Transcript

Lauren: Okay guys, thank you so much for joining us. I am here with someone you may recognize. You may remember her from The Today show, Good Morning America. She's made plenty of television and radio appearances. She's also the founder of Her Viewpoint, and is an OB/GYN based in Dallas, Texas. Guys, it's Dr. Jessica Shepherd! Dr. Shepherd, thanks for joining us.

Dr. Shepherd: Yay! I feel like I should be maybe adding a little applause, you know, like they have on the computer!

Lauren: Yes, I feel like we need applause! (laughs) We made it happen! It's such a pleasure to chat with you. We met at BlogHer LA a few months ago, and I walked up to you and you knew who I was, which blows me over! And I was, like, “Please be on my show!”

Dr. Shepherd: You looked at me like, she knows who I am! Yes, I know who you are!

Lauren: I couldn't believe it. Because obviously, I knew who you were! So it's such a thrill to have you on the show. And I know that our guests have been wanting to have a bunch of questions answered, also from an expert. We're also talking during Endometriosis Awareness Week.

Dr. Shepherd: I know! I’m very excited, yes.

Lauren: And you've also been posting some wonderful regular content about safety during Covid-19, which has been super helpful and super accessible for everyone.

Dr. Shepherd: Thank you for watching those.

I feel like it’s an opportunity to make it simple. But make it reputable information, one where people can actually take home a message.

There's a lot going on right now as far as what's true, what's not, what’s conspiracy, what's evidence-based. And so it's just taking that and simplifying it.

Lauren: Absolutely. And with a doctor that we can trust as well, which is great. So it's just a total thrill to have you on. Let's start from the beginning. Can you tell us about your area of specialty and about your practice?

Dr. Shepherd: I’m a trained OB/GYN; that's what I did for my four years in residency. But it was during those four years that I was, like, I think I really like being in the OR. And that's where I found my love for surgery. And then I did a two-year fellowship. So I did two more years after my residency in minimally invasive surgery, which allows us to do more complex surgery in the gynecological space. And it was during those two years of that fellowship that I did in Louisville, Kentucky, that I think I really found out what endometriosis was. So even though I'd done my four years, I really felt that that two years really opened my eyes to really see the disease for what it is, both surgically … but also now I consulted with all these women in my office to a much greater number and level that I'd seen in residency. And that's where I started to make the connection. I could see it and speak to it, because these women had such different experiences … and then see it in the OR. So it kind of merged that, and really started a foundation of me understanding the disease, but learning how to treat it both medically, surgically — and emotionally, too.

Lauren: Yeah, especially as a woman, who can relate to what's going on. We know that you come across endometriosis in your practice. What other invisible conditions do you come across frequently? And how are you diagnosing and treating these conditions?

Dr. Shepherd: You know, that's a great way to put it … the invisible.

Lauren: Because women's health issues are kind of invisible, right?

Dr. Shepherd: Exactly! That's what I was gonna say, is that anything below the belt … I like to call it ‘below the belt’ … either it falls into the category for women where they feel shame or guilt. And then from a healthcare perspective, it's hard to understand because now it’s … what information or how to get that information that will help us treat. One, we may not be asking the right questions. But two, is this awkward conversation.

Because women don't necessarily want to talk about it; they suffer in silence. And for us to extract that information so we can make better decisions is hard.

So it's a hard conversation. But pelvic pain, basically to answer your question, is that invisible condition that I deal with a lot in my office. Because it's not always endometriosis. It can lead to a lot of other things as well.

Lauren: What other kinds of things are we talking about here? If someone doesn't have endometriosis, and they're having pelvic pain, what else can they be living with?

Dr. Shepherd: It can run the gamut. An ovarian mass can be from fibroids. It can be from fibromyalgia. Fibromyalgia can have some pelvic issues, and then also dyspareunia from things like vaginismus or vulva issues. And so there's a lot of different things, whatever organ it affects. If it affects the external part, the vaginal area. Or internally, just from the organ itself — from the uterus, the ovaries, fallopian tubes, even the cervix. So there's a lot of issues that affect the nerves that are in the pelvis. And those are much harder to, one, diagnose. But to treat. And that's where … and we might get into it in this conversation … I really access a multidisciplinary approach to pelvic pain disorders.

