Your own health: what we need to know as female physicians

[00:00:00] Before we get into the episode, a quick word on who you’re about to hear from. Dr. Sian West is a board certified obstetrician and gynecologist and a certified Menopause Society practitioner in Michigan, and she specializes in perimenopause and menopause care, and she runs a telehealth company called the Tepa.

[00:00:17] I asked her to be on the show for two reasons. One, she’s a friend, so we’ll consider that to be my full disclosure, and she takes the science. And more importantly, shakes the science of women’s health very seriously. Every recommendation, every investigation, every treatment comes back to what the evidence says.

[00:00:33] So why are we talking about our own health when you’re here for a podcast about practice management? Even though clearly I think practice management is exceptionally important. I will admit our health is even more important and something about putting the oxygen mask on ourselves before we can put on somebody else.

[00:00:49] The purpose of this episode is to talk about what we should know, not just for patients, but for our own selves, knowing what might be normal, and even if it is normal, at what point there might be some treatment options or things that might help us feel a little bit better. We are all navigating being a doctor and being a person, but we’re also navigating our own health that is changing and evolving over the course of our lives, whether we wanted to or not.

[00:01:13] This is our first guest interview, and for your reference, there are going to be guests approximately every four to five episodes going forward. That is enough for me. Here we go. I am so excited to share this conversation with Dr. Sian West. You didn’t survive Residency to Struggle in practice. I’m Kate Reconstructive Plastic Surgeon and this is The Practice Runs Podcast.

[00:01:34] Small Changes to How we run our practices to get real tie back so that we can show up in our lives as the person and the doctor that we wanna be. Grab your tea, coffee, and let’s chat. Welcome to Dr. Sian West. End of practice runs podcast. We know, just talked about her intro, but does a full disclaimer. Dr.

[00:01:55] Sian and I are internet friends in real life. We have never met, but we’ve talked almost every day For how many months now? Like six. Six months. Seven, six months. Yeah. So the goal for today is to talk about basically ourselves and our own health because I think, and Sian you can talk about this, but we are trained and spent all of our lives taking care of everybody else in our lives and are the, tell me about it.

[00:02:14] Very, very last people to take care of ourselves. Absolutely. So today is about us, and I guess maybe, which makes us both feel very uncomfortable, right? Because, because like you said, like in our training, we trained for years about you have to take care of everyone else and you have to show up and you have to do more, and then you have to do more, and you have to do more.

[00:02:30] And so then how do we take a step back and think about how we’re gonna care for ourselves through all of this? It’s difficult without a doubt. And then on top of that it’s okay. Well I am exhausted and overworked and overtired, and what part of that is just the life and the job and all of the roles we have outside of our medical practices and what might be something more, and we’re gonna kind of come back to that later on.

[00:02:49] But that’s kind of one of at least my biggest questions for you as someone who specializes in the big transition that every one of us women physicians gets to go through, but no one is excited about. And as long as you don’t die beforehand, you’re gonna go through with the perimenopause and menopause transition.

[00:03:05] And I hope it looks better than some of the ones that I have seen. Again, love the women in my family, unrelated. Okay. So maybe one thing I wanted to actually ask you, and I don’t know if you see this differently in your practice, when you have female physician colleagues approach you or see you as a patient, do you find that they talk about their symptoms of things they’re experiencing differently than a non-physician patient?

[00:03:25] And if so, what’s different about it? Yes, 100%. We minimize, we minimize everything that we’re going through. I, I instantly think of one person in particular who not sleeping through the night, has history of a seizure disorder, is not taking care of herself, knows she needs to, and yet shows up every single day, shows up early, does all the work, gets her inbox done, makes sure she answers all of the questions, and then.

[00:03:48] Forgets that she has any health that kind of needs to get taken care of. I mean, I can’t remember the last time I had an annual exam, now that I actually think about it. I have had all of my preventative screening, but all a little haphazard. But I think it’s been like three years since I’ve had an annual that I will now need to book or gonna the dentist.

