Raising the Standard for Women’s Care with Celebrity OB/GYN Dr. Thaïs Aliabadi

This podcast is for educational and entertainment purposes only and does not constitute medical advice. The information shared reflects the personal opinions and clinical experience of Dr. Lucky Sikhan and myself Dr. Alicia Robbins and should not be used to diagnose or treat any health condition. Listening to this podcast does not create a Dr. patient relationship. Always talk to your own doctor before making changes to your health medications or treatment plan. Olivia Mann came to my podcast and talked about her breast cancer. Kim Kardashian talked about her psoriasis. Chloe talked about her surrogacy because when these women talk about their medical conditions, other people listen. That's how we bring awareness. Olivia Mann, she's become the face of breast cancer awareness. She helped save her own life and now she's helped millions of women. So I'm so grateful for these women. Hi, it's Dr. Lucky Sikhan and Dr. Alicia Robbins. We're so glad you called. Welcome to Call Your Doctor. Basically a group chat where your best friends happen to be hormone health experts with medical degrees. If you've ever wondered, is this normal or why am I like this? You're in the right place because whatever you're going through, you're never the only one. You can always call your doctor. Let's get into it. There are some doctors who quietly take care of patients and then there are doctors who end up helping to shape the biggest women's health conversations in the world. Today, our guest has delivered babies for Rihanna and Justin Bieber. She's treated the Kardashians. She helped diagnose Olivia Mann's breast cancer. Dr. Taís Ali Abadi, known as Dr. A, has become one of the most recognizable advocates for women learning to trust their instincts when something doesn't feel right. Dr. A has spent decades caring for women, whether that be Hollywood celebrities or women like you and me, and what's fascinating is that some of those very public stories have ended up teaching millions of women lessons that may have literally saved lives. I want to dive in and ask you what's it really like being Hollywood's OBGYN? How does this happen? Was this something that accidentally occurred? Is it just a matter of where you're located in practice? We want to know your backstory, essentially. Oh, honestly, I would say, first of all, thank you for having me on your podcast. There is really no back story. My patients are my patients. I'm a gynecologist. I've been in Los Angeles for almost 25 years. I was extremely well-trained at County USC, which was one of the top OBGYN residencies in this country. I feel like I got a really, really good experience and exposure during my residency. And from the minute I started my private practice, which is over 25 years ago, my patients have been my patients. Most of the time, I don't know who anyone is. I don't watch TV when they walk into my office nine out of 10. I don't know who they are. And I've always approached my patients the same way. I listened to them. I never dismissed them. I take their complaints very seriously. And I have provided, in my opinion, the highest level of care possible to women when they walk into my office. Further, well-woman exam. And the Kardashian just happened to be one of those patients who walked into my office. I never think of myself as a celebrity OBGYN. I feel like I'm a woman's advocate. I'm a woman's health doctor. And whether you have 100 million followers or if you have one follower, when you're sitting in front of me in my pink robe, you're my patient. And I'm going to give you all my attention. And I will treat you and try not to dismiss anything or miss anything in you. And that's how I build my practice. I love that. And I think there's so many headlines we have seen about things that have happened with certain celebrities where maybe the care wasn't optimal. And I think sometimes quote-unquote VIP treatment can actually lead to not the best care. And so you are who you are. You are such a fantastic OBGYN and doctor. I think because you take that attitude and approach. I definitely do. For me, like I said, once you wear that pink robe, you're my patient. Nothing else matters. I think most doctors wear it this way, right? When someone comes and sits in your chair, it doesn't matter what they do for a living. I don't even think about that. I'm trying to make sure I don't miss anything. I cover everything they need. I do the right blood test. That I do my pelvic ultrasound. That I do my imaging. That I do know. So most patients think we care, but really doctors, we care about the level of care we're providing. Yeah, and that's how it should be. Yeah. Is there anything that you do differently than you think that other OBGYNs don't, like do you offer routine genetic testing for every patient? I know that, you know, you were a big part of reason. I mean, I can tell you that I started implementing the tire cruisic score on every patient for every annual, like our new patient because of that story. But are there other things that you do that are maybe not usually part of the annual exam? Oh my god, yes. That's such a good question. And I'm so glad you're asking me this. So as women, when we go to our well-women or annual exam, we call it a pap smear. I don't even care about your pap-- I mean, I do care about your pap smear. Yeah, I tell you what you mean. Pap smear is the 20th item on the list that I have to put a check in front of. I look at women holistically. I address every system in their body before they leave my office. If they're young, they're coming to my office. A regular well-women exam is what? Is a pap smear, a breast exam, a bim annual exam. Maybe they talk about SDD testing. Maybe someone will talk about birth control and then off they go, right? That's generally-- and if you're 40, you get a prescription for a mammogram. Generally speaking, that's your well-women exam. That's standard of care in this country, right? Right. That's not a well-women exam to me. A well-women exam needs to address everything. If you have a teenager who comes in, if someone's complained, first of all, your fertility doctor, first thing you do in young women, make sure you're not missing endometriosis or PMOS in them. The leading causes of infertility, the majority of these women go through life or never diagnosed, do not eat Mr. Symptoms. Right. Check a baseline egg reserve, an AMH on every single woman in the reproductive age. I want to know what your ovarian reserve is. That doesn't mean if your AMH is low, you're not going to get pregnant. And if it's high, you're going to get pregnant. But it tells me where your ovarian reserve is. And if it's low, I'm