Lauren: Can you tell us about that? I'd love to hear about that. Is that sort of a more integrative approach, would you say?

Dr. Shepherd: Absolutely. When I was in Chicago before I moved to Dallas two years ago, I had a really robust team of pelvic physical therapists — shout out to all the pelvic physical therapists, I think they’re wonderful. And also colorectal, and also urogynecologists. And utilizing those services and expertise to narrow down and focus and treat and manage. And I say ‘treat’ lightly because I never promise my patients, “I'm going to one hundred percent take away your pain.”

I think the goal collectively between a doctor and a physician, especially when you're dealing with pelvic pain, is to improve quality of life.

Because that's going to be a different parameter for everyone. And we're really trying to improve their quality of life, and figuring out where it has impacted their life. And how do we move to an area where that's improved?

Lauren: And as you're saying, it’s sounding like there's no one way to treat all of these things. Because you’re dealing with nerves, you're dealing with actual structures in the body. Sometimes it's external. Sometimes it's internal. And so, it's a real case-by-case kind of situation, it sounds like.

Dr. Shepherd: Yeah, absolutely.

Lauren: What about hypochondria, in your practice? Do you ever have patients come in and you think, this is a hypochondriac. Or is it really that we need to believe women's pain?

Dr. Shepherd: I think that there are a small percentage of patients who are hypochondriacs. I would say they're very few and far between. I actually have a lot of patients that know they are, so we laugh about it. So they’re, like, “I know I'm coming in again for the fifth time this month. And this time, I …” And I’m, like, “Tell me. Tell me what it is this time." We have a good conversation about it. But they know they are, and they know that I know they are. But as far as pelvic pain, I wouldn't say hypochondriac. Because I think if most people are concerned about a pelvic pain disorder, they'll ask the questions, and as we sift through them, if we're able to get to a point where they’re, like, "Oh, okay, I was kind of reading into that.” And they can kind of walk away feeling reassured that, okay, I am fine. And then you have the ones who are, like, “Listen, I've been saying this for years and years and years, and no one's really been listening to me.” Those are the stories that I probably am more familiar with. Because when you look at, specifically, endometriosis, I would say that the average length or duration before diagnosis can run anywhere from six to 10 years.

Lauren: Yeah, that's what we hear.

Dr. Shepherd: And so frustration is built up because they have been repeating the story for so long. Again, I think it's to both sides, as pain is very subjective.

Pain is actually very difficult to describe.

And so, from a patient perspective, we have to teach patients how to express what their pain is. Because you've only really been taught, “Oh, my belly hurts.” Right? No one ever says, “Well, how does it hurt? How does it feel? Is it sharp, stabbing, dull, achy?” When you grow up, you’re, like, “My foot hurts. My belly hurts.” So no one really teaches us as we go through life, how to qualify or quantify pain.

Lauren: And describe it, yeah.

Dr. Shepherd: And we say, “Oh, you have pain. Take Tylenol.” But when we're really trying to sift through what that pain is attributed to, that's where we have to teach, “Okay, this is how we describe pain. This is how pain can feel.” But there's also pain that is normal and abnormal. That's a harder conversation to have.

Lauren:  Particularly in regard to women's health.

Dr. Shepherd: Yeah, it's true. It's hard to get into that cycle of “This is pain and that's okay.” Or, “This is pain and this is not okay.”

Lauren: Yeah, absolutely. I think that's a really well-made point. So we were talking about endometriosis. Do you consider endometriosis … given these long periods of time that people have to wait for diagnosis and treatment … do you consider it to be a public health crisis? We hear a lot of advocates in the space saying that it is. And I'd love to get your take on that.

Dr. Shepherd: When you look at a public health crisis or situation, at the actual definition, it's something that affects people and then the environments that it affects outside of those people. So if you were to classify it, you could technically say it's a public health issue. I don't know if I, all the way, agree with that. Not in a bad way. What I do feel is it is an under-represented issue. Under-represented to me is probably more defining of how I feel about it. Yeah, if you want to technically say the definition of public health is this, and this is why it could fall into those parameters … I think there's an argument for that as well. But for me, it's mostly an under-represented issue.

Lauren: And do you think it's under-represented because it takes people so long to get these diagnoses? That there are doctors who just aren't believing people when they're saying that something's wrong?

