- [Announcer] Support for this series comes from Inland Empire Health Plan a health plan with a mission to heal and inspire the human spirit, serving over 1.5 million members in the Inland Empire.

- I was thinking this morning about the signs of heart attack.

And, I think most people know the signs of heart attack.

But, most of the signs of heart attack that we know are the signs of heart attack in males.

- Behind every diagnosis is a person, a family, a story.

Hi, I'm Leticia Juarez and on this show we are listening to patients and the medical professionals who walk beside them, sharing their struggles, breakthroughs, and the lessons learned along the way.

Together, we're making healthcare clear, compassionate, and closer to home.

So, join me on this journey of Health Caring.

[soft piano music] ♪ - [Leticia] Today's episode is all about women's health.

What are the biggest ongoing concerns?

And, how are health professionals adapting their approach to meet women where they are in life?

We'll hear from local healthcare providers as well as women whose personal stories might inspire you to take charge of your own health.

Well, welcome to the program, Ms.

Kanita Bourne.

This is an important topic that I think our audience needs to hear and learn about.

So, thank you.

- Thank you.

- So, is there a gap in health education for women, especially regarding signs of chronic illness or how to advocate for themselves in a clinical setting?

- I think there is an educational gap for women when it comes to chronic conditions.

You know, the signs of heart attack in women are different.

But, that education has not been prioritized universally, right, for a number of reasons.

So, we know if you have a shooting pain down your arm, usually somebody's having a heart attack.

But, for women, you can have sweats.

You can be dizzy.

There's so many-- There's so many signs of heart attacks in women that are not talked about.

And, I think that's the same for these other chronic conditions.

When we want holistic health care for all, we have to change the education so that it encompasses all people.

We cannot continue to educate people universally on what is common for white men and think that the education is enough.

- [Leticia] Well?

Welcome, Dr.

Glupczynski.

And, thank you for joining us today as we talk about a very important topic of women's health.

- Well, thank you so much for providing me this opportunity to talk about women's health.

And, welcome to our office here in Upland, as well.

- I wanted to ask you.

What are some of the pressing issues facing women when it comes to women's health?

- I mean, I think sort of generally speaking, people have a lot of concerns about heart health, diabetes, diabetes prevention, cancer.

You know, cancers of any kind; breast cancer, colon cancer, skin cancer.

And then, probably mental health and stress and the effects of stress.

I think those are the concerns that people bring to me most often.

- [Leticia] I also spoke with Dr.

Shayne Poulin-- (knock-knock) - All set?

- [Leticia] serving the Upland community.

- I think really important to recognize is the chronic health conditions that we see in everyone.

Specifically, heart disease and diabetes just can present differently in women.

Acknowledging that lots of chronic diseases are in all genders, but they show up for different people in different ways.

And, that's really important to recognize.

- What does a wellness check entail for a female patient of yours that comes in?

- [Dr.

Glupczynski] A wellness check in some ways, it is those things that might get overlooked if you're coming in for more of a problem-based visit.

So, it's a very comprehensive kind of whole person-- - Mm hm.

- you know, assessment.

And then, we might have somebody who's feeling great, doesn't really have any concerns that are elucidated by our screening.

And then, somebody else might have more issues that come up.

And then, we sort of use that as a springboard to then sort of map out or plan out follow-up visits.

- Do you see that people are using different apps or social media to kind of bring up issues, too, when you see that people are trying to access in terms of service?

- [Dr.

Poulin] Often, birth control is a common one.

Certain diagnoses often will kind of come in waves, too; endometriosis, PCOS, perimenopause.

Those are all things I sort of see enter the "zeitgeist", if you will.

And, I actually think that's really great because it begins the conversation.

- Yeah.

- And, sometimes, it's the way people know, like, "Oh!

It's not normal that I'm in pain every month," or "It's not normal that I'm experiencing this symptom."

And, that's a conversation starter.

And, I think that, that is actually a benefit.

- Yeah, I kind of feel like women are juggling a lot more these days when it comes to motherhood, work, social life, and also taking care of, you know, maybe aging parents.

And, it's like there's a whole gamut there plus their relationships, as well.

- Totally.

You know, I mean totally, totally.

I see so many people who really are caregivers, and in addition to working full-time outside the home, you know, oftentimes putting their own needs or concerns last.

- And, that's what I wanted to ask.