going to start investigating why this number is low. Yeah, I look at their mental health. I screen for eating disorders. PMOS patients have eating disorders. I always say if you want to find PMOS patients, go knock on the doors of eating disorder centers. They're all sitting behind those doors. I screen for that. I do screen as they go through life. ISO fertility is very important for me. By the time they're 25, if they have family history of cancer, I will offer genetic cancer testing. I'm never surprised that someone doesn't show up into my office at 34 with stage 4 breast cancer because I missed an ATM gene mutation in them. So at 25, I offer genetic cancer testing. Some women will tell you, you know, my mom got breast cancer at 30. Then I do that genetic test at 20. I don't wait for 25. But generally speaking, I start discussing genetic cancer testing at age 25. By age 30, I know every single patient's lifetime risk of breast cancer. You need to know what that number is. Why? Because if your lifetime risk of breast cancer is 20% or more, you have to start imaging as early as 30, not 40. So this, you need to be 40 to have a mammogram is completely misleading. It has to do with your lifetime risk. So that's another thing. Yeah. If you have a high lifetime risk in addition to mammogram and ultrasound, I'm going to order an MRI. I'm going to know if you have dense breast tissue for my dense breast patients, I'm going to do a breast ultrasound. I'm going to ask about bone health, right? As we get older, our bones get affected. So I'm not going to wait until you're 60 to get a bone density. My chance at 40 will get a baseline bone density. I had osteopenia when I was 40. It's good to know that I was proactive. You know, I became more active. I started doing weight bearing exercises. But I needed to know that information. Also, a cardiovascular risk is very important for me. Every single patient, I check their APOB. I check their lipoprotein little A. I don't know if you guys have heard of it. Oh, yeah, we check those, yeah. Yes, right? To this day, women come to my office and they're like, well, I was at my primary care doctor and he told me my cholesterol is good. My LDL is good. But what's your APOB? What's your lipoprotein little A? 9 out of 10, it's never been checked. There are two good labs in this country that run an APOB. One is Cleveland Clinic and one is Boston Heart. If you can do it through quest, but you have to mark the correct test code. So they sent it to Cleveland Clinic. So I check an APOB. What is an APOB? Think of a bucket in your blood of four particles that can make plaque. Mm-hmm. Those particles are LDL, LDL and your lipoprotein little A. Lipoprotein little A is genetic. 20 to 25% of us walk around and we have a genetic mutation. And all of these particles carry the APOB protein and they can make plaque. So for me, especially for my perimenopausal woman, ideally in an ideal world, I want their APOB below 60. Not that 60 is a magical number and above it, you make plaque and below it, you don't. But if you want to reduce your cardiovascular risk, I want, ideally, an APOB below 40. But longevity is very important for me. Majority of my patients walk around with apobies in the one hundreds and they've never ever addressed it ever and their doctors are telling them they're okay. I get patients from longevity clinics coming to me with a phobia of 184 and I like a protein little a of 300 because the LDL was okay. The doctors say you're fine. What are you doing when you're finding these elevated levels? Are you looping in cardiology? Absolutely. Absolutely. I'm not a cardiologist, but I educate myself. I get the information and then I make a referral. If you have an apopie, I talk to them about these new medications like Repatha, who were that apelipoprotein little in this bucket of apopie. So I educate them and then I make a referral. If they're 45, I'm sending them for colonoscopy. If they're 45, I'm telling them that they need a coronary calcium scan. If they have risk factors, they need a coronary angiogram. If their cardiologist has not done it, I send them back to ask for it. What else? I mean, my point is every single visit includes all of them. It's like Uber or Comprehensive. I mean, every patient could only wish to feel like they are in the hands of someone that is being extremely comprehensive like this. One thing that and maybe I missed it that came to mind as a question because you talked about imaging and breast MRI and things like that. I think the lowest hanging fruit and you and I have talked about this before on your podcast is a pelvic ultrasound. A lot of women come to me in their late 30s, even 40s because of infertility or some other complaint. And I'm the first one who's ever done a transvaginal ultrasound on them, which is the best way to really image the pelvic organs. What are your thoughts on that? If you could change policies, what would be your recommendation? Oh my god, you nailed it. And I'm so embarrassed that I missed it on my list. I figured that you just told us. We assumed that is literally if you go into your gynecologist for a well-woman exam and you say hello, my name is Tais Ali Abadi. I'm here for my well-woman. I will do an ultrasound. You have to have a pelvic ultrasound. So when we do a pap smear, going back to that pap smear that they do and send a patient home, the pap smear checks for cervical cancer. But what about what's going on in the uterus? What about what's going on in the lining of the uterus? What about the ovarian cyst? What if you have an endometrioma? What if you have a septum? What if you have a polyp? What if you have a fibroid? What if it's pushing into the lining of your cavity? What if you want to go get pregnant and you have a big gyne polyp and you have no symptoms? It is crazy to me. A lot of patients, I think, they don't realize that the pap smear really only tests for cervical cancer, right? They're kind of like, I did my pap smear I'm good. And it's like, they don't know that that's not looking at the inside of the uterus or looking for ovarian cysts like that. Like you said, it's like tiny part of the well woman exam. There's so much more that needs to be addressed. How long is a new patient visit for you? I have to ask. Obviously, someone coming to you in their 20s isn't necessarily, you know, you're not talking about bone density with them. So we get that this is like casting a very wide net because you're talking about women aged, you know, teenage years to menopause. But how long are you taking for that new patient visit? Like, what does that look like in order to facilitate all of this? You know, my clinic is the clinic of dismissed woman. So I don't get your 20-year-old who's