Listen up, because today’s episode is going to be all about hormones and how to take ownership of your own health (a topic on the minds of just a few of us moms!). I am here with Dr. Marra Francis, an OB-GYN who focuses on helping women with genetic risk for certain cancers. Dr. Marra also serves as the Executive Medical Director for EverlyWell, a company we will talk about in depth today.
In a nutshell, her mission is to educate enough physicians so that no more women have to suffer a fate with terminal cancer that could have been prevented simply by taking an accurate family history, and ordering the correct diagnostic test.
Episode Highlights With Dr. Marra of EverlyWell
- why Dr. Marra chose women’s health as her passion and focus
- her tips on running a house with six kids underfoot (I get it!)
- the ups and downs of women’s hormones (and why men don’t struggle like we do)
- what you can learn by tracking your cycle every month, and apps that help
- how EverlyWell helps connect patients to the best laboratory testing for them
- changes in the health space that are making it easier to take control of your health
- and more!
Resources We Mention
More From Wellness Mama
- 15: Hormones & How to Have a Healthy Baby
- 80: What Your Monthly Cycle Reveals About Your Hormones With Alisa Vitti
- 108: Why the Birth Control Pill Screws Up Hormones & What to Use Instead
- My Home Organization System & How I “Get It All Done”
- Why You Should Never Eat Vegetable Oil or Margarine
- 9 Tips to Help Balance Hormones Naturally
- Lab Tests You Can Order From Home (Without A Doctor)
Have you had trouble getting the right lab testing in your area? Could you use a service like EverlyWell? I’d also appreciate it if you would please take two minutes to leave a review on iTunes. I value knowing what you think and this helps other moms find the podcast as well!
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Katie: Hello, and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com. And this episode is going to be all about hormones, and testing, and how to take ownership of your own health. Because I am here with Dr. Marra Francis who has been practicing as an OB-GYN since 2003, but in the last few years she’s shifted focus to helping women with genetic risk for certain cancers, to help them optimize their health and screen for any potential problems. She also travels the country educating other physicians in her areas of expertise, and she is considered a key opinion leader for the primary care division of The Myriad Genetics.
Additionally, as if that wasn’t enough, she serves as the Executive Medical Director for EverlyWell, which is a company we will talk about in depth today. The rest of her bio and list of awards and positions is literally as long as my arm. But suffice to say, she’s wicked smart, I’m pretty sure she gets more done in a day than I do in a week. And her mission is to educate enough physicians so that no more women have to suffer a fate with terminal cancer that could have been prevented simply by taking an accurate family history, and ordering the correct diagnostic test.
And also to make laboratory testing accessible, affordable, and understandable, so that all of us as individuals can better our own health and wellness without being dictated by our insurance. On a personal note, she’s also a mom of six, and she lives in Texas with her hubby and kids. Dr. Francis, welcome, and thanks for being here.
Dr. Francis: Thank you so much.
Katie: I have to say your bio is super impressive. And I have so many questions for you about hormones and health, and we’ll get to those. But to start, I’d love to hear just a little of your personal story and how you got into the world of women’s health to begin with.
Dr. Francis: Sure, Katie. So, let’s see, I sort of always knew I wanted to be a doctor. I had a brief moment in college where I thought that I might wanna be a herpetologist, and actually studied snakes in the jungle. I spent three months in the jungle actually studying insects. I had a run in with a poisonous snake and decided maybe I should go back to the medical school role. So I applied to medical school, and while I was in medical school, my mother passed away of breast cancer. And I think that that really made me focused on women and women’s health, and how, when you lose a mother, the impact on a family is so great. It really just made me focus on why it’s so important on keeping mamas healthy.
Katie: Yeah. That’s awesome. And I can’t even imagine, that had to be so difficult. I’m so grateful my mom is still alive today. But I can’t even imagine. And I know even just having had a friend who had a much less serious type of cancer, it really does make you wanna be able to fix the problem or do anything you can. And I love that you actually are doing that. One more side note before we jump into the really sciencey stuff. As a fellow mom of six, so I get asked this all the time, do you have any tips for keeping things running smoothly in your house? Because, like I said, I get asked this a lot, so I’d love to hear your take on it.
Dr. Francis: Oh my gosh, I don’t know if my house ever runs smoothly. My motto is, embrace the chaos. I think the more you try to control the chaos, the more you just make yourself crazy, but the kids sort of stay the same. So I try to embrace the chaos as much as I can. I taught kids responsibility young. Teaching your children safety in the kitchen, how they can get themselves breakfast if you’ve got a meeting, and you just, you know, you know you’ve just gotta get them fed but you might not be able to do it yourself. I think it’s a great life skill for them to be able to learn how to fend for themselves in the kitchen at a young age.
And communication. My kids are older now, my youngest is 11. So, now keeping my household running smoothly is all about communication. And the kids understanding that they can’t spring something on me last minute, if they need a ride, or if there’s been a change in a practice, that we’ve gotta have communication early on enough that changes could be made in schedules, or carpools, or whatever to kinda keep things going. And actually, that reminds me, if I didn’t have the women in my life that help me with carpools and getting kids everywhere, my life actually would cease to function. So get yourself a really good group of friends.