With doing all of that, it's important that women take care of themselves.

Because it's almost like you gotta put the oxygen mask on yourself first before you can give it to others.

- I tell people that every single day.

I mean, every single day.

It's almost like you maybe have, you know, heard me say that in the exam room!

I always say, "You know, when you get on a plane "and they tell you, you know, "if you gotta put on an oxygen mask "and you're traveling with someone who needs help, you have to put your mask on first."

You know, because people are caregivers, and they just take care of the people around them.

But, I really try and help people feel like, "If I'm not-?

"If I'm not doing well, my family's not gonna do well.

"And, I might think I'm sort of chugging along and doing okay, "but my body is gonna tell me "even before my brain does "that something is going on "and that I really need to-- I need, I need some relief."

- [Dr.

Poulin] And, you know, not to produce stereotypes, but women tend to be minimizers- - Mm hm!

(they laugh) - and sort of downplay sometimes symptoms.

And, quite honestly, sometimes people aren't as good as listening to women.

And so, even when pain is brought up, it's sort of brushed off.

Like, particularly when it comes to gynecologic conditions, the expectation that people should sort of suffer.

We need to change that narrative and recognize that pain can be a sign of things not functioning properly.

- What are some of the different screenings and preventions that are really important to catch as early as possible?

- [Dr.

Glupczynski] If you're 25 or older, you'd be offered cervical cancer screening.

If you are 40 or older, you'd be offered breast cancer screening.

If you're 45 or older, colon cancer screening.

And, again, that might vary depending upon family history.

The number one, number one, number one, number one cancer prevention is don't smoke!

(laughs) - Oh, that's not even one I thought about!

- Don't smoke!

If you wanna prevent cancer, don't start smoking.

Don't smoke, don't vape.

That's-!

- I was about to say, and vaping has to be thrown in there, too.

- Yes!

Please!

So that's, you know, the number one cancer prevention that I can offer people.

I tell ya another really, really, really big cancer prevention: the HPV vaccine.

I cannot emphasize enough how much the HPV vaccine is important in cancer prevention, preventing not just cervical cancer but HPV-associated throat cancers.

And then, skin cancer prevention.

That's another really important cancer prevention, in particular for women.

We know that rates of skin cancer, you know, for women, very, very high.

Younger and younger women coming in with skin cancers.

Please don't use tanning beds!

(laughs) - So, that's still a thing?

- It is still a thing.

- Okay.

- Please don't use tanning beds.

You know, that's a huge risk factor for skin cancers.

Colon cancer screenings: super, super important.

You know, everybody I think has breast cancer on their radar.

The number one cancer killer of women is still lung cancer.

Number three coming up right behind breast cancer is colon cancer.

So, you know, again, colon cancer screening starting at age 45; super, super important.

- [Leticia] Well, I wanna now go on to the older you get when your hormones start to take a dive and we enter the perimenopause phase.

- Yes.

- I think a lot of women don't understand what they're-?

They think like something's wrong but they can't quite pinpoint.

And, I think a lot of people think when they think "menopause," they think hot flashes.

- [Dr.

Poulin] It's so much more.

It's so much more.

So, when I think about menopause, menopause is technically going one year without your period.

But, before that happens, you talk about the hot flashes, night sweats, changes in your weight, changes in your metabolism, your mood, your sleep, all of these things.

And, they're not the same for everybody.

They can be subtle or they can be really dramatic.

And, I think what's most important to know is we can help you.

There are medications.

There's different therapies out there.

And so, you don't have to just kind of like grin-and-bear-it.

There's relief out there for what you're experiencing.

- And, I wanna talk about life changing, lifestyle too: how we eat- - Mm hm.

how we diet?

No, I won't say diet 'cause I feel like "diet's", like, a dirty word, but maintaining a healthy lifestyle.

- Yes.

- And, exercise.

And, that's gonna be really helpful as you become a mature person.

- Put the idea of weight out of your head.

Let's talk about the foods you put in your body.

Are they healthy?

Are they nutritious?

Move your body, exercise.

And, as we mature, some of those exercises need to change.

So, as you go through menopause or head towards menopause, weight-bearing exercises are gonna be really important to combat osteoporosis.

And, I'm not talking, like, going and bench pressing!

But even just, like, 5, 10 pounds can really protect your bones and reduce your risk for things like hip fractures down the road.

