While the starting point for this conversation was care after breast cancer, the core of the message is making yourself a priority. We think that's a great thing to be reminded of, especially as we formulate plans and intentions for 2022.
Laura Stratte, RN, BSN, CBCN, has over a decade of experience in breast cancer care. During her time at Ascension Columbia St. Mary’s in Milwaukee, she developed a survivorship care program focused on health and wellness for patients during and after treatment. As a cancer survivor and advocate, she’s worked with local and national organizations on education and outreach covering sexual health, cancer and the environment, and self-care. With an education in the fine arts prior to her turn to the medical field, she has been a survivor artist contributing to The Rare Chair Affair, a benefit for the Wisconsin Breast Cancer Coalition. She’s currently the Operations and Program Manager for Elektra Health.
Barb: My guest today has a lot of shared interest with me and the MiddlesexMD team. Laura Stratte is an RN who has worked in breast care, and has more recently shifted her focus into menopause. She is working with a technology company whose ambition is to Smash the Menopause Taboo. That’s a mission we at MiddlesexMD certainly endorse! Thanks for joining me, and welcome, Laura.
Laura: It is so great to be here.
Barb: Good. So, I was interested to hear that after eight years as a nurse navigator for breast cancer patients you then went on and developed a survivorship program. What do you offer there, and can you talk a little bit about what that looks like and what survivorship programs encompass?
Laura: Right, so survivorship is a phrase that can mean a couple of different things. It can mean the period of time after a patient is done with active cancer treatment. But in the program that we developed, we really looked at survivorship as starting from the time of diagnosis. Because what we talk about in survivorship is kind of all the treatment—the diagnosis itself that we do to people has a lot of collateral damage, right? Of course there are some physical side effects that can be late term, they can happen ten years down the road, it can be happening now. It can be psychological, financial, practical, sexual—it affects every single part of your being as you go through a cancer diagnosis and treatment.
So I really wanted to develop a survivorship program that could start day one after that diagnosis. We really focused on the wellness aspects of it, and how educating people about what they could do as far as exercise, nutrition, emotional health in order to help themselves feel as good as possible as they are going through this treatment—really setting the stage for when they are done with active treatment, or maybe they will never be done with treatment. That they can kind of continue these behaviors lifelong.
Because there are a lot of things that women can do—and people can do in general—to feel pretty good as they are going through treatment. We try to present it as, this is kind of the start—this is your job as part of the treatment. It’s kind of taking care of yourself, and it's going to help you feel better. Which is really what people want to do. They just want to feel better and as good as possible as they are going through this.
Barb: So it sounds like you didn’t abandon the navigator portion of it, you sort of rolled it into the survivorship?
Laura: Exactly, yeah. We offered programs: nutrition, we offered exercise classes, we offered this great form of yoga called YCat yoga that was developed specifically for people going through cancer. It was really more about meditation than stress reduction, and was fabulous. [The instructor currently offers Zoom classes.] We also did, okay, you are newly diagnosed, we want you to exercise and move as much as possible, here are some concrete ways to do that. We want you to eat well, and if you can't, here's our dietitian who is fabulous, and will help you get through treatment. We want you to take care of your emotional health and here’s our resources, and if you need help, here are signs that it might be helpful for you to talk to someone. Unfortunately, we had to do a finances 101 and insurance 101 kind of thing as well.
Really, it was a way to introduce ourselves as the navigator, and the support resources: introduce ourselves to the patients, and we were allies with them. We were partnering with them, and we wanted to make sure they knew we were on their team.
Barb: I’m curious as to how long, generally speaking, you would engage with a woman in doing that survivorship? Once they were through the initial treatment and on a road. Maybe beyond their active treatment, did most women continue to engage as survivors in what you have to offer? You know, I see many women, many survivors of breast cancer, and it's interesting how there’s a lot of attention paid to them in the now. But really, oftentimes five years later, I don’t need to see the oncologist, the surgeon doesn’t need to see me. But they may still feel alone in a way. They are still dealing with decisions to be made, with the impacts of maybe their treatment or their premature menopause, so I’m curious how you found women seeking support later in their journey.
Laura: That’s a great question, and it really varied. You know some women didn’t—so we would have a lot of women who would participate in our programs. Our programs are open to people going through treatment, done with treatment, and we would have a lot of women coming back and participating. But some people didn’t want to come back to the cancer center for an exercise class or eating. It was a trauma, and could be a trigger for them. So they would want to do stuff outside, and we totally understood that, so we talked a lot about whether we would partner with a different facility, a gym somewhere that we could do those programs there. We never got to that point.
You’re right, I think a lot of women, when they finish that active treatment, they might have some physical side effects that they are still experiencing, but that emotional side effect doesn’t start until six months, a year later, as they are trying to move forward, and they kind of feel stuck. So we, the navigators and my cancer program, work very very closely with patients, so we had developed a really great relationship with them. We would often have women calling six months later, years later, saying they needed some support or resources. We would often see them, if they would come in for an annual follow-up or every six months follow-up, and I think that was based a lot on the relationship we had—the nurses had with the patients themselves.