Katie: I love that. And that’s actually a perfect segue into hormones and health. Because I am becoming more and more convinced, after researching and recently being in Europe, just how vitally important that community, and those friendships, and those people are to health. I mean, to everything, mental health, but also to physical health. Like I know the statistics are that having those kind of close friendships is important as quitting smoking, more important than exercise. Like they’re super important. So I love that you said that.
Dr. Francis: Yeah. Very important.
Katie: Okay. So, under hormones and health, most of the people listening are women. And unlike men, whose hormones seem to pretty much stay relatively stable only changing on that 24-hour cycle related to sleep and food. Women have this whole cascade of hormones that changes throughout the month. And I know this can seem super confusing, and I think it can also give us a lot of insight into our body. So, I’d love to hear your take on what can we as women learn from our hormones?
Dr. Francis: You know, I think the most important thing to learn about our hormones is, what you said, our hormones are constantly changing. Not only do they change every 21 to 30 days, and everyone kinda has their own internal clock with regards to those type of cycles, but our hormones change as we age each decade. And how that affects us mentally, physically, how that affects our fertility, how it affects us after menopause.
You’re right, men tend to have very few daily or monthly fluctuations, men do get a decrease in testosterone every decade of life, it drops about 2%. So they do have a very slow gradual decrease in their main sex hormone which is testosterone. Whereas for women, we have sort of an abrupt start, which is puberty, we have monthly changes where our hormones go up and down, and then we’ve got gradual changes with age, until around 45 or 50, and then between usually 45 and 52 we have an abrupt change with menopause. Which even then can still kinda be gradual because for some women the effects of menopause can last six months to 16 years.
And so it’s really important for women to understand that changes in our body are normal, and recognizing what is our typical pattern is the best way for us to identify when something is not right. Those patterns will change as we age, and so we constantly have to be recognizing what’s normal for our body so we can identify when something is not normal.
Katie: For sure. And I know, one thing that’s been really insightful for me is learning just to understand and track my monthly cycle. And now there’s apps that do that for free now, and it’s great. But I’m curious, is that something you think is beneficial for most women to do, is to just track and kind of have an eye on our cycle?
Dr. Francis: You know, I do. I have five daughters, four of them are teenagers. And I will tell you that those apps are fantastic. And really obviously easy to understand, teenagers can use them with ease. I think it’s very important to track your cycle for several reasons. One is, it helps you really get a visual of what your normal is. Because, especially if you’re a working mom, or a mom, or you’re a student, your focus tends to be elsewhere than on your body. And so if you’ve got something that you can have, we used to, before smartphones, we would have people keep what’s called a menstrual diary, where they actually kept track of their symptoms each day and they had to write it down. Now with the app it’s so much easier.
But if you’re not focused on it, you’re gonna go, “Oh, wait, when was my last period? Oh, am I late, am I early? Is this normal time for me?” Because you’re not tracking it in any way, so it’s hard for you to identify when there’s really been a deviation of normal. So I love the apps, I’m a huge fan of them. They are very beneficial for people who are trying to get pregnant. And I think that it allows them to recognize early on if there may be a problem hormonally that may be preventing pregnancy. And then I think just for, I hate to say it, but life in general, if you have an idea of when your cycle is coming, and you’re, you know, making plans to go away for a weekend and you’ve got a couple of weekends to choose from, take a look at your app and figure out which weekend might be the better weekend for you to go away. So I just think that there’s a whole lot of life benefit to understanding your cycles and tracking them.
Katie: That’s so great. I know for me it’s been helpful, like whenever we’ve gotten pregnant, because I knew exactly when I ovulated so I could tell the doctor. Usually they just wanna know your last period, but I knew for sure when I ovulated, so that’s really helpful for that. And also just, I feel like to track things like stress can throw your cycle off, or whatever. So I love that you’re a proponent of that too. I think it’s really beneficial, and it’s, like you said, so easy. I used to have to do it on paper as well, and it’s gotten so much easier.
Dr. Francis: It’s so much easier. And, you know, you mentioned stress as being one of the factors that can affect your cycle, and it can profoundly affect not just your cycle, but even if your cycle is normal, stress can affect your fertility. I always would tell my patients, pregnancy itself is a very stressful state on your body. If your body is already under stress, naturally, it’s going to wanna prevent you from getting pregnant and adding to that stress. And so making sure that you control stress in your life is hugely important not just for keeping your cycles regular, but also keeping your fertility at its peak.
And then other things that can affect your cycle besides stress are sleep. So for a lot of people who are getting broken sleep, that can have a profound effect on your cycle. And you may be able to identify not just a cycle problem, but you may be able to, when you’re starting to think about, “Wait, why is my cycle changing?” You can identify whether it’s stress, because there was a stressful event, is it sleep. In some of these apps, you can actually check body weight and BMI, is there any change in your weight that it might be affecting either weight gain or weight loss because both of them can affect your cycle.
And you can even track medicines or supplements, and there’s different apps for that. And you might be able to identify that you started taking a certain supplement and within six weeks of taking that supplement, you started having changes in your cycle. So then you can kind of research, well, what might be in the supplement that could be affecting my cycle. And a lot of times, if you’re taking supplements for women’s health, there could be things in there that may affect your cycle.
