​Casey: Welcome to the WebMD Health Discovered Podcast. Today, we're doing something a little different and very special.

Lauren Summers: We're giving you a behind-the-scenes look at some of our favorite episodes this past month and how these conversations came to life.

Casey: I'm Casey, the executive editor at WebMD Health Discovered.

Summers: And I'm Lauren, Health Discovered's producer. Welcome to the WebMD Health Discovered Podcast.

Casey: We're highlighting these episodes because we want to explore what it means to have choices in your health, around your trauma, your relationships, and your fertility. When it comes to egg freezing, we're talking about choice in timing and family building so that instead of panic, we see egg freezing as an option.

Casey: When it comes to our triggers, we're highlighting choice in how we respond to our attachment wounds and reactivity in relationships rather than being directed by them. And finally, when it comes to trauma-informed care, we're talking about choice in the exam room. Something as simple as using the word stop, asking someone to pause, or bringing your questions to your healthcare provider.

Summers: We'd like to talk to you about what stayed with us while working on these episodes. We'll share how producing these changed how we think about the topics, specific moments that stopped us in our tracks, and our personal thoughts as patients and consumers.

Casey: The first episode we're looking at today is Thinking About Egg Freezing: Fertility, Facts, and Your Future. Lauren and I are in different stages of our lives, and so we approached this episode with unique perspectives that represented our diverse listening audience.

But even while looking at this topic through different lenses, Lauren is in her early 30s, I'm in my late 40s, we had some questions in common, and we very much wanted to dispel myths and misinformation to make sure our listeners could make informed decisions about their fertility options.

Summers: To discuss this topic with our host, Dr Neha Pathak, we invited Dr Temeka Zore, a double board-certified reproductive endocrinologist, fertility specialist, and OBGYN.

Something that stood out for me with Dr Zore is that not only is she very accomplished, but she approached this discussion with the understanding and warmth patients are often seeking during such an emotional decision that also has high financial stakes.

She answered every single question we had in such a way that left listeners feeling informed, hopeful, and prepared for their next appointment with their healthcare provider.

For me, this is the episode I would share with family and friends who had questions about egg freezing, whether they were just curious and hadn't even taken the first step, or midway through the journey and feeling frustrated and wanting some of their questions answered.

Casey: Lauren, I'm so glad we did this episode with Dr Pathak because I know you and I have had many conversations about this, and I am so happy that you're up for sharing your own experience.

Summers: You know, when I turned 28, I remember I started seeing an influx of all these ads on Instagram and Facebook about egg freezing, and I would see some of these ads that would say things like, "The best time to freeze your eggs is when you can least afford it."

And I remember thinking, "Should I start thinking about freezing my eggs?" Even though to the ad's point, I could not afford it at that time. I remember thinking, if I don't freeze my eggs now from 28 to 30, would I miss out on the opportunity?

And so it's so important to have episodes like these that shed a light on some of these questions.

Casey: I know she answered so many of my questions, being someone who is later in life at the end of that journey, but still has friends in that space who are curious. And I felt like one of the big takeaways from this episode is getting curious about it, talking with your healthcare provider, not making assumptions before you get your answers, and that there are options for every single fertility journey.

You know, one of the things that also stood out was that I had always assumed that this was some major time-consuming experience, and Dr Zorie did a really good job of walking the listeners through what it's actually like.

Summers: Here's a quick clip from that episode in case you missed it.

Neha Pathak, MD, FACP, DipABLM: How do you want people to think about this decision, this process in a really grounded and healthy way?

Temeka Zore, MD: I always tell people, like, even if you think egg freezing isn't for you, whether it's financial or just something that you just isn't for you, for whatever your reasons are, I always think it's good to come in and have the conversation and hear the information, because then it allows you to just make informed decisions about your health with information.

But I always say, like, it is very hard not to compare yourself to, like, friends, strangers, like, people your own age, but having very different results than you. And as much as I can say, like, try not to do that, I know people do. So then it, it still goes back to that same conversation of, like, there's really no piece of information I can give you today that's gonna say, like, you can't have kids, short of if someone is truly menopausal, in which case that's a different conversation we're having.