[00:04:03] Right? Like things you’re like, oh, I haven’t done that in five years. When I, last time I went. Yeah. Which was absolutely many years. It’s crazy. And I, one of the thing I think is kind of silly is I started social media about a year ago. And does do perimenopause, menopause education and that midlife health transition, and I hate the term midlife, but it fits the vibe.

[00:04:20] Right. And once I started posting on social media. About this specifically. People are coming outta the woodworks that I work with at the hospital. Nurses in the, or different physicians that I work with, people are coming out of the woodwork and now asking questions. Some of these people have al already been my patients and had never complained about some of these things, but the more I’ve been talking about this in a public space, the more people have felt comfortable coming up and actually being.

[00:04:44] Hey, you know what? I haven’t actually slept through the night in like a year and a half. I’m doing the 3:00 AM wake up. Like this is a very real thing, like the itchy ears, like that’s real. Like I thought that was made up. And I think that specifically this, this space that I embody within medicine, those specialty owns.

[00:04:59] And so it’s kind of this, it’s everyone’s job, so therefore it’s nobody’s job. And so physicians like don’t even know what it is. They don’t know about this, and we’re so undereducated in it. It’s pathetic. It’s so sad and so my going public with this has really changed the conversation that I’ve been having with, with my coworkers, basically.

[00:05:18] Specifically, hopefully like, oh, this is something I don’t just have to like survive through. Don’t just have to white knuckle through. Might be something that can, like sleeping through the night, you know, is something that maybe might be reasonable for me if I’m in my forties or early fifties or what have you.

[00:05:31] And actually on that, and this is something that I learned from you, perimenopause can start much earlier than at least I, in my non women’s health really role. Like what is, what kind of ages are you seeing that. People are presenting with some of these more perimenopause type symptoms and what are they?

[00:05:48] What’s really tricky specifically about perimenopause is that it lasts anywhere from, on average about four to seven years, but some people it could be 10 years. Now the definition of premature ovarian insufficiency is going to be menopause less than 40. So you could totally have symptoms start at any point.

[00:06:03] So if you’re in your twenties and you have all of these weird, what feel like menopausal symptoms, you’re not quote too young, you might actually have premature ovarian insufficiency, which is like literally the definition of it. But if you’re gonna look for, not these outliers, you could be mid to late thirties, but more commonly early, mid forties, but very common to see late thirties having that weird, Hey, I don’t feel like myself.

[00:06:26] I joke that it’s like the perimenopausal rage where just like, oh my God, I hate the way this person breeds and they chew when I just gonna murder everybody. No, it’s just period, like monthly period related. Yeah. When it’s outside of the menstrual thing. Absolutely. Absolutely. And so, and not only as we’ve changed a lot of different types of birth control.

[00:06:43] Like people might not be getting regular periods because they have an IUD, maybe they’ve had an ablation, like you can’t even use that as a sign anymore. But we also know that symptoms show up before your, your periods actually change. So what are you looking for? You’re looking for a bunch of really weird, vague symptoms where you’re just kind of angry at life and you’re not feeling yourself.

[00:07:02] Which is hard. More so. More so than you might anticipate based on just kind of Yeah. Potentially light situation. Otherwise, it’s not always. Absolutely. And it’s not always the, like, the quintessential, like cartoonish, like you’re just getting these wicked hot flashes all day long and you’re, you know, you’re, you’re out your layers in your layers outta your layers.

[00:07:18] Like maybe it’s not hot flashes, maybe you’re getting some night sweats, which I think it’s ridiculous that we call hot flashes. Hot flashes and night sweats. Night sweats. Like, it’s just the day, the timing of the day. Like that’s silly, but whatever. Hot flashes during the day, night sweats at night. But for a lot of women it’s just quote, I don’t feel like myself.