completely healthy who has nothing wrong with her. I get the zebra's, which really these are like dismissed endometriosis, dismissed PMOS, dismissed fibroids, dismissed breast cancer, dismissed. So my office visits tend to be longer because these patients fly from all over to come and see me because they already know that something's really wrong. So my first visits can be up to 45 minutes. First, my MAs go in, they take a full history. Then usually I have my physician assistants go in to basically write me a list of everything we talked about. We get it to do lists from them literally this long and my physician assistants get that list ready and then I go in and do the counseling, do the pelvic exam, order the hormones, order the blood tests and do everything else. So the whole process might take up to an hour for the patient. Right. But remember once you do that first visit, then I know everything about you. So next time you come, you don't have to spend that much time with me. I recently, you know, I check for dementia genes. I check the APOE 4 gene on every single perimenopausal woman. If they're 55 and older, I do the tau protein check for Alzheimer's, especially if they're complaining of cognitive health issues. So there's so much I do in their well-woman exam and I can't wait for a world where every single woman will get this level of care. When did you see the light and start adapting these protocols and doing things in this very thorough systematic way? Because we have to be honest, no matter where we've all trained, we've trained at the best institutions. It's just not part of the guidelines to this degree, like everything that you're describing. So when would you say was the turning point in your practice and was there a catalyst for all of that? I think turning point in in my life was training a county and seeing the six sick patients, especially the ones coming with metabolic dysfunction. I will tell you like in 2014, 12 years ago, I was giving GLP1s to my PMOS patients. When you know back then, I had trillicity and I was giving it. My PMOS patients were losing 60 pounds, 70 pounds. So one thing I think I do, first of all, I listen to my patients. That's all that you need to start there. Me, I never dismiss them. See, I would look for answers. I would never tell someone, your pain is okay, your irregular bleeding is okay, your facial hair is okay, your bloating is fine. I would take it seriously and I would dive in, I would order tests until I would get to the bottom of it. And over the years, my protocol got bigger and bigger and bigger, but also medicine has advanced. The problem is medicine has advanced, but where we providing clinics, it's still the same as when I left county 30 years ago. And it's fragmented too, right? I think we could talk about all of the gaps in the healthcare system, but obviously, you know, when insurance companies are not supporting the doctors and the clinics in order for them to be able to spend the time needed, it's not an excuse, but I think it leads to the situation where the doctors aren't talking to each other. Everyone's kind of in their own silo. And I think what's really nice to hear is taking this more holistic approach. It's kind of like what we all envisioned, the field of OBGYN was supposed to be. It's kind of like primary care and all of the things wrapped up in women's health in one. So it's nice to kind of see someone talking about going back to that model. I have the privilege of not accepting insurance and I dropped insurance because I did not have time. I was literally seeing 40 patients and then I would get calls upset patients because they couldn't get in. And it got to a point that I walked into a manager's office. I'm like, I'm going to hurt someone. I'm going to miss something really big in one of these patients and I'm going to be able to live with myself. And that's when I decided to drop insurance and that gave me this advantage of being able to sit with a patient and listen. You don't need a fancy test to diagnose women. Women tell you what the issue is. You don't, let's take endometriosis. It takes 9 to 11 years to diagnose these women. Most of them go through life they're never diagnosed, right? And however, I just listen to them. My accuracy is over 99.5%. So now they have a blood test. Great. I love that for everyone. But we don't need these fancy tests. Just listen to your patient. A PMOS patient is telling you she has irregular periods. She's gaining weight. She can't lose it. She has anxiety. She has PMS PMDD. History of eating disorder. She has acne, facial hair, body hair. She feels bloated. She doesn't feel like herself. Don't tell her eat less and go exercise. That's unfair. The worst advice. Yeah. 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It's sort of ironic that you or someone who has talked so much about women advocating for themselves and being such a good listener, yet you found yourself in a place where you had to advocate for your own health, especially when you were being told everything was fine. Can you tell us a little bit about your own personal story, the breast cancer diagnosis? Absolutely. So I started my breast imaging years ago. I come from a family with no cancers. So I had no family history of any cancers. I had a negative gene mutation. I did the regular genetic test and I didn't carry any genetic mutations for breast cancer. I never smoked. I've never done drugs. I've had maybe 20 alcoholic drinks all my life. So I don't drink. I've never been overweight. I've always been thin. I was never on hormones. So I was the poster child for someone who was healthy. I was exercising and I was not supposed to get breast cancer. When I was 48, I went for a mammogram and they saw something in my left breast and they said let's do a biopsy. They did a biopsy came back a typical lobular hyperplasia, which is pre-cancer changes in the breast. And I was surprised to even have that, right? So my doctor removed it and she told me to go and come back after six months. I came to my office and back then I used to calculate everyone's lifetime risk of breast cancer. So I'm like, you know what? This is weird, because I had no reason to check my own lifetime risk because everything was negative. And I figured I was around 12% because, you know, one out of eight women in this country will get breast cancer. So I thought I was around that number. When I had that biopsy, I came to my office and I calculated my lifetime risk. And it came out to 37.5%. I was eating my lunch and I almost fell off my chair. I'm like, wait, what? That can't be. I calculated it again. And it this number popped out on my screen. And I'm like, I can't believe my life risk is 38% almost. I called my