Dr. Shepherd: I think that's multifactorial. When I hear endometriosis sufferers, a lot of it does go to, “Oh, the doctor is not listening to me.” And then from my side, I’m, like, “Well, you know, those are my colleagues; I'm not saying that they’re all bad.”

I do think that we could probably do better training as far as what endometriosis is.

But I think, for a long time, it was such a complex disease and not much was known about it. And then as far as what we had to do to help, we were limited. So there's limited toolbox with this complex issue that we didn't know about. So it's not necessarily to make an excuse, but I do feel that when we look at endometriosis … one, I do think society has an issue with voicing issues that have to do with a female. And specifically pelvic. Because anytime I have a woman who expresses to me what her issues are, it seems as if they're almost shamed saying what their issues are. Literally because it has to be a pelvic issue. Because if we took endometriosis and all of a sudden it was an arm pain issue, right … people wouldn't have an issue with going to their doctor and being, like, “My arm really hurts. It hurts during my period. I don't know, it's really weird.” No one would really connect it. Because there's always this sexual connotation that comes with a pelvic issue, even though it's nothing to do, necessarily, with sex itself. I do think that society plays an issue with that. And also emotionally as well. It's a very emotional disease. And that, combined with society saying, ‘Oh, you know, I think we're brought up as females to … we don't talk about anything below the belt.’ So there's all of that that plays into it as well. As well as when you finally have kind of the balls to talk about it to your doctor, we go through this cycle of not being heard. I think collectively, it's this big, ugly, black cloud of all these things together. Not just one thing,.

Lauren: Yeah, absolutely. And I think also, at the referral stage, there probably needs to be more education too, right? Because a lot of people are going to a general practitioner who might send them home with Tylenol. Or going to the ER — who might send them home with Tylenol. Sometimes, it's about asking for that referral. If you don't know to ask for it … to say: I need to see a specialist.

Dr. Shepherd: And I think it actually could be as easy as, if you think of the social media world, like a hashtag. We maybe should be taught more hashtags in med school! And just be, like: “Okay pelvic pain, really bad period … it could be endo. Make sure to send them to an endo specialist or gynecologist. The notion that, make sure you tell your gynecologist, “Hey, that ER doc said to mention to you ‘endometriosis’.” That one little snippet of information could alert a gynecologist. Because here's the thing … a referral when they come to us … and this is why I want to give this background to it … from a physician standpoint, it's giving you the background story … when we get referrals and we hear stories, a lot of times there's information missing. Or, we don't know the full medical history, or how many people they've seen. So we're literally dealing with it from the first time we're hearing it. And so of course, we're going to go back to the management plan of what everyone else has done as well — because there's no continuity with this plan. That's why it gets frustrating because we’re, like, “This is the first time you're telling me this story.” And if I were to go back to my medical background, yeah, we could start with this … which typically would be maybe a birth control pill thing. But we didn't know, “Oh, you've seen six other doctors, and you failed all these therapies.” So there's such a story behind it that we are not always privy to. So we're like, of course, this is what I would start with.

And so it's that repetitive pattern of knocking your head against concrete, because you’re, like, “No, I’ve been to 10 doctors.”

It's just a very difficult conversation, that I think we have ways to make a little bit easier. And I think we have made progress. We just need to do a little bit more work.

Lauren: Yes, that there needs to be a little bit more structure in terms of diagnosis and treatment and treatment protocols. And things like that would probably save us a lot of time.

Dr. Shepherd: And the awareness of endometriosis. One, there's Endometriosis Awareness Month, and Week. And you see more of it on TV now. It's not this aloof diagnosis where people are, like, “What? What is that?”

Lauren: Yeah, more people are speaking up about it.

Dr. Shepherd: You know what I like to compare it to? And obviously, we'd need a few more years for it to be like this … breast cancer. Twenty years ago, breast cancer was, like, “Ooh, I don't know …” And now everything is … I mean, NFL, they have pink stuff.

Lauren: Absolutely. It’s just about that growing awareness. Same thing with fibromyalgia, too. People used to say that didn't even exist. And then 20 years later, it's a diagnosis. It's about us sort of catching up with the human body in a sense, isn't it? So, let's pivot here and talk a little bit about fibroids — because that's a condition that you mentioned as well. We've talked about them a little bit on the show before, particularly with regard to treatment, because of studies that have been done about power morcellators, in particular. I was wondering if you could talk to us about fibroid removal, and this use of power morcellators —and what your take is on all that.