And that's usually exceedingly rare. So then it's just a matter of, like, what do these numbers mean? And it's, again, not that you can't have kids, it's just that maybe when I thought I was gonna be, like, a one-and-done cycle, like maybe I'm gonna have to do this two or three times to get into that number that makes me feel good.

And I know this process is not inexpensive, and so I know that's also a very real conversation when it comes to finances if you don't have coverage for it. But I think just coming in here knowing that, like, I'm not telling you that you can't get pregnant. We're just talking about your follicle count, maybe the fact that you wanna delay having kids for five to 10 years, and like what options can we give you to really give you the best chances of having the family size you want in the future.

Pathak: I'd love to close our time together, asking you to speak directly to our audience for someone who is really inspired after this conversation to go and have this conversation with a healthcare provider. What are some of the questions that they should be thinking about, information they should be bringing to that appointment?

Zore: It's good to know in an ideal world, what does that family building process look like for you? Like, you may not even know if you want kids, but that's still a good place to start. Or if you do probably want them, how many and, like, when do you think you want to have them?

I think having that information, it just allows the conversation to be more tailored towards you as to like, quote, "Is it worth it?" Also, like, how many eggs should we consider freezing? Because again, I said, depending on what your life circumstance looks like, it may be a very different conversation, and I think also just being comfortable with whatever provider you're choosing. I know, an emotional field and it, it matters. It's a very important field because it's a conversation that, like, a lot of people don't even want to have until they're ready for kids, and we're having it just a little bit sooner than that.

So it ends up bringing up a lot of emotions that you didn't maybe think you were going to have. But feeling comfortable with your clinic, your physician, being comfortable asking questions. I always tell patients, like, it is truly your job to ask your questions. You should never feel stressed or bad for asking questions.

It's our job as physicians to answer them for you. And if you're not happy with, like, the care you're receiving, like, you are always welcome to get a second opinion. Just know that, like, so that you're feeling comfortable with, like, where you are in this process.

Casey: The next episode that really stood out for us is Triggered: Understanding Your Brain, Body, and Emotional Reactions. To dive into this topic, we invited Lia Love Avellino, a licensed clinical social worker, modern love therapist, writer, commentator, and community organizer. Lia's also the host of the Unprocessed podcast, and we love when she joins us on WebMD Health Discovered.

Summers: What we enjoy so much about Lia is her warm, realistic, and non-judgmental approach to delivering information.

Lia is always so thoughtful in how she shares to our WebMD Health Discovered audience.

Casey: And one of my favorite things about the episodes that she does with Dr Pathak is how they role-play. Almost like Dr Pathak sets her up with these situations of what would we do in this scenario? And Lia always does a really good job of modeling a different way of navigating a challenging conversation.

Summers: This is an episode that I would share with that friend who is confiding in me how they often feel like they snap at people they love and are wanting to dig deeper into their emotions as to why, and wanting a better understanding of their reactions.

Casey: Oh, I know. I love these episodes, and these are the ones I most often share with people because I feel like it really gets to the heart of trying to improve the way we show up in conversations, not just pointing fingers at other people.

Summers: Here's a quick clip from that episode.

Pathak: Help us understand a little bit about the difference between a trigger and a threat, and why does the brain respond to emotional triggers the same way that it responds to actual threats to our safety in the environment? So, actual threats to, I guess I would—what I would call our physical safety.

Lia Love Avellino, LCSW: Yes. It can be physical safety, or it can be emotional, psychological safety as well. So the brain only works on past programming. Anxiety or being triggered in some ways likes us to believe that it has future-predicting capabilities, right? I have a voice in my head, "Ugh, I know this is gonna go wrong."

Like, if I'm delayed on the subway, I'm gonna be—I'm gonna miss my client. So what my brain is doing in that quick moment is saying, "In the past, I was late for a session because of a train delay." But because we often respond automatically, we don't necessarily get the data we need to determine, am I actually gonna be late, or is my brain just using a past experience and scripting that onto the present or future?

Our brain's primary function is survival. It doesn't give a crap about us thriving. It just needs to know that we are safe. And when we act quickly and have an automatic response, we don't have enough time to check in with ourselves and determine, is this happening in the here and now, or is this about a past lack of safety?

