April 06, 2020


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“More joy and less suffering.”

Christine Marie MasonChristine Mason founded and grew technology companies starting in 1996. She's a mentor to young businesses and nonprofits, and has served as a futurist an innovation advisor for global companies like Estee Lauder and Panasonic. From 2009 to 2013, Christine curated and led TEDxSanFrancisco events; she continues to convene gatherings around the world. She serves on the board of the GRIP training institute, working in the California State Prisons with life-eligible inmates on victim-offendor communication, and with the Stone Research Foundation. She founded Rosebud Woman in 2017, after years of research into responses to women's intimate care needs. Christine is also the mother of four and a grandmother, in addition to being an author and business leader.


Dr. Barb: Christine Mason is an entrepreneur, yogi, writer, and mentor to new businesses and nonprofits. She's an innovation advisor to companies like Estee Lauder and Panasonic, as well as a mother of four and a grandmother. In 2017 she founded Rosebud Woman, a completely plant-based line of intimate care moisturizers and stimulants. I first met Christine at the International Society for the Study of Women's Sexual Health Conference and we learned how much our missions align. Welcome, Christine.

Christine: Hi. Thank you so much. How are you doing?

Dr. Barb: Good. And thanks for joining me today. I'm eager to hear more about your company and your mission and sharing that with listeners. So, but first I want to start out by saying your background is interesting. You have successfully founded and launched a half a dozen technology companies which seems quite different from the company that provides intimate care products for women. So, can you just share with us a little bit of your journey and what has sparked your interest in women's sexual health?

Christine: Yeah. So I was pretty bought into the traditional hierarchical climb in corporate America when I was in my 20s, but I took a first job out of business school and I had three little kids at home and I couldn't juggle that. And I saw that there were only two places to be as a woman who had a lot to offer in the world of work and that was either in charge or on this freelance schedule. And so, my journey to becoming a company founder was really driven by a culture that couldn't adapt to a woman with kids who wanted to work in it.

And so I becameI founded my first company then, and I built on a lot of things that I had learned on technology and heavy industry, and they all came very naturally. And then when I was in my early 30s I started to sort of long for a more feminine way of being. I started studying tantra and yoga and sexuality and plant medicines and things like that in parallel with my main work. And so around I think 2010, 2011 I shifted all the work I was doing in technology to innovation for health and wellness companies and still was doing this very high-touch sensuality, sexuality, women's health thing along concurrently.

And then when I got some free space I sold the company, I sold my house. I was like, "This is the thing that I've been working on gifting and making items at home and I want to turn this into a real thing." So I took my tech experience and I did a survey of 3,000 women on their needs and then turned that into this, with the best chemists and really great formulators and opinions and advice from medical doctors as well as homeopathic and traditional medicine people. So it's been a really amazing journey that combines both sides of my brain and life experience.

Dr. Barb: So your journey and your survey of 3,000 women, what was the unmet need that you identified that you knew needed a solution?

Christine: Well, I thought it was a just about moisturizing, like vulva and vaginal moisture, which I knew was a concern and that most of the stuff that I saw in the market was super chemy. But I was surprised to find out that there were more needslike there were more needs that I could solve also, by the way. But the top four needs that people said they had was dryness, lubrication, which go together, lack of sensation, basically the pelvic basin not being able to feel much of anything, particularly in the vaginal opening, introitus, or the vulva. The other one was irritation like soothing, itching, redness that could come after waxing or exercise or after sex, and then cleanliness, that's a tough one. It also got described a lot as odor but it wasn't just that. There were also concerns around scarring, stretch marks, particularly scarring from episiotomies that people talked about.

And I divided the results up by had you gone through regular menopause or surgically induced menopause or were you still actively bleeding and tried to see if the needs differed. And among the needs the only one that significantly differed by menopause or not was the moisture question; that was about twice as many women after menopause as before. But the others were pretty consistent regardless. The other one on the arousal or sensation was more tied to whether or not you'd had a vaginal birth or you'd had sexual trauma then it was tied to menopause. So, it was a very interesting study. So I really like towe're not trying to invent a new problem for women to solve, but actually to both address these underlying concerns and, in play or pleasure, there's nothing wrong with just having more comfort and ease and pleasure there either; it doesn't need to necessarily be medicalized.

Dr. Barb: So you identified this need, and now what, you network, you know people, your chemist plant base? So tell me how somebody takes this understanding of improving quality of women's lives and then is able to produce on that? I guess I just most of us...

Christine: The humility of that part of the trip. I have an interest in Ayurveda, I have an interest, like I was saying, in plant medicine. So the first thing I did was talk to Chinese medicine doctors, Indian doctors, what I call the white witches, the people who carry the Northern European plant medicine. What did they use for these particular conditions? And others, like period pain and things like that, what did they use? And then I talked to my doctor friends: what did they use? And then I looked at research on the plants. And I had already been with my blender in the kitchen for many, many years making a moisturizer and a lubricant and a skin cream as well that I was giving to friends like learning how to emulsify and do all that stuff.

So I thought, "Okay, now what I need to do is to make sure that this is medically accurate, that it's a good formula." And so, through my contacts at Estee Lauder I found an amazing chemist in the Los Angeles basin who was very heavily focused on plant based and organic, so super-clean-ingredient beauty as well as had the attributions of doing several skincare lines for famous doctors, really high-end lines like $200-, $300-a-bottle serums and things like that, that you would recognize the names of if I said it to you. And I walked into his office and I showed him my prototype formulas and he said, " Ha, ha, ha. They're well intended; they look like a cookie recipe. Let's see what we can do."

So, he took the formulas and upgraded them, added some new ingredients based on what we wanted to achieve, and then we started testing them on people. And we went through about four or five iterations on each product to get them right and then we did patch testing and gynecological testing as well to make sure that that worked, and stability testing and all of that. So I really owe it to Fred and then Francesca, our chemist, who's done some of the other products for really getting the formulas just right with us. So that was the formula part and I could pause there because there's just so much even in that—and specific ingredients that we discovered that I could talk about for days.

Dr. Barb: And what you determined was what women need didn't already exist?

Christine: It did not, no. I mean there were some verythere were some vaginal moisturizers and lubricants and that you can get from a doc; some of them are fine but most of them had really harsh chemicals where they were petroleum jelly, petroleum based, which we don't like in that part of the body. And then there were some things that you could use for cleaning but I thought they had also chemy ingredients. Plus they had this message that it wasn't just about cleaning the stove top or feeling better or having a non-irritating cleanser: it was about deodorizing and fixing you, which was not what we wanted at all. We just wanted people to keep the outside clean so the vaginome didn't get disturbed. So looking around I didn't see what we wanted.

And then a lot of the packaging that things were coming in was very neon and sexualized and I wanted something beautiful. Just packaging that you could put this glass out on your bedside and keep it and look at it and it looked nice and had that glow about it. The items themselves would become something you'd want to have out in your bathroom or on your bedside table. So yeah, those did not exist for sure.

Dr. Barb: And I—unfortunately we're only audio, we're not video, so we can't show our listeners the beauty of your products, but they are beautiful. [Here’s a link to some photos.]

Christine: Thank you.

Dr. Barb: Yes. So my website, MiddlesexMD, is just starting to carry your products because I do think you have found something very special and unique. But what's the response been to your company and your products?

Christine: I am a little overwhelmed. It's very culty-like; people love it. And I sometimes when I'm having a low night or something I'll just go read testimonials [laughs]; it's really lovely. 

Barb: It is lovely. 

Christine:  I vary the products and a lot of other stuff. Like we wrote a little book that talks about self love and teaches about your body parts and unwinding cultural messages around your sensual and sexual life. And I do a lot of women's circles with my team around the country on that and just getting people together and realizing that we don't have the red tent situation in the west, we don't have a lot of women gathering talking about these intimate questions. But when you start to put people in triads and dyads and they're talking amongst themselves on specific questions whether it's related to early sexual experience or periods and cycles or what they know about menopause, or how to care for themselves, that they just explode.

Callout: There's so much buried inside of us that isn't conversed about.

There's so much that's buried inside of us that isn't being conversed about, that's also the big opportunity. It's not just normalizing talking about the vulva or talking about your intimate life but inviting a space where people can be really authentic about that. And some people talk to their doctor about it but most doctors, unlike you, don't have a lot of time to have those more in depth conversations on sexuality and sensuality.

Dr. Barb: And I think as a provider recognizing the need we so appreciate people like you who can have an authentic, passionate voice speaking into the beauty of sexual health and I think you've nailed it.

Christine: I feel... I'm blushing. You can't see that because I'm on audio.

Dr. Barb: So I also appreciate the Rosebud Woman mission statement. Can you share that and talk a little bit about it?

Callout: I cut it down to more joy and less suffering.

Christine: Well it's long, but I keep trying to cut it down to more joy and less suffering. And it's about restoring this part of the body, the whole pelvic basin to body care and normalizing it and encouraging the integration of this into our whole self. So we do that in a lot of ways. My longer-arc life's work is connecting what's going on inside of our bodies, our inner lives, our spiritual life, our emotional, psychological life, with the cultural systems we create.

And so, I feel like the denigration and the denial of the vaginal area in general, like we say the pussy (I don't know if we can say that on your podcast), but the denial of that area is reflected in the way women are insulted in general. They're objectified; there's just a lot in there that I don't want to get into right now because the podcast is short. But that we believe that by shifting the way we think about our bodies that we can shift cultural systems. And when I say where is the world broken around women: domestic violence, economic opportunity, maternal health. So we do a lot to connect the dots between our own inner life and those systems, and we use a good portion of our proceeds to support charities that are working in those particular areas while we do the self correction and start advocating for full care and love of a woman's body in all of these areas.

Dr. Barb: And because this has been an interest of yours over time would you say you've seen some favorable results from the work and the efforts that we're actually culturally achieving a better sense of respect and love, self love?

Callout: There's body positivity, but there's still this... culture that wants you to look a certain way.Christine: I think so. I think you look at all around the world: women in Saudi Arabia are driving, in India now your local town council has to be 50-percent women by regulation. Here in the U.S. you're seeing the closing of the wage gap, that's a big deal. I think more body positivity, a lot of that. I mean I do sense in my lifetime that my daughters have a much different experience in some ways but then in other ways it hasn't changed it very much. Like particularly around the body pressure to conform to a certain image that is very bifurcated. There's body positivity but there's still this incredible intense Instagram culture that wants you to look a certain way and, yeah, it's not real.

So, there are changes in some areas, and the other side of that is I feel like the men's movement is finally getting its act together and saying, “each for equal.” That if women are respected in these ways and come into their power, then men have a much broader menu of ways that they can be in the world, how they can express, their expectations are diminished, et cetera, and they can be more genuinely themselves. Also a little bit free of the male role belief system or the gender roles that they've internalized. So that's my—I feel it's definitely changing. I just want it to change faster.

Dr. Barb: Yeah. Well, thank you for your efforts. So do you feel like in the work you're doing specifically through Rosebud Woman you're able to impact men as well?

Christine: I have gotten some notes from men, particularly the men who steal their women's Soothe product for their eczema. It's interesting because I get notes from men who buy the Arouse product for at home use or who buy the Honor product, which is the moisturizer, hoping to help their wives become more sexually active. Who don't understand why women in menopause don't have the same interest like they feel neglected and they want to put some spice back in the bedroom or something. And they say that it opens up a conversation with their partners or their wives that they hadn't had before, so to that extent yes.

I'm really proud of my friend Christopher Robbins, real name, who has a company called Soul Degree that is doing men's circles just like the Good Man Project and other things like that, where it's more men having the conversation with themselves. And Christopher, they are allies where we as women, if we're invited into this space to have a real talk with men who are conscious and want to know we can have that dialogue with them and otherwise it seems to be a secondary derivative benefit from the products.

Dr. Barb: Well that's encouraging. At MiddlesexMD we've had a number of instances where we've been blocked from trade shows or advertising that's been rejected. Just really not being able to get out there to have the frank discussion and use the proper terms for women in sexual health. Have you run into some of that same thing with Rosebud Woman?

Christine: I'm so glad you asked that, I'm so glad. So we advertise a lot on Facebook, it's a fairly effective platform but repeatedly you can't use the word vagina, you can't use the word, there's just a lot of words they block because they don't understand the difference between porn and the sexualization or objectification of women and women's health. And so, I know that 60 or 70 percent of women have this problem and I can pretty much tell you what conditions will cause it, "Can you help me find them," as I want to reduce suffering and they block our ads continually.

In New York, there's tons of ads for erectile dysfunction in the subway and dancers, ladies, “live, live, live” all the time, those kind of ads, strip club kind of ads, but when they tried to do ads for women's period care products those were blocked and they actually did a lawsuit. It took two years to get the MTA to accept that advertising. So one thing I'm concerned about as we move forward is algorithms and technology. They bake in the preexisting assumptions of the people who wrote them. The optimizations and the blocks are all done by an algorithm and so we're coding into our technology preexisting biases around women's bodies and women's health. And so, I'm really encouraging along with a few other firms in this space, Facebook and Google and other companies, to have a white-listing program that people who are in sexual health and wellness can be part of, that will stop the blockage of those ads, as well as a way for broader culture to understand the difference between those two things. There's so much more in that area to talk about, yes.

Dr. Barb: Is this something you were aware of before you were more personally involved in the sexual health business? Did you recognize that that was part of the fabric of our culture or has it more just come to your awareness now that you're working with the efforts of Rosebud Woman?

Christine: Yeah, I did not know. I just figured those companies weren't advertising. I did not know that they weren't being programmatically blocked from reaching me. I would have been very interested in a tantra course for example on how to improve your sensual and sexual life. I would totally have done that many times if they'd advertised that to me or the body love program that we're starting. I would've done that a decade ago if I'd seen it advertised, but if it was blocked, I wouldn't have known it; so it's a little bit of a negative proof.

Dr.. Barb: How has launching this company been different from launching the other companies you've been involved with?

Christine: Well, first of all whenever you launch a company of any kind you have to figure you're going to do it for three or five years and that all those people in your new company in that industry are going to be your best new friends. That's who you're going to hang out with. Like I got to meet you at a trade show. Prior to 2014, the people that I was meeting at trade shows were foundries and steel mills and guys who ran server farms [laughs].

Barb: [laughs] I’m not seeing it.

Christine: A very different cohort.  And so, "We're going to buy a tractor company in Nebraska." So I mean I would go do that. So it's a totally different milieu, number one. So I really like this a lot more, the beauty industry, the health and wellness industry, the people are just amazing. They're so kind, they're so sisterly, I love that.

Callout: I have been able to merge my personal mission and my practical skills.

And then number two, I have been for the first time able to merge my personal mission and my practical skills “more joy less suffering” and “inner life outer world”; those are my personal missions in life. And so, it's a beautiful both passion for me because it's direct to consumer and I'm selling right to the end user and sometimes the retailers and spas and doctors. But I'm having these dialogues where you can see the impact right away.

Now I started, I began starting companies in 1998 and so that, I guess 94 actually, but the first tech company was 98 and back then, to do what we did to get this off the ground just from a technical perspective it would not have been possible. So if you're a woman who has an idea for a business this is an amazing time, all the technology tools that are out there that can help you get up and running. So it's been easier to launch. And plus because I was clear on it from the beginning we haven't had any missteps in terms of I know what I want, how it should look, and this ongoing interaction with the customer that we're constantly tweaking and improving things. So also it's just been a really joyful project from the beginning. I don't have any sense of it being work, it feels more like joy.

Dr.. Barb: Well you can certainly tell that from the way you just described it, the enthusiasm and the joy that exudes from you, so again, thanks. Can you give the listeners just a summary of your products?

Christine: Sure. So we have our flagship and most popular product is Honor Balm and it is a bedside like I actually designed the jar to go like those old cold cream jars that your granny might have had. It's like a beautiful rose-colored glass with a lid that has a little embossing, so a modern version of that. So Honor Balm is a daily moisturizer, and it has an extract of bisabolol, which is a German camomile concentrate that has NIH studies against it on improving skin texture and resilience. It's plant based and beautiful and you just take a little bit on your hand, it's like an unguent and when you start to move it around on the skin it turns into an oil and you can manipulate that on the labia, on the inner labia, on the clitoris all the way into the introitus and really put that on at night, a little self massage, leave it on overnight and let it do its magic. It can be used as a lubricator also but it is oil based, so if you're using condoms that's not for you.

And then the next product is an experience product called Arouse, and one of its actives is a plant that I discovered in Hawaii: It's spilanthes acmella. And if you bite the little flower head off the live flower, your entire mouth explodes; it starts like foaming and salivating. And it's used in Polynesian culture for an oral hygiene because of the way it moves saliva and as a sexual aid. So that creates plumping and tingling in the labia and in the vulva overall. And it also has all kinds of adaptogenic, traditional aphrodisiacs like ashwagandha, maka, summa in the formula. So, I would say 80 percent of women have the experience that is described on the serum, and maybe 10 percent can't feel anything, and another 10 percent it might be a little too strong for. So I really recommend you to try that. You can also use that on your regular lips as a lip plumper and tingler; it's enjoyable that way.

The third product is Soothe. it's a soothing cream that has calendula, arnica, comfrey, all kinds of things to fight itching, redness, swelling. That's just a really great all-over cream for the whole body. And in the area of the vulva it works on if you've had a waxing or shaving irritation or if you've had rough sex or if you've been on the bike too long or any kind of irritation. It's also super cooling, it has a little tiny bit of mint so if you have other complications and you just want some ease, it's good countering infections.

And then the Refresh products are both a wipe, a bamboo wipe and a spray that are aloe and hydrogen peroxide, Witch Hazel, tea tree lavender; they're antiviral, antibacterial. They're really, really lovely, and they don't have any stripping cleansers while still being cleaning. And the wipes are really easy; toss them in your purse. The spray is probably better left at home. It's a glass bottle that you use after the bath or toileting. And then I have a new body oil coming out plus a couple of books and a journal for tip tracking at home your own relationship to your body and healing that over six weeks or so of content.

Dr. Barb: Good. Well, thank you for the work you've done and the work you're doing and what's to come, because I know we are all benefiting from your passion around this.

Christine: Well, for you and me I really hope that we proceed with our thoughts on doing an online program on “the change” and help people learn more about everything that's going on in a woman's life during the perimenopause and the meny-pause [laughs]... menopause era of the life. I mean I'm through that right now; it's a very alive time. I didn't expect that when I was 30 or 40. It's just the best time I have had in my life. So, I know you have a lot of medical and psychological information, and we're going to, I hope, proceed with that program and do more stuff like that together.

Dr. Barb: Yeah, I think that's what was so fun about hanging out with you, Christine, was your ideas. It's always about a new idea and how we can reach women and what could we do and what would that look like, and so it was completely energizing to me. So I'm looking forward to what we might partner on in the future. And as we finish our time together today, I'd like to ask where do you find fullness at this stage of your life? I think we've heard bits about it, but I don't know if you have a summary statement there.

Callout: There's nothing to fix about you; just be grateful and happy and serve.Christine: I want to just say a couple of years ago I had an accident, and I died. I was in that liminal space between life and death for a while and everything's been different: like there was nothing to fear. Death, that space was so beautiful. Maybe it was a trick of the mind, but I'll tell you ever since then, just being alive in my body, breathing, moving, starting and ending the day with blessing, starting and ending the day with thank you and I love you and clearing up any mishegoss that happened during the day—that's where my life is finding fullness. Loving the people I love and being infinitely grateful. Yesterday was the day of the blessing of blossoming trees, and it's an annual rite in some mystical traditions where you go out and you just say thank you to the trees for doing their thing. And that's what you are and that's what I am and that's what the listeners are: You’re beautiful nature and there's nothing to fix about you; just be grateful and happy and serve.

Dr. Barb: Well, thank you for your inspiration. Thank you for sharing and thanks for your time today.

Christine: All right Barb, thank you. Have a wonderful day.

June 11, 2019


about middlesexmd ›  

“We don’t talk about sex in the real world.”

Cindy GallopCindy Gallop has degrees in English literature and theater, and began her career as a publicist and marketer in the theater world. She switched to the male-dominated world of advertising and rose through the ranks, heading up accounts like Coca-Cola, RayBan and Polaroid. She’s known for being both “salty” and kind. In 2006 she founded her own brand and business innovation consultancy. As a speaker in the areas of advertising, branding, and business strategy, she has spoken at many conferences including TED and SXSW. She promotes diversity, representation, and conversation in industry. In 2009, she founded Make Love Not Porn, and in 2010 If We Ran the World, which brings together individuals and corporations with good intentions so they can take collective action. She told AdAge, “The idea is to let people say what they want to change, and then give them a network of people, companies, and groups looking for help to affect that change together, with each person contributing what he or she can.”


Dr. Barb: The daughter of an English father and a Malaysian Chinese mother, Cindy Gallop grew up in Brunei and studied at Oxford University in the U.K. She started her career in theater, but quickly found her way into advertisement. She enjoyed remarkable success in that field, and in 2003 she was named Advertising Woman of the Year. In 2009, she founded Make Love Not Porn, which she describes as celebrating real-world sex as a counterpoint to porn.

Cindy, welcome to the podcast!

Cindy: Thank you. Delighted to be here.

Dr. Barb: Thanks for taking the time to chat today with the audience, which I’m sure will find you interesting in some of the things that you’ve done and accomplished. I’d like to start out by talking about—I’ve heard you speak about getting over other people’s opinions, and you’ve been able to really successfully do that which has probably contributed to your professional success. And I think that place in space where women kind of get stuck at times. I’m just curious about a time when maybe you had cared about what others thought and what you did to get over it.

From the moment we are born, we are made to feel insecure about absolutely everything.Cindy: So what you’re talking about is the fact that I regularly speak about the single most paralyzing dynamic in business and in life is the fear of what other people will think. You’ll never earn the future if you care what other people think. And so people ask me, “How did I get to that point.” To be perfectly honest, 59 years of living basically. You know, there wasn’t a single moment that transformed my mindset. It was a gradual realization, that really not caring what people think is really the only way to live your life. I think that’s because, like all of us, I was socially conditioned as a woman when I was growing up to care enormously what other people think. So from the moment we are born, we are made to feel insecure about absolutely everything. The way we look. The way we dress. The way we talk. Nice girls do this. Nice girls don’t do that. Women spend the rest of our lives coming back from that, and some of us never do.

In my teens and 20s, you know, of course I was rampantly insecure as any of us is, at that age, and really cared about what people thought of me. And as I say it was the wonderful glorious process of growing old and leaving all that shit behind that took me out of that.

Dr. Barb: And it sounds like you came to that discovery far earlier than most women do. Or as you mentioned, some women never do. So, it’s really awe-inspiring to hear you speak like that.

Cindy: Well, thank you.

Dr. Barb: About the time you founded Make Love Not Porn was about the time I launched a website too called MiddlesexMD. I think we are both in a position to try to promote a different dialog around sex. My aspect and what I do would be around sexual health. So tell us about your project Make Love Not Porn and what inspired you.

Cindy: Sure. Make Love Not Porn was a total accident. I did not consciously intend to set out to do anything that I find myself bizarrely doing as I am doing now. I date younger men who tend to be in their 20s and about 11 or 12 years ago, I began realizing, through dating younger men, I was encountering an issue that, honestly, would never have crossed my mind if I had not encountered it so intimately and personally. I realized I was experiencing what happens when two things converge, and I stress the dual convergence because most people think it’s only one thing. I realized I was uncomfortable with what happens when today’s total freedom of access to hard-core porn online meets our society’s equally total reluctance to talk openly and honestly about sex.

I thought if I'm experiencing this, other people must be as well. When those two things converge, porn becomes sex education by default, in not a good way. So I found myself encountering a number of sexual behavioral memes in bed. And I went “Whoa! I know where that behavior is coming from.” I thought, “Gosh, if I’m experiencing this, other people must be as well. I didn’t know that because 11 or 12 years ago, no one was talking about this or writing about it, and I’m a naturally action-oriented person, so I decided I wanted to do something about this. Ten years ago, I put up a little money, a tiny, clunky website to MakeLoveNotPorn.com, that posted the myths of porn, and balancing with reality. The concept was porn world versus real world.

I launched at TED in 2009. I became the only TED speaker to say the words “come on my face” on the TED stage six times. The talk went viral as a result, and it drove this extraordinary response to my tiny website that I had never anticipated. Thousands of people wrote to me from every country in the world, and I realized I had uncovered a huge global social issue.