Dr. Shepherd: So, power morcellators … I would say that I used them all the time, as well as many gynecologists. Power morcellators are the tool we used in minimally invasive surgery to remove the fibroid or the specimen from the abdomen/pelvis to take it out of the body. And that's how you could maintain a minimally invasive approach because it uses a small incision. It’s kind of like a chopper that cuts it up into pieces. So back in 2015 … I remember this because I was on maternity leave … this is when the FDA came out with their blackbox warning. I think there's a lot of information out there; I'm glad you asked about how to sift through information. So the blackbox warning did not say you cannot use it. What it said is that … because of what happened in that particular instance, with a physician in Boston who had an undiagnosed cancer, and the morcellator was used in a minimally invasive hysterectomy, which then spread the cancer.

So that's where it became what we call ‘a sentinel event’, where we had to stop and take a look, and then make up different recommendations thereafter.

So after that, it wasn't to say that we couldn't use morcellators; it was needing to take a step and look at what happened. Do we need to change our approach? We do know that fibroids are benign tumors. There is a possibility that sometimes with hysterectomy, say … there’s an undiagnosed cancer that's there … that could spread. So what we took from that in the medical community was: The issue wasn't the tool. The issue was that there was undiagnosed cancer.

Lauren: So then you need to get tissue samples before the tool is used.

Dr. Shepherd: Right. And I think what the community took was that the power morcellator was the problem. But what we do know in surgery is that there are various ways to remove specimen from the body. The particular cancer in that case was very aggressive. It's a very aggressive cancer, and it's very hard to diagnose prior to a surgery — almost impossible. And so even if that person who had that undiagnosed cancer had it removed through open incision surgery. Or, it's so aggressive that it still has the potential to spread once you make an incision in the uterus to remove it.

Lauren: Wow.

Dr. Shepherd: So it was that particular type of cancer.

But it still allowed us to take a step back, which I appreciate because we need that in medicine.

That's how we get better in medicine … to evaluate things and move forward in a better light. So how we've now changed that is, we’re still using morcellation, but not the tool. So we still morcellate, but we use it like, say, a knife and remove the tissue. And it's in a bag.

Lauren: So it's much more contained.

Dr. Shepherd: Right. It's contained; there is no spread of any cells or tissue. Because it’s, one, contained. And two, we're not using the tool to remove it anymore. We just manually remove it.

Lauren: So it sounds like it probably takes a little longer, but it's the safer way to do it?

Dr. Shepherd: It’s a safer way to do it. So my colleagues and I who did fellowships and who are minimally invasive trained, we have now, over the years … we’ve been, like, “Let's stop, take a look …” This is what I love about medicine and science is that we said, “Okay, let's find a new way to take it out where we're not exposing patients to cancer, put it in a bag and learn how to do it manually with the knife.” And now we created a way where we can do it in the same amount of time.

Lauren: That’s amazing. That's wonderful. It's great to hear that now what you're able to do is really save people the headache that they might have had with power morcellators.

Dr. Shepherd: Yeah. Because I think if we had taken it for what it is and felt like, oh my god, power morcellators are bad, what would have happened? If you look at the epidemiology of it, then everyone would have just started doing open.

Lauren: And that’s really invasive.

Dr. Shepherd: Yes. And so that's how we kind of saved and maintained the integrity of minimally invasive surgery — by changing our technique.

Lauren: You also touched on earlier the emotional side of pelvic health issues. I'm wondering how you are addressing patients feeling that they're often shuttled between specialists. They've seen 10, a dozen doctors. Maybe they require better bedside manner or empathy. Do you take special care in your bedside manner because of the nature and the privacy of women's health issues, too?

Dr. Shepherd: Yeah, I think over the last 10 years of my career, I've really focused more on the wellness aspect of women's health. And that's encompassing the emotional aspect, the social aspect, the sexual aspect of these pelvic disorders. And how we integrate that as we transition through this management/treatment of whatever disease it is — whether it's endo, whether it's fibroids, pelvic pain — is that they understand that there's an emotional aspect to it, and I'm very open to it.

So I don't necessarily try to be the therapist, but I have a sex therapist and a relationship therapist that I send my patients to all the time.

Lauren: How wonderful.