And so what we wanna begin to do is question that kind of automatic response so we can determine if there's something now or then. Because what a trigger does is it prevents us from being creative. It prevents me from, in that moment, saying, "You know what? If I hop off the C train, I might be able to get the four or five and get to my office in time."

It narrows the pathway in our brain. There's something called amygdala hijack, where the part of our brain, our amygdala, gets so flooded and lit up that we lose access to the logical part of our brain, and we're all hot and bothered, for lack of a better word. But we don't get access to the other parts of us that may have different information, that might not be scared, that might not feel threatened.

Pathak: How can we tell the difference in the moment between something that is a trigger based on this old emotional wound, or as you said, our past programming, versus a situation that is genuinely unsafe or unhealthy for us in that moment?

Avellino: Yep, great question. So the first thing is just to set the context. And once we move from judgment to curiosity, this is bad, there is something wrong, to, "Huh, what's happening here?" We open up a whole new set of possibilities. So first is to be aware that our brain is just doing its job, right? That's, that's what it's here to do.

It's to help us navigate safety. When our ancestor saw a lion coming at us, at them, they could say, "Oh, shoot," and that would signal to their body to run, right? And this is another key thing about the trigger, is it is a body-based experience. But we live in a cognitive world that really values our thoughts and our narratives, and not so much our body-based knowing.

And so we go straight up into our head. So just set this context for yourself of, "Okay, my body's having an experience. My brain is doing what it's supposed to do. It's helping me decide if I'm safe or not, but my brain doesn't quite know." And so what I'm gonna notice is, A, I'm having an automatic response, and with every automatic response, we have an action tendency.

So, for example, step one, get curious about what that automatic response is or that action tendency. So historically, when I used to get negative feedback, I would immediately start to shut down and feel shame. "I did something bad. I'm wrong. Oh my gosh," right? And so that's an action tendency. That's my body saying, "This negative feedback that you're getting right now from your boss is like all the criticism, all the rejection you've experienced as a young child."

So what we wanna do then is part two, is practice the acronym STOP. Stop, T, take a breath, O, observe the data, and then P, proceed. And so what we want to do is check in with what's happening on the inside, step three, in a neutral way. "Okay, I got this feedback. My heart is racing. My palms are sweaty. I'm scared I'm gonna get fired."

And then step four is begin to look at that as just one part of us, not all of us. So triggers tell us, "I am afraid. Something's going wrong." Slowing down might tell us, "A part of me is afraid, but let me see what other parts are online." There's a trauma therapist named Janina Fisher, and she calls this dual awareness, looking at what's happening in the present, sticking to the data, and then being mindful that, "Oh, you know what? This really reminds me of something that happened in the past."

So we're shifting from I am afraid to a part of me feels fear.

What else is present with me? Dual awareness.

Casey: And the final episode that we're really excited to share with you today is Advocating for Yourself During Medical Exams and Accessing Trauma-Informed Care. When we first started building this episode, it was born out of a discussion we had about the CDC ACE study and how trauma survivors often delay medical care.

Casey: This was one of those episodes where listeners and survivors were in the room with us as we began shaping it and writing down the questions and talking about it with Dr Pathak and with our guest.

We had many discussions about how explicit to get, whether to include a trigger warning, and balancing clinical details with emotional safety.

We wanted listeners to hear themselves in this episode, and it was our hope that it would reach that person who has delayed medical care, who has almost put aside some disturbing or stressful symptoms. And we wanted to reach them and encourage them that there was a path forward, that they could access good medical care, and that there are resources available to them.

For Lauren and I, I think producing this episode changed how we think about verbal cues, nonverbal cues, safety, and power in the exam room. 

Summers: And in the middle of that discussion about the CDC ACE study, Casey came across Dr Bayo's TikTok, where she specifically addressed the topic of trauma-informed care and advocating for yourself during medical exams, and how being a survivor should not prevent you from accessing medical care, making informed decisions, or finding a provider who understands your needs.