I saw an opportunity both to take Make Love Not Porn forward in a way that it would make a much more far-reaching, helpful, and effective, but also to do what I believe in which is to do good and make money simultaneously. So I turned Make Love Not Porn into a business. What I did was I always emphasized that Make Love Not Porn is not anti-porn because the issue isn’t porn. The issue is that we don’t talk about sex in the real world. If we did, amongst many other benefits, people would then be able to bring a real-world mindset, the viewing of what is simply artificial entertainment. Our tagline of Make Love Not Porn is Process, Pro-porn, Pro-Knowing-the-Difference, and our mission is one thing only, which is to help make it easier for every single person in the world to talk openly and honestly about sex. To do that in the public domain—by which I mean parents to children, teachers to schools, one to one—but even more importantly, to do that privately in your intimate relationships. And the reason that’s so crucial is, because we don’t talk about sex, it’s an area of rampant insecurity to every single one of us.

We all get vulnerable when we get naked.We all get vulnerable when we get naked. Sexual ego is very fragile. People, therefore, find it bizarrely difficult to talk about sex with the people they are actually having it with while they are actually having it. Because in that situation you are terrified that if you say anything at all about what’s going on, you’ll potentially hurt the other person’s feelings, put them off you, derail the encounter, potentially derail the entire relationship, but at the same time, you want to please your partner. You want to make them happy. Everybody wants to be “good in bed.” No one knows what exactly what that means, and so you seize your cues on how to do that from any way you can. And if the only cues you ever see are important—because your parents didn’t talk to you about sex, because you school didn’t teach you, because your friends aren’t honest—those are the cues you take to not very good effect. So given this mission to talk about it, I decided to take every dynamic in social media and apply them to this one area no other social platform will go: to socialize sex. And to make real-world sex and talking about it socially acceptable and, therefore, ultimately just as social shareable as anything else we share on Facebook, Tumblr, or Instagram. So six years ago I launched MakeLoveNotPorn.tv which is an entirely user-generated, crowd-sourced video-sharing platform that celebrates real-world sex.

Anyone from anywhere can send to us videos of themselves having real-world sex. But we are very clear what we mean by this. We are not porn. We are not amateur. We are building a whole new category on the internet that never previously existed: social sex. So our competition isn’t porn. It’s Facebook and YouTube—or it would be if Facebook and YouTube allowed you to socially sexually self-express which they sadly don’t. So social sex videos on Make Love Not Porn are not about performing for the camera. They are about doing what you do on every social platform: capturing what goes on in the real world, as it happens spontaneously in all it’s funny, messy, glorious, silly, wonderfully, ridiculous, beautiful, humanness – we curate to make sure of that. I design Make Love Not Porn around human curation, and we have a revenue-sharing business model. Our members pay to rent and stream social sex videos, and half that income goes to our contributors whom we call Make Love Not Porn stars. Because we would like our Make Love Not Porn stars one day to be as famous as YouTube stars for the same reasons—authenticity, realist individuality, and to make just as much money. We want to hit the kind of critical mass where one day your social sex video gets a million rentals at five dollars per rental, and we give you half the income. We only answer to the economy. So yup. That’s what I’m doing and why I’m doing it.

Dr. Barb: I saw the focus that you mentioned was to promote good sexual values and good sexual behavior. Do you feel like you’ve seen the outcome that you have desired in that way? Or tell me how your understanding how this is changing people or how they are utilizing it.

Values like empathy, sensitivity, kindness, honesty...Cindy: Sure. When I say that Make Love Not Porn’s only mission is to make it easier to talk about sex, because we don’t do that currently, people don’t get how massively profoundly beneficial the impact of that would be. I designed Make Love Not Porn around my own philosophies, one of which is that everything in life starts with you and your values. So I regularly ask people this question: “What are your sexual values?” And nobody can ever answer me because we’ve not been taught to think like that. Our parents bring us up to have good manners, work ethic, sense of responsibility, accountability. Nobody brings up to behave well in bed. But they should because there values like empathy, sensitivity, generosity, kindness, honesty are as important as they are in every other area of our lives where we are actively taught to exercise those values. And it’s important to say also that what Make Love Not Porn is doing could not be more relevant now in the area of Me Too, because everybody’s talking about consent, everybody’s bragging about consent. Here’s the problem. Nobody knows what consent actually looks like in bed. Nothing educates people about great consensual communicative sex, good sexual values, and good sexual behavior like watching people actually having that kind of sex. And Make Love Not Porn is the only place on the internet where you can do that. Every one of our videos is an object lesson in consent, communication, good sexual values, and good sexual behavior. We are literally education through demonstration.

We don't talk about sex in the real world.But to answer your question specifically, I need to just contextualize it. The one thing that I did not realize when I embarked on this venture, was that I would fight an enormous battle every single day to build it. Because every piece of business infrastructure other text startups just take for granted. We can’t because the small print always says “no adult content.” And this is all pervasive across every area of the business in ways people outside this sphere didn’t realize. I can’t get funded. I can’t get banked. It took me four years to find one bank here in America that would allow me to open a business bank account for Make Love Not Porn. My biggest operational challenge is payments. Paypal would not allow that content, Stripe can’t, major credit card processors won’t, every tech service I want to use, be it hosting, encoding, and encrypting, the terms of service always say “No adult content.” We had to build our entire video-sharing video stream platform from scratch as proprietary technology because existing stream services will not stream adult content. I tell you that because if I had access to the same levels of funding and the same business services every other tech startup does, then we would have seen the massive impact on society that I and my team are setting out to achieve in Make Love Not Porn. As it is, what I can tell you is that while we have boot-strapped and limped and struggled to keep this business alive, our members write to us every day telling us about the beneficial impact we have had on their lives. We’ve saved marriages. We have rekindled relationships. We have helped couples get pregnant. We have helped couples recover from various impacts of cancer survival. We have educated people. We helped one young man recover from his own sexual assault. So what I can tell you anecdotally and qualitatively is that our community thanks us for what we are doing and tells us how we have transformed their lives every single day. I cannot point to a bigger impact on society as a whole until I have access to the capital and the funding that will allow me to scale on what we are doing in order to ensure that. But, I work doggedly every single day to try and achieve that.

Dr. Barb: Why is it that, as you earlier referenced, pornography is so readily available to anyone who wants to access it, but your efforts to contextualize sex and, again, socialize sex has so many obstacles?

Cindy: It’s worth pointing out that the pornography industry faces all the same obstacles that I and my fellow sex tech founders do because we are all lumped together and treated like pariahs. And that is a very bad thing. When you force an entire industry into the shadows and underground, you make it a lot easier for bad things to happen. And you make it much more difficult for good things to happen. So, I’m fighting that battle and I’m fighting it very publicly because the answer to everything that worries people about porn and sex is not to shoot down, sensor, clamp down, block, repress. It is instead to open up. Open up the dialog around all of this in the way that Make Love Not Porn is working to, open up to welcoming, supporting, and funding entrepreneurs like me who want to destruct all of this for the better, and open up a line to do business in the same way that everybody else does. Because when you do that, you completely transform the landscape of what is deemed adult and society’s attitudes towards it.

I like to repurpose in this context Wayne LaPierre’s of the NRA’s infamous gun control quote: “The only thing that stops a bad guy with a business is a good guy with a better business.” The enormous irony of the challenge we face is that my biggest obstacle for raising funds for Make Love Not Porn is the social dynamic that I call “fear of what other people will think.” Because it’s never about what the person I’m talking to thinks. When you understand what we are doing and why we are doing it, nobody can argue the business case is clear, it’s always their fear of what they think other people think, which operates around sex, unlike any other area. That is what really  crystalized for me; you know, this personal philosophy of do not give a damn what anybody else thinks because you’ll never own the future otherwise.

Dr. Barb: What’s next for your site?

Cindy: Staying alive. I mean literally. I know it sounds depressing, but every day is a battle to survive when the entire tech and business world is trying to shut us down every single day. Just staying alive is an achievement and obviously, I’m doing everything I can to grow in scale. I’m trying to find investors and funding all the time. But our survival is, by no means, certain while we face all these barriers.

My latest challenge is in order to grow, we have to promote ourselves. But Facebook wouldn’t take advertising from any venture related to sex. None of the social platforms will. Neither will traditional, conventional media. I and my fellow female sex tech founders want to advertise on the subway here in New York. The MTA will not accept our advertising. Although, interestingly, there are double standards at play because if you do travel in the New York subway, you’ll see that Roman, found by men, for men, is able to advertise all over the subway with posters that scream “erectile dysfunction” because that’s what Roman offers solutions for. So once again male sexual pleasure is welcomed and celebrated and allowed to advertise, and anything related to female sexual pleasure isn’t.

Dr. Barb: Yes, I understand your pain. I have experienced some of those same things. It’s so distressing because as a clinician, the impact of pornography on relationships has just been devastating. I have a friend whose son is at the college level interacting with students and he would say, “You can anticipate that every college male student is viewing pornography, probably on a daily basis.”

Cindy: Oh yes, I know they are. And also, by the way, are very large portion of female college students, which is why Make Love Not Porn is entirely gender equal. And by the way, what we also bring to the table is something very important, because Make Love Not Porn celebrates real-world everything; real-world bodies, real-world hair, real-world penis size, real-world breast size. You can talk body positivity all you like and preach self-love, nothing but nothing makes you feel great about your own body like watching people who are no one’s idea of aspirational body types having a bloody amazing time in bed. Getting turned on by each other, desiring each other. Our mantra is everybody is beautiful when they are having real-world sex. And they really are.

And also very importantly, we celebrate real-world emotion, real-world love, intimacy, feelings. One member, a man, wrote to us on our Make Love Not Porn stars. And he said, “The sex in that video was incidental. I want what you guys have. I saw the way they looked at each other. I saw the way their eyes met. I hope one day I’ll meet someone I can have that with.”

I wish society understood the opposite of what it thinks is true. Women enjoy sex just as much as men, and men are just as romantic as women, and neither gender is allowed to openly celebrate that fact.

Dr. Barb: Interesting perspective. Yes, I would agree.

So you’ve said you want to redefine how you live your life in a way that defies what an older woman should look like, talk like, think like, work like, be like, and have sex like. Other people I’ve spoken to in podcast interviews talk about being relatively invisible at this stage of life, specifically midlife and beyond. So how do we maintain our visibility? How would you speak into that?

Ask yourself, what do I believe in? What do I value? What do I stand for?...Cindy: Well first of all, I don’t give a damn what anybody else thinks [laughs], because who cares about other people’s view of your visibility? I consider myself a proudly visible member of the most invisible segment of our society which is older women. And the more of us who just go, “I don’t care what anybody thinks of me. I’m going to live my life exactly the way I want to live it.” That is the only way to be. So I encourage all—all women period, not just older women—to just—this is an important exercise—actually look into yourself. Ask yourself, “What do I believe in? What do I value? What do I stand for? What am I all about?” And then live your life according to those values. Do what means you being true to yourself. Because it’s very easy to live a life that slips into oiled grooves of societal expectations.

This is why, for example, I’m deliberately very public about the fact that I have never ever wanted to be married. I have never wanted children, and I’m enormously grateful that I always knew that as opposed to finding out the hard way by having them. I date younger men, casually and recreationally. I don’t want to be in a relationship. I cannot wait to die alone. I’m enormously happy on my own. I’m public about all of that. I’m not suggesting everybody do what I do, but  because we don’t have enough role models in society – for both women and for men, by the way – that demonstrate that you can live your life very differently from the way society expects you to, and still be extraordinarily happy. So be visible to yourself and, in doing that, you will absolutely make damn sure you are visible to everyone else.

Dr. Barb: You’ve lived all over the world, and you’ve used your voice promoting diversity and representation in advertising media and public life. What trends do you see that make you hopeful about where we are going as a society, and maybe in the Me Too era that we’re now experiencing and living?

Cindy: Ah, now, Barb, you’re asking the wrong question. Let me say what I mean by that. You’ve asked that question in the passive tense. Because everything that we want to see change—change is when you and I and everyone else make it change. And I don’t wait for things to change, I make them change. The trends are what we decide they are going to be. My favorite quote of all time is Alan Kay who said, “In order to predict the future, you have to invent it.” I’m all about inventing the future because to me people think the future is something that happens without us rolls us over in its wake, and I’m all about decide what you want the future to be and make it happen. Every single one of us can because change happens in the bottom up, not the top down. Every single one of us taking micro actions every day—small, tiny, easy-to-do actions that are designed to change what we want to see change cumulatively—those micro actions add up to a scale of enormous impact.

One of the things I love about the world we are living in today is that we as women are totally doing that. And the great thing about technology and social media—there are obviously downsides to it—but the upside is that it enables us to inspire each other, you know mobilize each other, come together absolutely, escalate those micro actions into change on an enormous scale. I love the fact that what I see all around the world is women doing that—anybody and everybody who wants to see a better and different world doing that, and that’s going to make everything we want to see happen, happen.

Dr. Barb: Those are words well spoken. Thank you. That’s encouraging and I think aspirational for all of us to think about it in those terms and, as you said, not make it passive but look forward and behave accordingly.

As we conclude our time together, I’d like to ask you where do you find fullness as this stage of your life?

Cindy: I am… fullness… what do you mean by fullness? [laughs]

Dr. Barb: [laughs] Happiness, contentment.

Cindy: Oh right! So I have a horrible time every day because building a sex tech startup is no fun at all. But honestly, I am fundamentally one of the happiest people I know. I consider myself a very lucky person in all sorts of ways. And I just feel enormously fortunate to be healthy. I feel enormously fortunate to be on my own—somewhere in a parallel universe are divorce papers are with my name on them; thank God I never lived that life. I feel very very lucky to have a wonderful family, to have wonderful friends. I feel very lucky to be turning what I believe in into a business, and having the chance to do something that if I can make it happen the way I want it to will make enormous difference on the lives and happiness of so many people. I am living and working my values and fundamentally, all of that just makes me feel very happy no matter what shit life throws at me. So, just living the life I’m living really.

Dr. Barb: Good. Well, thank you, and thank you for the efforts you are making in trying to, as you said, socialize sex and improve sexual values and sexual behaviors because I think we’ve got a long ways to go, and it sounds like you are in the lead.

Cindy: Well, can I just say to your audience, I would love all of you listening to this to please come to Make Love Not Porn, sign up for subscription, support me. But also, enjoy the site because we celebrate older sexuality and love and intimacy and happiness. We celebrate older bodies. As far as I’m concerned, life just gets better the older you get, so I’d also like to encourage your wonderful listeners to also consider becoming Make Love Not Porn stars! You can totally be anonymous. You can wear masks, faces are shadowed out of frame. We operate a rent-and-stream model so you can put your videos up and if anything changes—you know, relationship, circumstances, mind—you can take them down again instantly, or we can take them down for you. They are nowhere else on the internet. But seriously consider joining our amazing community and the social sex revolution. Because that’s what we call ourselves at Make Love Not Porn, and the revolution part is not about sex, it’s the social.

Dr. Barb: Well, thank you. And thank you for that invitation.

Cindy: Absolute pleasure. Thank you for having me on the show!

April 29, 2019


about middlesexmd ›  

"There's no better fashion accessory than confidence."

Debra Gunn DowningHaving started her career in business and advertising, Debra Gunn Downing took an evolutionary route back to her early interest in fashion. She is currently the executive director of marketing for South Coast Plaza, where she’s been for 19 years. Located in Costa Mesa, California, South Coast Plaza is the largest shopping center on the West Coast, and among the top five nationwide. 


Dr. Barb: Today our focus is fashion and all the ways it affects us, how we’re seen, and how we feel about ourselves. Debra Gunn Downing is the executive director of marketing for South Coast Plaza, the largest shopping center on the West Coast. Working with 250 retailers and the communities surrounding their Costa Mesa location has certainly given Deb a perspective on fashion over the past several decades. Welcome, Deb!

Deb: Thank you very much!

Dr. Barb: Eager to speak with you on a topic I have interest in!

Deb: Me too!

Dr. Barb: I understand that you’re a Michigan girl, like me.

Deb: Yes, I was born in Michigan and, gee, I guess I didn’t I didn’t leave Michigan until I was in maybe, my early thirties and have been on the West Coast ever since. But my heart is still there. I love Michigan.

Dr. Barb: What was your path that took you from Michigan to the West Coast?

Deb: You know, I went to school at a private university, Northwood University in Midland, Michigan, as a business major, and worked for a number of years, about eight years, in the oil industry. That’s a real fashion story unto itself; in the early 1980s it was predominantly men. But, you know I gotlack of creativity for me and really a business I wasn’t super-excited about took me to accept a position at an ad agency in Detroit, Michigan, Campbell Ewald, and they moved me to the West Coast to handle their cruise line business, and so I never looked back. I went kicking and screaming, because I loved Michigan and I didn’t want to leave, but I walked into Beverly Hills in February when it was snowing when I left Michigan, and everything was blooming, and I didn’t need a jacket, and it was the middle of February, and I just couldn’t see going back [laughs].

Dr. Barb: Enough said, fully understood, yes. So what’s been your involvement in fashion, how did you find your way more specifically to the fashion industry?

Deb: You know, my university had a fashion merchandising marketing major. In the late 70s, early 80s, no respectable woman wanted to be a fashion major. I wanted respect in the business world, and so I went the business route. But I always had this love for art and fashion and fabrics and that whole realm and eventually I decided, after a sort of midlife crisis, that I was going to pursue that, and I went to work first for Neiman Marcus in marketing and public relations in their store in Beverly Hills and eventually for all of their stores and I moved to Dallas and oversaw that for all stores. And eventually was recruited by a shopping center developer and from there and South Coast Plaza so all those years were really spent in a fashion world in a sense.

Dr. Barb: One of the things I hear from women in my practice and around me with friends is that as we get older we begin to feel a bit more invisible. What’s your perception of what we wear, and how we age, and how we’re seen. How would you speak into that?

Deb: You know, invisible is such a good word, and I think that’s exactly what happens, especially in today’s environment with technology and the internet. Every time I open Instagram there are forty million photos of some twenty year old posing in a  fabulous sexy beautiful outfit and she’s perfectly coiffed and perfectly beautiful and of course that can also be photo-shopped, but you’re faced with all of this beauty, young beauty, around you, and how do you find your own place in that and I think what happens is,  I think we make ourselves invisible. I see so many women that as they start to age they they fall into the mom jeans and baggy T-shirt thing or they wear the sensible dress with the little low-heeled shoe. They sort of fall into the invisibility factor. I think it’s important for us to break out of that, quite honestly.

Dr. Barb: That’s an interesting perspective, I guess I hadn’t thought about it from that angel, that we are creating it in a way, by our choices.

What we put on our bodies helps us feel good about who we are.Deb: [laughs] Well, you know, a lot of women as they get older, if you’re in the workplace and you’re dressing up every day, you might be a little bit more inclined to follow fashion. But if you are taking care of the kids and doing the household things, it can be very easy to fall into just a baggy pair of jeans and a t-shirt and what’s comfortable, and I’m a big proponent of comfort, but I think that as we get older it’s so important for our self-esteem our sense of self-worth, to feel good about who we are. And let’s face it, fashion, what we put on our bodies is what does that for us, you know, it’s what gives us our sense of style, defines who we are, says how we feel about the world.

What I think we all want is to be relevant.I have a friend who lives, as she says, in jeans. Her husband is an executive with a big company, they travel a lot, and so she has her glam-up outfits for when they are doing dinners or whatever, but during the day, she says, “well I just live in these jeans.” And you know, she had a pair of nondescript ill-fitting jeans on and  she had a nice blouse and a nice pair of shoes, but she said, what should I do? And I said, you need to go out right now and buy two of the best, best-fitting designer jeans you can find. If that’s what you're into, you can still be comfortable, but you still need to look good, you still need to feel good about yourself. She said, “you know as I get older and I have a grandchild, I’m starting to feel like, who am I?” I said, get rid of the blazershe had a big old sweater she would always wear, and I said get rid of the blazer and go out and invest, and I don’t care if it costs $2,000, in a beautiful leather jacket and maybe a pair of sneakers are trendy right now, platform sneakers or you know, a shoe that’s got a trendy heel, and just feel good. And she did. And she called me and said I can’t believe how I feel about myself! I’m not the aging grandmother any more. I’m someone relevant. And that’s what I think we all want, is to be relevant.

Dr. Barb: That’s an interesting comment because part of what I do within women’s health is sexual health, and certainly self-image and self-esteem is pretty critical to women enjoying sexual health, and although that particular aspect may not always involve clothing, I think, part of it certainly does. As we’re in loving relationships or establishing ourselves in relationships, so what advice do you have for women about finding that piece, that look, and I think you just spoke into it a little bit about discovering what you’re comfortable in, but more broadly, can you help listeners understand kind of how to find that spot where they can feel really good about themselves and comfortable.

Deb: One of the things I recommend for someone who’s not involved in fashion or who doesn’t feel like that’s their thing, and in that case women tend to become creatures of habit, they wear the same thing. One of my sisters has 25 of basically the same sort of tunic blouse in her closet and I was shopping with her recently and she said, “what do you think of this?” I said, “no! You’ve got a whole closet of them. How about this?” And I held up—she wears a lot of blazers—and I held up a blazer with a flower print all over it and she said, “I never saw myself like that.” Sometimes it takes someone else to move you past those boundaries, you know. A stylist, a sister, a friend.

I do it with my 27-year-old daughter. She’s brutally honest, both on the good and the bad. I can remember shopping with her when she was in junior high and I would come out of the fitting room and ask, what do you think? And she would say,  “Mom, it looks like a mom trying to be a teenager.” So I think having the honesty of someone who can not only tell you what you shouldn’t be doing but encourage you to move into an area that you’re not 100-percent comfortable with, but that is good for you,  that looks good on you. We all have a closet full of things that should probably be cleaned out. Closet cleansing is super-important. Get rid of those things. Make way for the new. It will feel so good and so cleansing but you’ll feel better about yourself.

I think in the sexual health arena too, I think that at a certain age, we should not be showing cleavage; it’s not attractive any more. You can certainly, under your clothing wear some sexy lingerie and still feel sexy and good about yourself, but not look inappropriate.

Dr. Barb: That makes perfect sense. Talking about the closet, do you recommend that you do that we do that with someone like a sister or a daughter, do you think we can be our own best critic and honestly make assessments? Or does it really take another person to help us engage in that?

When you get rid of things, you're opening your world to new things, both emotionally and physically.Deb: I don’t think we can help ourselves easily, because there are too many factors in the way. I think you need a friend, a sister, all the stylists do this as a matter of course in their business: They’ll come over and cleanse the closet that way they can also see what your wardrobe is so that they can build on it.  I think what happens is we all buy things that were too expensive or didn’t fit just right or we didn’t get the cost per wear, we didn’t get the CPW out of it, so it’s hanging there and we think, oh it’s horrible, I shouldn’t throw that away, I shouldn’t get rid of that, so we do need someone to come in and I do it with a friend of mine constantly and she holds it up and I’ll say no, it’s gotta go and she’ll try to fight for it sometimes, but [laughs] but you know when you get rid of things, you’re opening your world up to new things, both emotionally and physically, so I think it’s important.

Dr. Barb: So back to some of the rules of women doing appropriate fashion application and aging gracefully, you mentioned one about cleavage. Can you review in your mind, maybe some basic rules or maybe some fashion absolutes that we should all, we could all maybe generally embrace?

The number on rule is to know your assets.Deb: I think the number one rule is to know your assets. At any age, but as you’re aging, there’s that old adage that, the legs are the last to go and many women have beautiful legs, so don’t be afraid to show them. But if you feel your arms are crepey and wrinkly and you don’t want to show them, don’t show them! Wear long sleeve or a three-quarter sleeve. You’ll feel better about yourself you don’t feel like you have to hide something. But then some of the other rules that I think the mistake some women make, especially the cleavage thing, because you know, once you’re past 30, that probably doesn’t look that good anymore. You need to be able to look in the mirror and say, “does this look good?” But I think cleavage is one, and I think too much makeup often happens, too, because we’re starting to, we worry about aging, trying to compensate, but really less makeup is more youthful.

And then the other thing I think is one of the rules is: hairstyle. There aren’t really rules in terms of, hey you get to a certain age and you have to cut your hair off, because  people of all ages look good in different hair lengths, I happen to be more suited to short hair, but I have a friend who’s 70 and she has long hair past her shoulders and she looks beautiful. So I think knowing your look but, change your hair up cut it off sometimes, get some bangs, have some highlights put in and I think especially as we get older, the changing it up makes us feel relevant, feel less invisible.

Dr. Barb: When it comes to fashion musts, is there a short list of what we all likely should have in our closet?

Deb: I’m a big believer in timeless basics that you build on. Everyone needs a pant that’s not a jean that can be—today there are a lot of options it could be a wide leg, it could be a straight leg, but a very good quality pant and maybe it’s black or navy in a classic cut, and then definitely a good jean, and I think the older we get, the further we need to get from ZARA. We need to be, we need to find a really good cut that works well for us, and that fits our body appropriately so we can feel good about ourselves.