My job as a doctor is to meet people where they're at.

Your zip code is your biggest predictor of health in this country.

I could recommend all day long on how to eat right and exercise.

But, if that doesn't fit within your life, it's not gonna work.

And so, coming to the doctor and making sure you're getting all of your preventative screenings and having a full checkup is really important to understand where you are in terms of your health overall.

And, that's coming to the doctor for your routine checkups.

- [Dr.

Glupczynski] I think just the approach in family medicine, it really is seeing a whole person, seeing that whole person in the context of their family, their community, their environment outside of the medical walls, you know?

And, I think that's something, you know, special that we can bring to-- and offer somebody, you know, as a primary care provider.

- [Leticia] Shanti Jones knows all too well the importance of a patient-doctor relationship, and found what she was looking for here at Melody Health.

- [Leticia] Thank you for joining us and talking about women's health issues today.

- Thank you for having me.

- I wanted to ask you about your own kinda journey into finding this place.

I know that before you came here, you kind of didn't have that comfortable rapport that was now so important to you.

- Yeah.

So, before I became a part of Melody Health Care, I did not have as much confidence as I have now as far as wouldn't talk to my doctor, and just ask him questions.

I was kind of, like, scared or I felt like it was a dumb question.

Because of my age, I felt like I should have known.

But, once I came here, I felt like there's no such thing as a dumb question.

- As a woman of color especially, you know, we hear that there's issues in medical.

Like, whether it's, like, being heard and understood and knowing that, you know, when you're in pain or you're having an uncomfortable feeling, you wanna be heard by doctors that really are seeing you for who you are.

- I am so glad you brought that up because that is so true.

And, that's one of the biggest reasons why I came here.

They hear me.

And, you are so right about that.

Because as a woman of color, I have experienced times where I felt like I haven't been heard.

But, ever since I came here, I'm heard.

My voice is heard.

I am seen and I'm heard.

And, that's so important to me.

- [Kanita] You go to the doctor and you say to the doctor, "Something feels off."

And, the doctor says, "It's okay.

People have been giving birth for forever."

And, they dismiss you and move you on.

If you have providers that have been conditioned that Black women are stronger, they can deal with more pain, their skin is thicker, when you have a Black woman that is complaining, obviously you're not gonna hear her.

And, not because you yourself are a problem, it's because the education system taught you that "No, they can deal with more.

"So, they're fine.

Let's move on to somebody else who needs it more."

Having the system is not the issue.

Having access to the system is not the only issue.

Making sure that a system is able to hear the needs of this population, that's the issue.

What I think needs to happen is these really thoughtful implicit-bias trainings that are not just a checkbox, that are set to reeducate, reteach people about this particular population what the challenges are so that when they're going out there into the community, into the field, they're going there with a new set of lenses on and it's not just a cookie cutter; "What I do for this person over here "is what I'm gonna do for this Black person."

Because you cannot treat people the same when people are coming to you with years of, of inequity.

You have to be a little softer, you have to be a little more lenient.

The 15-minute appointments might not work here.

So, what are you going to do to change that for this particular person who is probably just terrified to walk in, let alone to advocate for themself.

- [Shanti] When I first walked in the door, I was a timid young woman that wasn't 100% familiar with her body, going through changes with my age, with just having a child.

And, I had more questions than I did answers.

Now, I have almost all my questions answered.

And, I know if I have a question that it will be answered in a timely manner in a way that I will be able to understand.

And, I love how it's an open door policy between my doctors, my healthcare team, and myself.

- [Leticia] How can women advocate for themselves during an appointment?

I know some women don't have that relationship with doctors where they feel like they're getting their needs met.

How can they advocate for themselves?

- [Dr.

Glupczynski] That's a great question.

And, I definitely recognize that some people do not come into a healthcare setting either feeling comfortable asking questions or advocating for themself.

I think-- Some of it I feel is on me to really try and set up an environment where people feel comfortable, and really just trying to draw questions and draw concerns out of the people that I'm working with.

If you feel like somebody is not hearing your question, maybe just say, "Can I-?"

"Would it be okay if I repeat my concern?

(chuckles) "This is what I'm sort of most concerned about and I'm worried it might be X, Y, or Z."

There's a dynamic.

There's a power dynamic, you know, between healthcare providers and patients.