doctor. I'm like, you told me to come back in six months, but I have three little kids. And this says 38%. If you told me I was about to board a plane with my children that had a 38% chance of crashing, I would look at you and say, you're crazy. I'm not going to board that plane. Yeah. And she's like, well, what do you want? I'm like, I want you to take my breasts off. And the first thing she told me, she's like, but why are you crazy? And she's a very, you know, she's, I'm not going to say who she is, but she runs the breast cancer center. And she said that her lifetime risk was high, that her family member died of breast cancer. And she would never do a double mastectomy. And I looked at her and I'm like, I know, but what you decide to do with your life and what I want are completely different. I don't care about my breast. I had breast implants too. I'm like, take him off and just take my breast issue, replace him with a bigger implant and let me go. Tell me, you know what, you're 48. Let's give it until 50. It's amputation. It's not going to look good. And the list went on and on. Anyways, that didn't sit well with me because I had three kids running around. So I asked so many doctors, I'm surrounded by gynecologists, breast surgeons, oncologists. Every single one of them told me I was paranoid. I was crazy that I didn't need to do this. Finally, the doctor who was willing to do this for me, against her advice. And she had done four mastectomies. And I said, you know what? Great. Let's go do it. She did my mastectomy. I almost died because I blood so much. And for you guys, you know, my hemoglobin was five. Oh my gosh. Oh my gosh. This is wild. This is wild, right? It took 10 hours. But you know what? I still woke up even though I felt so sick from all the blood loss. And I was so weak. I opened my eyes and I looked at my husband. I said, go tell the kids. I will never come home telling them that I have breast cancer. Mommy did this. And I'm so proud of myself. Well, a week later, actually, when I was in the hospital getting breath transfusion, my patient went into labor four weeks early. And she really wanted me to be there. And she started crying over the phone that she wasn't going to deliver without me. And I had my husband going to drive me to cedars with drains coming out of my chest with my pajama. And I went and delivered him. And I love him. And I have such a special bond because every time it's his birthday, I know it's the birthday of my surgery surgery week after my surgery. I was at staples shopping for back to school with my husband. And that's when my plastic surgeon called me and he said, he got off the phone with the pathologist. And you know, in medicine, when someone says, I talked to the pathologist, answer, untoproven otherwise. So I knew at that point. I just got chills. I literally just got chills. That's shocking. I mean, did you ever go back to those other doctors to say, hey, I got my mastectomy and look at these results or you didn't even bother. I sure did. Honey, you know, when someone says you have to answer your world comes collapsing. And I blacked out. I couldn't even, he was talking and my husband has it on video. I couldn't even listen to what he was saying because my brain went straight to the cemetery. You know, for anyone who's been diagnosed with cancer, it doesn't matter what stage you don't, you know nothing, right? You get this call saying you have cancer and they were digging in my left breast and it turned out they found breast cancer in my right breast. Wow. So all of it was so traumatizing and the same doctor who would not do my surgery in the first place gave me a call because you know, these two hospitals went upside down because I kept saying someone removed my breast, someone removed my breast. So I started getting all these calls from the radiologists from the surgeons and the same doctor, my first doctor told me you're so lucky. Oh my God. You're so good at acidity and we caught your cancer early. I'm like lucky. This is not what I had to fight because I had every reason to be diagnosed with breast cancer right now. You followed your intuition and it sounds like the way your brain works. It's not paranoia. You're being thorough. You're doing things that could change your management and it could change the management for the better. Can you talk a little bit more about this risk assessment? Like why is this only coming to light after Olivia Mann was on daytime television talking about how she was diagnosed with breast cancer after getting this lifetime risk assessment? Like how long has this been around and why are we only talking about it more now? Well, I was at least 10 years and I've always used that. It's called tire cusic. It's essentially a breast cancer risk calculator. It looks beyond just. Did your mom have breast cancer? Basically, it takes multiple factors. It's your age or reproductive history. When you got your first period, your family history. If you've had prior biopsy, if you have dense breast tissue, if you have had any high risk breast lesions and based on that, it calculates a woman's risk of breast cancer over her lifetime and that number doesn't mean you're going to get breast cancer. At least back then, now it's changing a little bit and I'll go more into it. But with this tire cusic, it's a simple formula. You can literally sit at home, calculate your own lifetime risk as long as you know the density of your breast and you know your family history. You just answer some of these questions and it tells you your lifetime risk. So if your lifetime risk is 20% or more, then you want to start your breast imaging as early as 30 and that imaging should include mammogram ultrasound and even MRI. Otherwise, we can miss these cancers. So this is a simple formula and I did it for myself. I did it for Olivia. Again, her lifetime risk was 30 some percent and she had a negative mammogram and negative ultrasound and I called her and I'm like, listen, I know your mammogram and ultrasound is negative but you need to do a breast MRI and at first she was hesitant because her physician friends were telling her you don't need to wise your doctor. So paranoid, but she's so incredible. She went and did it. Actually, she had, it's so hard to talk about her, because I mean, and she had, by the way, she had a newborn at home. Yeah. She ended up having two lesions in her right and one lesion in her left. High grade, high grade early breast cancer. It's so scary because, I mean, I've had breast imaging. I'm in my 40s. I've never had an MRI and it's a scary story because you assume the mammogram plus the breast ultrasound is going to pick up the majority of lesions. I'm wondering, have you talked to radiologists since all