And then I also think it comes down to building a wardrobe based on personal style and lifestyle. For me, I have three rules, and a little bit of a fourth for when I buy anything, and quality and fit are the top two. Buy the best quality you can afford. If you can only buy one jacket this season, then make it the best quality, tailor it to fit exquisitely. And my third for me must is an edge. I like a little bit of a fashion edge to it, I’m not good in a preppy look or a conservative look, I need a little bit of an edge. And then the fourth for me is comfort. And I think that’s pretty true for many of us. Nobody wants to be uncomfortable I don’t want to be tugging at something all day. Everything for me is an overlay of what is timeless. That doesn’t mean it’s not edgy or trendy, but it needs to run the gamut of multiple seasons, I mean, just for me, just in terms of how I live my life, I like to keep my clothes for a while. I don’t want disposable clothing. I don’t want to waste things. I occasionally do buy fast fashion to fill in a piece here and there, but I’d rather buy quality and have it for a long time. So that to me, if you find a framework of quality, fit, and then whatever is the sort of style icons are for you, the edginess or the preppiness or whatever, and you bracket your purchases within that area, you can’t go wrong. You’re going to build, and to think about it as building over time, if you build on quality you can keep those pieces for a long time and you can just continue to add the trendy jacket or the interesting shoe or that sort of thing.

One of my other big rules is shoes, because I think we tend to forget about shoes or we tend to think we’re going to buy one pair of shoes and it’s going to go with everything. That’s not the case. A shoe has a very important element in the finished look, in having yourself look put together. So I would say pay attention to the shoes.

And buy what gives you confidence, buy what makes you feel good.

Dr. Barb: And what resources are available for a stylist for those who don’t live in a big urban area or don’t have the confidence or comfort of inviting a stylist into their life. Are there books or online resources that can help an individual move through this?

Deb: Well, online is always a resource. I was traveling for instance, last year to Japan, and wanted to pack minimally and be able to fit in, so I went online to see what is the current style in Japan, and they were wearing wide leg trousers and crop jackets, so I think researching online for what the current looks are and then analyzing yourself and what’s going to work for you you know, I’m short. I can’t take a lot of fabric, so something that’s super voluminous, even if it looks chic as can be, isn’t going to be right for me, so I think doing that research, and then, when you do go shopping, and many times if you don’t have those local resources, it would make sense to go to the city and go to a department store. Because, you’re going to have a lot of options and all the big department stores like Saks and Nordstroms and Neiman Marcus, their sales associates are trained as stylists in a sense, but they also have stylists on staff that do not cost you anything, you’re not paying for the stylist’s time, so make an appointment in advance with the stylist at Nordstrom, give her, Skype with her or show her your look, tell her about your lifestyle and have her pull for you. And that will go a long way toward helping move you into the next realm of style.

Dr. Barb: And what about,on the subject of shopping, not every woman enjoys it but yet, has a desire to be fashionable. Do you have good resources for women who don’t want to walk into a shopping center or store to do their shopping. Besides Nordstrom online their store, are there any good age-appropriate combination of clothing or fashions that women could access?

Deb: Are you saying online or just in general?

Dr. Barb: Online.

Deb: You know, online is tough, especially for someone who isn’t as comfortable with fashion or style because there’s a rule of thumb, the industry average 33 percent return rate, and with someone who’s doing a lot of trial and error it’s probably 75 percent, so  if you don’t mind getting the stuff in at home and having a friend or someone come over and help you and then sending back what you don’t buy, that’s certainly an option. There are also some online resources where you sort of fill out a form about what your lifestyle is, what you like, they ask you a lot of questions, show you a lot of photos and then they send you, for a monthly fee they send you three outfits, I think it is you can probably create whatever you want out of it and then you, the more of those things you keep,  the lower your price is. So doing some of that online could help because they’re also providing an online stylist in a sense. I think that a lot of the online sites, particularly the big Matches and Farfetch and the big fashion sites are starting to do a lot more personalized service and interacting with the customer for someone who’s not that comfortable, who doesn’t want to go to a store, that could be a good option.

Dr. Barb: What would you say is the best thing about being our age? I’m going to put my age close to your age, I think. What is the best thing about being our age, as far as fashion is concerned?

We can continue to reinvent ourselves, and we should.Deb: You know what I really love about it is that you’re freer. You know, you can take risks more. You don’t have to be so concerned about our looks. It’s not that we’re not necessarily concerned, but there’s a mental freeness about it, because you get to a certain age and you aren’t as hung up, you’re a little more comfortable with yourself, you’re a little more at ease. That, I think, is a real benefit. I have a friend in Beverly Hills, she’s well into her 70s. She’s always been a fabulous dresser and I don’t know how long abo, but maybe seven or eight years ago she started dressing almost outrageously. If you walked into a room and you saw her she’d be in the most fashion forward, fashionable,  trend-setting thing you’ve ever seen and some sort of a head piece and an enormous skirt with hoops under it but, completely stunning. In fact, she’s always in all the photos when she goes to an event she’s in all of the photos and not as a ‘Glamour Don’t’ but as a ‘Fabulous Do.’ So I think she has the confidence to carry it off and I think that’s where we need to continually work on our confidence and self-esteem as we grow older, because we can be anything we want, we can continue to reinvent ourselves, and we should. Staying young and feeling relevant and feeling modern makes you feel good, makes you feel sexy.

You get to a certain age and you're a little more comfortable with yourself, a little more at ease.

Dr. Barb: Yes, it absolutely does, I think the right outfit makes all the difference on certain days and certain events and certain circumstances. And I think when we wear something that makes us feel good and confident, others will notice and likely comment, which helps me understand and establish what is a “Glamour do,” as you say, versus a “Glamour don’t.” encourage women as friends and colleagues to speak into that and offer up that compliment and comment of encouragement and enthusiasm around some of the maybe more daring things we might see our friends do.

Deb: I could not agree more because I think that does give us confidence, especially someone who’s trying to step out a little, to move out of that invisibility factor. We want to build them up and as women, we should help one another in that way. There’s no better fashion accessory than confidence. It just makes everything feel good.

Dr. Barb: Yeah, nicely said. Do you have hope and confidence that the fashion industry is going to continue to think about the mature woman, the over 50 woman as they continue to create fashion, do you think that we are  less invisible to them as they are forward-thinking about what would make us feel sexy and confident?

There's no better fashion accessory than confidence.Deb: You know, I do. It’s a good time for women right now. It’s a good time for aging women in the fashion industry. I don’t know if you’re familiar with this, but in the past couple of years, the number of older models who have walked the runway and I mean older, from fifty to seventy is pretty startling with the designer shows.So the designers understand she’s the customer they need to embrace, she’s the one with the money, she’s the one that’s buying it. But it’s also a business, so you’ve got this up and coming client that you need to address and I think, good for the designers that they continuallyKarl Lagerfeld, in his eighties, is still trying to create relevant and interesting fashion and It is maybe looking on the runway like it’s only geared for an audience, but if you walked into that store and start to look at the individual pieces, whether it’s Chanel or Max Mara or J Crew, you start to see the pieces are what we buy. We’re not all head to toe any designer or any brand generally, but there is something there for everyone. I don’t really see an ageism in fashion that is intentional, but I think again because it is a business and they need to keep the business going and because these are creative people and they are continually pushing the boundaries and sometimes the boundaries work for us and sometimes they don’t. But, there’s always, I believe there’s always something for everyone in there. And I’m not a believer, in one of the magazines used to have this section in the magazine that, what you wear in your 20s, 30s, 40s, 50s, and every month I would look at that and I td think, well I like some pieces from the 20s and I like some from the 60s and the 40s and I would wear any of them. I don’t like the hard and fast rules and I don’t think any of us should take that at face value in that way.

Dr. Barb: Yes, I like, because I would agree with that. I have three young adult daughters too and I occasionally thing, well wait a minute,  is this the look that I should be doing or am I transferring one of the looks my daughters should be doing, you know, that line of age-appropriate. I like your take on, you know, if you wear it with confidence, it doesn’t belong in any decade of your life specifically.

Deb: No! And if you keep always with a filter to, what is appropriate for me?  My daughter is tiny and she might wear a tiny little short shorts. I’m not going to do that, but maybe there’s a piece of that look, maybe it’s the denim skirt, or I might wear a denim dress that is still a piece of that look and it’s age appropriate for me.  And the flip side also works, I must say, my daughter raids my closet like crazy, so something must be happening in my closet that is relevant, because she lives in Los Angeles and I live south in Orange County and I’ll come home and I’ve got things missing and I call her, do you have XYZ? “Oh, yeah, Mom, I borrowed that, I hope you don’t mind.” So I think you’re right, we can’t stay in those lanes, that this is only for the twenty-somethings and this is only for the sixty-somethings, we need to mix it up.

Dr. Barb: Yes, that great, that’s refreshing news to me. So as we conclude our time together today, Deb, I often like to end our time by asking, where do you find fullness at this stage of your life. Can you share with the listeners?

Deb: Yeah, for me it’s about finding what feeds my soul, and for me it’s art and nature. I’m into mindfulness. I’m trying to be, especially as I age, try to be more present in the present moment there’s a story that I just love about my partner of 10 years, his mother just passed away, and she was the most incredible at 96, she was an artist, she was a fabulous woman. She told me a story one time about she’d had a small business venture with a friend, and this we 30 years ago they owned a duplex or something together and the two women sold it and  they each, their proceeds each was $10,000, which might be $20,000 or $30,000 today, but anyway, she took the entire proceeds, and she bought a painting, because art fed her soul, and I think that’s the way I want to live my life. I want to know what feeds me personally and I want to gravitate toward that. We all have our work and our things that we have to do in life, but I know I need to spend so much time in nature every day looking at something green or wandering in a museum and just feeling the stimulation of art those things, I think are more important the older we get, because that’s how we age fabulously.

Dr. Barb: Those are great words, and I hope that now that spring and summer are coming you can make your way back to Michigan so you can enjoy the beautiful nature we have to offer here.

Deb: Oh, Michigan is so beautiful.

Dr. Barb: Thank you so much for your time today Deb and thanks for sharing.

Deb: Well, Barb, it was my pleasure and I’ll look forward to meeting you in person one of these days when I’m in Michigan.

Dr. Barb: Okay.

March 18, 2019


about middlesexmd ›  

"We're not done! We're just getting started."

Jeannie RalstonJeannie Ralston is editor and "adventurer in chief" of NextTribe, a digital magazine she founded in 2017. She had already enjoyed multiple careers, including ownership of a lavender farm in Texas and as a teacher and award-winning writer for magazines like Allure, Parenting, and Real Simple. She had traveled and lived around the globe with her husband, a National Geographic photographer, and their two sons. NextTribe offers an irreverent, authentic tone and spirited attitude and includes articles written by top journalists that empower midlife women. A tribal community as well as a magazine, readers can connect offline through live events, travel, and gatherings around the U.S.


Dr. Barb: Our guest today has had multiple careers, as a teacher, magazine writer, and lavender farmer. Most recently, Jeannie Ralston founded NextTribe, a digital magazine begun in 2017 “for smart, bold women age 45-plus.” Welcome, Jeannie!

Jeannie: Well, thank you for having me! I’m glad to be here.

Dr. Barb: Yes, I’m excited to talk about the many careers you’ve had, and how you’ve come upon where you are right now. But one of the things you talk about is women feeling a bit invisible. So why do you feel that is, that women like us might feel invisible?

Jeannie: Well, I think it’s just how society has kind of operated for probably millennia wherewell in olden times maybe women didn’t live very much past 45but also more recently in recent history, where people did live longer, women after their childbearing years they were kind of like, “Okay, your work is done.” It’s kind of like, “You may go now. [Laughs] You can leave the stage. You’re good.” And I think that that idea has kind of stuck in the mind of society or as a whole that at a certain age women are done with their work.

We're not done! We're just getting started!

What I’m saying and what I know many many many women feel is, “Hey, we’re not done! We’re just getting started.” We feel like we have all these years ahead of us of being productive and creative and powerful, and in many ways, I feel like I’m at the top of my career right now. So instead of this idea that childbearing years determines your usefulness to the world, we’re saying, “No. We are dynamic women throughout, and we have a lot to give."

Dr. Barb: I think I’ve observed the same thing you have, that for many women after they’ve launched their families, I feel like many of them feel like they are finding their stride and their areas of passion and are pursuing some of their heart’s desires where maybe they haven’t had an opportunity to do that. So it is a little frustrating, that culturally we haven’t really embraced that for women.

Jeannie: Yes. I do think that’s changing. I think my own mother and probably some of our listeners’ mothersthey did, after their children went off, if they weren’t working outside the home, maybe they did more things like Bridge Clubit was just a different pace for them. I think what you are sayingand I think you are so rightis that now we, women at our ageI’m 58women our age are very muchwe’ve had careers, we’ve achieved a lot, and after our kids are gone, it’s a chance to build on all those years of experience. We’ve had education, you know, we’ve been leaders in our company, or innovators. So it’s a great chance to really put all those years of experience to work so we can really feel fulfilled that we’ve done all that we’ve had the potential for.

Dr. Barb: So why do you liken midlife to a woman’s Etch-A-Sketch moment?

Jeannie: [Laughs] I like that idea because I feel like it’s a time when you can have a blank slate. You can start over. You can like, okay, you’ve done all these things in your career, you’ve seen what you like in the world or what you’re good at and really what lights your fire. And maybe you haven’t been able to pursue it at the fullness it needs, but with this new time, your kids are gone, if you haven’t had kids, it’s just a time when a lot of possibilities come together because you’ve seen so much and done so much, so you get to make a decision. “Okay I want to start something different.” “I want to go in a whole different direction because I’ve seen that I’m good at this, and I’ve seen that I don’t like this, and let’s see what I can do for the next 20 to 30 years that is really going to rock my world."

For instance, we have somebody in our groupshe was a journalistand she just decided to just give up all that and work as an executive director at a nonprofit that works with women in prison. I mean she just decided, “You know, I’ve done enough of that. I’ve achieved what I’ve wanted to in this areajournalism; my heart wants to embrace these women who need help in the prison system. I’m going to devote myself to that.”

Midlife is an Etch-a-Sketch moment where you can go with your heart.So if you’ve made your mark in one area, maybe you... or you feel like you’ve done everything you can in one area, like maybe it’s a sales job and you’ve always wanted to start your own business. It’s like, okay, this is a great time to do that. I have a friendthis is very specific about entrepreneurship, but I think it applies in a broader wayI have a friend who has a new business and she said, “There’s two great times to start a new business: when you are in your 20s and you have nothing to lose, and in your 50s when you have nothing to prove.” I think that goes for just the whole idea of reinvention. “Okay. I’ve proved all I need to prove, and now I just want to go with my heart.” And that’s why I think it’s time for an Etch-a-Sketch moment where you can go with your heart.

Dr. Barb: Oh, I like that. Yeah. That makes a whole lot of sense to me; that comment. In the intro I mentioned that you had multiple careers, so obviously reinvention has been a part of your life. Can you talk a little bit about the role it has played in your own life and some of the careers you’ve found yourself in?

Jeannie: [Laughs] Well you know, I’m surprised at some of the careers I’ve had. I always thought I’d have different careers, but I thought that would always be around writing. I’m a journalist by training; lived in New York and worked for lots of magazines, written for the New York Times, the National Geographic, all that. But, I also became a lavender farmer [laughs] when I was about 40-something. That came about because my husband decided we had property that was good for growing lavender out in rural Texas. I was kind of reluctant to embrace it because I had two little kids and I’m like, “What? I’m a writer! What?” But once I finally let myself be open to this new direction, I fell in love with it because it was just so grounding in such a literal way. You know, I’m digging in the dirt. But I just found that I loved working with something on a farm and being in nature, and then I would spend a lot of time thinking of products with our lavender, opening up our fields for people, and having just a blast. So that was my first real reinvention, and sort of forced on me by my husband, but I think that what it did is it showed me I had capacity for other things. Like I wasn’t always going to be tied to writing. You know, I could branch out and do other kinds of work.

So after that I homeschooled our boys for a while because we were traveling a lot. We took them all over the world. It was like three years of homeschooling and traveling. So I was a teacher, sort of, with them, but then later on they went to a private school. They needed a teacher at the high school for a year while somebody was out, so I said yes. They asked me, and I said yes. So I became a teacher for a year. That was an English teacher, but it was phenomenal! It was just so gratifying to me, and again, it’s that feeling that, “Wow, I didn’t know I had this in me, and I’m so glad somebody asked, and I said yes.” I’m learning new skills, and how to engage with younger people, and how to make literature or any of thatreading and grammar and all thatinteresting. So, that was another reinvention.

I guess now the reinvention I have is an entrepreneur, and I’ve learned a lot! [Laughs] An entrepreneur with NextTribe and getting that off the ground. You know, I think there are lots of benefits of being a beginner again. I feel like I’m a beginner at the digital media. You know, what you have to do to have a publication online. There are so many intricacies that sometimes my head wants to explode. But I feel so gratified that I’m learning! I’m continuing to learn and push myself in ways I never thought I could. It’s very fulfilling.

It can be liberating to just let go of control.

Dr. Barb: So, in general, what I hear you say is reinvention is a lot about risk taking.

Jeannie: Yes. I think it is. You have to learn to be okay with being uncomfortable. You have to be okay not to be in complete control and kind of just say, “Okay. I’m going to attempt this, and we don’t know how it’s going to turn out because nothing is guaranteed. But, even if I fail in the process, I’m going to gain a lot." I think that’s my mindset. Even if it fails, I will have taken on so many skills and qualities that I couldn’t have ever imagined. So I think it’s completely worth the risk in my mind. I mean obviously, if there’s lots of money involved then, “Ah, scary!” It gets even scarier. But if you are trying just a newI know somebody else who left hershe got laid off, which a lot of times happens at this age, unfortunately, where companies get rid of the higher-earning older women or men at the higher levels and she was at a high position at a marketing firm and she got laid off. So now she’s going back and she’s going to be a yoga teacher. She actually wrote about that in our magazine. About being a beginner again. I think I mentioned that already about how that can be so scary, but it can also be liberating to just let go of control. And I think the main message is sometimes it’s just great to let go. Especially for us very, you know, type-A women who have achieved a lot. I think letting go of control is just really hard.

Dr. Barb: Can you speak a little bit more specifically as to what led you to develop NextTribe?

I still feel 29 inside.Jeannie: Yes. When my youngest went off to schooloff to collegeI felt this kind of emptiness that I think everyone has a nameEmpty Nest Syndrome, and I went online to see what do people do at this stage. I didn’t find anything that really spoke to me. What I found was it was either overly earnest and maybe a little too new-age-y for me, or it was depressing. It made me feel worse like I did actually have one foot in the grave or something. And I just felt like there was not a site out there that spoke to me the way I felt inside. Like I still feel 29 inside, and I think a lot of women do. We have all this energy, we talk with our friends the same way that we used to, we laugh, but there was nothing out there, I felt, that was speaking to me that way, like kind of recognizing who I really was. So with my journalism background and with all the contacts I have among editors and writers in New York and all over the country from my years in journalism, I thought maybe I could do something about it. I’ve got time now! [laughs] You know? [laughs] I don’t have my kids around. I’ve got a lot of time.

I found a friend who was willing to partner with me and help invest in it. It’s taken off more than I could even anticipated because I think there is a hunger for it, that kind of attitude.

Dr. Barb: Yeah. It’s a great site, and I do think as you mentioned you’re meeting a need. As you speak to that I think that’s where I found myself a few years ago. Obviously, my launch of MiddlesexMD was a completely different area of trying to meet women’s needs, but seeing a gap in what was available to women the need to try and fill the gap. But yours is big and broad and you are very comprehensive in your site, in your magazine, and in what you are doing. I love your tag line. It’s Age Boldly.

Jeannie: Yes.

Dr. Barb: Talk a little bit about Age Boldly. What does that mean to you?

Jeannie: Well, to me that means still be game. Still be curious. And the word game is really important to me. Too bad it’s also something you play. I’m thinking of it as sort of a character description. Be ready to say yes and to take on the world. We do trips. We do big events in different cities around the country. We have local groups in Texas. We’re only in Texas right now, but we want to expand our local groups so we can haveI think women our age aren’t used to having our social life on a screen, so we do real in-life gatherings in cities. And then we have the big events in even other cities.

But what I’ve found wherever I meet women who come to a NextTribe event, I say what we have in common is we are still explorers. We want to explore. And I also say we are yes women. We say yes to new opportunities and new challenges. So that to me is what Age Boldly is about. It’s just like for me, stand up straight, put your shoulders back, and just keep embracing the world. Don’t step back from the world. This is a time to keep embracing the world. So that’s what it means to me. I hope that makes sense [laughs].

Dr. Barb: Yes, and I think when we think about the name of your magazine, NextTribe, tribe really implies community.

Jeannie: Yes.

Dr. Barb: And I think we understand that community is really significantly important to our emotional and our physical health. So, not only are you trying to do a virtual community, but you are also trying to bring women together physically. It sounds like that would be your continued vision for what you can do for women moving forward.

So much energy and goodness happens when women are in the same room together.Jeannie: Right. Absolutely. We want to work on the two planes as much as possible. We did a storyyou probably talked about thisbut as you get older especially, you need your social network. It becomes more and more important. I can’t quote the studies, but there are studies about how your risk of Alzheimer’s increases if you don’t have a good social network. And you take longer to recover from a sickness or an operation if you don’t have that good healthy exchange with other people. You know, friendships and that kind of thing. We wrote a story where one doctor said not having good friendships is probably more dangerous to your health than smoking is [laughs] as you get older. The irony is, for many of us it gets harder to make friendships as we get oldermeaning making new friends. Because we don’t have the same pointyou know, when we have kids, or we’re in a job we come in contact with lots of peoplethe mothers of our children’s friends or in an office setting or whatever. So you have lots of opportunities to meet other people. But as you get older, people move away, or for God’s sake if you get divorced you lose half of your friends. These are all realities.

I think it’s more important for us to create opportunities where women can come together face-to-face. There’s so much energy and goodness that happens when women are in the same room together. There are other transitions that people are going through. Always during transitions friendships change and morph. You retire, the empty nest thing, maybe divorce, or any of those big transitions which a lot of us are going through. Your friends change so you have to think about replenishing and finding your tribe at this stage. And that’s why we call it NextTribe. These are the people you want to go through the next phase of life in. That’s what we hope.

Dr. Barb: It’s interesting you say that because it’s fairly frequent in my practice that I meet women who are fairly new to the community and, for a variety of reasons, have found our community where they want to spend the next phase of their life usually around retirement. And it might be around their children and grandchildren or just the destination they are looking for. But they find it difficult to connect as you mention.

Is there a specific way they can, or as listeners, use NextTribe to find other like women? Can you help with how to engage with NextTribe to find like-minded women to share some life events? Again, even if it’s not physically together, how can they do that virtually?

Jeannie: Physically, if you are in San Antonio, we’ve got you covered and probably in Dallas soon. I’ve also put out word for people who want to start a NextTribe group in their city. We have to have kind of an organizer kind of moderator for the Facebook group and organizing little events here and there. That would be a great way. We would help somebody get started. And then there’s trips. We have women on our tripsI promise with every trip we’ve donestrangers from all over the countryand they come together. By the second day everybody is pal-ed up and friends. By the end of the trip, people are texting each other: “I miss you.” “I love you.” “How am I going to go back!” [Laughs] It’s like a very powerful stretch of time when you are taking a trip with women who are like-minded. I say like-minded because, saying yes to the trip and not knowing everyone that’s on the trip takes a certain amount of boldness [laughs]. So that’s where people find each other.

As far as on-linewhat we can do on-linewell, we do try to write a lot of stories about friendship, and they are always well read. We do Facebook groups and so forth. I wish I could have more of an in-person presence in different cities, but we’re working on that.

Dr. Barb: Yeah, it sounds like that’s part of the longer-term goal. To even have a platform at which to begin to think about developing groups of women I think is exciting because I don’t think that it exists either.

Jeannie: Yeah. I mean we want to know where women are, and if you’re listening to this and you want to start something, you can always find us on our website.

Dr. Barb: So in conclusion to our time together, one question I like to ask participants is, where do you find richness at this stage of your life?

Jeannie: Oh, wow. Um, you know I find richness inI live right outside of Austin and on some property, and do find richness in nature. I go on walks with my dog on our property and take all those deep breaths and breathe it in. We actuallyI’ve written about how important nature is for counteracting any depression or anxiety. There’s real studies about being in nature. But I also find a lot of richnessI work out more now than ever [laughs], so I don’t know if that’s richness, but I’m more involved in that. I treasure the time I get to spend inside my head while my body is just working like crazy. It’s so helpful to me. And then, obviously, my family. My boys, who are now both in college, and any time I can spend with them, especially if we can go on a trip as a family.

I take lots of trips with women through NextTribe, but when I can go with my family, that’s even more special to me because it’s more rare now [laughs].