So I just think kind of just being very in tune and aware with everything that’s going on with your body, and you’re putting in your body, is really important.
Katie: Right. 100% agree with you. And, speaking of testing, so you are the Chief Medical Officer for EverlyWell. And I’m so glad I found you guys. Because for years, trying to manage my thyroid condition and working with doctors out of state, getting lab work has been a huge pain in the butt. And you guys made it so much easier. And I’d love to understand, before we go in-depth on what the different tests are, and what they can tell you about your health. I’d love to understand the unique way that you guys test. Because I know I’ve done like blood spot tests for IgG before for instance. But you guys are able to test a wide variety of things. And so I’d love if you could kinda give us a primer of how the science behind that works.
Dr. Francis: Sure, absolutely. So EverlyWell was created by our CEO Julia Cheek. And basically, we don’t create any of the science, we connect consumers with lab testing. So we have created a tech platform that allows you to order testing off of our website, the kits go directly to you at home. It’s all self-collection methods. And then it gets shipped directly to the lab that’s gonna run your test, and then your results come back through our web-based platform. All of the testing is validated by the lab itself, all of our labs are CLIA certified, and a lot of them have CAP accreditation. And what they did was they actually validated dried blood spot card, or dried urine sample, or saliva testing against traditional lab testing.
So they said, you mentioned you have thyroid. They took a sample from the same person, same day, same time, one was a venipuncture, so the typical blood draw that you would have if you go to a lab draw station. And one would be a finger prick, so something that you would be able to do yourself. And they actually had these individuals do it themselves. Put it on the dried blood spot card and then they ran those two samples in their respective machines, and they compared the results they got.
And there’s always variation among lab testing results. There’s sort of a standard acceptable variation. And as long as the results from multiple individuals on multiple different occasions fell within those standard variations, then you can say that dried blood spot testing has been validated for thyroid testing, and is as accurate as a venipuncture. And so we just found labs that have already done this, some of them have been doing it for 20 years, and we just made this technology available to people.
Katie: Got it. That’s awesome. Because I used to have to drive like almost an hour out of the way to a lab that would do the right kind of lab test that my doctor needed. And now I can just do it in my bathroom before making breakfast for the kids, and it’s much faster, I’m so grateful that it exists now. And I love how easy it is too with the app, and, I’ll mention, it’s cheaper too than I used to have to pay for lab tests. I love that you guys have kind of revolutionized that.
Dr. Francis: It’s fantastic. And, you know, really, it was sort of the last area of healthcare that consumers could truly own. You know, I always would give my patients copies of their lab results, but I’d have to explain what they meant, because it’s just a list of biomarkers, and a list of the results, and no explanation. And so while I could share that with them, it didn’t necessarily mean they could understand it without an explanation. The way that we have our results, and the way that they are, you get exactly what you would get if you had the blood testing done through your doctor, but you additionally get results that explain to you what is this marker? Why is it important? You know, why should you care about it? Here’s some additional information.
So it really supports the consumer in understanding, really, that last part of healthcare, which is lab testing. Everybody is a Google MD these days, and, you know, we have great websites like Harvard Public Health, and the Mayo Clinic, and Cleveland Clinic have these amazing websites for people to understand medical conditions. But really, they couldn’t own understanding their lab testing and now they can.
Katie: I’d love to hear your take on that as a physician. Because I know for years that was a frustration for me, that, in order to get my own blood results I had to go through a doctor who then had to give me my own…it just seemed like a little frustrating to me for a long time. And I know, at least from what I’ve read, that you are a proponent of people being very active advocates in their own healthcare. And I think this actually will hopefully go a long way towards fixing a lot of the health problems we’re seeing.
I’m a huge fan of doctors, I love doctors, and I think you wouldn’t make it through eight years of medical school if you didn’t truly care about people, but I also think people need to be more involved. Patients need to be more involved directly in their care and understanding. Because I feel like medicine is one of the most important aspects of our lives. Our health is super important, we can’t just outsource that to a doctor. But I’m curious your take on that, just of people being like very involved advocates in their own health from the doctor’s side.
Dr. Francis: Yeah, you know, it’s interesting and it’s definitely even…I started practicing in 2003, and even in the last 15 years it’s changed so much. And if you think about, you know, medicine when I was a kid and my mom would take me to the pediatrician, I think about how it was back then, and it’s changed so much. Patients are becoming much more responsible and taking ownership in their healthcare which is fantastic. I think that the way that the healthcare industry itself is changing, and with the way that, unfortunately, reimbursement is changing not just for the patients and the consumers and what their insurance will and won’t pay for, but really what they reimburse for for a physician’s time with a patient is changing.
And so the whole economics of healthcare and being able to have a practice and speak to patients in the way you want has changed so much. That’s why we see, you know, a lot of functional medicine doctors who take very, very few patients, spend a lot of time with them, but they don’t take, you know, insurance reimbursement. Or you see VIP sort of concierge medicine, they limit the number of patients they see so that they can spend more time and they don’t take insurance reimbursement.