We didn’t have a systematic follow-up that went that long, however. There might be some programs now—and I hope there are—that would have kind of a more long-term way to manage survivorship, so to speak. I think that’s coming, but it can really vary like I said. It often comes down to what the woman feels like she needs from the nurses that she worked with.
Barb: During this, what did you learn about women’s orientation towards self-care? What was the level of engagement? Can you talk a little bit about that?
Laura: There’s a couple of different camps that people can fall into. I think most people have an idea of what it means to take care of yourself. But sometimes it can be really fuzzy. You know, oh, I need to eat well, I need to exercise, I need to manage my stress. But what does that really mean? What does it really mean to eat well? What do you mean when I say I need to exercise? How much? What do I need to do? What constitutes exercise? So a lot of people don’t have that basis of understanding or knowledge.
Oftentimes those who would be really hungry, and, you know, “I want to learn all of this,” and that was a great opportunity to teach and to really move the needle quite a bit. Some people had that background, they knew what to do and maybe they had done it in the past but life got in the way, and those habits weren’t maintained. And it was really more a problem with execution and implementation as far as doing all these basics, like exercise on a regular basis, eat well. So then it was a matter of how can we work together to create strategies so you can actually do these things and create these habits?
We don’t want to forget, I feel like sometimes when I am talking about survivorship, I always get into the conversation of talking about exercise and eating well, but there’s this emotional piece of this that a lot of people don’t equate self-care with the emotional tending to ourselves—and we say this at Elektra Health when we talk about menopause care—it is that situation where if you are on an airplane you’ve got to put the mask on yourself first before you tend to anyone else. Tending to yourself holistically, body, mind, and spirit is so important, and I think that was the hardest; the mind and spirit part was the hardest to help women see that that deserves attention. And there, you’ve got to pay attention to that and tend to that, and here are some tools to do so.
Barb: And I think a cancer diagnosis probably has a different level of interest and engagement and attending to self. So in my practice, which is around menopausal women as well—and many of them of whom obviously don’t have a cancer diagnosis—we really try to emphasize lifestyle and how much more important it becomes.
Can you summarize maybe the top three recommendations you would make for women who are approaching—haven’t had the cancer diagnosis, but are approaching menopause—how could you give them some bullet points of what to do?
Laura: Right. I kind of look at, if you ask for three, I’m going to talk about four really briefly. It really comes down to eating/diet, exercising, stress management, and sleep. So, I think sleep is one start, because sleep really affects everything. So many women as they are going into perimenopause have sleep issues, and people can have sleep issues—chronic sleep issues that they learn to live with—and I don’t. When a woman says, “Oh, I’ve never slept well.” That is like, “Ahh, no! You can sleep well.” And you have to work and pay attention and tend to that. So, if you aren’t sleeping well at night, talk to someone. There are things you can do to help yourself. You can go to Elektra Health and look at sleep problems, we have a lot of great tips and, there is a lot that can be done.
Exercise then—just move as much as you can, as often as you can during the course of the day, and add on strength training, absolutely. Build that muscle mass. As far as nutrition, stop eating all that added sugar that is in everything. So really look at whole food, plant based. So plant heavy doesn’t necessarily mean that you are giving up meat, but a lot of plants and the sugar. That’s the basic one to start.
And finally stress management. This is again, like sleep. If you do things that help you relax, if it’s that meditation, if it’s exercise, if it’s journaling, if it’s reading, make that a priority. Do something every day, even it if is for five minutes a day: Get into the habit of tending to your stress.
Barb: I feel like a broken record, and I think we just need to keep repeating this message over and over again. I think women have underestimated the importance of prioritizing themselves and all those things you mentioned, and I’m grateful for all of the resources that are becoming available. And one of those resources is Elektra Health. So let’s pivot a little bit and talk a bit about Elektra Health, which is somewhat of a new role for you, and is a technology-based company. Can you tell us about it?
Laura: I’ve been with Elektra Health for a little over six months. It is a women’s health company that—we’re helping women navigate the menopause transition. We are on a mission as you mentioned, to smash that menopause taboo. And we do that by empowering women through virtual care, education, and community.
One thing that we have noticed is that a lot of women don’t know that much about menopause; they know what it is generally speaking, but they don’t know the details. They don’t know what’s involved, and they certainly don’t know what happens—all the ways that menopause can affect the body. It is not their fault. It is because society doesn’t really talk about it.
So we’re here to start changing that conversation, changing the narrative, educate women on what is happening. What you may experience. What you can do to manage the symptoms, so you are prepared, and you can really take charge of your health. And we also want to change the framework. Menopause often has a very negative connotation, and we often hear, we ask women, what’s the phrase or word you think about when you think about menopause? And people don’t think good things about menopause. But it can really be a good time in a woman’s life where if we embrace that change, it can be a time of transformation. We can transform, we can reiterate and recreate. This is the start of the rest of our life, the gateway to the rest of our life. Looking at it in a different way and changing our minds can be really powerful, and we want to do that as well.