[00:07:35] And there was a study where the biggest thing was I don’t feel like myself anymore. How do you put a number on that? It’s hard. That’s really hard. So then what do you do? Like if you’re kind of there, but you’re like, okay, is it because I have multiple littles at home, I have aging parents, I’m taking care of, I’m working all the time, and that is what this podcast is about, trying to stop that.

[00:07:53] But what is the next step to be like? Is this something that might be treatable or is this. This my overwhelming life at this stage? Well, step one would be, let’s pretend you have your own clinician who knows how to work it out. And knows how to deal with it, and doesn’t just blow it off and say, oh, well it’s anxiety.

[00:08:11] Oh, well it’s your age. Oh, well, it’s normal. It’s common. Yes, it is normal. It is common. But that doesn’t mean you don’t do something about it. That what makes me super frustrated. So let’s just pretend that you have someone who’s going to believe you. Mm-hmm. Which is sad, but let’s just pretend you have someone who’s gonna believe you.

[00:08:24] First thing’s gonna basically be like a pretty simple workup. Like make sure you’re updated on all your annual, your annual preventative labs, C-B-C-C-M-P, thyroid, like are you incredibly anemic? Is your ferritin nine? Like mine is right now. We’re gonna talk with that. I wanna circle back on it ’cause that was mind boggling on your Instagram this week.

[00:08:40] Yeah, the fact that like, I don’t know better, that’s ridiculous. But anyways, like make sure there’s not something else that’s going on and if you are of the age and nothing else is really going on, if you wanna call it perimenopause, I’m cool. Calling it perimenopause. For some reason, like within healthcare, there’s this like almost policing of who’s allowed to be perimenopausal.

[00:08:58] That’s kind of ridiculous. But do a workup. Make sure it’s not something like leukemia, you don’t have hypothyroidism. Make sure it’s not something else that’s going on that’s making you, you know, exhausted and waking up in the restless legs and hot flashes. So in the absence of, so if you start with that workup, you’ve kind of done it.

[00:09:13] If in the absence of something super obvious on blood work, if that comes back relatively normal or like normal enough. Is it fair to assume that it’s probably perimenopause fair and or stress? And how does that fit? Like what does, how much of role does stress have to play in potentially all of this?

[00:09:30] Ooh, so back in March, I went to the Harvard Menopause Conference, and one of the things that I found to be incredibly interesting was the amount of women that are actually getting diagnosed with A DHD in their forties, because we don’t show up the same as really hyperactive little boys. We tend to cope really well, and we come up with a bunch of amazing mechanisms to get through life and to be high functioning achievers.

[00:09:49] And then we hit perimenopause and all of that just kind of, it just slams to Hal. All of that, we got it. All of that slams to a halt, and your coping mechanisms are no longer working. Yet what you end up hearing within medicine is, oh, everyone thinks they just have a DHD. Well, a lot of women do, and they’re just actually underdiagnosed.

[00:10:08] Now, I am not psych, I am not the person to get in and out at all of that kind of stuff, but I do know the psychiatrist that was up there was like, this is a really big deal and we’re undertreating women. So. Is it the stress, right? Is it the potentially undiagnosed A DHD? Is it you are not sleeping, you are not taking care of yourself, and therefore all of it’s compounding and you feel worse.

[00:10:28] Yeah. So like if someone comes and sees me and they’re like, I, I feel terrible, and everything is the worst, and we start treatment, part of that is also going to be your sleep hygiene. Part of it’s gonna be, do you actually eat your fruits and vegetables? How much do you exercise? You have to do this whole body, whole life examination of all of that, because the reality is estrogen doesn’t fix everything.

[00:10:48] Despite the fact that I do think it fixes quite a bit, but it doesn’t fix everything and it’s not right for everyone. But you really need to look at all of this. So is it the stress in the perimenopause or is the perimenopause making the stress feel worse? I don’t know. Probably a little bit of both.