And for whatever that’s worth, it’s because a doctor’s time is not valued, and so they have to see a larger number of patients in their clinic to be able to pay the bills, to keep the lights on, and to keep the medical equipment up to date, and keep their staff, you know, getting salaries. So there’s a give and a take. The reason why I love this type of testing is, I’m gonna give you an example. If you have a thyroid condition, and it has not yet been diagnosed, and you come to me for a visit and you say, “I’m gaining weight, I’m tired, I’m cold, my hair is falling out, my period’s all over the place, it used to be regular now it’s, you know, every sometimes 35 days, sometimes 14 days. I can never know when it’s gonna come, oh, and by the way I haven’t been able to get pregnant in the last six months.”
And you come with this whole sort of big basket of complaints, I’ve got a limited amount of time with you and I can say, “Okay, you’ve just given me symptoms that may be thyroid, may be an ovarian dysfunction, or maybe we’re looking at some type of other cause of infertility.” And then I have to say, “Okay, what testing am I gonna do? What testing is gonna be covered by your insurance?” Because I don’t wanna just order a bunch of testing and then have you get stuck with a large bill, you won’t be very happy with me.
And so I take my limited amount of time with you and I figure out what I’m gonna test you for and then you leave, and you still don’t have a plan, and you still don’t have answers. You and I then have to get back together either on the phone or in person, and discuss the results and discuss what the plan is. Now, for some people, they don’t wanna come back in, they want it over the phone, but it’s kind of impersonal, and I may not have time to do it myself, so you may have my medical assistant calling you with those results, and what my suggestion is for a plan.
If you take EverlyWell, and you say, “Okay, these are all of my symptoms,” and you say, “okay, my cycle is messed up, but I’m also having all these symptoms that may be thyroid.” You can quickly do a fertility test, you can quickly do a thyroid test. You may find out that your ovarian hormones are perfectly normal, your thyroid is completely out of whack. Now, when you make that appointment to come see me and you’ve got limited time with me, you and I can spend that entire time talking about your results and what the plan is, rather than me having to take the time to figure that out and get back to you. So I think that this allows patients and physicians to maximize the time that they have together, and I think that it just makes the whole current model of healthcare delivery more efficient.
Katie: I agree. And that’s such a great perspective to hear from your side. Because I’m sure that doctors have many of the same frustrations as patients with the reimbursement, and like some of the problems in the medical system. Like with doctors truly wanting to help people and patients truly wanting to get help, I feel like you have solved a huge gap there. And I’ll share on the show notes of what I do personally. But we have a mixture of healthcare sharing plus an app called Study MD, and also you guys. And so I feel like I’m very much in control of my health, but I’m working with these amazing doctors who are my partners.
And even that subtle shift of me being able to order my own labs, and then go to a doctor having said like, “I did my research, I have these results can you help me figure out what to do.” That’s just so much more empowering, and I feel like puts the patient in a position of realizing like, I’m willing to take the steps to move forward with what I need to do because I’ve already taken a step. And I think you’re right, I think it totally helps both sides of the dynamic so much.
Dr. Francis: Yeah. I really do. And I think that once this type of testing becomes more understood, I think once it becomes more sort of mainstream, then I think that it’s just going to make office visits so much more efficient. And, you know, you think about just, another example would be a diabetic. Diabetics, if they’re well controlled, you know, they still see the doctor every so often to make sure that they’re not having any issues with their feet, or their eyes. But if they’re not very well controlled, they have to get testing called a hemoglobin A1c, and it may be as often as every three months.
It would be so much easier if when they make that appointment to see the doctor they have those results with them, and it didn’t require them to go to a lab to get it done. Because I will tell you, I have two daughters with thyroid issues, and unfortunately this type of testing we can’t do on anyone under 18, so I still have to do the traditional, make the lab appointment, go to the lab, hope that the doctor’s orders made it there because sometimes they do, sometimes they don’t. Then if they’re not there we’ve gotta wait, we gotta call the doctor’s office, we gotta get the lab request sent again. Then we get the blood drawn, then we go to the appointment. If I could just do my daughters thyroid testing at home, and then just go to the appointment, it would save time, money, effort, energy, and frankly frustration. So, for anyone over 18, they have that opportunity now to be able to do that and save all of the backend of getting to the lab and just get to the doctor with the results.
Katie: Yeah. Definitely a time saver. And I hope this is okay to ask, but is there ever a potential that it could be done on children as well, or are there concerns there that prevent it from being possible?
Dr. Francis: You know, we’re always trying to see if we can expand into being able to offer testing under the age of 18. As you can imagine, there is a lot more sort of legal hoops to jump through. There may be some issues of primary custody, and who has consent to medical treatment, and when does there have to be a notification. So it’s just trying to work through some of the legal logistics. It’s not that this lab testing would be any different on children. They may have a different normal range than an adult for certain markers. It’s just being able to offer it in a safe and responsible manner via the web, you know, the Internet
Katie: Got it. That makes sense. And yeah, I could see that with the custody issues and also just with making sure the results are understood. That makes total sense. So let’s go a little deeper with the labs. Because I know, as a patient, until you actually really delve into the research it can be hard to understand. You guys solved this problem already. But, like when you get a lab result and it says like, abnormal, abnormal, abnormal, but you don’t know what it means. So, from a physician’s side, can you walk us through what some of the different tests are, and what they mean, or like what kind of insight can these give us into our health.