Dr. Barb: Well, I think what you are talking about is what I would say to patients of the importance of self-care. I think that is somewhat a lovely time of life to be able to slow down just enough to start to recognize the importance of that. It sounds like you’re fully embracing that.

I recognize my limits... I need to sit under a tree for a while and breathe.Jeannie: Oh, yes, yes. I do. I work too many hours as you probably do, but when I’m not working, I kind of recognize my limits for one thing, and then when I’m not working I’m like, okay, this is what I need. I need to go get a massage, or I need to just take a walk or I need to sit under a tree for a while, you know, and breathe. I think that’s what’s great too and comes from experience of knowing yourself and knowing your limits and what you’re good at and what you need. I think women this age are probably really good at self-care because they’ve seen what happens when they don’t take care of themselves. We’ve all had some mental collapse in one form or another. Like, “Aww, I’m just burned out.” Or maybe even depression. I’ve had depression, so for me I understand what it is that I need, and I’m very determined to get it because I don’t want to feel off-balanced.

Dr. Barb: Well, thanks so much for your time today, Jeannie. And I’d like to say thanks, too, for pursuing your passion for the benefit of women so we can expand as we move forward and look to the next horizon. I think you’ve done a great job of bring together a lot great information and topics and opportunities. I’d like to encourage listeners to check out NextTribe.

Jeannie: It’s NextTribe.com. I want to thank you for first of all recognizing that NextTribe has value, and also having me on. I know you do great work and I appreciate that. I’ve listened to your podcasts and seen your website and read stories, and I know you are doing great work. It’s so important. There’s so much needed to be done, and I’m glad to be on the same journey as you are.

Dr. Barb: Yeah, thanks again.

Jeannie: Okay. Thank you.

January 07, 2019


about middlesexmd ›  

“Everything in life that we do is a balance of risk versus benefit.”

Carol TavrisDr. Carol Tavris and Dr. Avrum Bluming are the co-authors of a new book on the role of estrogen in women's health. Carol writes, teaches, and lectures to educate the public about psychological science. She is a Charter Fellow of the Association for Psychological Science and the recipient of honors from, among others,  the Society for Personality and Social Psychology, the American Association of Applied and Preventive Psychology, and the American Psychological Association.

Avrum BlumingAvrum is a hematologist and medical oncologist and a Master of the American College of Physicians, an award bestowed on fewer than 500 of the 100,000 board-certified internists in the United States. He is Emeritus Clinical Professor of Medicine at the University of Southern California and a former senior investigator for the National Cancer Institute. He has been researching and publishing about breast cancer and the effects of hormone replacement for several decades.


Dr, Barb: I receive a book in the mail every now and then in hopes that I’ll read it and comment on it somewhere. The authors of one of those books joins me today, Avrum Bluming and Carol Tavris, who wrote Estrogen Matters. This book is exactly what I needed to read, and I am so thrilled someone took on this project. I’m just really happy to have them with me today to talk more about the book Estrogen Matters. Welcome!

Avrum: Thank you, it’s good to be here.

Carol: It sure is! Thanks.

Dr. Barb: So can you tell me a little about yourselves and what roles you’ve played in medicine over the years and how you came to write this book?

Avrum: Sure. This is Avrum talking. I’m a medical oncologist, and I have been since 1967. I’m a former senior investigator for the National Cancer Institute, an Emeritus Clinical Professor of Medicine at the University of Southern California, and about 60 percent of my practice for over 50 years was devoted to the diagnosis and treatment of breast cancer.

The more you know, the less you fear.The subject of hormone replacement therapy has come up with increasing frequency over the past 20 years, since most of the treatments that we use to treat breast cancer, besides surgery and radiotherapy, usually induce premature menopause or have aggravated the symptoms of already existing menopause. And in an attempt to help women understand the conflicting opinions that have been presented in the lay literature, Carol and I decided to write this book to empower women to be able to deal with this subject intelligently, and also with the understanding that the more you know, the less you fear.

Carol: That’s a pretty good summary. I’m Carol, and I’m a social psychologist. My interest and my life’s career has been in presenting good scientific research to the public in psychological science, medical issues, and others as well. So I’m well aware of the problem of trying to talk about research in a way that people can understand and can benefit from. That’s been my great passion and interest. Avrum and I found a shared interest over the years in exactly this problem of how best to communicate scientific research in a way that people can benefit from.

Now I should tell you, as a woman of a certain age – that is to say, past menopause – I have no vested interest in the subject of HRT. Both my mother and I sailed through menopause with no particular symptoms. I never took HRT myself and so it was easy for me to take a kind of feminist “oh-hormones-are-not-necessary position.” But Avrum’s research and his commitment to understanding this question has really changed my perspective in recent years of our years working together.

Dr. Barb: I appreciate how you discuss this really complex topic. I’m a gynecologist who does primarily menopausal women’s health, so every day – multiple times every day – I have this discussion with women, and the consistent confusion and misinformation has been so disheartening to me. It’s become such an obstacle for women to receive safe and effective treatment. It’s really great to have other professionals speak into this and support the idea that it might be a safe option to offer women.

I would like to start with how you set up your book. It starts with the main idea of “Who killed HRT?” Can you summarize that for us?

Avrum: Sure. The first thing most American women think of today, if they think of hormone replacement therapy, is breast cancer. That’s because breast cancer is the dominant public relations face of hormone replacement therapy. There are a couple of things we ought to understand from the beginning. First, hormone replacement therapy really needs the use of estrogen when a women reaches menopause – and we can discuss the indications for it in just a minute. We add progesterone, which is another female hormone only in women who have a uterus because we know that estrogen, given alone, can increase the risk of uterine cancer. If progesterone is added to estrogen, that increased risk is eliminated. So hormone replacement therapy refers to either estrogen alone in women who don’t have a uterus, and the combination of estrogen and progesterone in women who do. Women generally believe that estrogen causes breast cancer. And it doesn’t. So, we started the book by attacking that misunderstanding.

If you look at the data supporting the “estrogen causes breast cancer” belief, you’ll find several lines of evidence. One that is used most often is when women who start periods early and reach menopause late and are, therefore, exposed to a longer lifetime exposure to estrogen have a higher risk of breast cancer than women who don’t follow that pattern. The data suggesting that are incorrect. If you look at the studies, the studies don’t say that.

Carol: I want to back up a step here. By the year 2000 there was a general virtually world-wide consensus in the benefits of HRT for women in menopause. That conviction and that belief came to a screeching halt with the publication of the Women’s Health Initiative in 2002. That nationally-funded study was, as we describe in the book, a scientific disgrace. There is really no other word for it. But it scared the hell out of women and out of many physicians because it claimed in its first – we have to stop the study for press announcement – that women on HRT were at greater risk in developing breast cancer. That turned out to be a statistical fluke that was gone in following analyses. So we have done a very careful analysis of what that Women’s Health Initiative did and said.

They have walked back their own scare findings in recent years, but these have not made the headlines. So what we do in our book is show the massive accumulation of evidence of the benefits of HRT for women’s heart health, and bone health, and brain health, and menopausal symptoms health, and sexual health – all of which were diminished by this unrealistic fear of breast cancer that the Women’s Health Initiative launched.

Dr. Barb: I remember that day in July. I walked into my office and by noon I had numerous phone calls from patients the day that that news broke. As providers, we hadn’t even seen the research and all of the clinical data that they were making these statements from. So it really was a bit of a travesty on all levels that we couldn’t even help guide our patients through the initial impact of that. I feel like we are still working through that each day, and that was 16 years ago that that headline came out.

Avrum: I’d like to point out that usually a study like that is released in the medical literature, the clinicians review it, and then are in a position to discuss it with their patients. And uncharacteristically, this study was released by headline, by press conference, a week before the article was available in print, and clinicians were put in the situation you found yourself in.

Dr. Barb: In the book you talk about the power of attitudes when it comes to looking at treatments and just generally in the medical field. I’m curious. Maybe, Carol, you can speak into how we can begin to move the needle or change the thoughts around what has become such a – you know, as you say, the True North now is the understanding that estrogen causes breast cancer – so how can we continue to move the attitude of women that it has been falsely planted?

It's not that estrogen diminishes somewhat in menopause; it plummets to one percent of what it was.Carol: Well you know one thing is the rising consciousness and awareness of physicians like you who have to come to realize how misleading the Women's Health Initiative was and will increasingly, we hope, be in a position to use this evidence to reassure patients that there are other trends that feed into women’s suspiciousness of HRT. One is the Feminist Health Activist Group that has generally been opposed to unnecessary medicalization for women – a view that I completely agree with by and large – there is an over-medicalization of normal problem of life– but this one is quite different. In a sense, the one thing I learned from Avrum in doing this book – when you talk about hormone replacement – see this is a word many feminists dislike: “What do you mean replacement? It’s perfectly normal. Menopause is as normal as…” But I didn’t realize that it’s not that estrogen diminishes somewhat in menopause, it plummets to one percent of what it was premenopause. That means it really is replacing estrogen, not just filling the tank a little bit. That’s one thing that women need to understand is that there really is a major change in hormone levels during menopause.

Second, I find this really interesting: how many women are drawn to everything but HRT. Every other possible thing including placebos and health things and vitamins and every alternative. Or bioidenticals which is an ironic word because if it’s identical, why not use the one medication that has the longest track record of research and safety indications? But your question about how attitudes should be changed: well, I think the conversation is turning. I think awareness of the problems of the Women’s Health Initiative is growing. And this has to come both from physicians – again like you – and from women themselves who I hope are beginning to realize the many benefits that HRT can provide for them.

Dr. Barb: In your book you talk about the plethora of bothersome symptoms that women may experience during menopause, which I just had to smile as I read the whole chapter because again, I’m hearing multiple symptoms every day. As you mentioned, the lengths women go through to avoid the most effective therapy we have available for them is just astonishing to me and what they are willing to suffer through for this unnecessary fear; it’s been such a frustration to me. But I don’t know that we want to spend a lot of time on the bothersome symptoms of menopause because I think many women are aware of them, and I think the good news is there has been more public awareness of how menopause disrupts women’s quality of life now expanded to mental health, sleep, joint pain, vaginal dryness, some of the things we hadn’t always associated with it, so I think the conversation has been elevated just making women more aware of how menopause can impact them.

I’d like to talk a little bit more specifically around some of the areas that you address including heart disease. You know, some of the things you point out about the leading cause of death in women and just some of the critical research that we do understand around heart health and estrogen. Can you expand on that a little bit?

Avrum: Absolutely. Heart disease kills seven times as many women in this country as breast cancer does. When women hear that what they usually say is, “Well, heart disease is responsible for the death of older women, but younger women die of breast cancer.” In point of fact, in every decade of a woman’s life from age 40 on, heart disease is responsible for more deaths than breast cancer among women. In fact heart disease is responsible for more deaths than the next 15 causes of death in the United States among women. And, estrogen can decrease the incidence of serious heart disease by 50 percent.

In 1991, Lee Goldman who was then at Harvard and is now the Dean of Columbia Medical School published an editorial in the New England Journal of Medicine saying that because of the effects of estrogen on heart disease, it is time for action – meaning prescription of estrogen, not debate – meaning not just talking about it. That was 1991.

In 1995, Bernadine Healy who was not only a cardiologist but was the first, and thus far only female director of the National Institutes of Health, wrote a book about hormones and said,  “Based on what I know – this is 1995 – I will start hormones without... in a blink when I reach menopause.”

In 2000, 22 percent of women in the United States were taking hormone replacement therapy. The Women’s Health Initiative came out in 2002, and over the next eight years, that number fell to less than five percent.

More women who've had breast cancer die of heart disease than of breast cancer.Carol: I want to add to this that more women who have had breast cancer died of heart disease than of breast cancer. That’s an extraordinary and important piece of information. I would say on this also – and this is really a theme throughout our book – that the prevailing methods and treatments and interventions for these problems such as heart disease – well let’s just say statins for heart disease were bisphosphonates for osteoporosis and so forth, but there are many – and what the health initiative people say is, “Oh, well we have ways of helping women prevent heart attacks and so forth, but statins do not have any effect on women in preventing a first heart attack, and they have many more side effects and serious consequences than HRT does.

So we want to make clear that we examine for each of these medical concerns that women have in midlife and in an older age we examine what the alternatives are to HRT. In Avrum’s immortal words, “Estrogen is better.”

Dr. Barb: I wonder if you can share with the listeners the understanding about the window of opportunity hypothesis and the timing of initiating hormone therapy. Can you explain that a little bit?

Avrum: Sure. When the Women’s Health Initiative came out it said that hormones not only cause breast cancer – a conclusion that was not statistically significant and not valid – it also increased the risk of dementia, heart disease, and earlier death. It turns out that the median age of the women in the Women’s Health Initiative was 63. Most women reach menopause somewhere between 48 and 52. Giving estrogen to women who might already have compromised vasculature, meaning early but not yet detected heart attacks, might have for the first year after they start hormones an increased risk of a cardiac event. That is not seen among women who don’t have a history of heart disease and who start hormone replacement therapy within ten years of the menopause – and the ten years are therefore called the window of opportunity.

Carol: Basically that means when a woman enters menopause, the benefits to her of beginning HRT at that time are safest and most effective continuing through that ten-year period. What we also show in the book is that for some conditions such as preventing osteoporosis and cognitive decline, the benefits for women need to be continued beyond that window of opportunity if you will. That is for a woman’s lifetime. But in terms of alleviating symptoms, of quality of life, all the typical symptoms associated with the onset of menopause, women do well to begin it when they enter menopause.

Dr. Barb: And then there’s bone health which I think is often overlooked as a significant health risk to aging women. As a matter of fact, I rarely have women bring that in as a concern about their future health. In my own history my mother died of complications of a hip fracture when she was only 61, so I really see bone health as a critical part of aging well. Can you share a little bit about the understanding of what hormones might do regarding bone health?

Avrum: Sure. In the United States and throughout most of the western world, the number of women who died within a year of a hip fracture is about the same as the number of women who die of breast cancer. That is often ignored, and it shouldn’t be. We know that estrogen is capable of reducing the risk of osteoporotic hip fracture by 50 percent. What people who are antagonistic to HRT will say is, “Well we have very good ways of preventing hip fracture." The answer is the drugs called bisphosphonates when given either intravenously or by mouth can, in fact, reduce the risk of hip fracture for the first five years that they are administered. But beyond five years they don’t seem to work well and, in fact, can be associated with an increased risk of unusual fractures in the region of the hip, and that’s often ignored when the concept – when the subject of hip fracture is discussed.

Carol: And I would add to this because I would call up Avrum and say, “Ah, so what? Should I be taking calcium here and vitamin D and get my bones strong [laughs], and what Avrum explained to me which I hadn’t realized is that calcium and vitamin D and so forth affect the outer structure of the bone, but that is not what you need to do to prevent bone fracture which depends on the internal tensile strength of the bone. It’s the ability to bend when challenged if you will. Estrogen is really the best and most effective way to preserve the interior flexibility of bone.

Calcium and vitamin D do not prevent menopausal bone fractures.

Avrum: A short way of saying that is that calcium and vitamin D, in spite of what we hear on television, do not prevent menopausal bone fractures.

Carol: Well said, indeed.

Dr. Barb: And then behind breast cancer is the fear of dementia, another fear I hear expressed probably nearly daily. So this is an area that has had very confusing headlines around hormone therapy, and does it add to the risk of dementia or not. So can you expand on some of the present understanding of women and hormones and the role with memory and cognition?

Carol: Yes, I’ll tell you what I can remember of this [laughs]. For me, a colleague in my field, Barbara Sherman in Canada, had been studying the effects of estrogen on brain function in animals and humans in experimental studies in real life interventions, and for Sherman there is just no question that estrogen was a tremendous benefit in preserving cognitive function in animals and in humans. So Avrum and I from our different professional directions were able to confirm this research in many many studies around the world the benefits of estrogen for preserving cognitive abilities and protecting against the risk of Alzheimer’s and other dementias.

In spite of everything you read... nothing delays or prevents Alzheimer's disease except estrogen.Avrum: In 1900 only five percent of all American women lived beyond their fifth decade. Today life expectancy is close to 80 years. A women in her 60s is twice as likely to develop Alzheimer’s disease as she is to develop breast cancer. And the cure rate for newly diagnosed breast cancer now approaches 90 percent. The cure rate for Alzheimer’s disease is zero. In spite of everything you read and the drugs that are being tried – both those advertised and those requiring a prescription – nothing significantly delays or prevents Alzheimer’s disease except estrogen which can decrease the risk of Alzheimer’s disease by up to 50 percent.

Carol: I want to add one thing to that, also from Barbara Sherman, that I think is so important. Sherman used to say, “People say taking hormones isn’t natural. There’s something wrong with it because it’s just not natural.” What isn’t natural is living 30 years beyond menopause. Women used to die much earlier as Avrum just said. What isn’t natural is living to be 80-85-90 years old. She said, “If estrogen can help preserve our cognitive abilities in those later years, I’m for it.”

Dr. Barb: Do you have any insight into what the mechanism of action might be of the role of estrogen in brain health?

Avrum: Absolutely, and in fact that’s discussed in the book. One of the things that you know, Barbara, from reading the book is we aren’t just giving our opinions. It is the kind of book that is written for both the lay audience and for the professional physicians, so that it references studies, and these can be independently researched by the people who read the book. We know – and this is work from Roberta Diaz Brinton who used to be at USD and is currently in Arizona, that estrogen can increase the growth of projections off of neurons in the brain allowing them to make additional connections with other neurons which is a way of preserving nerve function. It also stimulates the support cells called oligodendroglia. These cells are also responsible for normal nerve health. We go into more detail in the book; I think I’ll avoid the detail in this kind of a discussion.

Carol: But we don’t want to alarm your listeners in the sense that – Avrum just made a very important point and this is what’s of interest to me as a science communicator. What we want to do in this book as what Avrum just said so clearly, is we want leaders to know that this is not just our personal opinion, or that we are mouth pieces for the drug industry or any other such thing. Neither of us has any vested interest in HRT commercially, personally, and so forth. But what we do feel very strongly about is giving leaders the information they need, and then with as much detail as they are interested in pursuing. If they want to know what all the studies are, look guys; here it is. If you don’t, we’ll cut to the chase. But we really want to emphasize that our point of view comes from a review of 70 years of research on the benefits of hormone replacement therapy.

Are there risks? Yes, of course there are risks. We think they are minor risks in comparison to the major benefits for most women, but that will be something for every woman who reads this book to determine.

Avrum: We are very pleased that if you look at the people who endorsed our book, they include Jerry Kassirer, who is the former editor in chief of the New England Journal of Medicine; Vince DeVita, who is the former director of the National Cancer Institute; Michael Baum, who is one of the leading breast cancer researchers in England; Leslie Turnberg, who is former president of the Royal Society of Physicians and Women’s Health Act.

Carol: Yes, Women’s Health Act.

Dr. Barb: Yes, I get excited about that, and I’m curious about what kind of reaction you have had to the book.


Carol: [laughs]

Avrum: The silence you hear on this end of the line is, the people who have read the book have loved it. The reviews that we’ve gotten have been almost all five star. We’ve been waiting to be criticized, and we’ve asked to be criticized by the people we criticize in the book. And…

Carol: Silence from them. Silence from them. So you know, I don’t know. Are we just, um, little noisy characters that are on the fringes of this discussion that we’re not even worth arguing with? I don’t know. So far the women, who have read the book, the physicians who have read the book have been ecstatic as they have written to us to tell us. But still the Women’s Health Initiative has not responded.

In science you always keep an open mind. You look to change your mind. That's how we make progress.

Avrum: We’re also not trying to sell anything here. Henry James once said, “Nothing is my last word about anything.” And that’s certainly true. In science you always keep an open mind. You look to change your mind. That’s how we help make progress. But in order to develop this concept more, we welcome the criticism that we just haven’t received so far.

Dr. Barb: You know, I’m going to quote you. But in your book you state that “It can be daunting to hold and espouse a minority opinion in medicine.” And I would say for the last years that I have been doing menopausal women’s health, I can totally relate to that. Because I would say my non-gynecologic colleagues, and some of them on occasion have openly admonished me for my efforts, but my patients just keep me doing this because they are so fervent in their response to treatment. And the success of how hormone therapy can, literally – women have talked about saving lives!

Just this week I had a patient who herself is an attorney. She had such a remarkable improvement in her quality of life on hormone therapy that she has a daughter who is in medical school, and she is recommending her daughter pursue an area of medicine that will address women’s health care and, specifically, to help further this understanding, and help women achieve this improved this quality of life. So I’m so happy to know that you have opened the door to allow women to rethink and revisit the safety of choosing a very effective medication option.

Carol: Thank you so much for saying this. We seem to hear this over and over again from women who found once they go on hormones just feel so relieved. A psychotherapist wrote to us. She said, “I deal with women in midlife,” and she said, “I see so many of the conflicts, the problems, and unhappiness, and depression that they have that right in their lives. And they attribute it to everything but menopause. And they go on HRT and their lives are changed so much for the better.”

Avrum, of course, has been hearing from his patients constantly over the years that he’s doctored: “I’ve moved to Minnesota and no doctor over here will not prescribe me HRT, and I’m 78 years old and they’re worried I’m going to get dementia! And never mind that I’m running my own business."

I'm hoping that the voices of women... are saying "Look here! The evidence supports this!"

So, I’m hoping that the voices of women, you know, are going to their physicians and saying, “Look here! The evidence supports this!” That is going to be startup of this transformation that we need.

Dr. Barb: And you also pose a question of, “Can a breast cancer survivor take estrogen?” which has totally been taboo. And I have a number of patients – breast cancer patients – who are on estrogen, but they make that decision against multiple voices advising them not to. You know, I had a woman tell me, “I might as well step out in front of a semi-truck if I’m not going to have that as an option to continue." So again, this idea that that could be an option, can you give me a little insight as to how you have that conversation in helping those patients make a decision about whether or not to consider estrogen for a treatment?

Everything in life that we do is a balance of risk versus benefit.Avrum: Everything in life that we do is a balance of risk versus benefit, and we have to understand that. We are not marketing this, just the way we object to people uniformly condemning it. It requires an informed discussion with the patient. What I’ve done for the last – it’s now 20 years – is because I was aware of how women with a history of breast cancer were suffering, I reviewed the literature to see what we knew about hormones and breast cancer, and what I found is we used to tell women who had breast cancer – premenopausal women – they should have their ovaries removed since if estrogen causes breast cancer, we’re removing the ovaries to prevent it from coming back. And there were seven large studies that looked at that, and the result was it didn’t have any effect on preventing it from coming back.

Currently as many men who die of prostate cancer in this country as women die of breast cancer, and testosterone has been linked more closely with prostate cancer than estrogen has with breast cancer. Do you know how many studies there are of castrating men who had prostate cancer to prevent it from coming back? The answer is zero, and there never will be.

And yet, we have those seven large studies in women. We told women that you must never get pregnant after breast cancer since pregnancy bathes the body in estrogen. We now know that pregnancy does not increase the risk of recurrence, and now women are getting pregnant after breast cancer. So William Creasman, a gynecologist in South Carolina, said, “Well if women can continue their periods after they’ve had breast cancer, and if getting pregnant after breast cancer doesn’t increase recurrence, why can’t we give estrogen to women with a history of breast cancer?" And there are now 16 studies in the literature which we quote and cite in the book looking to see what happens to women who take hormones after breast cancer. And 15 of the 16 studies found that there’s no increased risk of recurrence.

I have to mention, though, that these studies usually don’t follow women, or at least haven’t recorded on them beyond ten years. One study called The Habit Study, which came out of Sweden, found an increased risk of breast cancer occurrence. That study lasted two and a half years; they did not accumulate the patients they said they were going to study; the study has been criticized in the literature, and that short study is cited by people against hormones as being the study we should follow, whereas there are 15 studies, including one that I did and published up to 14 times annually in the literature, showed no increased risk of recurrence.

And let me add, as long as nobody has jumped in, I’m still not routinely recommending it saying it’s something you should do. It’s something that can be considered. You have to look at the benefit and risk of this approach, discuss it with your physician, and then make as an informed a decision as you can.

Dr. Barb: Exactly. I think that’s the nuance there. And I do want to add to that that I think most organizations have recognized the safety of using localized estrogen or treatments for vaginal atrophy. That’s another area of interest that I have around sexual health that so many women, especially our breast cancer patients, who often are very young, have had significant impact to their relationships as a result of the menopausal atrophy that occurs and really don’t know about the safe options that are available to them.

Carol: Absolutely. That’s really important. Even the Women’s Health Initiative, rather grumpily, has finally acknowledged that vaginal inserts and the use of estrogen, vaginally, is completely safe. They are so grumpy that they’ve walked back their earlier dire warnings, and yet any product with estrogen in it still has this sort of serious alarm warnings – may increase the risk of dementia or heart disease or blah blah blah – which is not the case.

