding after menopause.
• 18:55
  Dr. Komal Patil-Sisodia: You need to make sure that you have this evaluated.
• 18:58
  Dr. Komal Patil-Sisodia: If it continues or returns after a reassuring test, you need further evaluation.
• 19:03
  Dr. Komal Patil-Sisodia: And please report it to your doctor and make sure there's a plan to look into it.
• 19:08
  Dr. Komal Patil-Sisodia: Usually, that requires going to a gynecology visit, getting an endometrial biopsy or a pelvic ultrasound or both possibly, but it should not go unaddressed.
• 19:19
  Dr. Komal Patil-Sisodia: Lastly, when you're creating a plan for menopause care, it has to fit your life.
• 19:25
  Dr. Komal Patil-Sisodia: One of the most useful themes was the support women need to make care possible.
• 19:30
  Dr. Komal Patil-Sisodia: We can recommend all sorts of things like exercise, sleep treatment, or follow-up visits, but what if you're caring for a parent?
• 19:36
  Dr. Komal Patil-Sisodia: What if you are working crazy hours at your job, or you're worried about the cost of care?
• 19:41
  Dr. Komal Patil-Sisodia: Those details will affect what you can do next and whether you can take action for your health.
• 19:46
  Dr. Komal Patil-Sisodia: So when my patients come in to see me, I often ask them what's going on in their life, and I try and listen without judgment just so we can pick realistic goals and pick a realistic starting point for what therapy may be appropriate and meet some of their goals.
• 20:05
  Dr. Komal Patil-Sisodia: The same thing goes for talking about alcohol, tobacco, cannabis, or anything else that people are using to cope with these symptoms.
• 20:13
  Dr. Komal Patil-Sisodia: Knowing what you use and what you hope it will do allows us to have a pretty helpful conversation about your care.
• 20:21
  Dr. Komal Patil-Sisodia: And the goal is always to create a plan that you can use with a follow-up to see whether it's helping.
• 20:26
  Dr. Komal Patil-Sisodia: So what I'm bringing home from this meeting is the value of taking the whole story seriously.
• 20:32
  Dr. Komal Patil-Sisodia: When you say,"I don't feel like myself," you should have room to explain what that means.
• 20:36
  Dr. Komal Patil-Sisodia: Your symptoms, your body changes, your health history, and daily life all help shape the next step.
• 20:42
  Dr. Komal Patil-Sisodia: You don't need to sort out your concerns into medical specialties before asking for help.
• 20:48
  Dr. Komal Patil-Sisodia: You need to bring the whole picture to your doctor's office.
• 20:50
  Dr. Komal Patil-Sisodia: My job is to help my patients work through it and explain what may be connected and recognize what needs its own evaluation.
• 20:57
  Dr. Komal Patil-Sisodia: We can all be encouraged by progress in research and still ask careful questions.
• 21:04
  Dr. Komal Patil-Sisodia: We can all recommend treatments and explain their limitations, and we can all change the course of treatment when something is not helping.
• 21:12
  Dr. Komal Patil-Sisodia: For your next visit, I want you to think about what has changed, what is affecting you the most, and what you would like help with first.
• 21:20
  Dr. Komal Patil-Sisodia: Bring your medication list, your supplement list, your history, and all of your concerns.
• 21:27
  Dr. Komal Patil-Sisodia: I hope this recap helps you feel more prepared to ask questions and take part in decisions about your care.
• 21:33
  Dr. Komal Patil-Sisodia: I'll see you all on the next episode.