And, many people feel that internally.

They kind of internalize it.

You know, I have some people who come in from backgrounds where you were very deferential to the healthcare provider.

And so, you know, whatever they say, you're gonna say yes.

You're not gonna-- You know, you're not gonna say no.

You're not gonna not do what they tell you to do.

- Not gonna push back.

- You're not gonna push back.

And, I try to encourage people to, you know, push back a little bit!

You know, push back.

- [Dr.

Poulin] Part of it is just being in an overall good state of health.

You know, we talked about some lifestyle changes; making sure that the food you're putting in your body is healthy, you're exercising, you're getting sleep, your stress is managed.

All of these things are really important to your health.

(knocking on door) - [Leticia] My neighbor and good friend, Diane, is an amazing woman whose healthcare journey is filled with perseverance.

She has inspired me to focus on my own health, not only for myself but for my family, as well.

- Can you tell us a little bit about your experience as a woman, and as a woman that has undergone a cancer treatment?

- Well, I was diagnosed with breast cancer when I was about 55 years old.

And, I had a 5-year-old at that time.

And, I saw my life pass before me, and had tremendous anxiety and was so scared.

- How did you discover that you had a lump in your breast?

Did you do it through a mammogram or through a self-examination?

- It was through my annual mammogram.

And, I was lucky because I did my mammograms every year.

And, they found it really early.

And, my OB/GYN called me and told me that I needed a biopsy immediately.

We decided to do a double mastectomy so that I wouldn't have to worry in the future.

I didn't need to have chemo or radiation.

And then, I was allowed to get reconstruction soon afterwards.

It was not a pleasant experience.

And, this is 15 years later.

- Knowing that you had to go through a biopsy, you didn't know what was gonna happen.

That must've been a very-- just stressful time for you to have to wait for the results.

- It was the worst that I can remember.

And, looking back, I tried to tough it out, and I didn't wanna take anti-anxiety medicine.

But, I should've.

There's no reason to go through that if you don't have to.

- What would you tell women about their mammograms?

- Of course, have them done regularly.

I know they're not always the most pleasant, but it's a lifesaving test, so you need to do it.

- What did you do after your mastectomies were done and you were in the clear?

- Well, I went through the process of expanders.

They were replaced with silicone implants.

And then, I felt like a 16-year-old!

So-!

(chuckles) And, I actually had areola tattoos because I wanted it to look as normal as possible.

And, I didn't want to have the nipple placed because I thought that I could go without a bra, and that would be one of the biggest boons from having to go through this.

- Well, that's a good thing.

- That's a good thing.

- Yeah.

You have had to have them replaced, though, since.

- Yes.

- Talk to us about that.

- My plastic surgeon told me, when he did the initial implants, he said, "In 10 years, we're gonna take another look because sometimes there's leakage."

So, I didn't go after 10 years.

I was in denial thinking, "I'm fine."

So, after 13 years, I did go.

Had the testing, and found out that I did have a leak.

So, then I had to have them replaced.

- [Leticia] Did that leak cause anything to your health that you noticed?

- [Diane] It caused nothing that I noticed.

And, it was a very small leak; caught, you know, in good enough time.

So, again, get your mammograms every year.

And then, be retested after 10 years to see if you need replacements.

- Got it.

Do you still have to undergo mammograms?

- Nope!

- Okay.

You know, women get their checkups, whether it's pap smears or, you know, get your mammograms done.

How important do you think these screenings were to just helping you just have this life of health and wellness?

'Cause you are a very healthy person.

And, I'm gonna ask you in a minute, what your age is!

(Diane laughs) - Okay.

I'm diligent.

I take really good care of myself.

And, I'm an advocate and a mentor.

And, I need to practice what I preach, so I am very careful.

I get all my screenings on time.

And, I'm happy to help anybody that has questions about theirs.

- I know, like, as we age as women, it's very important that we maintain our fitness level because we lose so much bone and muscle.

And, you make sure to maintain this in your life.

Can you talk to us about some of the activities you do?

- It's funny because I thought that once I became a senior, it was time to downshift.

So, I started downshifting and it just didn't feel right.

So then, I started upping everything.

So, I do Pilates four times a week!

(chuckles) And, I do aquamotion twice a week.

And, I love it.

I walk, I travel.

And I try to get all my friends to do it, too.