Dr. Barb: I know. That’s the other – the labeling for our products has always been a hurdle for us too as providers to try and help women put that into perspective.

Carol: In the book, the couple, the woman who was prescribed vaginal inserts, and she and her husband then read the dire warnings that came with the package and decided, no, no; they’d rather not have sex than have her get dementia and heart disease. That’s really unfortunate.

Dr. Barb: It’s tragic what’s happened, but again thank you for your efforts. I just want to just repeat that the name of the book is Estrogen Matters, but the subtitle is important: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives – Without Raising the Risk of Breast Cancer. So I’m so excited again. It sits in my consult room. I’ve got it sitting out. I point it out to women, and I’m recommending that women take the time to go through it to help be better informed about making their own decisions for their own health and wellness.

Carol: Well, well, Dr. Barb. Thank you very much for such warm support from you. We are very, very grateful.

Dr. Barb: In conclusion, I often like to ask those I’m interviewing about where do you find fullness at this stage of your life? Would you be willing to give a minute and share that?

Carol: [laughs] There’s an unexpected question.

Avrum: When I was five years old, Barb, and I used to get depressed, one of the ways I dealt with it was I would walk in Brooklyn, New York to the nearest shopping center. I find an old lady who I guess must have been in her 20s who is having trouble carrying groceries, and I offered to carry the bag for her. And I would follow her home – clearly it wasn’t a big bag; I wasn’t very big myself – and when we’d reach her home, she usually offered me a nickel and I would turn the nickel down and bathe in the praise that I got just from being a help. That feeling has never left me, and I’m still trying to do that.

Dr. Barb: Well you have done that in this book. I will say the accomplishment of publishing this book hopefully will bring you great feeling of accomplishment and improving many women’s lives despite not having to carry bags for them.

Avrum: Well, this call certainly helps. Thank you so much Barb.

September 24, 2018

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“Open your mind to new ideas about what it might look like to grow older.”

Susan Donley with Dr. Barb

Susan Donley, Strianews.comSusan Donley is publisher and CEO of Stria, a new media platform for the “longevity market” launched in March 2018. Stria provides information, experiences and content that inspire cross-sector solutions for our aging society, providing a foundation of understanding and insight for longevity professionals. Previously, she served as publisher and managing director of Next Avenue, a national public media service for America’s booming older population. In 2015, she founded Next Avenue’s Influencers in Aging, an annual list of people changing aging in America. She was recognized for her leadership with the 2017 What’s Next Boomer Business Innovation Award for media.


Dr. Barb: We at MiddlesexMD first crossed paths with Susan Donley when she was leading Next Avenue, the first and only public media’s national resource for the boomer population. Since then she’s begun a new venture, which you’ll hear more about. It supports her mission of improving the lives of older people through powerful media and impactful communications. Welcome Susan!

Susan: Thank you. Thanks so much for having me.

Dr. Barb: So let’s start with your background. You’ve had a career in media and communications, and I know you’ve been involved with PBS, including some of my favorites like Ken Burns’ “Civil War,” and PBS Kids, and “Masterpiece Theater,” and most recently you were publisher and managing editor at Next Avenue, which served over 45 million readers. So was it that experience that led you to focus on those of us who are 50 and older?

Susan: Yeah, it really was. Throughout my career I worked in non-profit strategy, and communications and public media, but I didn’t really have a single area of focus. So I worked in public health and homelessness, obviously all kinds of programming like some of the shows on PBS that you mentioned. But working on the research and development phase for Next Avenue was really my first introduction to issues of aging. And then leading the site for four years really sort of got me firmly rooted in the field, which I love – I’m so passionate about it, and I will stay in it for the rest of my career.

Dr. Barb: So you launched Stria earlier this year, and that’s with a focus on what was new terminology to me: the longevity market. That’s different from what we in healthcare might term geriatrics – at least it seems like maybe it’s a bit different from that term, which strikes me that may be a better term than geriatrics could have been discovered along the way. So, what do you mean by this longevity market, and how will Stria be integrating that or intersecting with that?

Susan: This is often the first question I get when I’m asked about Stria, and I love that, because it tells me that we’re hitting the scene early. So there’s a ton of good that we’re going to be able to do. I think most people know that the demographic shifts in our country have really created unprecedented convergence of need and opportunity in our society, and there also is an increasing demand for innovative solutions from entrepreneurs and businesses. So emerging from this set of unique conditions is what we are calling the longevity market.

Our definition really begins with the core needs of people over 50. There are obviously many desires and potentials surrounding life as you grow old: money and security issues, issues of health and longevity, caregiving, learning and connection, purpose, even spirituality and identity. If your work supports any of these aspects of life for older people, you’re part of the longevity market. What Stria works to do is to unify all of those multiple lines of business and service and study and research that define the field and surface the issues from out of those silos, so that no matter what part of the field you work in, you have exposure to the ideas that matters most. Ultimately, I really believe in the power of media to fill the role of a convener and to make a difference in the world. Stria’s mission is to provide information and content and experiences that will inspire cross-sector solutions for an aging society.

Dr. Barb: Will Stria actually bring individuals together? Is there a way that they will connect as well, or is it informational?

Susan: Stria is certainly a virtual community. We hope that – we like to elevate our readers’ thoughts and perspectives, and we get essays and interviews from leaders, so there’s a virtual convening that happens every day at Strianews.com, which is where our original journalism resides. But in addition, we have a line of business called Stria Live, which are some executive-level, small, live-event convenings where we bring together a curated set of folks to have a purposeful conversation that moves progress forward on a single issue. Mostly it’s a virtual convening, but we also will have live events.

Dr. Barb: What would you see as the two or three most important areas to address for this longevity market?

Susan: When I was a publisher of Next Avenue, I had the great good fortune of getting to know many of the leaders who have been working and aging, and I heard several concerns that our field was too siloed, that ideas sometimes seem slow to advance, that problems often feel intractable, and that we are continuing to talk about them over and over. At the same time, the urgency of the demographic shifts were only intensifying. So the macro issue that Stria seeks to address is really that fragmented nature of our field. Especially as we are seeing new businesses enter the space, we want to assure that those folks have access to the incredible legacy of study and understanding that exists around aging.

But when it comes to the most important needs of older folks themselves, as opposed to the field of longevity, the list is incredibly long. What has been most prominent in my mind right now is that we are really seeing sort of a tale of two kinds of aging. There are some folks who are aging successfully – and they are doing great – while others are really being left behind. There are these hidden folks, literally hidden – isolated in their apartments or in their communities – but also metaphorically hidden. And the thing that strikes me as significant is that these aren't the people that you would necessarily expect. There are middle class, or even upper middle class people who are expecting to make a smooth transition into aging who are finding themselves in trouble. One unexpected event – loss of a job, something going on with housing, a health crisis – can really push them teetering over the edge. So bringing some of those hidden people out of the shadows, and finding ways to create more stability among people from sort of all walks of life I think is a really critical issue right now.

Dr. Barb: How or who helps bring these people out of the shadows, as you stated?

Susan: I think interestingly, there are many women in particular who fit into this hidden category. I don’t know if you are familiar with Elizabeth White’s fantastic book. It’s called Fifty-Five, Unemployed, and Faking Normal. I really recommend it. It is Elizabeth’s own story. She is an incredibly bright, well-educated, well-employed woman who found herself single and unemployed in her 50s. Rather than admitting to her friends and family that she was in financial struggle, she faked it. She would try and present the face that she was doing fine and living in the lifestyle that she had been living all along, while in fact, she was really in crisis. And some of the issues that are related to aging and ageism were having a direct impact on her life. For those women or men who are able to step forward and claim their space as Elizabeth was able to do in her book, I think that’s one really important way to get people out of the shadows.

In addition, I think that the people who work in the aging space – community organizations, governments, and so forth – it’s really our obligation to find out what is actually happening with folks and go get them, sometimes literally knock on their front doors and bring them out of isolation.

Dr. Barb: What kinds of organizations are you reaching out to and interacting with?

Susan: With Stria, we are really for and about the entire aging ecosystem. It’s a very broad set of folks within the longevity market. Right now we are about – one-third of our readership is nonprofits and associations; the traditional people working in aging. We are about one-third businesses and entrepreneurs – so folks who see a market opportunity and want to leverage that; and then about one-third are the consultants and agencies and vendors who are serving the field. So we are trying to keep a good balance between all the different kinds of folks whose work influences aging.

Dr. Barb: It’s interesting to think about because in my clinical practice in women’s health, which is primarily focussed on perimenopause/menopausal women, which sort of by definition is 45 or 50 and older, so that’s the vast majority of the women I see day to day, and it is an interesting time of discovery and journey, and it doesn’t all go well. I’m always struck by this idea that I think most people anticipate getting to that stage of life it’s going to be an achievement, and you’ve worked hard, and you’ve watched children, and you’ve had some accomplishments, and then here you are with a lot of uncertainties, both professionally and personally and in relationships. I have wondered and have had many patients ask about what are the resources? Are there support groups? How do I navigate this? Who can help me? Do I have some skills and gifts I didn’t know how to use before but maybe I could discover now? So is Stria the kind of organization that could help give resources or answers to those people who really don’t know how to successfully move forward and feel like they are making the most of the years ahead?

Susan: Yeah, the phenomenon that you are talking about is something that I see all of the time. Particularly while I was at Next Avenue, our readers expressed just exactly those kinds of concerns, and across the board the idea of creating opportunities for older people at any point in their aging – you know a 50-year old or a 70-year old – to be able to find purpose and meaning and access ways to be productive and give back is an ongoing and significant issue. Stria is trade-media, so we’re really for the folks who work to develop those kinds of programs. The average consumer might find Stria interesting if you’re, you know, sort of an aging nerd [laughs], but we are not a direct-to-consumer resource.

Dr. Barb: Okay, so that makes sense. So you are going to help create in my community the resources that might make people like me be more successful as I seek out the resources I need to continue to age successfully.

Susan: Exactly. So if in your community someone wants to create a new community organization that connects, let's say, women heading into retirement, with new inter-generational volunteer opportunities (I’m making this up). The person leading that organization would be wise to subscribe to Stria so that they would have access to really an executive summary of what’s happening across the field. What do they need to understand about older consumers, about the way that the aging ecosystem is put together, and about the other kinds of programs that exist so that they can create the best program possible to deliver in your community.

Dr. Barb: I love that your passion about depicting honestly what older really looks like, and it is I think parallel to my own mission. Actually I just saw a woman yesterday in her early 70s who had been widowed. And in my field of practice, which includes sexual health, I’m always inspired by women like the woman I saw yesterday who is pursuing a relationship. Our discussion was around what this was going to look like and what this meant for her sexually. I’m just curious, more broadly,  what are some of the stereotypes and misperceptions that you have become aware of for those who are 70 versus 30?

Susan: Yeah, I think the biggest misconception is that older people are often sort of lumped into one homogenous group. So someone thinking about older people are lumping together a 50-year old woman and an 80-year old man. Obviously those are two very different people with very different needs. But for some reason there’s a sort of conception that once you hit a certain number in your chronology that you become part of a special class that is all of the same.

Ageism is the root problem lurking behind every stereotype or misconception.

The thing that I find, is that ageism is really the root problem that lurks behind every stereotype or misconception. The more specific ones: old people can’t use technology; old people don’t seek out new brands – all of that day-to-day stereotyping of older people is driven by the inherent ageism in our society and in our own selves.

Dr. Barb: What’s the process of moving beyond that? Is it new language? Is it new conversations? How do you envision removing some of those stereotypes?

Susan: I think the answer is yes. It’s everything. I’m always surprised. I had the opportunity to talk about ageism with groups of folks, and the more you talk about it and you start to hear examples of ageism, you can sort of see a light turn on. All of a sudden there’s this realization that this ageism is everywhere. I think about in mainstream media, like late night or on Twitter, there are jokes about sort of at older people's’ expenses. You know, ha ha ha about diapers and canes and hip breaks. It’s something that we just gloss over and sort of take as a given, even back, I don’t know, 20 years ago the over-the-hill parties. It’s entrenched everywhere. So I think the first thing that is most important is becoming aware of it.

Now that I fully see ageism, I catch myself even, saying things. Even things that are intended to be pro-aging or for older people, are sometimes packaged in ageist language. For example, there are so many things with Granny as a descriptor. Granny Pods are the tiny houses that older women can live in I guess on their family’s properties. There was an activism group that was pro-gun restrictions and they called themselves Grannies. I think that that language can be really harmful, even without meaning to. The other language example that is a particular pet peeve of mine is in the news media, the phenomenon of shifting demographics is often called the Silver Tsunami. Silver – sort of a double whammy – silver is a euphemism because heaven forbid we actually say “aging,” and tsunami is a catastrophic national disaster that brings death and destruction. What a way to describe the literally millions of productive citizens that are in our country!

I think it starts with perception and then language, storytelling – it’s the same as really any change in the way a society thinks. It’s incremental. The difference of course, with ageism, is that it’s a class of which everyone will become a member if you’re lucky. It’s especially ironic because there’s no one who doesn’t want to end up being a part of this group that we still talk down to and about every day.

Dr. Barb: Yes, that’s fascinating when you think about it that way [laughs]. It is somewhat inexplicable I guess when you speak about it in that way that this is where we have found ourselves culturally. Is this true in other cultures as well do you think? Is it unique to our culture?

Susan: Ageism expresses itself uniquely in American culture, but it is not unique to our country at all. The aging of the population, in fact, is far ahead in other countries. So they are dealing with the implications of an aging society well in advance of where we are. But ageism unfortunately is everywhere.

Dr. Barb: How do assumptions and stereotypes affect product design for older people?

Susan: It’s interesting. There’s a movement now for folks in the field that is sort of a trend of designing with older customers as opposed to for older customers. The sort of mantra is “nothing about me without me.” We found that there are well-meaning innovators trying to solve problems that they saw in older people’s lives for older people without really understanding what those people need and want. The result, not surprisingly, was that the products failed and the lesson was misinterpreted as “old people can’t use technology.” In truth, the product wasn’t designed for that specific customer. It didn’t work for them, and so it failed. It was a failure of the product, not a failure of the customer. I can’t think of another area in which the customer is blamed for not adopting a product that doesn’t work for them. But this is what happens in product design for older folks. If they don’t adopt this, we say, “Well, they don’t know what they’re doing.”

Fortunately, that is starting to change, and there are examples of businesses who are getting it right. In fact, just this week, GreatCall – the company that makes an array of technology for seniors including the Jitterbug phone which is that big-button phone – GreatCall was acquired by Best Buy this week. And the CEO of GreatCall is David Inns. He is someone who is really dedicated to understanding the needs of his customer. He’s creating products, and has for years, that work for them. The result was an 800-million-dollar acquisition this week. So there is proof that when you do it right, there’s success to be had and there’s real money to be made in this market.

Dr. Barb: Yeah, I would imagine that to be true. It’s really heartening to hear that because when you hear about the financial power of this group of individuals you would think that many companies would be engaging that population to help create solutions.

Susan: It’s shocking how little that has happened in the past. But the great news is that the AARP estimated the value of the market at 7.8 trillion dollars, and businesses are starting to see the value. There’s just money to be made, and so they are going to have to get it right in order to seize that opportunity. So we are starting to see improvements.

Dr. Barb: Given the broad view you’ve had of culture at both Next Avenue and Stria, what advice would you give – to women in particular – about advocating for ourselves?

The results of age-friendly work improve the entire community.Susan: You know I think that my advice – maybe it’s a little simple – but I don’t think that we all need to be revolutionaries who are aging here. My advice would be to sort of start where you live and look to your community and see if there are ways that you can advocate for improvements locally. You can find out if your city has any age-friendly initiatives. The age-friendly movement was created by the World Health Organization and is supported in the States by AARP, and it is city or county or state-wide efforts to make the places that we live better for aging. The results of age-friendly work, by the way, improve the entire community. Businesses get more traction, real estate value goes up, everyone can live better in an age-friendly city. If there’s age-friendly where you live, get involved.

We don't all need to be revolutionaries. Start where you live.I, myself, am involved in the DC Age-Friendly Task Force. You can look to the Village Movement. If you’re not familiar, the Village Movement, it’s been around for a while, but it’s gaining in popularity. Sort of a membership-driven, grassroots organizations that are run by volunteers – sometimes there’s a paid-staff member – but they are coordinating access to services and volunteering opportunities for things like transportation, health and wellness programs, or home repairs. So checking into villages where you live can be a great way.

Open your mind to new ideas about what it might look like to grow older. And then I also think just for yourself even, just start to open your mind to new ideas about what it might look like to grow older. I think looking into tech training opportunities; if you need help learning how to set up your iPhone – certainly get that – but there are also opportunities; you know, learn how to set up a story on Etsy and sell your whatever – knitting. Or learn how to upload your digital photography and make scrapbooks for your grandkids if you have them. I think finding opportunities for intergenerational programs, those programs – study after study has shown that intergenerational programs are amazing for the kids, amazing for the adult, and improve the community at the same time. You can make art. Again, studies show that participating in the arts, especially music, is incredibly good for your cognitive health. I think everyone would be singing in a choir if we all had exposure to that data.

Ultimately, it's not about aging; it's about living your life.

Ultimately, it’s not about aging; it’s about living your life. You don’t have to set up an advocacy program. Just get out there! There are literally millions of women over 50 forging the path of what it is going to look like to grow older in this country. I say, “You’re not alone. Just go for it!”

Dr. Barb: Yeah, great! Thank you for those words of encouragement.

Susan: I also should add on a more practical level, if you haven’t started planning for your own long-term care needs, get on that! The one practical thing that everyone should be doing is thinking about how they are going to care for themselves as they are aging. It’s a looming crisis, so that is the one sort of more practical thing I would advise.

Dr. Barb: As a health care provider, I will thank you for that input as well because certainly as you mention it is a growing crisis and not going to be changing imminently, so plan ahead, as you said.

Where do you personally find richness at your current stage of life, Susan?

There are literally millions of women over 50 forging the path of what it's going to look like...Susan: You know it’s interesting because my work in aging has changed the way I think about aging. I’m certainly more focused on planning for the future in a realistic way. I’m more aware of the possible contingencies. We’re not all going to be healthy and independent until 88, and then we pass in our sleep. So I’m more aware that I’m going to need help, and I’m more dedicated to thinking about how would I design the life that would make me happy, but also give me all the support and care that I need.

I have to admit that I am not as far along in my financial planning as I should be, but I am certainly more aware of it. I feel more guilty about it every day, thanks to my work. In general, though, I’m less concerned about the external “stuff” of aging. I was at a meeting, and it was primarily women, and we were asked to say our age, and there were so many women who were uncomfortable saying the number. I don’t want to feel ashamed of myself because of something as meaningless as chronology. That number just doesn’t say very much about who we are as people. That ageism – I just won’t be defined by the stereotype.

There’s a quote actually from Dolly Parton – or credited to Dolly Parton. She says, “I don’t worry about the dumb blonde jokes because I know I’m not dumb. I also know I’m not blonde.” That’s really how I think about aging.

Dr. Barb: I think those are really great words because there is something about the number that I think plays a bigger role than it should for many individuals. Thank you so much for your time today, Susan.

Susan: Yeah, thank you. It was a great conversation, and it’s wonderful that you’re putting these kinds of discussions out there. This is the authentic reality of our lives, and talking about it in honest and authentic ways is how we’re going to make things change.

Dr. Barb: Yes, I’m excited that there is real effort being put into the thoughtfulness and intention around providing more success.

Susan: Yeah, it’s fun. Those of us who work in the longevity market are lucky people. I’m really proud to be a part of it.

September 10, 2018


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"What is it that I want to give to myself?"

Dr. Barb with Jill Tanis

Jill TanisJill Tanis, co-founder of The Nourish to Flourish Society, studied exercise science and psychology at Hope College. She worked as a corporate wellness education coordinator for five years before returning to study at the Institute for Integrative Nutrition in New York City. She is a Certified Holistic Health Coach, studied under Marc David at the Institute for the Psychology of Eating, and is certified at the Mastery level of the Transformational Coaching Method, which focuses on deep change work using neuro-linguistic programming. She has been coaching private clients and group programs for the past 11 years.

Dr. Barb: Something that has really inspired us, and I’m sure our listeners as well, is hearing the energy, passion, and care that our returning guest, Jill Tanis, brought to the podcast in her first appearance. Jill has overcome several health obstacles – both mental health issues in college and now a chronic condition. And she uses that to empower women to flourish in their own lives. We are excited to continue our conversation with her today because we knew she had more that she needed to add to the conversation. Thanks for joining me again, Jill.

Jill: Thanks for having me back, Barb.

Dr. Barb: In a recent blog post, you write about how often you hear women tell you that they’d forgotten to eat that day. And that resonated with me because I had a recent conversation with a cardiologist, Dr. Stacey Rosen, and she talked about how women have a tendency for meeting the needs of others, caring for others, making that a priority, and oftentimes not addressing some of their own needs. I wondered if maybe that was a symptom of that because I think in the busy-ness of our own lives and days we’re “not putting on our own oxygen mask,” so to speak. What are some ways that women can help themselves feed themselves, maybe just beyond the food prep the night before?

Jill: Yes, we – and I say we – I had my own private practice, but also we had been (my business partner and I; you’ll hear me refer back to her), but we come across this all the time in the work that we are doing with women, so I love that you are bringing this up. Practically speaking for me if we’re talking about some ways that women can "feed" themselves beyond just prep – I mean practically, it’s not very sexy, Barb, but grocery shopping. [laughs] Grocery shopping is a non-negotiable for me. It sounds interesting, but I think before we can get even to this idea of how do we regularly feed ourselves or prep the meal, we’ve got to have the food in the house, and a plan of when it gets prepared.

An interesting little poll that I used to do in a group program that I taught several years ago called “The Family Food Revolution” – it was a group of moms every single time, 30 women at a time – at the beginning our four-week course, I would say to the women, “How many of you plan out your weekly meals and grocery shop ahead of time?” It was an eye-opener for me every single time that on average, two women out of the 30 would raise their hand. What I learned from that was, “Wow! Okay, we’ve really got to go back to the basics here.” Right? Some really nitty gritty basics of making time to do that.

We're motivated to care for others, but how are we motivated to care for ourselves?It’s interesting that you’re talking about the oxygen mask, because we can do these things or are motivated to do these things for other people, but how do we figure out how to do it for ourselves? Because if I’m going to make a meal for somebody else, I’m going to go to the store. I’m going to make the meal. I’m going to take the time. So for me personally, when I take the time every single week to get everything on my list for the week ahead, and exponentially, I’m more successful in fueling myself for the week. If I don’t make the time to think about my meal until the day of, the chances of it being a great meal or any meal, for that matter, while also not producing stress along the way, is way less. That has worked for me and so many clients I work with. I would just say that that is something that if you are not, as a woman who is listening, not cultivating this in a weekly practice, I can tell you how many clients I’ve worked with who come to me scattered and not feeling themselves; not making the time. And just this one practice has made huge differences in their life – not just for them but for their families.

Some women find that it’s maybe every three of four days or whatever it looks like, but by and large, before we can talk about how do we get the meal on the plate, there has to be this forethought of planning and shopping for them. At four p.m., the last thing I want to think about is what’s for dinner. And I’ve already made this decision ahead of time by going to the store, I don’t have expend more energy making one more decision. And I love that the decision for what I’m going to eat has already been made for me when I set my meal in place at the beginning of the week. I recognize this takes practice, and we talk about this and support women and figure out how to do this. But it’s just something for women to think about when they’re waking up in the morning, what does that feel like? And I will tell you, Barb, there are times, where I don’t want to do this for myself – you know. And I teach this stuff!

I had one of those examples this weekend, this past weekend. So in those moments where I don’t want to, I go inward for a moment and I literally visualize: Okay, if I don’t go right now, what will my week look like and feel like if I don’t do this, and what will my week look like and feel like if I do. I can still make the decision not to, but over the period of time that has been a really helpful tool for me. So I think for a lot of women if you don’t know where to begin, and you would like to have something that is done for you and get you started, and I know we’ll talk about this, but our Reset is a great place to begin for accountability in guidance and coaching, just getting you a jump start into that.

Dr. Barb: I would say that I’m one of the 28 women in the room who did not raise their hand about doing that, and for a variety of reasons. Probably the ones you hear from most women, it’s the time and intention to do it in advance, the dislike of grocery shopping, the changes of schedule, or who’s at the table, and what I thought might occur didn’t occur. I’m curious, are you supportive of some of the new technologies we have available to us and tell women (and men) who want to opt into having others shop and deliver it to the front door? Do you see that as a helpful tool for your clients to maybe be more successful?

Jill: So helpful! There are many women in our Reset who will get our recipes and we have our grocery list, and they will use those services that are available wherever they are, in whatever town they are. And I will say that if we didn’t have those services, they wouldn’t have likely been as successful. I love that. Whatever you can do to make yourself successful at the goals that you want – I believe firmly in accountability – and if that is part of the rhythm, that is awesome! That is great!