[00:10:59] Chicken or the egg? Probably both combined with not sleeping, being overworked, and no time for ourselves. That’s sounds about right. I wanna go back to your ferritin comment because just for context, this past week you had a carousel on ferritin. Yes, and like I had gone to med school once upon a time. My undergrad that I dropped out of, let’s not get into that, was in nutrition.

[00:11:19] Like I thought I knew stuff, but it was specifically about hepcidin. And the recommendation for women that taking iron supplementation every day, which is something I’ve been told basically to do my entire life. ’cause I’ve always been low. If I take it every day, my absorption is not as good. Yep. So I got super serious about my broaching and take about a year ago, and with that managed to completely trash my iron and ferritin and feel kind of silly ’cause I 100% should know better.

[00:11:43] So I basically ended up doing this whole series on anemia and iron and ferritin. Just recently. And so the big moral of the story is we absorb heme and non-heme iron basically through our diet. Well, not a lot interferes with that, but in these large dosages that we get with supplements, you increase your hepcidin for about 24 hours and therefore you decrease your amount that you’re absorbing for the next 24 hours.

[00:12:08] So then of course. On top of our really complex lives, you have to remember every other day to take your iron, which is really, and ultimately, even though like taking it every other day mm-hmm. Is still overall in a week more absorption than a lessened. If you take it every school day, lessened dose every day, ah, it’s better to take your one dose every other day.

[00:12:26] And when I think back to when I was in med school, it was like twice daily dosing. And so you just had people that were incredibly constipated and nauseous. From their constipation and still anemic. Un unrelated, but personal thing, when I take iron every day, I don’t sleep as well. It’s amazing though, ’cause I don’t feel tired.

[00:12:42] I wake up at like 2:00 AM and I’m like, let’s go. Which you know, being type A I’m like this is amazing. More product productive time. But like after a while you’re like, this is not good for me. Yeah, yeah, yeah. So I had to cut it to half. I kind of wonder if you’re having GI symptoms and it’s the GI symptoms that might be waking you up.

[00:12:58] Interesting. Maybe because some people are really sensitive to iron and there’s different types of iron, and I’m not the person to get in outs of all different types of iron, but some people get a lot of GI upset from it. So maybe that you maybe not recognized and that’s why can you up at 2:00 AM but you’re like, Hey, I got more stuff done today.

[00:13:12] I’m so productive, look at me. And that is probably the crux of the reason that we’re both here actually right now, doing this a podcast while having clinical practice is Dear Lord. Okay. Can you talk a little bit about like, treatment for menopause? Like we, we talk about the lifestyle stuff, obviously. I mean, it’s very easy, so easy for all of us not to do it.

[00:13:30] ’cause let’s just be honest, it’s the lowest thing on the task list and we never get to it. Mm-hmm. But if we have actually put the effort in for lifestyle, for eating, for sleep, hygiene, we’re doing what we can. Like what are. Treatment options and, and what can they like realistically do for us in terms of symptoms, knowing, as we all know, everyone’s different.

[00:13:49] There is a ton of things. There are hormonal, non-hormonal medications. People don’t realize how many different things there are, and the reality for most people, they don’t. Most people don’t have a contraindication to rine and progesterone. Now, women’s Health Initiative came out in the early two thousands, scared a lot of people said that there was, you know, basically was gonna give you breast cancer.

[00:14:10] There was eight more cases of breast cancer per 10,000 women. So less than one per thousand. That doesn’t mean it’s not zero, but the height, relatively speaking. Exactly. And so there’s a ton of people that are absolutely terrified. I can’t tell you how many times people, I even bring up estrogen because I think it might actually be the best thing for them.

[00:14:28] And it’s like, no, that’s just gonna give you breast cancer. So there’s still a lot of clinicians as just across the board that aren’t up to date on, on the newest stuff. ’cause I feel like the minute you talk about hormones, people are like, oh God, that’s really scary. And so I just wanna say like, they’re actually not scary.