Dr Francis: Sure. And, you know, we have a lot of different tests to choose from. We have general wellness tests which are anything from heart health, to sleep and stress, to heavy metals. We just launched omega-3 basic and plus which I’m extremely excited about. Because, you know, just thinking about health and wellness, and especially thinking about women’s health and wellness, and thinking about women who are pregnant or who are gonna breastfeed. You know, so many Americans are deficient in DHA that being able to see where you are with regards to omega-3 fatty acids, I think is amazing. And this is not testing that typically could routinely be done at an annual exam, or a Well visit. So we’re super excited to be offering that.
We have a suite of men’s health tests which men can take that include multiple hormones, or if they just wanna check their testosterone level. We have sexually transmitted disease testing for both men and women. And then we’ve got a very large suite of women’s health tests. And they range from doing a complete valuation of your hormones and looking at the three different endocrine glands that can affect a woman’s health and wellness, and those three being thyroid, ovary, and adrenal glands, to just looking at estrogen and progesterone, if you’re post-menopausal and you either wanna know where you’re at since you’ve gone through menopause, or maybe you’re postmenopausal and you’re on hormone replacement therapy, but you’re still symptomatic. And rather than go to the doctor and say, “Hey, this is how I feel, do we need to adjust my meds?” You could do this testing at home, and go and say, “Hey, this is how I felt, and this is why I felt this way because, look, my estrogen is still really low, so can we please adjust my meds.” You know, to fertility testing to see whether or not it looks like your hormones are balanced to ovulate.
And then we actually have an ovarian reserve test, which is simply a day three FSH level. It does not look at all causes of fertility or infertility, it just is an indirect way to see if you still have a normal amount of eggs remaining. As we get older our egg reserves go down, when they get down to a certain level our FSH day three levels go up. And so it’s a way to see if my day three FSH levels are up and they’re up consistently, it probably means my egg numbers have dropped. Which I think is really important for women especially if they’re thinking about childbirth, delaying childbirth, just getting a general idea of maybe how long they should wait before they go get help if they’re not getting pregnant. You know, there’s different recommendations based on age. But if you’re young and you’ve got an abnormal ovarian reserve test, that may be a reason to take action sooner, than if you’re young with a normal ovarian reserve test. So that’s our women’s health.
And then we have some energy and weight tests, which include obviously a full thyroid panel. We’ve got metabolism tests, vitamin D testing. So, again, along the lines of general health and wellness and just inflammation in the body.
Katie: I love that. And so if someone is trying to figure out like what would be some signs that someone should get something tested? Like what should someone look for? So I have women writing to me all the time with essential thyroid problems they’re trying to figure out, or anxiety, or depression, or like sudden weight gain, these kind of problems. Like what signs would someone look for about when they should get tested, and how would they know what tests to get?
Dr. Francis: So the first question is, what sign should they look for. You know, it’s really gonna vary and that’s why at the beginning of this call we talked about why it’s so important to just sort of be in tune with your body and what is normal for you so that you can recognize when there’s a deviation from normal, whether that’s in your cycle, whether that’s in your weight, whether that’s in your sleep, in your skin, in your digestion, whatever it may be. Just recognizing when something is not just, “Oh, I had a bad day,” but, “This has been going on now for a week, or two weeks, or two months, it’s not getting better and I need to kind of figure out what’s going on.”
When you go to the EverlyWell website, you can actually go onto our “choose a test”, and if you click on any test, there’s always symptoms that may be associated. So you can figure out what your symptoms are that are abnormal, and then you, maybe you’ve got a multitude of symptoms and as you’re going through the test menus you find that one test that’s like, “Oh my gosh, this is me, this is exactly how I feel.” And it can help you understand that that’s probably a good test for you to take if you have, you know, the bulk of the symptoms that are associated with abnormalities that can be found from that type of testing.
Katie: Got it. And for anyone listening, so if you’re driving, don’t worry about writing all these down, everything she said is gonna be in the show notes, but I’m also going to link to EverlyWell, and a special link for you guys. So make sure you check that out in the show notes. I’d love to also go a little deeper on, from a physician’s perspective, what to do when you get lab results that aren’t normal. Because I know from the patient’s perspective that can be very scary, especially when you just see that something’s wrong or off. So what would you say to someone who maybe is testing and getting abnormal lab results?
Dr. Francis: Sure. I mean, the first thing that I would say is, none of our tests are testing for conditions that are immediately life-threatening, right? We don’t have a test to tell you whether or not you’re having a heart attack. We have a test that will look at your cholesterol and lipid profile and tell you whether or not you would be at an increased risk of having heart disease if you didn’t do anything about, you know, the abnormalities that you got.
So the first thing is, nothing is immediately life-threatening. So with all of our test results, don’t panic. Even if it’s abnormal, it’s good news in the sense that you’ve figured out why you’re having the symptoms that you’re having. And now you have, you know, sort of the impetus to go make that doctor’s appointment, keep that doctor’s appointment, don’t forget about it, don’t skip it, because, you know, “Oh, I skipped it because there was something going on at my kids’ school that was more important.”
This is time when you have to say, “Okay, my health is really important and I need to put a little investment in me, otherwise, I’m not gonna be able to be around here to take care of my family, like, in the manner that I want to. Because I’m gonna be tired all the time, or I’m gonna gain so much weight that I don’t wanna throw on a bathing suit and go to the town pool with my kids,” or whatever it may be. So I always say don’t panic, but make the appointment, and make the commitment to you and to your health to get this looked at.