There’s definitely benefit when I’ve gone and brought my kids when they were young to shop with me. I look back on that – it’s hilarious – three kids under five, and I’m shopping for stuff. But I see how that’s been an imprint on them now. And I did that with my mom, so that’s probably why it’s easier for me to do that now. So I do think there’s a sense of modeling that can be supported to whatever we want to give to our kids as an opportunity. But equally supportive is, I’m still going to find a way to meet those health goals that I have with the options that are available to me. And this is what I’m doing, and I love that.

Dr. Barb: That last time we talked, you mentioned the 14-Day Reset. And I understand you have a Fall Reset coming up.

Jill: Yes.

Dr. Barb: I love the description where it says, “Fall in Love with Self-Care.” What do you find are the forms of self-care that women most easily adopt or are most able to successfully maintain?

Jill: Hmm. This is a big juicy topic, Barb. I feel like the reason this is in our Reset is because we can have the meal plan, we can do all those things, but if we don’t get into those deeper rhythms of learning this larger sense of self-care, when we do that, those other things come more naturally. Like because I have a deep sense of wanting to practice self-care in my life, that’s probably why my grocery shopping goes better for me. Right?

The bottom line, I think that whatever it is, whatever the self-care is, at the heart of this to me is really supporting women and give them permission to let it be okay. Giving them permission to explore self-care in any realm and what works for them. Like this is a practice. This is not something where – I was just talking with somebody who was in the Reset just a couple days ago. We were talking, and said, “Self-care is in some minds is like a spa day or a weekly massage, or getting a mani/pedi.” And it’s so much more! Right? Daily practices that feed you and give you life, not only life-giving, but there’s a sense of a restorative nature to it as well for all the things we empty out in our day. What are those things that we can do that fill us back up, so that we can serve well? So that’s why I say giving yourself permission is key, and I would say starting small. Those are the things that are most easily adopting.

Your day will not fall apart if you take ten minutes for yourself to eat. It could be the gift of slowing down enough to take just ten minutes to sit down and eat your breakfast or your lunch. Because what I’ve found is that the majority of women that I support do not start out by doing this when we work together. They are standing up. They’re rushing around. What the message that I have for them is that your day will not fall apart if you take ten minutes for yourself to eat. In fact, you might find the opposite is true. It might be life-giving and energizing for the rest of your day. And in fact, what is the message if I am not doing that? What am I believing about, whether it’s my work or my significance of always having to keep busy doing something for somebody else that I cannot stop and honor my body’s need to refuel? So that’s one thing I would say about that.

The forms of self-care look vastly different for every woman. I find women that have self-cared by knitting, reading a book, drinking their morning tea and having some quiet space in the morning. It could be with a bunch of women that they love, that they meet with on a regular basis to celebrate being together. It could be the accountability of a walking partner. It just runs. But I think the intentionality of it is really important as well as giving you permission.

Dr. Barb: So Jill, can you give us some tangible ways for women to be successful in some of the self-care approaches?

Jill: Yes. From that food piece, I have a thing that I find for most women is that they skip lunch. Right? And that seems to be a very common thing. I want to mention that one of the things we do on Reset is we encourage you to reserve a portion of your dinner for lunch the next day, so it’s done. So you’ve got lunch ready to go, and you just take what you had for dinner and you put some aside – if you have a lot of kids, put it aside ahead of time – and if you live in a home with less people you might have several lunches from that one dinner.

A couple of other quick ways would be... smoothies are another great way to get a quickly-prepped breakfast into your day. And we love this. And when we designed this for the Reset, women love them because they are designed to carry you from breakfast to lunch. And very rarely will you be hungry for a morning snack, so it just lessens the thought about all of that altogether.

The other thing that came to my mind is I have a friend who partners with a couple of other moms, and each week they take turns to make meals. So one mom makes the same three meals, drops them off on one night, the next night another mom does it, then the night another mom does it. So they all eat all the same meals, but it gives them a couple of nights off of cooking. So a couple of tangible things that might be helpful for our listeners.

Dr. Barb: I see that your credits are somewhat like mine when I talk about self-care as well. It’s often not a difficult conversation to have when I see women because they are frazzled. They are at the end of their rope. They’ve had it. Something has to change. So, I feel like encouraging women to make an adaptation to their life is an opportunity that they are willing to consider, because they must. I’m just curious as to what strategies you use to encourage and support women in making those changes in advance of hitting the end of their rope. Because I find that’s a really more challenging scenario for me to communicate to women.

Jill: Yes. I agree with you. First there’s the commitment and permission to invest in themselves, whatever that might look like. So whether it’s a Reset where you are committed, you’ve created the time and money to invest in it, or it’s a group – like if you’ve always wanted to do Pilates, you know that’s going to be good for you; you invest that time and commitment in just showing up. The strategies for me are all about accountability. In what ways can I find what really resonates with me and give me the ability to show up for it every single time, or at least most of the time. For me personally, in certain phases of my life when I haven’t been as motivated – we talked a little about my chronic issues with autoimmune disease – I didn’t have the energy to get up and move my body. So the strategy for me was asking women to come, friends to come and walk with me. My husband walked with me. I signed up for a tennis class. I showed up every single time. So I think it’s the commitment and permission to invest in yourself. Along those lines, the strategy for me is to figure out what that actually looks like for you. Because self-care has such an open-ended – the possibilities are open-ended.

What is it that makes you come alive?I say to women, “What if you were to finish this sentence: ‘I want to feel more of ____.’” And then just start drilling. Mostly it’s, “I want to feel more calm.” “I want to feel more energized.” “I want to have more peace.” – whatever those things are. And then continue to explore. Like, “When I’m done doing X,” and you would insert whatever self-care practice that is, “I feel more ___.” Whenever I’m done doing yoga, I feel more relaxed, I feel more calm, grounded, connected to myself, whatever it is. And you connect those two. You want to feel more calm and connected, and then you find those self-care practices that go in that direction and allow those things to be true. Because if you want to feel more calm and connected or more relaxed – whatever it is – and you decide that self-care looks like running five miles a day – it can – but maybe for you that’s stressful, or you don’t enjoy it.

One of the terms I use with women is embodiment, which is this idea of being in and with your body on her own terms. What is it that makes her come alive? What is it that makes her feel relaxed and her calm? Not what makes your neighbor Susie feel calm or your friend so-and-so, what is it for you? Then being able to look for ways through the commitment and permission and accountability to invest in those things.

Dr. Barb: Let’s talk more specifically about diet and food. I understand your 14-day program includes recipes for the time period that they are in the program. Can you talk a little bit more specifically about how it is you create those, and what your criteria might mean, and what thoughts or intentions go into creating that?

Jill: Yes. Our Reset at the base level, like when we decided what do we want to create here from a food piece. So there’s the whole self-care piece that we’ve talked about, but when we created the plan, we wanted to create what, in a larger sense, like in an anti inflammatory plan. So we want to remove even inflammatory foods, what my business partner, Angelle, has called the "suspicious seven." And it’s really easy to remember. She’s an educator and she always comes up with these great little terms. We removed what we call the suspicious seven which are corn, soy, dairy, gluten/grains, peanuts/legumes, eggs, and fine sugar. In fact, we do add coffee, alcohol, and caffeine to that mix too, so I guess it’s really ten, but we never tell women until they get in the door [laughs] about those three. It’s kind of a “Oh yeah, these are part of it too.” But these foods all contribute or can contribute to inflammation in the body. And they can contribute to gut health, and balance, and blood sugar, and hormonal imbalance, and fatigue, and mood swings, and cravings – so we start there. And maybe you’re thinking, “Oh my goodness, that’s my entire diet. What would I eat?” [laughs]

In its place we’ve put together a delicious and satisfying meal plan, done for you for 14 days, breakfast, lunch, and dinner, where you don’t feel at all like you’re missing any of those things. It is possible. If you talk to the women who are in Reset, by and large, everyone is like, “This meal plan is so delicious.” And that’s our goal. We want it to be delicious and satisfying and so good without realizing that all these things are missing.

And we don’t stop there. We talk about eating with them. So it’s not just about the food, it’s about encouraging them to eat in a meal rhythm, which in the Reset is three meals a day. And they are satisfying and fulfilling enough to get you from one meal to the next without being hungry. So no snacks. Which sounds maybe again for a lot of women, like “Are you kidding me?” But it’s amazing when you experiment with this. Women are like, “Wow!” Not only does it allow our bodies to move into fat-burning mode, but it also helps stabilize blood sugar which helps stabilize mood and cravings and sleep and supports our hormones. I know we talked about this with my business partner, Angelle, in a recent podcast – these foods for supporting hormones, but this is it in a nutshell.

So we give you that plan. And then in addition to that, we have a guide book to help you prepare. We have a shopping list, prep tips, we have a Facebook community to navigate all these things, ask questions, get coaching, prepping tips., and really inspire you along with all these other women to help you succeed in our goals. That’s how we planned the actual food portion of the Reset, and it’s been very very well received.

Dr. Barb: I would say that choosing recipes can be very difficult and so through this plan and beyond the plan, I think your website includes additional recipes that continue to support and promote that approach to dietary modification. So is there a longer-term plan to help women then maintain and sustain a dietary plan along that line?

Be in tune with your own unique body.Jill: Yes. There’s a few things we do. Practically speaking, after every Reset we offer a 12-week meal plan that is put together by one of Angelle’s long-time colleagues, Chef Jackie. So that’s available and they are very Reset-friendly. For women who want specifically the next several months to have this, that is available to them. During the Reset what we do is – you know a lot of women who come in with “What should I eat?” During the Reset we encourage women to really pay attention to their unique body and what’s going on during the Reset. She’s constantly speaking and communicating with you, and we try to help you tune in to that during the Reset about how to listen to that body piece, be into your body and with her so that, for example, after the Reset, maybe you choose to add gluten back in and you realize wow, you get so bloated. Or you get a migraine. Or whatever it is, something that maybe she experienced before the Reset, it went away during the Reset, and then voila, it comes back. Now she has a pulse into her body cues as to what gluten might be doing. It might take some time for her to come to terms with that that might not be a good idea. So she honors her journey, her body cues, honors that it’s maybe going to take time to get into this rhythm. For example, I went off gluten about five years ago. It took me nine months to be completely be off gluten because I would go back. “It’s okay.” Then I’d remember, “No, this is how it made me feel.” And it just took that long for me to realize, “Hey, this isn’t what supports me.”

We tell women to make a few tweaks during the Reset. Try those anchoring experiences that really worked for you, and then go experiment with them for a few months. Then come back to the Reset, again a different meal plan for like winter, fall, and spring. Come back, grab a few more things on your journey, and continue along your own continuum.

Dr. Barb: Do you have recipes that you come back to over and over?

Jill: Oh yeah. I do, and it’s interesting because I did reach out to our community and I asked them what gives them the staying power to be a favorite. It’s amazing how really in fact people are probably surprised to know that I have a very simple meal plan. And it doesn’t take me a long time to prepare. And I probably only have 10 to 15 meals in my rotation every few months with maybe one or two new ones throughout the month or one a week or something. I keep it super simple.

When I did a little question to my Reset community, the same thing. What are the staples? What are the ones you come back to over and over again? It had to do with the taste and the ease and just that it worked really well for the whole family. That’s actually our goal in the Reset to do all those three things – the taste of it we want to be delicious, we want it to be easy, and we want it to be something that everybody will love.

Dr. Barb: Yes, which of course can be a bit of a challenge when you are trying to work around others in the family who may have different interest or appeals than your own. So I would say that. Unfortunately, probably in my household, the vast difference of food preferences has resulted in restaurants being a great choice because everybody gets to pick out the menu with what they want knowing we are all going to be very different, one from the other. Unfortunately, that has been a go-to, so I assume the foods that are available to women who are preparing for families are basic enough that the expectation is most individuals around the table are going to be able to enjoy that, and not too exotic I would say to introduce to the picky eater.

Jill: Very true. I would say that a lot of women are super surprised that they’re delicious, they taste amazing, they are easy, and they recognize the names of them. We just put a twist on them to remove the inflammatory foods. So a lot of them you will see, for example in our upcoming Reset we have baked chicken fajitas. Oh, everybody recognizes what a fajita is, and it’s super easy because it’s a sheet pan recipe. You cut it up, you add in enough seasonings for it, and it seems to go over wonderfully.

The other thing I would say too about kids is, I thinks it’s helpful for parents to know that you can take a kid – and even adults really – being introduced to a new food can take ten to twelve times before they are willing to try it. Our taste buds are constantly regenerating, so my advice is being able to find recipes that you can create that maybe pair with a familiar food to them, so there’s something that – I avoid using the word, “I have a picky eater.” We try to re-frame that for parents like we are trying to encourage adventurous eaters, people who are curious, people who would be willing to have a couple of what we call no-thank-you-bites. Be able to prepare a new meal with already familiar foods.

I did this with my son. He was three. He hadn’t touched a strawberry until he was three, but I just kept putting it on his plate. Kept putting it on his plate. Just a strawberry. Then finally one day, he looked at me and said, “I’m going to try this thing.” [laughs] And he did and he was like, “Oh, I love it. I really love it. Mom, why didn’t you have me try this earlier?” So it’s just testament to – it can be a long haul sometimes – but I’ve watched kids’ palates change. Or if you find things that do work with them. Like we have tons of smoothies in our Reset for example, and kids just start to really gravitate towards those. Start there. You know? Just develop the palate a little bit at a time.

Along those other lines, Barb, I would say for me, “I’m not a short-order cook. This is what’s for dinner.” Sometimes you’re going to love what’s for dinner, and sometimes you won’t. It won’t be your favorite, but for my family, I talk a little bit about how it’s a bit of a life metaphor where we don’t always get what we want, and how do we work with that, especially if somebody is serving us something, to be grateful. And also, what am I enabling if I just let them go in this direction, “Oh you don’t like this. I’ll make you something else.” Let’s do this as a family. So there’s just a lot of good learning that happens along the way. Parents – moms especially in our group – get really excited to support each other along that journey together.

Dr. Barb: So many women may not be able to participate in Nourish to Flourish. What wisdom might you share generally with women to help them move to a lifestyle that is going to be improving upon and allowing them to flourish more?

Jill: Hmmm. We talked earlier about that commitment, investing, and giving permission to invest in themselves. I think that’s a big one. But, I also think that expectations play a big role about what it’s supposed to look like or what you think it should look like. I was just talking with someone from the Reset a couple of weeks ago and she said, “When I looked at what you guys were doing, I said ‘that was way beyond what I can do.’” And she had no connection to that. And then she got to know us and she realized, “Oh, this is step by step; this is a guide, these are real moms who get it. And for her it was like, “Wow, if I have this expectation that I have to completely revamp everything we’ve ever done, of course it’s going to feel like you can’t do that.”

What is it that I want to give to myself?I want to say that expectations, I think, play a huge role, and whatever women choose as far as moving towards the lifestyle they know they should be making, often with these expectations, the question that we ask is, “Instead of what am I giving up – the coffee, or got to give up sugar or alcohol, or got to give up whatever it is, what am I gifting to myself? What is it that I want to give to myself? Be curious about what’s possible. What is possible for me?” Because this – whatever it is for a lot of women, whether it’s the migraines, or it’s the bloating, or just terrible PMS symptoms, or whatever it is, this is not working for me. So I encourage women to be curious and be open, and to hold those expectations loosely that it needs to look like something, and just move in that direction of making a commitment and the permission to invest in themselves whatever that looks like.

Manage the things that you can manage.Dr. Barb: My experience has been that women underestimate the connection between food and the outcome of how they feel and function. I think you just stated it well. I just wish more women would have an expectation, as you put it, of how much maybe they can control in their lives. They feel like they can’t. My message to women is often: manage the things that you can manage. There are some things that maybe you can’t manage. What your pituitary gland is doing at this moment, directing your ovaries and other endocrine organs may not be directly under your control at this moment, but what you have for lunch today is under your control today. Or whether you choose to exercise. I think this connection of understanding food and their general health and wellness, there’s such a huge disconnect. So I hope a major message that women can get from this is that hitting that reset and taking those steps is likely to have a very favorable outcome in some way. It may be like you said, it took you some time to go through the journey to understand exactly what some of those connections were, but at least start.

Jill: And I want to piggy-back by saying, yes I found out that maybe for example gluten didn’t work for me. But my health is constantly evolving, as is yours and everyone listening to this. I feel like a lot of women feel like it’s an arrival point. Like if I can just, you know, just tell me how to do it and I’ll do it and this is where I’ll stay. But our bodies are constantly shifting and changing through the month. Our cycles shift and things shift, so the message is really about being in tune with your own unique body, and listening in, and making course corrections along the way.

I'm learning as I go; some days are better than others, and that's okay.Let’s say a couple days don’t go as planned, and then I hear women say, “I’ve fallen off the wagon, and I went off track, and now I have to get back on track.” Our goal, my goal is to teach women a different language about how to go about looking at this. It’s all a journey. If we have the language of, “I’ve been bad. I’ve spiraled down.” And somehow leave it alone versus, “This is all part of my journey. I’m just learning as I go, and some days go better than others, and that’s okay.” What I’m committed to is my health and my discovery of what most nourishes me – and some days that goes great, and some days it’s not – that’s okay, but I’m committed to this journey.

Dr. Barb: As we bring our conversation to a close, the last time we did this, you talked about the Sabbath as a practice that you honored. That it was really life-giving to you, and very purposeful as the way you honored that day. Now, as we talk later, as we approach a change of seasons, I’m just wondering if you have anything to add to that as to how you look ahead to be reinvigorated and find your sense of self and purpose.

Jill: Hmmm. It’s interesting. My oldest son, this summer he turned 12. And I had this gravity of realizing that I have like six more years with my oldest at home. It’s really starting to sink in. Six more summers, six more Christmases with us intact as a family at home. I started to just really reevaluate and ask questions about myself, my role as a mom, and really how I’m soaking in this very – what I would consider – this very rich and precious season of life. With that is a backdrop in large part I took the summer off to be with my kids. To be off of work. My schedule with how busy I am during other months just allows me to slow down when they are home. So I loved that pace, the morning walk routines with my friends, my husband, loved the mornings with my kids; all that stuff. And now they are back in school, and yeah, you’re right. It’s a catalyst for me to jump back. I always had a Sabbath in some ways of my summer to be able to jump back in with renewed energy and clarity for a very full September. I’m very excited about it.

But in that process, I – more on a deeper level – I’m really reassessing this idea of purpose and sense of self. Like when you asked that, it’s really interesting. I’m experimenting with dropping this large ideal that I’ve had of where I thought I’d be when I’m 40, or when I’m 50. Or to find some grand purpose or sense of self for my whole life. And I find myself now exploring this day to day, day by day. That versus this really big picture of all trying to find this big grand purpose, and instead waking up and being playful and curious (for lack of a better word) presence to the littlest things. Like yesterday we were watching our 7-year old making a sandwich for lunch in the morning before school. And he was focused, and he had some butter all over the counter, like it was just a mess. And my husband and I just shared this endearing laugh of behind the scenes – not in front of him of course – this depth of love for this little tiny human. And watching him grow. I just find myself soaking in these moments that are deepening the clarity to my sense of self and purpose, and really being more present to nature, to the littlest things. It helps me to be more authentic in relationships and in my connections. So that definitely is what is resonating with me right now.

Dr. Barb: Well thanks Jill. I appreciate your sharing that, and I think it’s a great message that I think we can all take to heart and look for opportunities in our own days to cherish some of the small things, and stop to appreciate some of those, again, small miracles, so to speak, that are in front of us that we normally don’t take the time to appreciate. So, thanks again for sharing with our listeners, Jill. I appreciate it.

Jill: Thanks for having me.

July 09, 2018


about middlesexmd ›  

"Relationships need cultivation; they need work."

Michael Krychman with Dr. Barb

Michael KrychmanDr. Michael Krychman serves as the executive director of the Southern California Center for Sexual Health and Survivorship, medical director of Sexual Medicine at Hoag Hospital, and clinical faculty member at the University of Southern California. A gynecologist, obstetrician, and clinical sexual counselor, Michael is an author of several books (three of which we offer in our shop) that reflect his desire to help patients and their partners overcome sexual health challenges and experience a higher quality of physical intimacy. He has been an advisor to MiddlesexMD since our first year of operation.


Dr. Barb: Today I’m speaking with Dr. Michael Krychman, a long-time friend and advisor to MiddlesexMD. Michael is an obstetrician and gynecologist specializing in sexual health and couples’ intimacy, as well as in survivorship medicine. Michael is also the author of 100 Questions and Answers About Life After Breast Cancer and also co-authored The Sexual Spark. He’s also authored many journal articles in the area of women’s health and women’s sexual health. Welcome, Michael!

Michael: Hi Barb. It’s great to be here. Thank you for having me.

Dr. Barb: Yes, and thank you for taking the time to join me so listeners can hear a little more about your area of work and, more specifically, about women’s sexual health.

I know a lot of your time and energy is focused on couples and couples’ ability to regain intimacy often. So what are some of the most common obstacles you encounter in your practice in helping women navigate this?

Michael: Well you know, Barb, I think because of my clinical practice I have a diversity of patients – different backgrounds, different ethnicities, different age groups – and I think that the commonality between what has been going on in the diversity of couples is really the change in communication and really a function of society. We are becoming very very stressed. We’re working longer hours – harder hours – to maintain the same level of financial support for our families. We’re not eating well. We’re not sleeping well. We’re not exercising. And the things that we should prioritize in terms of communication, in terms of connectedness, are really falling by the wayside. So we’re not taking care of ourselves on a physical and emotional plane, as well as the fact that we kind of put our relationships in autopilot. We feel like they are going to just continue to be positive and move forward, and we don’t put enough effort into it.

I typically see a breakdown in communication. People are not even talking to face-to-face. They are communicating by text, by sticky notes. They don’t spend time together. They are not really communicating on a “couple level” in terms of emotional intimacy. They are really very often business partners or co-managing a household. They talk about operational things – the kids, soccer, tennis, and what have you. But they really need to start refocusing on maintaining that relationship. So very often it’s really a return to the importance of what is actually going on in the relationship. Focusing on the dyad, focusing on the couple themselves, and really trying to re-understand what the importance of those facets are.

Dr. Barb: I’m interested. Do patients present to you with other sexual complaints other than relationship issues, and it’s not as a much of a physical issue as much as it is in turn a relationship issue?

Michael: Well, you know, Barb, I’m both a sexual medicine gynecologist and also a sex therapist. And as you, in your clinical practice, you really do the diversity of both mental and psychological, very often patients will present with one issue, and it’s really a function of a conglomeration of issues. So sometimes women are having physiological issues – they may have menopause and dryness and discomfort – and again that may not necessarily be the primary issue. They may not be interested. So they are avoiding, they are not aroused, and subsequently, their natural arousal mechanism is not being activated or utilized appropriately.

So again, it’s kind of what I would say a sexual medicine detective story that unfolds. You really talk. Sometimes they come in about a physiological issue and ultimately – there’s medical – but ultimately at the end, there’s more stress and fatigue and relationship issues that are the co-primary impact factors. Alternatively, you may have women come in and say there’s low desire, and there’s no interest, and you may find out that the primary issue is an undiagnosed medical issue. So again, I think it’s a balance. But very much so we need to look at both of those facets in tandem and see how they work together.

Dr. Barb: In your book, The Sexual Spark, you provide some really practical assignments for couples. Take me though a little bit of that. What might help couples achieve a more intimate relationship? What kinds of assignments are you suggesting?

Michael: This was a book that I co-authored with a female gynecologist, a great colleague of mine, Dr. Alyssa Dweck. We kind of were – I’m on the west coast and she’s on the east coast – and we were talking and collaborating and really seeing that the same kind of issues are prevalent, irrespective of geography, irrespective of age – some are more common as the duration of relationship increases – but I think one of the big issues is sex gets very boring. A sexual script is like reading the same book. Although you may have your favorite book and really enjoying it, reading it three times a week, the same story, the same beginning, middle, and end, sometimes can be boring and problematic, and it really becomes much more operational than a sensual journey.

Modify the sexual script. Be unpredictable. Be playful.

One of the biggest issues is modify the sexual script. Be unpredictable. Be playful. Focus on sexual pleasure and the journey of sex rather than just the ultimate goal of sexual orgasm. I think that’s a very important issue that we sometimes forget about.

Dr. Barb: It sounds like you’re talking about couples discovering more novelty.