Dr. Shepherd: Because if you think about it … say endometriosis. Again, it has to do with below-the-belt, shame and guilt. And so it does socially affect people's relationships. Whether they have pain with sex, or they just don't have sex because they’re, like, “I just don't want to deal with it.” Now what if we get to a place in their management therapy where that's not an issue anymore? But emotionally, mentally, they've been traumatized. And so re-entering that space in their life requires someone to transition them, and that's where sex therapy comes into effect. Because they need to get back to it a normal sex life or sexual intimacy or sexual relationship and wellness.

Lauren: Which can be nourishing in its own way, too.

Dr. Shepherd: Absolutely. Because who doesn't love sex?!

Lauren: Thank you! Yes. I'm glad we have an OB/GYN who’s pro sex! (laughs)

Dr. Shepherd: Pro-sex all the way! (laughs)

Lauren: I love it! Let’s get into our healthcare system a little bit. You've touched on it here and there. But I'm wondering in what ways you're seeing our current healthcare system here in the US working for patients? And in what ways you can see that it needs improvement, and you could maybe imagine improvement, in certain areas?

Dr. Shepherd: Yeah, I think we're in the perfect era to see how it's not working for us, i.e. Covid! We have the best health care in the world … I put that in quotes right now during this time. We have been shown that possibly we don’t, literally because of insurance and capitalism. Because we've had other countries who have had the same kind of issue — an epidemic — and they have dealt with it much better. So, healthcare — as far as looking out for the community, meaning the population — other countries have shown us to be very shameful right now. It allows access to some, and not to others. That's where I have an issue with how we deal with health care in America, and insurance companies, and how we allowed that to be something that is really good — because we have good resources. We have amazing resources. We have amazing health care providers from so many different specialties that other countries do not have. But sometimes, to access and to tap into the resources, there is a lot of red tape or barriers, and cost. It's like that seesaw where sometimes we're rocking it out. We're able to give really exceptional care and access that other countries have never even seen before, or been able to have access to. But sometimes, we have shown ourselves our side where we're not necessarily giving people who really need that care, the care that they need. And as a physician, that's hard to watch, because my job is just to give care. So I don't care how you got to your doctor's visit.

For lack of a better term, my job is … when you get here, I don't care what religion you are, what gender, what color, what faith … my job is to take care of you in your health.

And it becomes very hard for us as healthcare providers to watch the system work against us and against our patients. And that takes away time. Maybe I have to spend time on the phone because the same insurance carrier can deny one patient surgery and treatment, and not another. That is just the weirdest thing to me. And I don't understand that.

Lauren: Yeah, absolutely. What about ways we could improve the system? Are there ways that you could imagine fixing it, sort of off the bat?

Dr. Shepherd: Off the bat, I think that if we found ways to, for example, cash pay. When people think of cash pay, they always think it's going to be some exorbitant amount of money that's due. But when you actually look at the amount when people have commercial insurance carriers … how much they pay towards their deductible, and then how much they might pay towards a co-pay when they go to the office or towards a surgery. If you really gave them the option, say … Okay, if you didn't have insurance, if you paid this amount, you could get this type of care … I think if you put it out that simply, people would be like … oh, well, depending on where I am in life, or how healthy I am, or whatever the issue is, whatever the surgery is that I couldn't get with insurance, and I just had to pay that to get it … I think would actually be eye-opening. I think that if people were allowed those options, they might choose differently. But many times they are not given that option. And that's where it becomes a little bit cumbersome.

Lauren: I’m glad you bring it up, too, because I think one way to circumvent that third party insurance system sometimes, if you're trying to see a specialist who you're unable to get into see because of your insurance company, you can often call offices and say, “What’s your cash rate?” Because a lot of doctors will take cash, and it may well less than you think.

Dr. Shepherd: Yeah, and that's what we offer at our office as well. And many times because you're paying cash, we have the ability to take off a certain percentage — because you're paying cash. And so we are able to provide that for some patients. Not a lot of patients know that they can do that. And sometimes, like you said, your insurance will dictate, sometimes, who you're allowed to see. But you’re, like, “But no, I want to see that provider.” And, again, that's the red tape.

If you were able to circumvent that and call that office and say, “Hey, I want to see you, what would that cost?”, I think people will be pleasantly surprised to see that.