[00:14:42] They are really safe for most people now, not everybody. And I think what’s really hard is it’s difficult for people to figure out like what’s real versus what’s hype. Because when all this stuff you see online, social media, like estrogen and testosterone cure everything. And that’s not true. Because if you eat like trash and you don’t sleep, then you, it’s not gonna cure everything, right.

[00:15:02] But if you’re not sleeping, figuring out why. And I think finding a good practitioner for perimenopause specifically can be difficult because are you not sleeping because of the hot flashes and the night sweats? Are you not sleeping because your progesterones just tanked? ’cause that’s the first thing to go.

[00:15:21] Perimenopause and that helps us kind of sleep and relax and it, it’s nice. It’s just nice and calming. So if that’s gone, like do you need estrogen to get you to sleep better? Do you need progesterone to get you to sleep better, or do you really just need like a legit. Sleep meds and that’s hard to tease out.

[00:15:37] So it depends on what someone’s symptoms are and of course their contraindications and their past medical history and all of that. Of course, of course. I mean, I’ve gotta say like in med school, and, and this is no fault in med school, but just like, it was like my takeaway was like, yes, estrogen will cause breast cancer causes cancer, it kill you.

[00:15:52] And that and, and that once you get down to thing again, and I don’t even like, honestly don’t remember, and I’m sure we had one, but like I don’t really remember any education in med school about menopause and treatments and all the appropriate things. I don’t remember. Anything in residency, and I’m an OB, GYN, like I literally take care of women for a living.

[00:16:09] I remember it was touched on over the course of like more, almost like, I think more like the family medicine type time. Like these are things mm-hmm. That patients might come in with and, and these are things to think about. Mm-hmm. But more as a glossed over, not you’re losing 50% of your bone mass and we should be talking about it.

[00:16:23] Yep. Type, yep. Kind of type thing. Okay. What is one thing you wish every female physician would be doing for her health? Lifting heavy weights. Why? It’s a big topic in the media right now. Exactly. We’re all talking about it, but Exactly. Yeah. My Instagram is stacked. Stacked with lifting heavy. Mm-hmm.

[00:16:40] Lifting heavy, multiple reasons. Osteoporosis is a really big thing. No one. Osteoporosis isn’t sexy. Nobody really cares about osteoporosis in your thirties and forties. We test most people at 65. Actually, I don’t know what the Canadian guidelines are, which mainly is too late for most people. So lifting heavy, decrease your risk of osteoporosis.

[00:16:58] There is a big genetic component, but that’s gonna be huge. But also increasing your muscle mass. Increasing your muscle mass, you’re going to decrease. Your risk of chronic disease, your risk of cancer, if you do get cancer, you’re going to tolerate things like chemo better. Just having more muscle mass is literally the best thing that you could do for your body.

[00:17:17] Now, exercise was not shown to decrease things like hot flashes, so maybe it’s estrogen too, but it’s amazing how much of your health is improved with literally just having to wear muscle mass. Not to mention if we’re exercising the mental health, the time for our cell, like all that whole kind of beautiful like upward spiral that happens even though it’s like so easy not to.

[00:17:36] Okay. Can we touch back on osteoporosis, and this is a very selfish question. Is there a point that it’s like almost too late that you’re like, nah, it’s not really worth supplementing with calcium because you know the damage was done? I would say no. If you didn’t have it when you were in your teens, no.

[00:17:51] You can, you can lay down some bone and you can build muscle at any age just to, you just have to put the work in. That’s truly it because the more muscle you put on, the better your bones are gonna be. And there’s literally no age that that doesn’t happen. Yes, as you get older, it is harder, but just lift heavier but smartly.