Michael: Yeah, and I think that’s an important facet. Very often we have a sexual script. You know if you ask women how they know their partners are amorous, they often will tell you the same story – he turns off the television, he takes his shower, puts on his lucky shorts, you know, scooches on over to the bed. And it’s a really well-contrived, controlled script that unfolds like a favorite book, and it’s very predictable. Many couples gravitate toward that because it is safe. It’s comfortable. It’s like wearing a comfortable pair of shoes. You know your feet are going to be comfortable at the end of the day. But sometimes it’s important to spice it up – sexual accessories, sexual positioning – you don’t have to go to Fifty Shades of Gray novelty, unless you’re interested and it’s not for everybody – but sometimes just modifying the script changes your biological-neural-hormonal environment in which you act. It increases oxytocin, it increases noradrenaline, which will certainly help the overall experience.

Dr. Barb: You’ve even brought this to couples’ retreats where you’ve gone to some really cool locations, and couples have joined you to really do some hands-on instruction around that. I’m just curious, can you outline what one of those retreats might look like?

Michael: Yeah. That was really exciting. I was doing some retreats all over the country; even in exotic locations like Bora Bora, where you really give people, you know, you do a variety of exercises, and we talk about trust exercises. We talk about anything from creating a sensual environment, or talk about feng shui sexuality, how the environment in which we live – our bedroom, our home – how is that influencing our sensuality and sexuality? We talk and do trust exercises. We had couples go swimming with the sharks, and how different positions and different levels of excitement and concern can rebuild sometimes trust that may have been weakened over time. We rehash and revive and restore the problems that may have experienced in the early part of the relationship to learn from those. You know, those that do not learn from the past are doomed to repeat it. So really, talking through exercises. And, using a very sensual environment that focuses on the couple really enhances the overall experience. So we are trying to use all of the senses. We have a beautiful environment in which the event takes place. They have periods to do private behavioral exercises and take back to the privacy of their own rooms some of the things that they have learned in order to enhance their overall marriage and sexual experience.

Dr. Barb: Are those available to couples who would like to reignite their own relationship? Are there organizations who provide those kinds of weekend retreats that someone could investigate and consider attending?

Michael: Yeah, there certainly are. This was organized by a specific organization. I’ve done ones where couples have gotten together amongst their friends and organized it. It doesn’t have to be in an exotic location like Bali or Bora Bora, what have you. We’ve done them in major cities. I do them for small groups, I’ve done them as well. So again, there’s a variety of organizations. I think you just need to look at the details of the program, what you are looking for, and what you want to get out of it. Again, there are variable in time, variable in professionals that do them, but again certainly are very available at a variety of times throughout the year.

Dr. Barb: You also have an interest and focus of your practice on survivorship medicine. Can you talk a little bit about your observations of, specifically, cancer survivors and how they are affected sexually and what you might do to help promote sexual health for that group of women?

We are all surviving somethingMichael: You know, I think you bring up a good point. Cancer survivorship I do, I certainly have a whole variety of patients in my office. I worked at some Kettering [Memorial Sloan-Kettering Cancer Center, New York] for quite some time and I do have a large group of patients who do have cancer. They have the added issue of being poked and prodded. They have both physiological issues from the cancer and other facets in terms of keeping the cancer from occurring, whether it’s chemotherapy and radiation. So they certainly have a lot of physiological issues, coupled with the concern of recurrence, of pain, fatigue, as well as the financial and child-bearing concerns that all of us do face on a regular basis. So again, very special attention to reconnecting. Sometimes cancer is viewed upon as a third party which is invading the relationship. So again, the same kind of path. Survivorship for me in my definition – originally I think, when I first started practice about two decades ago, primarily focused on cancer. But really if you think about it, Barb, on a global level, we are all surviving something. We all will grow older, will have a chronic disease, the average women will take about four medicines chronically as she enters the menopause – survivorship is really about wellness and about prevention. How do we stay well? How do we prevent disease? Irrespective of your diagnosis, I think we are all surviving something. How do we optimize that?

It’s back to the grass roots of precision medicine – diet, exercise, stress, of course sex is very very important from a biological and an emotional standpoint. We know sexual health and general health are very much intertwined, that’s probably the take-home message that sex is a very important physiological activity, and we need to address it and optimize it given the patients and what their specific needs are,

Dr. Barb: It’s interesting you say that because yesterday I was at lecture given by a pain management specialist. I’m also preparing a lecture for community, and it just feels like the common message that we are coming back to with women specifically, and men as well, is really lifestyle. It seems so basic, but I think physicians over the last 20 or 30 years have gotten away from some of that and are more quick to prescribe things and, like you said, we are symptom of our culture right now where we are much more fragmented in relationships and time and intention that our message has to be about the basics of lifestyle. It’s always just remarkable to me how impactful that is. But I don’t know that individuals are willing to invest in that. Has it been your experience that when you emphasize it, you find people actually are engaging to make changes that will favorably impact their relationship?

Michael: Well, I think in the acute crisis, people are very eager to make change, but preemptively people fail to recognize. We kind of ignore the important things that are going on. So I think it’s really important to recognize that specifically that we very often fail to recognize the most important things that are going on until it’s too late. Sometimes it’s too late and the damage has been done.

Relationships need cultivation; they need workRelationships are challenging, they need cultivation, they need work, but I also think that in today's’ day and age, we are a victim of our society. We don’t take care of ourselves. I just submitted an op-ed to the New York Times about sleep, and chronic sleep deprivation, and how people devalue sleep. If you sleep a lot, you are lazy, right? You are not productive. But sleep is a critical facet to the human psyche, biologically and physiologically. So I do think that we need to go back to the basics. Very often what we are now moving towards, Barb, is what’s called precision medicine: optimizing the medical experience on an individualized level. No two people are going to experience the same disease in the same way. No two people experience sexuality in the same way as well. So we need to kind of understand those issues and the impact and how that will help us towards optimizing health as well.

Dr. Barb: Is there a resource you could give for those who want to find professional therapy with a sexual focus in mind?

Michael: What I would recommend, you know, I think that there are a lot of very good resources. I think we can refer people. There’s the American Association of Sex Educators, Counselors, and Therapists. I think that’s an excellent resource. The International Society for the Study of Women’s Sexual Health. I know your blog has been exceptionally helpful in connecting women with other women. I think there is certainly a growing network of increased awareness, both amongst patients, both amongst providers. And again, many clinicians like myself and you do engage with patients over telemedicine. I think it’s really important to recognize that patients are not alone, and that there are certainly a lot of things we can do to help them help themselves. I think you can seek and you shall find, right?

Dr. Barb: Yes, good. And you’re always on the cutting edge of what’s next and what’s coming. Is there anything we can look forward to in the upcoming developments for treatments or understanding around women’s sexual health?

Michael: The biggest exciting thing was the latest approval just recently from TherapeuticsMD in Bexy which is a bioidentical-vaginal insert that you can put directly into the vaginal mucosa for moderate to severe dyspareunia – a symptom of VVA due to menopause. We have had what they are calling the “Real Launch of Addyi.” As you know, it just happened. It’s going to be available by telemedicine at Addyi.com. So this is getting more press, more notoriety, a lot of articles coming out on Flibanserin or Addyi really at a cost effective way to get it to women who are really needing it.

In addition, Bremelanotide, which is Rekynda, is a [subcutaneous] on-demand injection for changes in female sexual dysfunction, and has been filed at the FDA. So I would stay tuned. That’s probably coming down the pike. We don’t know exactly when, but it should be going to the FDA for approval and discussion. I know that the file has been submitted, so I think we just need to kind of wait and see where that goes.

Dr. Barb: Good! Well thanks. It’s an exciting time to be involved in women’s health, and I think we are going to have continued additional options to offer our patients.

So in closing, Michael, can you share with listeners where do you find richness as this stage of your very very busy life?

"No" is a complete sentenceMichael: I think for me the biggest richness and the biggest thing we need to focus on as health care professionals – I mean what I think is really interesting to me is that we are now seeing an increased incidence of suicide, increased incidence of problematic of professionals – overworking, underpaid, very stressed out, electronic medical record, a lot of impact in terms of how they function. I think the most important thing that recharges me is trying to develop a balance. As you and I are passionate about what we do, we practice happy medicine, we give back something that has been missed and belonging to patients. I think at some point we need to have a balance. And many people are out of balance. And that is really personal and professional goals, setting limits, and I would say “no” is a complete sentence. Sometimes we have to learn that balance and take care of ourselves in order to better take care of our patients.

Dr. Barb: Good. Well thanks so much for sharing with us today, Michael. I know listeners appreciate your insights. Thanks again for your time.

Michael: Thank you, Barb. It’s always a pleasure to be here, and thank you for all that you do.

April 30, 2018


about middlesexmd ›  

“You just need to know. Information is power.”

Michelle Robson with Dr. Barb 

Michelle King RobsonMichelle King Robson is the founder of HER Inc., a data-driven consumer health technology company making health and wellness better for women. Mobile and web platforms EmpowHER and SkinSAFE help women understand their health and wellness and improve their health choices. Michelle has become a nationally-recognized women's health and wellness advocate and spends her time speaking before women's groups, health care organizations, political leaders, regulatory bodies and the media about women's health and the importance of women advocating for themselves and their loved ones.


Dr. Barb: I’m Dr Barb DePree of MiddlesexMD. Our guest today, Michelle King Robson, has built an information powerhouse and a community in response to her own health challenges. The initiative she’s taken has not only made it possible for her to reclaim her own health, but also made it possible for thousands of women to get reliable information for their own wellbeing. Welcome, Michelle!

Michelle: Thank you, Barb. It’s so great to be with you. How are you?

Dr. Barb: I’m well! How are you?

Michelle: I’m doing great, keeping busy. Keeping busy with all these women’s health issues, like you are.

Dr. Barb: Yes, and you truly have created an empire, which I’m sure is demanding a lot of your time and attention. And I think our listeners would be interested in understanding, really, a bit of your journey that has led you to become such an active voice in promoting women and women’s health.

Michelle: Well, as you know, about—I launched EmpowHER about eleven years ago because of an unnecessary hysterectomy that I had when I was forty-two years old. And, of course, what happens when you have a hysterectomy, you tank. I lost all of my hormone levels within the first twenty-four hours, and then nobody knew how to get me back to my optimal health. So, I just completely declined over the course of a year. I spent that year trying to—going to different doctors, reading as many books—I think I read thirty-two books on the subject and became an expert by default, as I like to say, which is never any fun for a patient. But, it was really the lack of information that even the physicians had, the healthcare professionals had, about how to treat what was going on with me. I was given medication I didn’t need, now I have to take, I still continue to take. And then I was given things that just weren’t right for me.

So trying to navigate this whole healthcare system was a nightmare, and when you are sick and you are trying to advocate on behalf of yourself it’s even worse. And then you have no brain function, you have sleeplessness, you have everything, right? There’s nothing that’s going right in your body, and it’s very difficult. So I guess when I finally found the right doctor to help me, who happened to be Tucson, Arizona, and I lived in Phoenix at the time, and who knew she was there—and I went all over the country, right?

... You never want to get a woman mad, because she's going to start a company.So once I found her and I started to feel better after about five days—after not wanting to live anymore, which is not uncommon, which I’ve seen a lot since starting the company. Women silently suffer, as you know, and they don’t talk about what’s going on with them. And I was one of those silent sufferers, and it was hard for me to get out of bed. But she was my last-effort doctor, and she really helped me understand what was happening with me. She spent a lot of time with me, she got me well, and after about five days of, you know, feeling, starting to feel better, like myself again, I got mad. And I always say, when I speak, and I know you’ve heard me say this, “I got sick, I got well, I got mad.” And when you get a woman mad—you never want to get a woman mad, because she’s going to run off and start a company.

Dr. Barb: And I’m just going to say, thank you for your response to that experience! Because obviously you have changed the lives of so many other women, in ways that, as a provider, we’re pecking away one at a time, but you were able to create a platform and a voice to bring knowledge to so many people. So tell us a little more about that.

Michelle: I started to fight the FDA, actually; this is how this all kind of came about. And it was over a drug that was being pushed, and it was a drug that was—it was an interesting time in the world of women’s health. I knew a couple things, I knew that only 37 percent of the clinical trials were being done on women that had to do with medications, so I knew that we were getting medication that wasn’t tested on us, that was specifically tested on men. I knew women’s health was completely underserved—I knew that from my own experience and then I learned that as I continued to navigate more and more through and helping other women advocate. 

Women coming together... that's what I needed.And that’s what really prompted me to start EmpowHER, because there was such great need and demand for it, and there was nothing like it that existed on the web back eleven years now. The web was a very different place, and I still always say, it’s still in its infancy. But, I wanted it to be good, credible information for women: that women could ask us questions; we would respond within 24 hours, which has really helped make us successful to this day. We’ve been doing this for years. I wanted great content, I wanted people like yourself, who could come on, we could videotape, you could share your information knowledge, because you have such vast knowledge as a healthcare professional. And I wanted the ability for women to have access to, you know, doctors like yourself, to other women who are sharing their stories, so that they could connect to each other, because there’s nothing like another woman. You don’t know until you’ve walked in somebody else’s shoes, and it was one thing to have doctors, which we’ve got a lot of doctors on the site, but it was another thing to have these women come together, start their own groups on EmpowerHER, give information to one another, because that’s what I needed.

I needed someone who could advocate on my behalf, who could say, here, you need to read this book, here you need to check out this doctor. All the things that I was in search of, I did not have access to. And I wanted to make sure that no woman on my watch was ever going to experience what I experienced, not if I could help it. And that’s when I dedicated my life to women’s health and to helping women, you know, whatever it is. Develop a checklist for women, so when they go to the doctor they know exactly what to do before they get there, during the visit, after the visit, because they always forget things. Just the very basics, but also, having seven hundred fifty conditions on EmpowerHER that are all focused on women and then having about sixty five topics, again all focused on women, like sexual health and relationships would be considered a topic, so I wanted to just give women everything that they needed that was good for them and helpful for them. It isn’t my decision to say, you need to do this and not do that, it’s options and choices, right? It’s something that we’ve never had as women. We’ve never really been given options and choices around our health—you’re not the norm. I know you do that, but you know, a lot of doctors don’t even talk about sex, let’s just be clear. They don’t say the word vagina, it just kills me what goes on. And these are really important things for women, hugely important, they’re life changing.

Dr. Barb: And I just want to make sure that our listeners know, EmpowHer, so for those who are interested in knowing more about your site, again, it is robust, it is complete, it is comprehensive, and so much of what is online is individual’s opinions and experiences, but you bring together that, which is of value, but also leaders in healthcare to help facilitate some of the discussions and try to put a clinical evidence based element to the information that you provide. So again, thanks for what you’ve done.

Michelle: Yeah, no, you’re exactly right. And just to add to that, you know, I looked for the best and the brightest in the field, like yourself, so I wanted healthcare professionals, scientists, researchers, everybody who really has touched women’s health in a significant way—those are the people that I went after for my board. Those are the very healthcare professionals that are on the site, there are videos. Because, again, there’s lots of information, especially in the technology age where you have access to everything. The problem is, that the accessibility is so easy but yet the content isn’t so great. And you know, you can be led down a rabbit hole very quickly if you’re not careful, and I want to make sure that women have good, always science-based, professionally based information. Even though the women are sharing their stories, that’s great and it’s hugely helpful for them, but they also need to have access to doctors, like yourself, who really are experts in their field.

Dr. Barb: So this leads me to inquire about your more recent endeavour around SkinSAFE?

Michelle: Yes, yes.

Dr. Barb: So, tell me about that and what prompted you to pursue this issue?

Michelle: Well, one of the things that happens, as you know, we both know, and I say this when I speak, is that when you have a complete hysterectomy and or you’re menopausal, you’re going through menopause, everything gets dry. So your skin gets dry, everything dries up, as I like to say. That’s one of the things, of course, that happened to me. But it really happened where my skin was concerned. So I became allergic to ingredients, I started to develop allergens that I never had. Number one, I couldn’t get a cream to penetrate the top layer of my skin. So it was like pouring water in oil, what happens? It doesn’t go anywhere. It was the same thing with my skin. I don’t care what product, if it’s La Mer, if it’s $500 to you know, the most very basic thing, putting olive oil on my skin. I tried everything, but nothing would penetrate the skin. And I went from really oily skin, Barb, to really really just dry as can be. But with that came rosacea, I was having allergens to my skin was flakey, dry, red, it just was a whole host of different things. And it wasn’t just my face, but it was also my body, so I went again, in search of, “I need to figure this out.” Right? Because this isn’t good, I can see my skin is changing quickly.

So I went to, again, many dermatologist, I was put on more medication type products that I could use to help the rosacea, to help—they used a term called contact dermatitis. And contact dermatitis is just a big old bucket for anything that is wrong with your skin. So if your skin is broken out, they will throw it into the contact dermatitis bucket. So, I of course, had contact dermatitis, I have rosacea, I have all these things. They gave me medication, it didn’t work. It didn’t work. So, I finally found the right physician, the right dermatologist, again in my own backyard. Shame on me for not looking, because Mayo Clinic has a wonderful dermatology department, so I went to Dr. Jimmy Yiannias, who looked at my skin and he said, “I think I know what’s wrong with you, you need to be patch tested, because you’re having allergens, ingredient allergens.” and I said, “Okay, how long does the patch testing take?” and he said, “It takes five days.” and I said, “I don’t think you understand this, I just started another company called EmpowHER, I don’t have five minutes, let alone five days.” I’m such a good patient, aren’t I?

Dr. Barb: [laughs]

Michelle: [laughs]

Dr. Barb: And I can actually imagine that conversation.

Michelle: And Jimmy would tell you the very same conversation, because I think part of it was like, “Really, you really want me to figure this out?” But we started talking and trying to figure out why I only had five minutes and not five days to patch test, and he did say, “I’m pretty sure I can help you anyway.” And he found out why I was so passionate about EmpowHer and why I couldn’t take that five-day period. And I’m not saying that women shouldn’t do it, because everyone should be patch tested. Anyway he handed me about 25 pages of product and said to me, “Here’s a printout that I’ve created, this is the data that I’ve been collecting for [I think at that time it had been about twelve or fourteen years worth of data, from all the Mayo dermatologists],” and he said, “and I think that these are products that you can buy that I believe will help you with your skin, so that it will stop your allergens.”

And I said, huh. Should I look at this? And there’s all these different products, there’s Clinique, there’s Fannamean, there’s Maybelline, you name it. I said, “Well, where did you get this?” He said, “Well, my father suffered from ingredient allergens, so I’ve been doing this for a long time, because it’s just been a passion of mine.” And I said, “how do I get ahold of this? I want this for our women.”

So fast forward, I tried for, I think six years, to get it, and I finally, Mayo came and said, “Look we’re ready, do you want this data? Do you want this information, would you like to create some type of relationship where we can launch this thing called SkinSAFE?” and I said, “Absolutely, we are all over this.” And so we did. Jimmy was able to help me, Dr .Yiannias was able to help me with my skin, immediately. I left there—first of all, he compounded a cream for my face, which literally just changed my skin, completely, totally—and they compounded that at Mayo. And then I went shopping and I bought all new product, all product that was recommended on his list. And by golly, in a couple weeks, my skin was cleared up, it looked dewy, fresh, clean, no more dryness, no more rosacea, no more contact dermatitis, it was gone.

And that’s how we started SkinSAFE, same thing.

Dr. Barb: So this was a list of products that he had procured, understanding what the common skin allergens, irritants are, and obviously, compiling that and meanwhile, we as consumers, you know looking at it—

Michelle: —have no clue.

Dr. Barb: Exactly! You walk up to a counter and how do you begin? And how do you interpret labels, and then, you know, after how many failures of products, how do you try to cross-reference which products it might have been that was the irritant. It really is a nearly impossible journey to do individually.

Michelle: It is. You couldn’t be more spot on. And that’s what was happening, that’s what happens with everybody, because you can read the labels, number one. You don’t understand, if you are allergic to fragrance like I am, for example, I can’t have fragrance in my products. Well, botanicals are fragrance. Now, they may list on the front of it, it says, “It’s fragrance free” but, it’s not, because it has botanicals in it. How many of us have product, to your earlier point, that’s under the counter, that we try once, that doesn’t work, we can’t use it and we can’t take it back. And that happens all the time. And it’s actually bad for us.

So this was created because we know that—we know Mayo’s top ten allergens that cause the vast majority of people to suffer from babies to teens, preteens to adults. And even more mature skin, which is what my skin is. So it goes across all barriers, so everybody uses this, we actually, you can scan a product into the system. There’s two ways: with SkinSAFEProducts.com, which you can go to online and you can look at all the product on SkinSAFEProducts.com, and there’s ten categories. The way this system works, it’s personalization for your skin. So you can turn on and off filters, so you can turn on and off fragrance—if you’re not allergic to fragrance you can turn it off. But, you’re allergic to MCI, you’re allergic to parabens, you’re allergic to other things, you can leave those filters on. Then what it does, it will show you product that actually is okay for you to purchase. It takes all the angst out of it. The other way that you can do it is, you can download SkinSAFE, it’s all one word, you can download SkinSAFE on an iPhone, Android, and you can go in and you can scan your product into the system, using your barcode; if the product is in they system already, it will come back to you immediately and tell you how it ranks.

The ranking is based on the top ten allergens again. So, let’s say we scan Maybelline—an eyeliner, which I actually use, for $3.99, or Revlon, excuse me. And you scan that in and it comes up in the system, it shows you what it is, shows you the product and also says it’s “Top Free”; that means that it doesn’t have any of those top ten ingredients that are bad for you, and so that’s a product you know you are going to be safe with. There are 30,000 products in the system today. They’ve all been scanned in by the consumers, it’s crazy at the rate that we’re going with the amount of people that are scanning. Because so many people are suffering from allergens.

The other thing that I will say is SkinSAFE—the number one reason people go to the doctor, and I don’t if you know this, Barb, but I didn’t know this, I didn’t know any of this when I started the company: The number one reason Mayo says people go to the doctor are for skin conditions—number one!

Dr. Barb: Yeah, I saw one yesterday, and I’m not a dermatologist, so I’m probably not a great person to try to help women discern. But I think having this tool to refer patients to, who are suffering, and as you were talking earlier about what you experienced in menopause, you couldn’t see me nodding, but I was nodding as I’m recognizing this generalized dryness and feeling like the products I’ve used, while I don’t know if I’m so sensitive to them, but I feel like the effectiveness isn’t what it once was.

My understanding is, from your app, you're not necessarily promoting the best, you know, wrinkle cream, or the best moisturizer, you’re really helping individuals understand the likelihood of tolerability and again, lack of irritation or—

You just need to know. Information is power.Michelle: Exactly, so they can actually—we show you all the ingredients, every single ingredient. We also, let’s say the product ranks 91 percent. You can click on the ranking, on 91 percent, and it will show you why it doesn’t rank “Top Free,” why it’s not 100-percent okay for you. Lot of times when it’s 91 percent it’s because there’s fragrance in it. And you know, it’s just really personalization for everyone around their skin. We don’t promote any particular product, we simply say, these products are “Top Free,” these products rank 91 percent, these products rank 83 percent, and then we show you all the ingredients, we show you why it ranks that way, and then you get to make the decision. Maybe this product is fine for you, maybe this is a product that you’ve been using and you scanned it into the system and you’ve never had a problem with it, and it doesn’t rank as high as I would like it to rank, but you’re okay with it. That’s fine too. You just need to know; information is power. Just like with EmpowHer, information, knowledge is power. And this is putting the knowledge base into the hands of the consumer.

By the way, there’s a back end for the dermatologists, so the dermatologists, the allergists, the pediatricians, Barb, you should probably have access to the back end too, for your patients. You can give them the front to go to, but the back end actually allows the physicians to pinpoint what the allergens are, because they’ll patch test their patient, or just know what they are, give them a PAC Code, which is a “Patient Allergen Code” and they send them to the front end of SkinSAFE, where they can see only product that’s good for them. And that product then they can purchase right there on SkinSAFE; they don’t have to go anywhere else.

Dr. Barb: So it’s a store as well

Michelle: It is. It’s a great way for the dermatologist to have access to all the ingredients, and this is constantly changing, too, by the way. So, we change, we just added a propylene glycol is a big offender in a lot of products, so we just added that particular badge to our system. So we are constantly adding things. We have what we call a “Teen Safe Badge” because we know there was a study done last year regarding young, preteen girls who were putting an average of eighteen products on their skin, and it was affecting their hormones. There’s about nine different ingredients that affect a young woman’s hormones. And so we took those nine ingredients and we put those into the system, so that our algorithm knows those nine ingredients are in there or not, and then it will give a badge and it says “Teen Safe,” which means that teens can use it and it’s safe for them.