of this became more widely publicized? Like, do you get pushback from the radiologists about this, especially those that focus on breast imaging? And do you have a hard time getting insurance to cover these exams on the basis of this lifetime risk assessment? So I fight and no one questions me. I don't allow people to question me. If you're going to question me, I'm going to move my patient to another center. My patient's health is not up for negotiation. Number one, number two, insurance companies know if your lifetime risk is high, they have to cover your breast MRI. But if you're not calculating someone's lifetime risk and you're not putting in the diagnosis, they're going to say it's not covered. Right. Then again, a lot of times it needs to be covered and they still don't cover it. So that's another issue that we really needs to be addressed. - I mean, as a tip for women and clinicians alike, when I started, we now put a charting template. We have like a space for the tire cruising just so that we make sure we don't forget to do it with our new patients. And I can't tell you how many people we find with elevated scores that we now have, like just like a steady referral to the breast cancer center down the road. Because of this, I can't believe that this woman, and like you said, Dr. A, like they're coming from these longevity clinics and yet, no one's done a basic screening. I just think sometimes basic preventative screening is just not, it's not utilized as much as it should be. And I mean, it should be standard part of the annual exam. Yeah, yeah. - And you know 50% of women walk around with dense breast tissue, right? If you have dense breast tissue, it makes it hard for the mammogram to pick up that lesion. And dense breast tissue is associated with higher risk of breast cancer. So you need to know if you have dense breast tissue. And if you do a 2D mammograms not gonna cut it, you need to ask for a 3D mammogram. And in addition to your 3D mammogram, you need to ask for a breast ultrasound. Now, if you do those and your lifetime risk is still above 20%, then you also need to ask for a breast MRI. But these are so simple. That's why honestly, I started my CMD podcast because I give all this information to women. And you know, I love my celebrity patients because I bring them into my podcast and I use their platform to bring awareness to the condition that they have. Chloe talked about her surrogacy because when these women talk about their medical conditions, then other people listen, their followers listen. And when they listen, that's how we bring awareness. Olivia Mann exploded the tired music in the world, not just in this country. And I literally bow down to her for bringing so much awareness. And she always says there's nothing she's done that has been more powerful than just, she's become the face of breast cancer awareness. She helped save her own life and she's helped millions of women get the information they need. - It's something that I've learned in the process of creating content and being a doctor on social media. And I often will joke, all we need is a Kardashian to mention this one issue and all of a sudden the amount of discourse around it and understanding and intrigue. I mean, look at AOC right now, dominating the headlines for doing something that thousands and thousands of women have done, egg freezing, but it's still something that we don't talk about enough. She's raising the issue of why isn't it covered by insurance? Like we're talking about there being a lower birth rate and a shrinking population, but we're not doing the things that are needed to support people being able to have children at a later age. I think it's incredible when celebrities or people who have platforms are sharing because I think it makes such a difference. And it seems frivolous and silly because it's like, oh, celebrities, but it is actually I think one of the most important, powerful public health tools that we can be leveraging to improve education because I think there is such a huge knowledge gap not just in the world of fertility, but you're absolutely right. Like every day, today I diagnosed endometriosis PCOS. I told someone they have a bike cornea at uterus, like it shouldn't be at the level of the specialist. These are things that you're absolutely right that people should be walking through life and learning about themselves from an early stage. (upbeat music) I see so many women on GLP ones and what a lot of people don't realize is just how easily that can lead to dehydration or electrolyte deficiencies. Did you know that when you're really low on electrolyte, it's so much harder to think clearly or feel like yourself, especially with everything most of us are juggling day-to-day. It's part of why I've started using instant hydration myself. I take one in the morning before I go to work and when I'm traveling or working out and I've generally noticed a difference in my energy and focus. It's made with real French gray sea salt zero sugar and it actually tastes good, not chalky or overly salty like most electrolyte mixes. 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Do you feel like just keeping your ear to the straight that you are hearing people with more awareness of endometriosis? Do you think that nine to 11 year delay in diagnosis is shifting in a positive direction? It's definitely shifting, but it's still nine to 11 years. Listen, podcasts like yours, like mine, social media has brought a lot of awareness to endometriosis, and now we have this new blood test that's approved in this country, and there's a saliva test in the UK that women can actually ask for when they feel like they're getting dismissed. We are definitely moving in the right direction, but there's so much more we need to know. The problem is, let's talk about endometriosis. Endometriosis is not just painful periods, right? It's a whole body inflammatory estrogen dominant and progesterum resistant condition that affects every part of your body. So it's not just about pelvic pain. These patients can have multiple symptoms from painful periods, to painful sex, to pain in the pelvis, chronic pelvic pain, bladder symptoms. These are patients who bounce to the GYN office complaining of we're current UTIs, but their cultures are negative. Pain with bowel movement, bloating that doesn't go away, fatigue, exhaustion, inflammation, brain fog, anxiety. So it's a whole body condition, and yet their pain is minimized. Their symptoms are dismissed, they're told they're okay. I have patients they fly from all over this country, and all they tell me is, they already know their diagnosis. They just want validation. - They just need someone else to tell them, wow. - At least for