[00:18:07] And if you’ve never lifted weights, please get some help. Get some doctor’s advice. Might be your friend who you’re chatting with, like, you know, in the hallway. Be like, okay, yeah, I think you’re fine. Go talk to ortho. How do I lift heavy? How do I lift heavy things? Well, they’ll invite you into the or. Some of my best friends are orthopedic surgeons, so like, you know, fully appreciate them, but it’s fully like, yeah, just go lift the heavy stuff that they do every day in the OR with the lead on.

[00:18:29] Be fine. The hammers, I cannot imagine. So a little bit off topic, but I could not imagine going through pan menopause, menopause, having hot flashes while wearing lead if they seem horrendous. Oh, that sounds of terrible. I’m not there, but I have not talked to a colleague yet, but I should ask some of them.

[00:18:45] Be like, are you okay? Should we be checking in on our female orthopedic surgeon colleagues and be like, are you actually dying? Like probably, yeah, probably. Probably should be. I mean, just like just being scrubbed in under the, OR lights. It’s a million degrees. I have a horrific nickname that I probably shouldn’t say, which is Wet Thighs West because I’m so sweaty that I have to change my scrubs every time I get out of the or.

[00:19:09] So throw some hot flashes. We can keep that or edit it out. I might die. Yeah. Might die also, I don’t care. Let’s get some darker scrubs, right? When you have like, can we talk about how my scrub in the or? Oh, see, you’re so lucky. We have like the really dark navy blue scrubs. Do you know who looks good? Can’t, can’t really tell.

[00:19:24] Yeah. Do you know who looks good in Navy blue scrubs. Everybody and everybody looks more put together. We still have the kind of like lighter kind of bluish, greenish ones and it, you know? Mm-hmm. There’s, there’s no hiding in those ones. Oh, no. Mm-hmm. Okay. Well, orthopedic surgeons, we’re gonna check in on you and see how you’re, uh, how you’re doing there.

[00:19:39] That was, I think, my big questions. Is there anything else that we should talk about that you think we need to know from your, like, expertise, what you see, what people are asking you? Related or unrelated social media colleagues. Other, or maybe if we’re, if we treat patients, don’t wanna find someone. But I don’t know how you normally go about that in Canada.

[00:19:59] Mm. Yeah. Usually it’s through like our family physician, nurse practitioner, potentially, and then referral. But again, there isn’t as much of like the men. There’s not, I mean, don’t quote me on this, at least where I am, there’s not as many like sort of more menopause specific practitioners. Yet, though I definitely hear the conversation.

[00:20:18] Those who are kind of specialized, the Menopause society, which like the Menopause Society is not specific to America. I actually think that the President right now, I think he’s Canadian, he’s a psychiatrist, some psychiatrist from Canada, and so the Menopause Society is a host of different specialties that come together to then care for women in this stage of life.

[00:20:37] So how do you find someone, or if you. Treat women, whether you’re a family physician or obstetrician gynecologist, or other psychiatrist, women, where can people go? One, to look for someone who does it, or two, maybe even to learn more yourself if that’s something that you wanna do, because we all need CME credits.

[00:20:53] I highly encourage every doctor who potentially takes care of a woman. In her forties, fifties, or sixties. Sixties or beyond, to please go get some education on it. Because it is amazing how much misinformation is being told to women. And one of the things that I find is like I will see someone start someone on a regimen that’s completely evidence-based.

[00:21:12] Like I am not big in all of the crazy, ridiculous things. I really like here in America. FDA regulated meds. I love science, science. Um, but yet they will go and see their family practice or their cardiology or whatever, uh, you know, enter any specialty or the pharmacist. And they’ll get told, this is gonna give you breast cancer.

[00:21:30] Like that happens all the time. And that is not accurate. I, we’ve talked through the risks and benefits. It’s all in the chart. So I would say if you have not gone and read much about menopause and the updated science, please, please, please, please do. But to go and find someone for yourself, I would say, you know, start with your own practitioners, obviously, right?