And then if you come to me, depending on what the testing result is, you know, some of our tests are screening tests, and so they’re not diagnosing a condition, they’re screening people to see if they may be at risk for problems with their health and problems with their wellness. So the first thing that may happen is, I may do more testing. And it doesn’t mean that I didn’t trust the testing that you had, it means that if you, let’s say you’re a man and you do the men’s health test, and everything on your men’s health test is normal except for your TSH. Well, I have to do additional thyroid testing on you because you didn’t do it yourself, you just did the men’s health test, so that I could see what exactly is wrong with your thyroid, so then we can go ahead and treat it. If you did the men’s health test and your TSH was wrong, and you went, “Huh, my TSH is wrong, maybe I should do the thyroid test now and see what’s going on with my thyroid.” And you came to me with the thyroid results, then we could make the treatment plan from the thyroid results, because you took the first step and the second step.
So a lot of it is just gonna depend upon how far did our customer go with sort of their investigation before they went to the doctor. So the more information that I have, the, you know, the more time I have to just say, “Okay, here is what your thyroid results show, this is the condition that this indicates that you have, this is how this condition is treated, this is what I think we’re gonna do.”
So it’s gonna be individualized. Some people may say, “I have an abnormal TSH, okay, I identify there’s a problem, now I want my doctor to do the rest of the testing.” And that’s also perfectly fine. Because our testing is just meant to fit into what works best for your lifestyle, and what works best for your health and wellness. But, again, first thing is always don’t panic, no one’s gonna…you’re not gonna open up your results and it’s gonna say you’re in the middle of having a heart attack go directly to the ER. And we don’t do that type of testing. So there’s nothing that’s going to be immediately life-threatening.
Katie: Yeah. That’s great perspective. Are there certain conditions that you guys see, because I’m sure you must get a lot of health data, that seem to be more on the rise in general, or is it really kind of across the board?
Dr. Francis: Well, I will say that, in general, thyroid disorders seem to be very common. Obviously more common in women. One thing that I think is very interesting is, if I said to you as a woman, if I told you you had a one in eight risk of blank, can you fill in the blank?
Katie: Breast cancer or heart disease.
Dr. Francis: It’s breast cancer, right? So one out of every eight women in their lifetime have a risk of getting breast cancer. Interestingly enough, it’s the same statistic for women getting a thyroid disorder. So one out of every eight women in their lifetime will develop a thyroid disorder. But women don’t know that statistic, we all know the breast cancer. And a lot of it has been education, and, you know, a lot of organizations that are raising the awareness of breast cancer. But just to put it in perspective, you’re just as likely to get a thyroid disorder as you are to get breast cancer.
I think that we tend to see a lot of thyroid disorder in people. We tend to see it also in a lot of younger people. Testing for thyroid in general, just as part of your wellness screening with your doctor, doesn’t start until the age of 35. Now, you will get an initial thyroid screening every pregnancy because it’s really important to identify thyroid disorders in pregnancy because it could actually affect the developing fetus. But if you don’t get pregnant before 35, you may never get screened for a thyroid disorder until you’re 35, unless you’re symptomatic. So I think that that’s something that’s very interesting.
I definitely answer a lot of questions from our customers about their thyroid results, and it does seem to be one of the more common abnormalities that I field just with customer service. Obviously we see a lot of abnormal cholesterol and lipid profiles because of the diet that we have in this country. As I said earlier, I’m really excited about our omega panels, I think it’s gonna be really interesting to see how people take that information and use it. Omega-3 fatty acids play such a major role in our overall health and wellness literally throughout our whole life, and it can affect cognitive function, and it can affect risk of heart disease, it can affect, you know, your child’s ability to do hand-eye coordinated movements at a young age, it can affect learning level in young school-age children.
So I just think that that to me is such an important piece of information that really until now people didn’t have easy access to. But it’s something that is so simple to fix just by making some changes in your diet. So it’ll be interesting to see what other sort of trends we see with our customers, and how they reach back to us and ask about different questions with their test results.
Katie: That is so fascinating. Even as a thyroid patient, I didn’t know that the risk was as high as breast cancer. That’s really staggering, I’m shocked by that actually.
Dr. Francis: Yeah, in your lifetime, you know, it’s overall in your lifetime. And so, you know, I always find that interesting. I don’t know the statistic for heart disease off the top of my head, but I actually think the risk of heart disease is higher than one in eight for women. And heart disease still remains the number one killer of both men and women in this country. So being proactive about your heart health from a young age I think is just super important.
Katie: For sure. And I’m curious also just what about testosterone in men, because I get a decent amount of emails from women whose husbands have had low testosterone, like lab tests that shows low testosterone. And I’ve read that there’s been like a societal decline in testosterone over the last few generations. Are you guys seeing this as well? And if so, are there things that men can do proactively to help with that?
Dr. Francis: Yeah. So, there is. And I will tell you that one of the biggest factors affecting testosterone levels in men is obesity. And the more a man’s BMI increases, and once they get past the BMI of obesity, the more profound effect it has on testosterone production, and the higher their estradiol levels become. So they’re getting an imbalance in testosterone and estrogen within their own body because of the increase in weight.