Lauren: Yeah, I think that's a great tip, actually.

Dr. Shepherd: Tip number one!

Lauren: Exactly! Tip number one! Yes, indeed. We're getting there! So, I know a lot of the work that you do is about health in general — maintaining our body's health, exercising, eating well, etc. I'm wondering how disciplined patients need to be when it comes to treatment and lifestyle? Does a diagnosis of, say, endo or fibroids mean that people who are living with these conditions need to up-end their lives entirely? Or is it about finding balance?

Dr. Shepherd: I think balance … and I say that loosely because I think balance is different for everybody, that scale is different for everybody. But what I have seen a lot of, particularly in fibroid patients is, they'll come to me and say, “Hey, I have fibroids," and we'll go through a whole consult. I'm really the kind where I will offer you any and everything — and you figure out what's best for you. Now, if you come up with a certain option, I will be, like, “No standing on your head is not going to eliminate your fibroids.”

Lauren: It’ll do something but it won’t help your fibroids! (laughs)

Dr. Shepherd: And even after that entire consult, they'll say, “Well, I have heard that this diet can eliminate it.” And I will say, “I have no problems with you doing a diet. However, I want you to look at that diet and see if it has longevity. Could I have you come back into my office in 10 years, and you'd still be on that same diet?”

Many times those diets are very restrictive.

Lauren: They’re not sustainable.

Dr. Shepherd: Yeah, they're not sustainable. And I want my patients to be healthy in the aspect that they're doing things that are sustainable. But also worth doing, and something that is enjoyable. But is also healthy. And I think you can obtain that. But it can't be something so restrictive in order to accomplish something. Because as soon as you get off that diet, for whatever intended purpose that you did it, it would come back. I'm very evidence-based. If someone did a study — a double-blinded, randomized, controlled study on a certain diet — and they showed me a definitive decrease in fibroid size, I would say, “Absolutely, let's do it.” But I really haven't seen that. And so my goal is: how can I decrease inflammation inside your body? And that is something that you can obtain through certain diets that are not restrictive, and you can live your best life. You can really live a more fruitful life by yes, affecting your diet. But not in a way where you're miserable. Because when I look at them, I’m, like, “I would be miserable on that. You’d hate me!”

Lauren: (laughs) I’d be very moody; it would not help the situation. Absolutely. I think that's really good advice. And even when it comes to exercise, this idea of sustainability … you don't have to be running 16 miles a day, you just have to be moving your body in a way that feels right.

Dr. Shepherd: Yes! And that's what I try to promote in my brand. There are a lot of influencers, for example, who are into fitness. And I even fall into this, where I look at them and think, man, if I could just do that!

Well, I have a job. I can’t spend two hours in the gym. I can't do that.

So I try and take from that what I think would be new to try, or exciting to try, and just form some type of routine in what I can do within my time at work and being a mom and a wife. Being like, okay, I'm going to devote 45 minutes to my workout and in my workout, I'm going to try and put these little tidbits in there.

Lauren: I think that's really nice advice. It's great to hear a doctor being pro-balance!

Dr. Shepherd: Yeah, because I don't have two hours to work out.

Lauren: Yeah. Because you know, your life is busy, too! Here's a really great basic question for people who are tuning in: How often and at what age should women begin getting regularly checked for Pap smears, and things like that? What testing are you recommending regularly, and how often and at what age?

Dr. Shepherd: I love giving a shout-out to you, Lauren. I really think that you are doing a wonderful job in empowering women in their health. I'm really impressed with how much you care, and that you stay true to your brand. Like you are, this is what I'm doing. This is my cause. And this is what I want women to know. So I really applaud you for that. But now, for women that want to get their annual checkups, here's what I say: I say that women should be very in tune with their body. And one of the best ways to do that to start early. So a lot of my patients who are in their 30s, 40s, 50s, I really encourage them to start bringing in their daughters as early as 15. Not for an annual or Pap smear, but to literally sit and to just chill.

And for me to be, like, “Hey, who are you? What grade are you in? What are you interested in?”

Lauren:  Get to know your doctor.

Dr. Shepherd: Yes. So that when they have an issue, they know that they can come somewhere and confide in me. Because I want it to be as if they have a resource. A lot of what happens in young women's lives is because they didn't know who to go talk to. And if they know that it's confidential, and that there's someone there on their side, then they're more likely to come back and talk to me. And I always reassure their their mothers, “When you bring them, I can't tell you what we're talking about. But just know in confidence that this is all to build and empower them. So know that I'm trying to help you.”