So, I have a lot of fun.

- Now, can I ask you how old you are?

- I'll be 72 in a very short while!

(laughs) - So, you've been very active.

Most people would think, "Oh, 72?

"You're not gonna be getting around as much."

But, you're very active.

- I'm more active now than 10 years ago, I'd say.

And, for me now, I hear my friends, my older friends, complain about aches and pains, and getting out of bed, and getting up off the floor.

And, you know?

Sure, I'm-?

It's a little bit difficult sometimes.

But, I don't have anywhere near the issues that my friends do.

And, it's because of my health.

And, everybody needs to know that they need to stay in shape when bad things happen so that they can take care of themselves.

- And, having those regular checkups is part of the deal.

- Regular checkups, regular exercise.

I call it the three E's: exercise, exfoliation and elimination.

(Leticia laughs) - What's the elimination part?

- Well, the elimination part?

It means to cleanse the body, of course.

- Mm hm?

- But, it also-- Clear your head.

Keep things clean.

When you have a clean room, you have a clean head.

Make your surroundings beautiful, and want to be there, and just make a haven for yourself.

And, appreciate yourself and love yourself.

Be good to yourself.

- Do you think that having a child later in life kinda helps you maintain this youthfulness?

Like, let's talk about that, 'cause you do have a 20-year-old son.

- I'm so glad you asked that, because I think about that a lot.

And, it's funny.

I'm kind of straddling because my son is 20.

I had him when I was 50.

And, all my son's friends' moms were 20 and 30.

So, those-- That's my peer group.

So, I think with my son being 20 and all my friends being 20 years younger than I am, 30 years younger, we're keeping each other young.

- Now, how did that process go?

Like, what made you wanna have your son later in life?

- Well, my husband and I didn't marry until we were 48.

And, we both had wanted to have children and never had the opportunity.

So, we put our heads together and we made it happen.

We went through IVF, for sure.

It took a little work, but I was able to carry 'cause I was in such good shape.

And, I'm telling everybody to stay in shape.

Start now!

I don't care how old you are, start now and don't stop.

And, it was easy.

Really, I had no problems.

- What would you say as being like what they would call an "advanced maternal age," how are you in the best shape of your life at 50?

- Well, I had this little baby.

And, I was able to take him to LA Fitness and put him in daycare.

And, I had a personal trainer.

And I worked out, because that's my background.

- You were a PE teacher at one point.

- That's right.

- So, you obviously have that knowledge and you've kept that up throughout your life.

- Right.

I did that selfishly.

Because I knew that I would wanna keep in shape, so I might as well make it my life's work.

And, I felt great, and I had to keep up with that kid!

- I also know that, like you said, you mentioned you do Pilates.

- Yes.

- One of the things that Pilates is really good for, especially for those of us who are getting older, is balance.

That can be a very big issue.

As you grow older, people tend to lose their balance.

- One fall could just kill ya.

It wouldn't necessarily kill you immediately, but if you break something and you wind up in the hospital, it could change your life.

And, you may or may not get out of that bed.

Your body takes a lot.

It takes a lot of wear and tear.

And, when we get older, something's gotta give, you know?

It's not there forever.

- Definitely as our friendship has grown through the years, learned a lot about staying healthy.

And, I definitely could do more!

- Well, you have a busy life.

- I do.

- I know because when I had a very busy life that this was difficult.

But now, exercise is my number one priority.

Everything else has to work around that.

- Yeah.

Someday, it'll be my priority.

- Yeah.

- Right now, it's, like, fifth!

- Well, I'll keep an eye on you!

- Oh, thank you.

Well, thank you so much for being out here with us today and talking about your experiences with just women's health, growing older, wiser but fabulous, as well.

- You're so sweet.

Thank you.

[peaceful music] - [Leticia] As women, we take on so much, caring for our partners, children, parents, and even our friends.

But, it's just as important to include ourselves on that list.

Your health is the greatest investment, whether it's finding a doctor who will listen to your concerns, scheduling annual visits, or simply making time for some self-care steps that can lead to a lifetime of health and wellness.

So, be good to yourself by staying on top of your health.

[light uplifting music] ♪ ♪ ♪ - [Announcer] Support for this series comes from Inland Empire Health Plan, a health plan with a mission to heal and inspire the human spirit, serving over 1.5 million members in the Inland Empire.