So we reached out to Dr Bayo and her team and had a great call where we all shared our goal of providing survivors with a toolkit for navigating healthcare. Dr Bayo Curry-Winchell is a nationally recognized health advocate who is board-certified in family medicine, and she is also the founder of Clinicians Who Care.

Casey: One of the most helpful things Dr Bayo did in this episode was frame a complex situation for survivors who are very often holding invisible trauma. Dr Bayo communicates this challenging topic with so much clarity and compassion, reminding listeners and survivors that you are not alone, that you can listen to your body, and there are options for you to access medical care that feels safe to you.

Summers: Something that really stood out to me in this episode was Dr Bayo sharing the message that you are always allowed to stop an exam, leave the appointment, and get a second opinion. In the exam room, there's an unseen power imbalance that is so often overlooked.

Dr Bayo empowered our audience by reminding us that we can always temperature check how we're feeling, giving us autonomy over our bodies.

Casey: I really love this discussion between Dr Pathak and Dr Bayo because I've had my own experiences in exam rooms where I felt like I couldn't speak up when something was happening that made me uncomfortable. And I had an experience a few years ago with a clinician who was trauma-informed, and that's why this episode was so important to me because I know how I felt in that moment when she noticed what was going on with my body, that I was very rigid and I couldn't complete the exam.

And she paused and checked in with me. And it was sort of the reminder that I needed that it's okay that we do that with ourselves. We're allowed to check in with ourselves. We're allowed to pause when something makes us feel uncomfortable.

We're allowed to ask questions. We're allowed to ask that our healthcare provider communicates what they're doing in what part of our body. Now, not everyone's going to have had the experience I had with an incredible provider, and mind you, that happened to me at 40. I'd never had a doctor behave that way prior to that, so that was incredible.

And that's why we worked on this episode, because we want people listening to know that they can feel comfortable accessing medical care. And if there's a barrier to treatment, there are resources available to help them navigate that. And one of them is clinicianswhocare.com, a resource Dr Bayo spoke about in this episode, which will be linked in our show notes. This is a tool to find clinicians who have been vetted, whose trauma-informed care is based on patient reporting, and this just might change how and when you access medical care.

Summers: Here's a quick clip from the episode.

Pathak: What are some of the long-term health consequences of putting off routine exams, and what do you want patients who may be listening or know someone who may be suffering in this way and putting off care, what do you want them to know?

Bayo Curry-Winchell, MD, MS: That delay shows up in not getting your Pap smear, maybe not getting a full exam, getting your heart checked out, blood work. And it reminds me of a patient I had a few years back, a woman in her mid-30s who had not gone to a doctor maybe since she was a child, when she was in my clinic and she was sharing with me that she was feeling tired and having headaches, and I said, "Oh, you know, how long has this been going on?" And she said, "For a couple of years, but you know, I'm stressed. I just have a lot going on." And I said, "What prevented you from coming in sooner?"

And she said, "Well, I was also just afraid that it wasn't gonna be anything. I didn't wanna waste anybody's time. And I also have a real fear of seeing doctors." And I asked an open-ended question, "Tell me a little bit more about that." And that was a beautiful moment because in that moment, I provided space that I didn't even know I was gonna provide.

And she shared with me that coming to the doctor was very triggering. And that's why although she had had this fatigue and headache, she decided not to come in. And so it's really important that we remember that the symptoms that your patient comes in, there might be other things that are a part of it that could prevent them.

And so fast-forward, she ended up having a blood pressure of 170 over 110. And so she has essential hypertension. We were able to address it, but she had been walking around with elevated blood pressure for who knows how long. But because of what had happened to her in the past, she had decided not to show up.

And so it, it has real consequences. We all know that elevated blood pressure can stress the kidneys. It stresses the heart. It can increase your risk for a heart attack or a stroke. And so that is how it shows up in people delaying their care and can ultimately impact their longevity.

It can lead into someone not living as long as they were hoping to or not being able to do the activities that they love.

Pathak: For someone who's listening today, can you help someone understand what they can do to take an active role in scheduling that next appointment, and what are some of the words they can come into the clinic with to have that conversation without waiting for the provider to pick up on cues?