Lauren: That’s really awesome. That’s above and beyond what a lot of doctors are willing to do.

Dr. Shepherd: I find that if we can start them young, then why not. Giving a quick anatomy lesson so they're comfortable with their body parts, and saying them. And seeing the terms and knowing what they are. And then going into 21, which is the age at which the American College of Obstetricians and Gynecologists (ACOG) … this is when we start Pap smears.

I love asking women when they come in for a Pap smear, do they know what it’s for? Many do not.

A Pap smear literally is a screening test; it is not diagnostic. It does not say if you have something or not. What it does is take cells to allow us to see if they're abnormal, or normal, and if you've had HPV exposure or not. And from those two things we can decide: Does this warrant looking more in depth? Or, can we put you on the track of recommendations, which would be every three years from the age of 21 to 29. And then starting at the age of 30, every three years with the HPV test. We want you to ask for that HPV test.

Lauren: Yes, absolutely. And sexual health testing, probably?

Keeping regular with that as well?

Dr. Shepherd: Yes. That actually can start earlier than 21. So that's why I start those visits early. Because if we start to have young women who become sexually active and they may have been exposed, I want them to know they have somewhere to go where they can get STD testing. Because that can actually be done through urine and blood. So we don't always necessarily need to use a speculum. And that's what I let them know, too, at that visit … even though that might sound intimidating, I don't always have to use that. I can do STD testing and contraceptive counseling without using a speculum.

Lauren: That's really, really awesome. I love that you're creating a relationship with these younger patients in particular.

Dr. Shepherd: Because that's what our healthcare should be, right? Its a relationship.

Lauren: It's a partnership. And I think that gets missed in a lot of practices. So it’s really exciting to know that you're one of those doctors … although I knew you were already! (laughs) So is there anything you'd like patients to know about gynecological care resources that they can go to — how to request appointments, what to know about their doctors, how to know if their doctor is right for them? Do we need to get a bikini wax before we come see you? (laughs) She's shaking her head, guys! She doesn't care.

Dr. Shepherd: I am going to share the link with you. It's hilarious, but SheKnows which is Blogher Reshma … she's probably the director of marketing or video … we did an interview on Wine and Gyn.

Lauren: Oh, I love that. I knew about that. And that was another reason I was like, I love Dr, Shepherd!

Dr. Shepherd: She asked me that same question about, do we need to wax?

I go, “By the time I leave the room, I will not remember what your vagina looks like.” The amount of vaginas I see a day … I literally cannot remember one from the next.

When I walk out the room … if someone were to quiz me on it, I'd be, like, “I don't know. I don't know even know what it looks like.” So yeah. So you don't need to wax or shave. You don't need to get a pedicure before. Please just come in.

Lauren: Just come as you are. Maybe have a shower.

Dr. Shepherd: Showers are always good. Even wipes, wipes are good. Right before you come in. But no, really, I think relationship to me is the most important. I think about seven years ago, I was, like, I'm gonna make a commitment to make sure that I can establish that relationship however I can. So that women feel when they come in, it doesn't need to be an hour-long visit. But we can bond and we can get things done efficiently and effectively. And they can walk out empowered. They can walk out and touch someone else's life, because they’re, like, oh my gosh, this is really good information I learned. You should know this. And if people don't like me … not everyone's gonna like me. That's OK! I'm always, like, if you feel we didn't click, I'm really okay with it because I don't want you, when you come, to feel as if we're not getting the most out of our visit. I will even refer them to some of my colleagues or friends and be, like, “Go test them out. Go see who you like, because this is your health. And you should be impacted by the information that you get. But you're also in charge. This is you; this is all you.”

Lauren: I love that. Such good advice. So we're going to get into a little more advice here.

Dr. Shepherd: Okay.

Lauren: And we're on the tips. I wanted to know what your Top Three Tips are for someone who may be like … something's a little funky. Maybe they've got an invisible condition like endometriosis or fibroids, and they're coming to you for help. What would your top three tips be for these patients?

Dr. Shepherd: I would say, first thing is to do either a backlog or start a journal going forward. Because what's really helpful for us, especially when you're thinking of an invisible diagnosis or condition, a lot of it requires a history.