these patients, now I think you know they're two tests that are approved. By the way, if you listen to a patient, 99% accuracy you can diagnose their endometriosis, but if you're not listening, then you can do the HER Resolve Test. HER Resolve Test uses microRNAs, proteins, and steroid hormones, and they use this AI algorithm to predict who has endometriosis. And what they do, they basically miss about two out of 10, so they're diagnosing eight out of 10 patients. [BLANK_AUDIO] test is positive, that means it's correct. Right. But if it's negative, it doesn't mean you don't have it. But at least it's picking up eight out of ten patients. The other end of tests that's now available in the UK, I have the HR Resolve test in my office, but it's not readily available to everyone right now in this country. Right. But the saliva test in Europe, same thing. But that one only misses one out of 20 patients. And they use about I think 109 specific microRNAs and that's why it's a more accurate test. And that's saliva test. But these are all a step forward for all these patients who are getting dismissed. If we can diagnose eight out of ten, if we can diagnose 97% of these patients with a saliva test, then I would be so excited. The problem is you diagnose, but majority of doctors still don't know how to treat. So then what. Right. Right. That is the problem. What about silent endometriosis? Because this is something that fertility patients talk about, ask about a lot. I'm getting the sense that you're saying usually there are clinical signs and symptoms, but maybe what people are calling silent endometriosis, it's just that they're looking for the wrong symptoms. There's subtle symptoms that are affecting other parts of their body and other aspects of their life that aren't chronic pelvic pain per se. Is that what you're saying? 100%. I just operated on a patient who had recurrent bladder infections and she had taken so much antibiotics. And I'm listening to her. I'm like, this is not a UTI. Your cultures, I got all her medical records and all her cultures are negative. That's endometriosis and to prove it otherwise. If you're bloated and your bloating doesn't go away, if you have to be picked up from school because your pain is so bad, if you can't have sex because it hurts with deep penetration, if every time you have a bowel movement, it hurts. If you're walking around with chronic pelvic pain, all of these could be endometriosis symptoms. Right. So, and you know what? In the bucket of fertility, when I go through my buckets of why someone is not getting pregnant, you have the female factor, you have the male factor, you have the anatomy, and then the next ones are roulette endometriosis and roulette PMOS, leading causes of infertility. Don't miss them, but majority of these women go through life. I mean, I don't have to tell you guys. You're not sending people for laparoscopy, though. Like you're just saying, based on history, clinical signs and symptoms, maybe plus or minus these tests that are newer and, you know, quite sensitive, that should be enough, right? So, I don't even need the blood test. I just do it for as part of research, right? I can act on my consciousness. My accuracy is 99.5%. I operate every single Friday. I have a line-up of endometriosis patients that travel from all over the country, and I'm extremely good. So, I never make with, I am that referral. People come to me. I think 1% of gynecologists know how to operate, and 1% know how to deal with advanced endometriosis. You have to remember, this is an inflammatory condition. These patients have a lot of scar tissue. I took two of my patients last Friday. One had a five centimeter endometrioma. One had seven centimeter endometrioma. One was from London, and the other one had traveled from another state. So, these patients, they have such chronic pelvic pain, and they even have an endometrioma, which is easily seen on ultrasound, and that takes you at least to a stage three, maybe four, and they're still being dismissed. So, surgery, I operate. I love surgery because it is definitive, and I can treat. I don't operate to diagnose. I already know my diagnosis. I usually suppress, and you want to give it progesterone, endometriosis implants grow with estrogen, and their growth slows down with progesterone. I love IUDs. You can do birth control pills, but because these patients have a lot of anxiety, information, and their limbic system, which is their emotional headquarters, already on fire. Yeah, I rather start with IUDs. I love for younger girls. I do a Kylie and IUD for women who've had children. I use a marina. And if that doesn't respond, usually gold standards to go in and cut these lesions out. So, I do that proscopy while they're under. I put a IUDN, and if they have an end stage, I might use a GNRH antagonist with those in addition to the IUDN surgery. So, not every single patient is treated the same way, and surgery is not to diagnose. I operate to treat. I know, I'm never wrong. So, I go in and I cut these implants out, and it makes a huge difference, especially with stromal endometriosis, who, you know, they don't have regular blood field lesions. So, they're harder to find during that proscopy. They're like little white blisters. Right. And it sometimes takes me five minutes to find those, and they tend to be more painful and more inflammatory. One of the things that breaks my heart, and that I think it's important for clinicians, especially that are seeing women with endo, like in the emergency room who are coming for pain, is that these women literally have nerves that have been hyper sensitized to pain, that have been spiring so much that they actually feel more pain than one would think they would from these lesions. Like, their pain is out of proportion to what you can see on imaging sometimes. And so, you know, it breaks my heart because I know so many of these women go to the emergency room, they're given a short course of percussed or whatever, and then it's just this vicious cycle, no one's treating it. So, important to realize that we know that those nerve endings are firing off all the time and these women are suffering so much. Yeah. And literally, their brain is getting rewired. So, what you and I might perceive a two out of ten, they perceive a ten out of ten. And that's where it is rewired, exactly. The stage of the disease has nothing to do with the pain. Sometimes stage one patients are in the ER, and stage four patients have mild pelvic pain. I have a quick question because we talked a little bit about GLP ones and now we're talking about endo. Are you at all hearing that GLP one agonists are helping women with endometriosis? Because that is definitely something that people are