[00:21:45] Like start with your gynecologist, start with your family practice. If you don’t get much of a response, the Menopause Society has Menopause Society certified practitioners. Now I, I am MSCP certified. So basically you go, you take a test. The test isn’t specific for physicians, so the test is like. You could be, uh, physical therapy or occupational health, or a nurse like Allied Healthcare Professionals.

[00:22:11] Yeah. Allied Healthcare professionals. Like there’s a whole apps here. Look at that. Yeah. There’s a host of people who can take this, this test and get the MSCP certification. Okay. But on the Menopause Society website, you can find practitioners so that you can find someone who actually is menopause certified.

[00:22:25] And a lot of what’s popping up everywhere is telehealth. And so if you don’t have someone that’s close to you mm-hmm. Telehealth might be the thing to do. Which actually is a perfect segue because now, and I will say whomever’s listening to this, if you are in Canada, obviously you know there may be someone here if you are in the States or people, but you have also pursued, and your opening have opened officially the Tepa Tele.

[00:22:44] Yes. Oh my God. Very exciting. Which is your own sort of menopause Peron Pouse specific telehealth company. Yep. Yep. Here in Michigan I’ve got plans to, you know, expand to other states, but it is a basically private practice menopause, perimenopause, specifically called the tepa, uh, telehealth Menopause. I dunno.

[00:23:04] I thought it was pretty nifty. And so I started, I read it in meeting. It was like, oh, that’s very clever. Well done. And was it your own brain that came up with that too? The, the backstory of it is I was on a medication that puts you into menopause and was literally at my hairdresser. My head was in the bowl getting shampooed and I was trying to say telehealth menopause.

[00:23:24] And I was literally trying to tell her how I couldn’t figure out a name for my telehealth menopause practice. Mm-hmm. And what came out of my mouth was the very like brain fog menopausal state that I was in. ’cause it’s med was. Know, I just can’t come up with a name for the telepo. And she was like, that’s it.

[00:23:39] And I was like, there we go. That was so good. So I’d love like to pretend that it was like on purpose clever. But no, it was actually, but I also like kind love the fact that it came out, but it fits menopause brain fog. Clever. I mean, but that it’s, it’s kind of perfect in that case, like honestly. Yeah. So the tele pause.

[00:23:55] Amazing. And where else can people find you if they wanna One? I think honestly, as a physician, not that I treat women in that capacity necessarily, has been so educational. Where can they find you? Or do you just should know about it so that you don’t tell them the ES estrogen is gonna kill you. Exactly.

[00:24:09] Or when they ask other questions or when I’m doing a procedure and literally women start, I do a lot of skin cancer for reference. Should I stop local anesthetic? Should I stop my transdermal estrogen? No. No, you shouldn’t. Or, or they literally start steaming. And you’re like, there might be. And then they’re like, this is the 17th time today.

[00:24:25] And I kind of wanna be like that. Maybe there’s something that could be done for that. Yeah. Have you potentially talked to someone about your hot flashes? Yeah. Like, this is significant because my, oh, they’re not that bad. My loops are steaming up at this point. Like I kid you not. I did tell her and I was like, maybe, maybe, I don’t know, but not my area, but maybe talk to your family doc about this.

[00:24:45] Yeah. Uh, yeah. So where can they find you on all of the very social things? Yep. So I’m on all the social medias. It’s just Dr. Sian West and Sian is spelled SIAN. So Facebook, Instagram, LinkedIn, TikTok. And then the tele pause also has its own pages, which is just the tele pause on all of those same social media sites.

[00:25:04] Amazing. And I will say again, it is my like best women’s health CME that I get on a regular basis. So thank you for that. And my own like selfish hep sit-in. Okay. I think that’s it for me. This was, I mean, we talk all the time, but this was a much more fun conversation, so thank you and for sharing both your expertise.

[00:25:21] What you know, and I hope this was useful every for everybody. Otherwise, have a great rest of your day. Bye. As always, thank you for being here. Now go get some time back and have a great day. Chat again next Tuesday.