We offer telemedicine visits to women in New York state. Right now if you are outside of New York state, you can meet with one of our providers, who are menopause experts, to have a conversation to just really learn more and get answers to your specific questions. So it’s really empowering with that one-to-one attention that you get by talking to someone, talking to a nurse practitioner or physician. We have education programs that range from a talk about sleep and what you can do to help yourself sleep through the transition, to a ten-day email program we call “smash taboo” which is free. You can sign up at ElektraHealth.com. And we also have community—that power of knowing you are not alone in this journey is really incredible. We have a private Facebook group, and we have events where women can just be together and help each other through the shared experience.
Barb: It is interesting that word: taboo. And I don’t know that I would have thought about it in the context of transitioning through menopause, but it certainly is appropriate. I’m curious if you have any insights to know how we got there, why we find ourselves needing to smash the taboo.
Laura: That’s a great question, and I think part of it is that historically women’s health has not gotten a ton of attention, right? And menopause has really kind of gotten the least amount of attention to women's health. And I think it has to do with, first off, only about twenty percent of our ob-gyns in the United States receive any training and residency in menopause care. So on the provider side, there is a big gap in what they know and how they train. I’ll be 48 in a couple of months, and when I started working at Elektra I realized that no one’s ever really talked to me or asked me about menopause. They will ask if I’m still getting my period, and that’s it. But that’s where it stops; the conversation never went on.
Fifty million women in the United States right now are going through menopause or have been through. About two million a year will go through menopause in the United States. This is something that is a [near] universal female experience. One hundred percent of women will go through menopause. So I think now we’re just seeing this big wave of attention to women’s health. And a wave that, yeah, we deserve care, and we deserve proper care in this. We’re riding, like I said, this great wave right now, and it's really exciting.
Barb: And I think I would add to that: Because there’s been a void in education and conversation, I think women out of necessity and their own desire have filled in the gaps on social media of sharing experiences, and there’s a lot of misinformation that has resulted and been shared, and that’s widely available. So I think, not only is it smashing the menopause taboo, but it's now trying to redirect the menopausal conversation to be evidence based, quality based care that—what we know, what we don’t know—there’s so much bad information out there around this topic, because of the void. And I think, again, Elektra Health is trying to step into the place of trying to turn the ship in terms of elevating the conversation, but adding to it that evidence-based approach that we want women to have around it.
Laura: Exactly. And just a few weeks ago Elektra launched our twenty-first-century guide to menopause and it kind of gives women the overview of menopause. And we drill down to 25 symptoms and kind of explain what’s happening in your body, why it is happening in your body, and what are things that you can do about it. Because there are a lot. We cover lifestyle, we cover supplements and other holistic, integrative practices. We also cover hormone and non-hormone-based medications as well.
All of our content has been vetted by our physician advisors who are menopause experts. We take a very holistic and integrative approach to care, and it is evidence based. We hear time and time again that women will go to Doctor Google and they kind of search and go down this rabbit hole, and it is really hard to tell what has some research behind it and what is the quackery. So women really appreciate the fact that we have done all that research for them and can point them in the right direction.
We also, when we were writing all of the content for our guide, we were really really careful on making sure that we had very actionable, concrete steps that women can take. We aren’t just saying, eat better or eat less sugar. Here are some ways to do that. Here are some specific resources to use and here are ways to learn more. It is really about empowering women to give them the information they need to actually make those changes and to be prepared as they are going through this transition.
Barb: Good, thanks. So just to clarify, Elektra is E-l-e-k-t-r-a Health. So if they want to seek more information they can find you online and access resources.
So as we summarize our time together, in conclusion, for many women we like them to share about more personally, where do you find fullness at this stage in your life?
Laura: This is a great question in that if you had asked me this a year ago I would have had a very different answer. So I’ll be 48 in a couple months, and I have really learned I’m a very risk-averse person. But I left the clinical world. I jumped into something that was totally brand new. It felt like the biggest risk I could have ever taken. But it has been so liberating, empowering. It's been so exciting to be outside of my comfort zone, which I would avoid at all costs beforehand, and so I’m finding fulfillment just in kind of doing these things that seem really exciting and new and like I see myself now. This is the time, the start of the rest of my life, and I’m really really excited, and I think taking those risks can be incredibly empowering. And I feel great.
Barb: Yeah, I think that’s really exciting and I think for many women, this kind of fork in the road of looking forward and—professionally but personally—also in trying to say, hey, is this the way I want it to continue to look, or could there be something new and different? And I think that nudge to look at something different, I think generally my experience has been it leads to just wonderful discovery of interest and gifts. Sometimes there are crashes and burns of, “wait a minute, that wasn’t exactly what I sought to be,” but then you can pivot again. I think it’s really great that you’ve found in yourself a new passion, so to speak.
Laura: Right! And I think that’s something that at a lecture we always want to have, to talk about menopause in that kind of framework. That this can be a transformation, and it is a great time to reflect and reexamine and be ok with the fact that we’re not—our bodies are not going to be like our 25-year-old self, but they are going to be something new and different, and it is still going to be amazing. The world is at our fingertips, and we just have to jump in and live.
Barb: Thanks for the words of encouragement, and thanks for your time today, Laura. I appreciate it, and I know our listeners will as well.
Laura: Thank you so much, it was great to be here.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.