talking about a lot. Yes. So, endometriosis, these implants, every time we have a period, let's say one hypothesis is that some of these endometriosis going to the pelvis, a normal immune system gets rid of it. With endo patients, the immune system actually sticks these cells to the wall of the pelvis bladder over a tube. And each one of these become an island. They start making their own estrogen. They grow nerve fibres and they grow blood vessels. Every month this gets worse and worse. These lesions are highly, highly inflammatory. And there are new studies that says GLP ones, besides addressing the metabolic dysfunction, they actually directly affect the inflammation in these patients. So, I do, I look at their weight, but I do microdose GLP ones, especially for my patients with advanced disease. Yeah. I've started doing it as well, especially because a lot of my patients who are on long journeys, they're struggling with weight gain that they can't shake between cycles. And so, I feel like I'm optimizing them metabolically and maybe from an inflammatory standpoint. And I think that there's enough discussion about this and some preliminary data that it is interesting and we should probably be acting on it to help the patients that are in our current practice. The one thing I want to bring up is that in my practice and I have data, I don't think anyone has seen as many PMOS patients in their life as I have. Literally, I've been seeing these patients for years and I don't think anyone has the data on GLP ones that I have on these PMOS patients. And because I operate on my endometriosis patients, I will tell you, based on my data, 61% of PMOS patients have endometriosis. So, when you see one, you better not miss the other. So, if you have an endometriosis patient who also has weight issues, who has symptoms of PMOS, she probably has PMOS also because they go hand in, a lot of patients they go hand in hand. And that's my data for my office. And the other thing is 90% of endometriosis patients have leaky gut. Chronic information in the pelvis affects their gut. So, leaky gut, which a small intestinal bacterial overgrowth, can cause fatigue, can cause insulin resistance, can cause weight gain, can cause brain fog, can cause bloating. These are patients who just have no energy, they're weight fluctuates. So, whenever I operate on someone with endometriosis, actually, I take a video and I can look at their bowel and I see that it's descended. And what I do with those patients, usually after I suppress and take care of their endometriosis, then I go fix their leaky gut. In my experience, you can't fix that leaky gut until you address the underlying endometriosis. Fascinating. Wow. Well, your patients are so lucky to have you. And thank you so much for sharing your knowledge with us. Dr. A, shifting gears a little bit before we end. We want to talk a little bit about medicine and social media. You have almost half a million Instagram followers. You co-host Shia MD. You've built a large educational platform in order to share your wealth of knowledge for women to be able to empower them. We are also content creators. It makes our creators a bit more dynamic and we do this to reach a wider audience to help support women so that they can advocate for themselves. But I want to ask you, what do you think is the responsibility of being a physician influencer? And it's a bit uncharted. And what are some red flags that you would say, you know, for women to look out for? Yeah, it's uncharted territory. I want to hear your thoughts. I would say social media is great, but it's not a place that you want to get your diagnosis from. You want to get your treatment from. The problem is there's a lot of influencers with millions of followers who are actually giving medical advice and talking about supplements to take, talking about diets to follow medications to take. And it becomes a very dangerous area to be honest with. you, you know, on my passion is PMOS and endometriosis. And I listen to reputable podcasts with reputable doctors on it, and they still don't get it right. So, yeah. So it's very tricky, especially for these two conditions. It's important for women to know, to get their information from someone who specializes in that condition, right? It's great to listen to social media and to learn to advocate for yourself. But at the end of the day, you need a reputable, experienced physician specific to your condition to diagnose and to treat you. Where do you see things going? Like in what direction? When it comes to the misinformation problem, which, you know, I could talk about all day long, it, it makes my blood pressure rise, you know, people send me posts and I debunk them. And it just feels like a game of whack-a-mole. Do you think more and more doctors getting on social media is going to solve the issue? Is it going to further confuse patients? I'm starting to think the solution isn't the whack-a-mole game. It's actually just giving people the critical thinking skills and the education so that they can't be duped. What are your thoughts? I think women, first of all, they need to be their own advocate. In order to become your own health advocate, you need to be educated on your topic. And instead of relying on social media, I much rather have my patients go on cloth, go on these AI platforms and try to put their symptoms in and see what those diagnoses are and then finds physicians who actually specialize in those conditions. I think social media is a dangerous place because I hear it all, you know, I've been treating, for example, PMOS patients with GLP ones for years. And it's been a game changer since 2014 for my patients. And I have a broken heart when I see people just destroying these GLP's. Not knowing anything, not having any experience, they start talking about blindness and putting such fear. It's your algorithm, too, right? The more you wash, like my algorithm is all like bad things. Mine is scary. Mine is filled with the Clancy case right now. I'm like, I need to take a break from that. She's a good example. I mean, I did a post about that. This is a perfect example of a woman who symptoms were not dismissed, but she was not treated correctly. No one advocated for her postpartum depression is real. It can happen up to a year. So you might be fine. And then it can come and look what she did. She kept warning people that she was going to hurt her children and no one took her seriously. It also highlights the fragmentation of the healthcare system. And I think telehealth can be great, but I think it kind of exposes the cracks in the system. You know, I think as physicians, we all got into this field because we wanted to help patients. And I feel like somehow we have