Curry-Winchell: The first thing I recommend is writing down all of your fears, whether you wanna write it in your phone, write it in a journal, say it out loud, record yourself, because then those fears, that anxiety lives somewhere. And when it lives somewhere, you're then able to address, "Okay, I am extremely anxious that this doctor may dismiss me," or, "This doctor may not take my symptoms seriously," or, "I'm just nervous to be in front of this doctor."

And when you do that, you're able to decide how would you like to respond to what may happen in that doctor's visit. So doing that what if, which a lot of people have just in general, writing it down and then deciding how you would like to respond.

The other thing I would recommend when it comes to your appointment, I would do three things. First, write down the most pressing things to you. You can jot it down on your phone. The second thing is, what would I like my doctor to address from these three things? And the third thing, what is my goal when I leave that doctor's office?

And that gives you a real sense of control of what you would like. I like to help empower my patients that by having what you want out of that appointment, what you're expecting, it helps you become a part of that appointment. So instead of things happening to you, you are a part of the care because you have decided, "This is what I want out of it."

Pathak: I'd love for you to help us be really concrete specifically around the exam phase of the appointment. So a lot of patients don't realize that they have choices, that they can be a part of the decision of how the exam is conducted, how a healthcare professional approaches them, when they might need a break to ask for that and to advocate for that. What do you want patients to know before they go into that exam so they know exactly how to have that conversation so that they can be a part of the exam as well?

Curry-Winchell: I love this question. So for me personally, when I see every patient, I try to be as intentional as possible. I sit down. I try to be eye level because just that in itself can make someone feel comfortable where you're not standing over them. The other thing I do is I ask, "Is there anything that I could do to make your exam more comfortable?"

And that's a wonderful thing because that opens up the opportunity for the patient to say, "Yeah, I would love for you to let me know what's going to happen before you touch me, before you perform any exams." And I ask very open-ended questions, curious about, you know, your care, curious about what your thoughts are.

And before I touch my patient, I always say, "Is it okay if I start listening to your lungs? Is it okay if I listen to your heart?" And a lot of us as clinicians, we were trained to, you go in the room, you introduce yourself, and then you just start listening to their heart, listening to their lungs. But there needs to be a conversation.

This is a relationship. I am touching you. I am performing an exam. And in order to do that, I need to consent to your approval. And that starts with sharing and asking those questions first. So that's what I do. Before I even lift up my patient's shirt, and I even do this with little ones, with my pediatric patients, I say, "Is it okay if I listen to your heart? Is it okay if I lift up your shirt?" All of those things are really important. And so I think those are really things that not only a clinician but also a patient can say, "I would love for you to walk me through how this exam is going to happen." Meaning, what are you going to do before it happens?

The other thing that I love for patients to share, "I would like to let you know that I would feel more comfortable if I need to say I'd like to take a break, I need to pause during this exam." Now, and I know during certain procedures, I always share this, that can't always happen. But a lot of things in an, in an exam room, that is possible.

And so I think those are real ways that both the patient and the clinician can do. And that's what I do in my, exam room. I, I share all the options and I share everything because in the end, it's about them. And I'm here just to be a part of their care. And I am so grateful that I get to

Casey: Across these episodes, from trauma-informed exams to exploring a fertility journey to understanding triggers, we kept coming back to one idea. Your body and your story are yours, and you are allowed to ask for care that honors both.

Summers: Each episode gives a different tool, language for the exam room, tips for navigating your relationships and triggers, and a new way to look at your fertility options. We deliberately chose episodes that sit at the intersection of evidence-based medicine and lived experience, an inflection point where Health Discovered lives.

Casey: Thank you for being with us today. We had a great time sharing some of our insight from behind the scenes, and we hope to continue being your companion health podcast, always one click away in your pocket or on your computer, offering health information, resources, and reminding you that you are not alone no matter where you are in your health journey.

Summers: To find out more information about the episodes mentioned in this podcast, please make sure to check out our show notes. Thank you so much for listening.

Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send us an email about topics you're interested in or questions for future guests, please send us a note at [email protected].

Casey: This is Casey.

Summers: And Lauren.

Casey: For the WebMD Health Discovered Podcast.