So we do see a lot of low testosterone in men, we see a lot of low testosterone in young men. And the first recommendation, it’s not go run to that low T clinic, the first recommendation is, focus on nutrition, exercise, and weight loss. Because if you can get your body weight back down to a more normal range, your testosterone problem will fix itself.
Katie: That’s a great point. And one thing I wanna make sure I also talk to you about, because you have an expertise in this, is basically the hereditary or genetic risk of cancer. Because I get questions about this and I’m obviously not qualified to answer them, so I don’t. But I know that that’s a concern, and I’ve had friends who have proactively, for instance, had a mastectomy to prevent getting breast cancer down the road. And I know that you’ve done a lot of work in this area. So I’m curious for people who know that they maybe have a genetic risk factor, what kind of advice you give to those patients?
Dr. Francis: So there’s two parts to this, one is knowing that you already have a gene, and what are your options. And the second part is, how do you get to the point of finding out you have a gene. So, not everybody needs to be tested for these genetic conditions, you have to have a certain either personal or family history of cancer that puts you at an increased risk of potentially having one of these genes, which would then be the reason to screen you for them.
So I actually still see patients in a private practice half a day a week, it’s, you know, a very small clinical practice, I just don’t wanna give it up I really enjoy seeing patients. And in my clinical practice, all I do is discuss genetic testing with individuals who’ve been referred to me because they have a family history that their doctor is concerned about, and they want to see, should they be tested, and they want to make sure that they get all the information before they test. And then the other group of women that I still see are women that have identified as having a gene and being high risk for cancer, and so they’ll sort of stay with me and get their routine six month screening done.
So the first question is always, who should test? There are guidelines surrounding what criteria need to be met in order to test. So, there’s easy ways to make the criteria, and I’m actually happy to share with you the questionnaire that I use in my office, which is very simplistic. But it takes the criteria that are set forth by the National Cancer Coalition Network, also known as NCCN, and it makes it a yes or no questionnaire, so that if someone has a yes, I know that they’ve met the criteria for testing, it makes it very easy to identify them when they’re coming in for a visit.
Once they’ve identified as testing, we test them. Now, not everybody is gonna test positive. And the thing that’s really important to remember is, you can have a high risk of hereditary cancer because you carry a gene like BRCA1 or BRCA2. Or you can have a high risk of familial cancer because you found out you don’t carry the gene, but there was enough people in your family with breast cancer that that still puts you at a higher risk than the general population.
So, depending on which one of those two buckets you fall into, you’ve identified a gene which means you’re at the highest risk, or you don’t have a gene, but you still have strong enough family history that we’ve gotta screen you more often. Then we can talk about what to do next. There are guidelines for BRCA1 and 2-positive women as to how often they need to be screened, medications that they should be offered to reduce the risk of both breast and ovarian cancer, and surgeries that they can have done to try and prevent the cancer from ever developing.
And then under the familial risk, depending on how high the risk is, typically starting at above 20% lifetime risk, or about a one in five chance, then there is a recommendation for increase in exams, increase in screening, potential medications. In some cases, if the risk is high enough, meaning like a one in four chance or greater, then you can also discuss preventative surgery with that group of women. So, a lot of it just depends on which bucket of risk do you fall into, how comfortable are you with screening versus being proactive, and, you know, one of the things that I always tell women is, if you have a BRCA gene, I can do all of the screening in the world, but I will not reduce your risk of developing cancer. With screening, we just hope to catch it sooner, we don’t prevent cancer by screening. The only way to prevent cancer is to think about some of the medications that we can offer or the surgeries that we can offer.
I think it’s really important to make that distinction, because I don’t want a woman to ever think, “Well, if I just get more breast imaging, then I won’t get breast cancer.” No, no, no, you’re still gonna have an 87% chance of getting breast cancer if you’re BRCA1 positive, we’re just hoping to catch it at an earlier stage. That’s why we’re doing the increased screening. So I think it’s a very important distinction when you’re talking to people of the generic risk, that they understand the difference between just screening more often or being proactive at decreasing risk.
Katie: Got it. Yeah, such an important distinction.
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Katie: I know from your bio that you also have a personal interest in staying really healthy and fit. So I’d love to know, on a personal note, are there any things that you’ve come across in your research or personal experience that you would offer to other women as tips for staying healthy?
Dr. Francis: You know, I’d say the two things that I really try to focus the most on in my personal life, well, I mean, I’m active, right? I’m constantly active, whether it’s running between meetings, or driving kids to different sports. My exercise routine has changed over the years simply because of a time constraint. So I actually started doing sports with my kids. I was a competitive diver in college. One of my children is actually a competitive diver. So a few years ago I would go to practice with her and I would dive with her, because I had to take her anyway. And it was an opportunity for me to have some regular exercise.
I don’t think any 42-year-old should try to go off platform again, but this 42-year-old a couple of years ago did try to go off platform again, and I injured my shoulder, which also ended my diving career. So if you’re gonna choose to do sports with your kids, choose it wisely. I now do a different sport with one of my other children two nights a week on the nights that I have to drive her just to get the exercise in. So I think my lesson in that is, you really have to kind of prioritize time for you, however that fits in with your life. Whether it’s doing it with your kids, or doing it on your own time, you really have to prioritize time for you.