morphed into this system where we're all like I've said before in this conversation in silos. And it makes it harder to kind of step back and appropriately treat the whole patient as a human. It's like you're kind of distilling them down to these distinct systems. It's hard because everyone is becoming so much more and more specialized. Yeah. But it does expose, like you said, well, there's really no infrastructure for postpartum that's like specialized for postpartum women. Like I remember when I was doing OB, I was the one screening for postpartum depression and I had a patient with postpartum psychosis and I was on call. And I was covering the labor and delivery floor and her husband called me completely distraught. She wasn't threatening to her herself or her kids, but she was completely disconnected from reality. And I tried sending her to the emergency room, the emergency room. They didn't have a site consult, then they kept her there for a little bit, then they discharger to follow up with psych on the during the week. And I was like, no, she needs to stay. And I'm like, I'm not even a, you know, I'm an OB/GYN, of course, but like I'm trying to talk to get psychiatry to see or anyway, this is such an important crucial part of women's health that really they're just sort of left hanging. I mean, yeah, the system is so challenging. You guys 50% 50% of counties in this country do not have an OB/GYN. And then that's the thing. It's like basic care. There's a basic care desert in so many places. You know, and when I hear, you know, I love longevity and I love sort of all the cutting edge things in the test. I do love that. But when you hear the conversations between men and women, it's so sad that it's so disconnected because it's like women just want basic care. Here's the thing. What she just said, that 50% stat, we have the FDA debating like peptides. Right. I'm like, forget about the F and peptides. Let's make sure women are getting breast cancer screening and getting diagnosed with endo and PCOS. Exactly. It's like, it's matting. Or HRT. I know, I specialize in perimenopause, you know, for women to access HR, they can't even access HRT. And yet, you know, men are talking about doing all these peptides and plasma free cysts and filtering their blood. And it's like, you women can't even get an endo or PCOS diagnosis. I made it my mission. I literally feel like I was placed on this planet to help women. And I always tell my daughters, I have two daughters that stand for it. And I keep telling them, you have to help me come up with a solution for women's health because I'm not leaving this planet until I fix this situation because I want, I don't want women to get basic care. I want every woman in this country to get the care that I provide in my office. And I think I know how to do it. Wow. You know what? I needed to have this conversation. I want to thank you because I think as a clinician, we can get burnt out and beat down. And especially if you spend time on social media, it can be very depressing, right? And I get through the day by just saying, like, okay, I'm making my difference in my little corner of the internet. It is really lovely to talk to a colleague and your energy and your passion and your mission. We are very aligned. Yes. I inspired. And I just think that it kind of renews. Like sometimes you need that fire lit inside of you. And I, yes, I need to go do, I need to go workout or something. I have so much energy from this conversation, but you are really an inspiration. And I know how busy you are. I mean, you're doing it. You're a jack of all trades. You're doing all these things. But the fact that you spent this hour with us to share your viewpoint and, you know, you're just a brilliant, brilliant doctor and colleague. And we're so grateful for your time. We'd love for you to share. Yes. Where can people find you and learn from all of your amazing resources? Honestly, I would say my GMD podcast. I do it for everyone. I do it for every woman on this planet. We cover every single medical condition. And I dive deep into it. I literally give women the tool they need. I even give the dosages of prescriptions sometimes so they can actually go and ask their doctor. So GMD podcast is my baby. If you are listening to this podcast and you think you have PMOS, I have a platform I created. It's called OV, OVII.com. I have a calculator. Women can take the questionnaire and I can tell you whether or not you have the likelihood of having PMOS. PMOS is the one of the leading causes of infertility on this planet. And you absolutely do not want to miss it. And I have an amazing supplement that I created for these PMOS patients that will help reduce their cravings, help with their insulin sensitivity, help with their mood, help them ovulate. And we've had a lot of people get pregnant. But the message I have, thank you. First of all, thank you for having me. But I would say, be your own health advocate. No one is advocating for you out there. Your doctors are great. They're amazing. But at the end of the day, if something, if you have a symptom and you feel like something's wrong, 99% something is wrong. And we're so into and women are so into their body, do not dismiss your symptoms. I wish I said it in the intro. But when Alicia and I, you know, we're best friends. We did residency training together. When we thought about this podcast a year ago, GMD was actually one of the podcasts and conversations that are at the forefront of our inspiration behind having this show. So thank you so much for coming on. Thank you so much. I'm so proud of you guys. I'm thank you. Listen, we all need to like stick to yeah, and raise the standard. Yeah. That's what we're doing. Working together at a time, raising the standards. That's right. One patient at a time. Thank you for being here. Of course. Thank you. One of the biggest takeaways from today is that celebrity stories aren't just for entertainment. When someone like Olivia Mann or Kardashian shares their personal health journey, millions of women suddenly recognize themselves. They make appointments. They ask questions. They get a diagnosis. That's the real power of these conversations. Thank you so much for joining us for this week's Call Your Doctor. And thank you for sharing your perspective and expertise with us. Thank you for calling. We hope you got the answers you needed or maybe a lap you didn't expect. And remember, whatever you're going through, you're never the only one. Call in with your questions for us at 754 Call Doc. That's 754 225 5362. If you love this episode, hit follow, leave a review and send it to a friend who needs it. We'll see you next week. Take care of yourself and remember to call your doctor.