And a history of how long, how intense, what things make it worse, what make things make it better.

So many times when you go to the doctor's office, you're not going to remember a month previous what happened, or even two months. So it's very helpful when you can at least show a timeline; times when what happened, what didn't happen, so I can put pieces together a little bit better, and make the appointment much more fruitful than me spending time extracting a lot of information — which we could have both looked at together if people bring it to me. The other thing that I would say is, either bring a notebook to take notes or bring someone with you if you're uncomfortable with whatever situation you're going through. Or if you know you're not a good historian, or if you know you're not good at retaining information, bring someone with you who is a good opponent or has a strength that that person is going to remember everything that was said.

Lauren: Bring an advocate with you.

Dr. Shepherd: Yes, bring an advocate and someone who you know is not going to be biased, someone who can be objective and help you through the process as well. And then three, I would say is, again, going back to that relationship. Especially with endometriosis, we know that there's that wall of frustration — because most people have repeated their story over and over again. Be open to the process. One of the things that I found is, when patients are referred to me or they find me through the Internet, and they come to me with their fibroids or endometriosis or any condition … many times they have a wall up. And I understand why the wall is there. But the first few visits, I do spend trying to figure out who they are and why that wall is there — so we can break that wall down, so we can get somewhere. And that's the psychological, emotional part of these conditions, that many times medical professionals … and this is maybe not our strongest point … we're there to treat. So we're usually, like, “All right, let's get to the problem. Let's fix this problem.”

Lauren: Well, and you're often on time constraints, too, if you're dealing with insurance companies.

Dr. Shepherd:  Yeah. And if you think about how we were trained, we're disease/treat, disease/treat. Which is not a bad thing, but sometimes it's not the best because we're so focused on disease and treat. And that's our strength. What we do really well. But sometimes, we have to take a step back and incorporate that emotional, psychological.

And if we need to send someone to counseling and then have them come back … it's almost like massaging it out. Like massaging out a tight muscle, and then coming back when you're not as stressed.

And I find once everyone can decompress, then we can move forward and get positive feedback and positive outcomes by us both being on the same path. So it's not to say that I expect everyone to walk in and not have a wall up. I know why they're there. My job is to figure out, how can I bring this wall down so we can both move forward together.

Lauren: Was there anything else you'd like to share with everyone tuning into this episode today? Certainly, tell them where they can find you.

Dr. Shepherd: Yes. And I'm going to make sure that you give this favor back — because of my podcast, which is Breathe + Bloom. And we are on Instagram. We're on YouTube, and also Spotify. And I'll share those with you so you can share with your listeners. But that really is like the offshoot of my medical profession. It really is to inspire and motivate people in their wellness. Again, because I think health is not just 'I have a medical diagnosis’ or ‘I have something wrong with me and I get it fixed.’ That's medicine, and that’s what we do. But health is really … how do we take that full circle of emotional, spiritual, sexual, physical, and make that who we are. It’s so multi-dimensional; it's not easy to pay attention to all of them at one time, but at least being aware of it. And that's what makes us this robust person that we can be. That's what I love to tune into. I love for others to see that. And that's why I bring guests on so that they can share their stories or their tips, and what they've learned in all these different aspects of health in their life, and wellness. And someone can literally just hear someone's podcast or their episode and say, ‘You know what, I'm going to try that in my life and see if that is helpful to me.’ So that's really who I am and what keeps me going.

I love wellness, and I love what we can accomplish if we're open to the process.

Lauren: I think that's a perfect place to end! Dr. Shepherd, it’s been such a pleasure having you on the show. I've been fangirling since I met you. I adore you!

Dr. Shepherd: I really admire you.

Lauren: You can’t say things like this to me. You’re going to make me blush! I'm just so thrilled to have had you on the show. I'm really excited for everyone to tune in and hear your perspective. And I think it's great to get this medical perspective from someone who's on the frontlines and dealing with patients like us every day. I really appreciate you taking the time to give us your thoughts.

Dr. Shepherd: Absolutely. Thank you for taking this time to be with me in this hour. I'm very humbled, and I can't wait to hear the final segment.

Lauren: Hey, stay safe out there, kids!

Dr. Shepherd:  Yeah, stay home. Stay healthy!