And included in that is prioritize time for sleep. Because if you don’t have enough sleep, everything is gonna start to fall apart during the day. So my number one tip is really prioritizing you in your lifestyle, and my second tip is really watching what you eat. So many people have such a busy lifestyle, it is so easy and convenient to go through a drive through and get in that habit. My recommendation would be, don’t.
Fast food is filled a lot of times with sodium, and it’s filled with omega-6 fatty acids which are actually bad for you. It’s also part of what makes it taste good, is they’ve got hydrogenated fats which gives it flavor. You know, but it’s so convenient but it’s really in the long run not convenient when it’s gonna affect your heart health, or when it’s gonna affect your weight, or when it’s gonna affect how active you can be with your kids. So, prioritize the food that you eat personally, and the food that you serve your family. Those have probably been the two most important health and wellness tips that I’ve chosen to focus my effort on in my lifetime.
Katie: I love all of that so much, and especially the fact that you do sports with your kids, because that’s not even something that probably crosses most of our minds, and you’re there anyway, it’s brilliant. I love that. And I love that you said sleep, because that has been my nemesis that I have finally conquered in the last year. And it is absolutely life-changing when you get enough sleep, I think it fixes a lot of the other problems if you just start with that.
Dr. Francis: You know, it’s so huge. And I remind people, you know, I don’t do obstetrics anymore, but when I did and I would have the new moms come in, and they would just be at their wit’s end, and they felt like it was never gonna get better. I would remind them that, a) it was temporary, that your baby will sleep through the night eventually. But, b) I would remind them that in times of war, a form of torture was sleep deprivation. And so literally every night when you’re getting up, you’re being tortured a little bit. And it’s having a profound effect on your body.
So I would encourage them, even if they were breastfeeding, you know, to pump and to be able to have a bottle so that they could at least get maybe six hours of straight sleep. Even if they could just start with that and get at least one rem cycle in, it would make a world of difference for how they felt the rest of the time. And so sleep is a huge priority no matter what stage of life you’re in, but especially for moms. I’m guilty of it, which is why it’s a priority in my life. I will stay up extra late to get stuff done in anticipation of the next day, and it will affect my sleep. And I have to learn to let it go, and just remember that it’s still gonna be there, and it’ll still get done tomorrow, that I don’t have to deprive myself sleep to get it done.
Katie: I’m right there with you. For years I could never…I would stay up late either just to have the quiet time after the kids were in bed, or to get things done. And now, I never thought I would be this person, because I’ve always been a night owl, but I’m going to bed between 9 and 10, and it’s been amazing. Because I’m naturally waking up at 6 a.m. and getting stuff done. So, it’s an important shift but a hard one, I totally get the struggle.
Dr. Francis: Yep, absolutely.
Katie: So as we start to wrap up, a couple of questions that I love to ask at the end. The first is, what book has had the biggest impact on your life?
Dr. Francis: So this was a hard question for me. I read a lot. I typically have three books going at any given time. Part of that is the time constraint, part of that is just because I get excited about a new book when it comes out. But when I thought about this, my father is the reason why I love reading, and he read “The Lion, The Witch and The Wardrobe” to me at age two, and then he went on to finish “The Chronicles of Narnia.” And that book series was in my room and it was the first book that I, like true book not little children’s book. But when I was able to read on my own at age four, he still laid in bed with me and I read the books to him.
And I think that that whole series, but especially “The Lion, The Witch and The Wardrobe” really just solidified my love of reading. And how it can be shared in a family, and how it can just get you on a path of being excited to read for the rest of your life.
Katie: I love that. I’m also a fan. I mean, I’ve read that to my own kids, it’s such a great book. Also if you could magically give one piece of advice to everyone in the world and they could all hear it, what would that be?
Dr. Francis: We’ve talked so much about health and wellness, I don’t think I need to tell you that’s my magical piece of advice. If I had to give a magical piece of advice, and thinking especially about women, it’s that, while you think your struggles may be unique to you, they’re actually not. And there are more people that are like you than are different than you, and I think that goes back to having that good group of female friends as you age in life, that you can depend on, not only just for help with kids and carpools, but really to make you realize that you’re not alone.
And that, because women’s bodies all eventually do the same thing, right? They all eventually go through menopause, or they all eventually go through puberty, or they, you know, may or may not all eventually go through a pregnancy and have the changes that come with that. Having a group of women around you to just be able to say, “Oh my gosh, have you ever felt this way?” And all those women will go, “Yep.” And then you don’t feel like you’re alone. I think it’s really important to have that sense of community in your life in all stages of your life.
Katie: Absolutely. I 100% agree. And this has been such a fun interview for me. For anyone listening, like I said, all the links to all the testing and everything that Dr. Francis has mentioned will be in the show notes at wellnessmama.fm. under this episode, so you can find them there. But thank you so much for your time, and being here. I know from your bio that you are probably one of the busiest people on the planet, and am so grateful for your time. Thank you so much.
Dr. Francis: Katie, thank you so very much, it’s been a great time for me too.
Katie: And thanks to all of you for listening, and I hope to be with you next week on the Wellness Mama podcast.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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