We created a “Lip Safe” badge, because I just had a situation, and a lot of people do, I’ve had chapped lips forever, but I was at the dermatology conference a couple weeks ago, and my lips blistered. I put something on them, and they literally blistered. I was in so much pain, and here I am talking to all these different brands, and I can’t hardly speak, because my lips are swollen and they look just awful. So I said to Dr. Yiannias, “Can I create a ‘Lip Safe’ badge? And how many people have trouble with chapped lips or what I’m having, the blistering?” And he said, “It is so common, you have no idea.” So I said, “Good. I’m going to create a ‘Lip Safe’ badge.” And I did. And it was so interesting, because for men, toothpaste is the biggest offender for them getting chapped lips. Then they go buy chapstick, and chapstick is not a “Top Free” product, so now they are adding insult to injury. For women, it’s the lipsticks, the lip glosses, those types of things that we are putting on our lips that are not “Top Free,” or there’s something in there, and typically it’s lanolin that causes the problem, that causes the lips to do what mine did, which is blow up and blister.

This “Lip Safe” badge, we created it, I couldn’t wait for it, because I couldn’t wait to find a “Top Free” product, because I can’t find a “Top Free” product or lipstick or lipgloss to save my life. And sure enough, the first one I tried, which was Neutrogena, it’s a hydrating lip gloss, and it’s I think, like $3 a piece, no more chapped lips. I’ve had chapped lips for at least the past 15 years, maybe 20.

Dr. Barb: Wow, it’s fascinating, so again, thank you for leading this charge. Now, with what I do, through my practice and my website, MiddlesexMD, we’re talking to woman about vulvar healthcare, vaginal healthcare and women are reaching for lubricants and moisturizers and products to address vaginal/vulvar health, sexual health, and certainly we understand in menopause, that’s an area that becomes uniquely challenging and more sensitive as well. Does your site, does the SkinSAFE site address the sexual health related products?

Michelle: It does; yes, it does. I knew this would be a topic of discussion for us, because of course, anything that touches the skin is going to be in the system. So whether it’s eye drops, whether it’s mouthwash, whether it’s lubricants, whether it’s anything feminine hygiene—you bet it’s in the system. And if it isn’t in the system, it needs to be scanned by whomever is using it, you know whatever consumer is using it and we’ll get back to them and let them know, you know, this is how it ranks. Because, I believe that women should only be using what I would consider “Top Free” product as lubricants. It also deals with condoms and everything else. Anything that’s touching the skin needs to be put into that system, and so, yes, there is a whole area, it’s called “Personal Care,” and from “Personal Care” you can go to “Hygiene,” it just covers everything. I can’t wait for you to go use, really take a deeper dive, because your patients are going to absolutely love this; I mean everyone is loving this, but particularly women, because as we know women are buyers, they are buying for the family. But, I will say, it really does tell you what products are good and which aren’t.

The other problem that we have with all of these products is that you can get one batch, so let’s say you buy a bottle of shampoo, and it works great. The next time you start having a reaction, and you don’t know where that reaction is coming from, because it can’t be from the shampoo, because you’ve been using the same shampoo forever. Well, not necessarily. It can be the shampoo, because there’s an ingredient change that occurred from batch to batch. Either they couldn’t get that ingredient, or they got a cheaper ingredient or substitution for that, and they don’t have to tell you this. So, you as a consumer, you're scratching your head, no pun intended, trying to figure out why you’re having this issue with your scalp, and it’s because there was an ingredient change and you didn’t know about it. So we always recommend you scanning in that new product as well, even though it’s the same product you’ve been using, to see if there’s been an ingredient change, because they won’t tell you. And it’s more frequent than you think. And when it says hypoallergenic on it, again, there’s no such thing.

You can say anything on a label... but that doesn't mean it's true.We’ve created the standard with Mayo for hypoallergenic; there’s been no standard. You can say anything you want on a label when it comes to skin care, but at the end of the day that doesn’t mean it’s true. That’s the same with organic; you can have one little teeny tiny organic thing in there and the rest is not organic, and yet they’ll claim it’s organic. You know, buyer beware, this gives the opportunity to the consumer to actually understand what they’re buying and getting the best product for them. And the lubricants, the condom, all those things that are so critical, and at some point I want to have, and I know we’ve talked about devices, and you and I can talk about devices all day long. But, devices as well, need to be put into this system, so that we make sure that there’s nothing that can irritate the skin. Whether you’re using them for sexual pleasure or you’re using them because you need to ensure that you keep everything healthy.

Dr. Barb: Do you have any optimism that there might be more push for truth in advertising or—

Michelle: Absolutely, yes.

Dr. Barb: I would like to think, as you know, hearing about understanding more about the contracts we enter into unbeknownst to us, when we even sign up for an app and you know, the knowledge that these companies have about us, I’d like to think that this knowledge will lead to consumer advocacy for more transparency

Everyone wants to know what's in their products.Michelle: Totally. You know, our market really has been, the millennials that are really, you know, they want transparency, they don’t believe marketing, they don’t believe any company who’s marketing their product, they want to know. They want to know what’s in it, and if they don’t know what’s in it, if you’re not honest with them, if they’re not giving us the ingredients that we can put into the system, they’re not buying it. They’re not having it. And we talk about the millennials and we think that’s just happening with them, I will say that it’s, yeah, I’m going to make a broad statement and say, it’s not just the millennials, it’s everyone. Everybody wants to know what’s in their products. You know this hit and miss, that’s the way we used to practice, that’s the way we were used to doing things. Now as these tools are being created to help the consumer, you know the consumer is using them. Because we make it very easy and simple for someone to find out what works and what doesn’t. And the price point varies too. You can go from a very expensive product to a very inexpensive product. Like I said, my Revlon colorstay lip—not lip liner, eyeliner, which I had a huge problem with eyeliner for years, never knowing I was allergic to is, is like $3.99. I was buying $60 eyeliner that was causing me to have an allergic reaction.

Dr. Barb: Yeah, it is a tough, tough place to navigate, so again, thank you for all the work you’ve done, not only behalf of women in this case, but everyone who is searching for a better option.

As we close our time together, Michelle, can you share with our listeners, where do you find richness at this stage in your life?

I want women to have everything they want and need to live happy, healthy lives.Michelle: I think my richness comes from several different things. I think my richness comes from my relationships with my family, with my friends, with my partner. And I will say that my richness, my true richness is the passion that we both share for and around women’s health and wellness. I want women to have the opportunity to have everything it is that they want and need to live happy, healthy lives. And if I can make just a little bit of a difference in as many women’s lives as I can, that’s my goal. And that’s what I wake up every morning thinking, did I save, change or improve somebody's life? And we can monitor that actually that on EmpowHer, and every morning I’m not disappointed, because we’ve done just that. Now, I’d like it to be a million women a day, but you know, it’s really, I find it so enriching for me to be able to do what I do every day and knowing that I’m making even a small difference in the life of someone.

Dr. Barb: Well thanks for sharing, and I can say I know you are making a difference, too. And it’s so great to spend time around you, recognizing the passion you bring to everything you do, and the get-it-done approach, because I don’t know if I know anyone who’s been more successful in getting it done. So thanks for what you have been able to do and what you will continue to do on behalf of women.

Michelle: Oh, well you’re welcome. And thank you. I’d like to do more, I’d like to create more tools, I’d like to continue on to help the patients, but also help the healthcare professionals like yourself, because you’re busy, too. You’re navigating a very difficult system today and working, and you want to do the best you can for your patients and I want to try to help that become an even better experience.

Dr. Barb: Well, thanks for your time, Michelle.

Michelle: Thank you, Barb. Thank you so much.


August 01, 2017


about middlesexmd ›  

"Women are great reinventors."

Lesley Jane Seymour with Dr. Barb

Lesley Jane SeymourLesley Jane Seymour made an immediate entry into journalism after graduating Duke University as an English major. She reported for Women's Wear Daily, The Daily News, Harper's Bazaar, Vogue, and Glamour before assuming editorial leadership at Redbook, Marie Claire, and More magazine. She was named Most Powerful Fashion Magazine Editor by Forbes during her tenure at More. In addition to writing (including two books) and editing, she's pursuing a Master's of Science in Sustainability Management and has mentored Brazilian women creating social enterprises through Vital Voices Global Partnership. Her latest venture, Covey Club, is described in this interview (and the second installment that follows).

Listen now.


Dr. Barb: Our guest today is Lesley Jane Seymour, an award-winning journalist, editor, author, and entrepreneur. She’s known for her leadership as the editor-in-chief of Redbook, Marie Claire, and especially for us, More magazine. More was a magazine that I really valued. I valued it for the way that it not only validated, but inspired women at a life stage that others are writing off. Her interests are varied and deep, from sustainability, to design, to history, to leadership.

Lesley, welcome. Thanks for being here today!

Lesley: I’m so glad you’re having me!

Dr. Barb: I have to say you’ve been someone I’ve admired from afar for a long time, so I feel like it’s a special privilege to get a chance to have a direct discussion and hear more about your life and your influence for many other women. My background, of course, has been in women’s health care for many years, so I feel like we share some of the same passions around women’s issues and....

Lesley: Ohhh yes!

Dr. Barb: So you’ve had a front seat to changes in the media over the last 30 years. And my, how they’ve changed over that time. What do you see as maybe the most positive change?

Lesley: Oh! Good question! [laughs] Can I say there’s anything positive today? The positive thing that’s happening is that the miraculous nature of internet and all of this tech stuff has allowed people like me, who the sad part, have been closed out of our old lives in disruption from the print world (which is really collapsing) to recreate that experience as a solopreneur, in a kind of crazy whacked-out nutty way…. And as an example, I’ll give you this project which I’ve been working on since the magazine closed – which is now called Covey Club – it went through a couple of other incarnations. But “covey” means a small group of birds, and I wanted it to be small and cute and cozy kind of thing.

For a year and a half I’ve been working on creating a kind of “digizine”/club for the same More reader who has no place to go, basically. There’s nobody writing for us anywhere. Lo and behold, after a year and a half, my beautiful designers in England working on it, it arrives in my inbox. And it’s like holy moly! This is the night that it arrived; I looked at it and I thought, “Wow, this is the thing I had to go to a job for!” I had to put on my pantyhose, I had to put on my Spanx, I had to put on my lipstick, do my hair… I had to commute through the snow and the sleet… to do this! To contact people and present people with things that are beautiful and intelligent and smart… and here I’m doing it from my own home! It’s crazy!

I explained to a friend of mine who is a Broadway producer who is now retired – he’s living down in New Orleans – I said, “Imagine that you could – from your bedroom – put on a full-fledged Broadway musical by yourself.” That’s the miracle of what’s going on. That’s the insanity of what’s going on because, of course, once you get it going, how the heck do you do it by yourself? It’s crazy!

Dr. Barb: Yes it is crazy, and I think the other thing is there’s so much out there that to try to help women discover the avenues they want to discover – for me in health care, we all know what it means to Google a condition.

Lesley: Yes! Oh, my gosh! Don’t do that! [laughs]

Dr. Barb: Yes, exactly! So I think for me, it has been overall favorable in my career as well, but also just feeling like so many things get lost in the morass of options.

Lesley: Yes. You can’t stay on target anymore. I mean, these are the things I’m going to write about; I’m just going to learn so much about this. And I’m not ADD at all; I can’t imagine what somebody does today who has ADD. But you end up working on something, a ping comes in, you end up down a rabbit hole fixing something that’s going on with your computer… an hour later you’re coming back trying to finish one thing, the news feed is coming in….

Everything's out there.You can’t find anything. You can’t hold on to anything. You can’t organize anything. What’s amazing is everything’s out there, but you can’t find what you want. And that’s kind of what Covey Club is going to be is a platform where you can say, “I want to know anything about women 40-plus.” “I want to find health info.” “I want to find your product that you’re talking about, your books.” I want to be that crossroad where you can just log in there, I’ll be directed... I want beauty resources… I want fashion resources… I want health resources… I’m not going to try and recreate everything that’s out there, but I will try to weed through the good stuff, and talk about and bring people together with the good stuff. There’s a lot of “junk” and a lot of bad information put out by people who really don’t know any better – I don’t think they are trying to put out bad info, but they do. And, that’s what’s hard. Today you need a policeman at the center of all the cross streets so you can get across.

Dr. Barb: I will speak personally about this, I think that was the beauty of More magazine. It arrived to me, and every page was information that was helpful and valuable to me, and I was one of those cover-to-cover readers, enjoying the variety of aspects. And I didn’t have to go through 48 different magazines to find the articles I wanted. It was distilled for me in that one magazine. So I have to say, I mourn the loss of the print, but I understand the importance of the changes that are coming, and I hope your future in this endeavor is going to continue to reach all the women you have over the past.

I will just tell you that my own story in healthcare was that about 10 years ago – and again, I’ve been a More magazine consumer for as long as More magazine was out – but, I went back to do a masters in Medical Management, and expand my profession to have a bigger understanding of the business of healthcare. As a result, it inspired me to start the business I have – that’s MiddlesexMD, which is around women’s health and women’s sexual health – and I felt like you were alongside inspiring me. During that time, my sister went back for a doctorate – she’s a bit older than I am, and she’s in nursing – she went back for a doctorate!

Lesley: Yay! All our older school-goers! It’s so great! I’m five classes away from finishing my sustainability degree, but Covey Club is getting in the way. [laughs]

Dr. Barb: Yes. Well, my sister actually mocked up an article to send to More magazine. She thought we were newsworthy at the time, I’ll just let you know. [laughs]

Lesley: Yes! It’s a great thing. I mean there’s a wave of older people going back to universities. I think they’ve finally figured this out… I mean Columbia in New York, has certainly figured this out… there’s this giant population of reinventors sitting at their doorstep, and they better figure out how to bring them back in. They’ve done a very good job of it.

Dr. Barb: So what do you think are the characteristics of women kind of reinventing or recreating themselves? What is it you would say to somebody as they wonder about what could be next for their lives?

Women are great reinventors.Lesley: I think many women are, first of all, women are great reinventors. They’ve been brought up being reinventors. I mean, the essence of everything we do with our makeup, with our hair, with our bodies, with our “whatever”… we’ve been reinventing ourselves from the first day we, you know, had a consciousness, practically. I mean, that is why my tray is full of all these lipsticks that all look the same is it’s because each single one of them when I put it on, it’s going to make me a new person who’s going to have that perfect life, right? And, that started when I was 13. That’s what we’re being sold. And there’s a nefarious part of it, but there’s also a wonderful part of it which is that, we’re good at that. You know how you feel when you get a new haircut, or you get highlights, or you just feel like a new person. And I think we have to take that idea into the second half of our lives and realize that we may either be forced to reinvent ourselves, asked to reinvent ourselves, or life’s issues may suggest that you may need to reinvent yourself.

Who do I really want to be? What do I really want to say to the world?And, also as you get older, very frankly – I just turned 60 in January – and it is mortality breathing down your neck… where you say like, “I don’t have all the time in the world now to figure out who the heck I want to be. What do I really want? Who do I really want to be? What do I really want to say to the world? How do I want to impact the world?” And it’s not just about a job. It can be about your body, it can be about your relationships, it can be about everything. You can take segments and work on them, but I think using other women who reinvented themselves is an inspiration and looking at what other people do for themselves.

A new beginning is always great. It’s the thing that used to get me to go to school with my new notebook and my little pencil case, for those who remember that. I think that’s kind of how we have to look at our lives, and now with technology at our door, forcing disruption in our jobs and in our lives, we are forced to reinvent more often.

I go around the country, really talking to women and telling them, “Even if you’ve been at your job for 25 years, and you love it and they love you, you need a reinvention idea in your back pocket. Because reinvention may be forced upon you. When that company is absorbed, or goes out of business, or it’s bought and moved or…” The world is moving and changing, and we need to be prepared.

The world is moving and changing, and we need to be prepared.Dr. Barb: Yes, and I think interestingly, some of the research has suggested that women at this age, and I’ll put myself in that as well… my practice is primarily perimenopause and menopausal women’s health, but women at this age are open to learning new things, and establishing new habits. So I find it an interesting opportunity to talk to women at this stage of life, and kind of saying, “Okay, the fork in the road looks like this if you continue doing what you’ve been doing…” and whether it’s joints or weight or whatever their life health thing might be… “…or you can make it different. But It requires that you approach it differently.”

Lesley: Yes.

Dr. Barb: This is the way you need to think about it, and surprisingly, at this part of my practice in the last few years, women come back… I’ll use weight as an instance. I saw a woman the other day. She came back and had lost 32 pounds since last year!

Lesley: Wow!

Dr. Barb: And I said, “My goodness, congratulations, how did you do this?” And she said ”You told me I should!”

Lesley: Wow!

Dr. Barb: Yes… and it doesn’t happen often enough, but I do think it does speak to women’s interests and motivation to try to approach things in a different way. So, I think people like you out there speaking to this, and encouraging women and… because it feels uncomfortable. So many women are in a social situation, whether it’s marriage or job, that they aren’t sure how to take that next step. I wish we could pair women up with mentors a little bit more intentionally to…

If she can do it, I can do it.Lesley: Well, that’s one of the things that we did at More and I hope to do at Covey Club also, is put a “pu pu platter” out there of potential inspirational ideas and concepts. Because I think that’s how we relate, and that’s how we move forward. You know it’s the old if she can do it, I can do it. Right? I mean look at me: I’m sure I’m the most hilarious part of this whole thing, and I’m going to write about it in the newsletter is that, Hey, I’ve studied reinvention for 8 years, and now I’m starting at the bottom! Boy, is it eye opening! It’s lesson-learning; it’s exhilarating; it’s terrifying; it makes you cry every other day. But, it’s an adventure. You can either decide you’re going to run away and you’re not going to deal with where we are today, or you’re going to face it head-on and tackle it; and you need to look at other people who are doing that. Let me tell you, I look at all these other people who are entrepreneurs, and who have done amazing things, and I’m inspired by them. So, it’s kind of a mutual inspirational society. [laughs]

Dr. Barb: Yes, and I think a lot of times we think of mentoring as younger, you know this next generation, pairing them with mentors. But I think sometimes we overlook the value of mentoring another woman at our stage of life.

Lesley: Oh yes!

Dr. Barb: Because we do need to see that somebody else has done it, and how did they do it, what were their obstacles, and… I like your sharing your vulnerability of feeling like you want to cry one day and...

Lesley: Oh, it’s horrible! It’s horrible because you’re isolated, Barb. You’re isolated. I’m not an isolation person. I’m like a mega-uber extrovert, so it’s really tough working alone for me. And I recognize that. I call work the second family. The easy thing for me to do and someone like me, and with my personality, is to say, “Okay, the way to solve that need for what I call the second family is to parachute myself into some existing second family that already exists.” I know how to jump in, parachute in, get with the flow, start organizing things, blah, blah, blah.

But at this stage in my life, I don’t want to do that, so when I feel this need (because both my kids are gone – we just dropped my daughter off last week in Boston; she’s living and working Boston now), that’s an enormous transition. You know, I’m all alone – you know, like me, my husband and my two cats! But what I’m trying to do is force myself to use that desire for the second family, that desire for this bigger group that I’m part of and that I can lead or be involved with to drive creation of this project.

Instead of looking for something that is pre-fab, I want to make it myself. Because I don’t want to go back to another situation where I have a guy telling me, “Yah, that sounds interesting… let me check with my wife.” I want to run it. I don’t need to ask permission from a bunch of guys who’ve done less than me. So the key is finding a business method and a way to fund this that actually allows me to do that. And it’s new; no one’s done it, and it’s scary, and you do cry. You cry… you know, you’re waiting for… I just put a little test out in a field of a 100 beta testers, and I’m a big researcher, so I’m always looking at what readers and members say, and I get the surveys not attached, so not many people can see it… Anyway, I get two responses. I go in there and look at the responses, and one of them is like I’m not interested in this… this is a bad blah, blah, blah… whatever, it was all negative… and I’m like crying. I’m like “Oh my God! It’s over! I’m dead. I can’t do this….” [laughs] You know, and then you pick yourself up and you’re like, “That’s two responses!” I need a hundred!

Dr. Barb: Yes.

Lesley: But you’re all alone. It’s really hard.

Dr. Barb: It is hard. But I liked your comment on a second family because that just feels right to me because family shares, and family is always honest and gives you feedback and encourages you. So, I think that maybe that can replace our old “sisterhood” term. But a second family is a nice way of thinking about it.

Lesley: Well, and you get to make your second family. And also, you need a second family when your first family grows up. It’s very very hard, even if you’ve been a career woman, which I’ve been. But you know we’re very involved with our kids. We’re very attached to them. We’re very close to them, especially because of technology. I mean I talk to my daughter three times a day still, and I don’t think there’s anything wrong with that. I’m not telling her what to do or telling her how to lead her life. We just have a really tight relationship, which I think is actually in response to our parents, which were the 50s generation people who were like, “Go outside and play and come back at 5 o’clock. See ya.” And they’d lock the door.

I had one girlfriend who actually told me her mom would do it in the snow, and say “You don’t come back ‘til 5, we don’t even want to see you.” We can’t even imagine that. So we do need a second family. Especially as you get older, there is an isolation that descends on all of us, and no one wants to talk about it. It comes out first as loneliness. You can’t figure out… is it something wrong with my marriage? Is it something wrong with… What the heck is that?

When you really dig around into it, a lot of it has to do with structure and your personality. A lot of women are ashamed to even mention that they’re lonely at this age. And they are lonely because they are going through changes, and the structure is changing. You have to solve that issue. So it’s funny, when I was creating Covey Club, one of the friends who is helping me is from Seattle where they do all this start up, start up, start up, and they have all these words. She kept saying to me, “So what are we solving for? What are we solving for? We’ve got to solve for something.” I’m saying like, “I don’t know what you’re talking about… solving.” I’m not like getting someone a date. I’m not making a car come pick you up. I don’t know, what am I solving for?

I spent about two months thinking about it. I really dug down to the core of it and I said, “You know what I’m solving for? Dislocation and isolation,” which we all feel no one wants to talk about. And underneath it all, I know the majority of women who are 40-plus are starting to feel it and they’re starting to feel it as their kids get older. They’re starting to feel it as they turn around and see that they’re the oldest person in their firm. They start to feel it as their parents get older and they have to take care of them. I mean… I have 8,000 people on Facebook, and I am disconnected.

Dr. Barb: Yes. I want to step back into your More magazine days and ask you about what was your most memorable interview?

Lesley: Oh, that’s not fair! [laughs]

Dr. Barb: [laughs] You can’t pick a favorite child either, can you? [laughs]

Lesley: Yes, no, but I do. And it’s really the highlight. I have to tell you, I led such a blessed career life, way beyond what I ever thought. I’m ashamed in the feminist world, to say, “I just thought I was going to be a writer.” I never dreamed that I would to do all the things I got to do and run so many magazines and meet so many interesting people and travel the world.

The most interesting interview I did really was with Mrs. Obama, sitting in the dining room in the White House and interviewing her about the photos that she had picked for us for the issue that she did where she guest edited. She’s just such an amazing, amazing, grounded, sensible, intelligent, thoughtful person, that when we finished the interview, I said to her because she went through all the history of the different photos and told me anecdotes, so I put in the magazine afterwards… I just said to her, “God, how do you stay so grounded in this kind of situation when you’re living in a fishbowl?” She said, “You know, this place makes you more of whatever you were when you came in here.” And I’ll tell you, those are words of wisdom that I think are playing out on the national stage today in another way.

It’s just so interesting to see somebody like that and how they maintain themselves and their realness and their authenticity through all this stuff. She was a real… I just became a very big admirer of hers. You know, she didn’t have it so easy, and yet can talk very clearly about it. I’ve traveled around the world with her when she was launching Let Girls Learn, which I thought it was an incredible program. When you really dig in and understand how bringing girls to the table, around the world… but you don’t understand what is the ROI on that… why should I care about a little girl in Cambodia? The reason why you do, is the facts are there. When you bring women into peace process, when you bring women into business, when you bring women into government, when they have a seat at the table… things are less dangerous. They are more stable. They tend to share food, they share resources. I mean, it’s not that we don’t love men. We do. It’s just a different way of looking at the world and our security here is actually bolstered by all that. I thought she had just a really interesting view – expansive view – on how you make us all more secure. So, she was just a rock-star interview.

And then I got to interview her again in front of the whole publishing world, when she came to speak with Lena Dunham and Julianne Moore where we talked about “media with purpose.” Three weeks before they pulled the plug on More magazine [laugh]… that was really fun. But it was an amazing interview. Talk about people who are so jaded, the place was packed with every single person in publishing, and not a peep out of them for an hour. People came up to me afterwards and said that was one of the most amazing interviews we’ve had.

Dr. Barb: Thanks for sharing that. I guess I had no idea who you might mention, but after speaking to it, I’m not surprised that she might have been your selection. I think she does represent beauty in just a genuine sense of self that so many women can learn from.

Lesley: Amazing! Amazing! And I’ll tell you the most funny thing about it: I photographed her before she was First Lady. When I first walked into the magazine, which was 2008 in January, I was looking around for somebody who would represent who the More woman was but was not a celebrity. She was out there and people were giving her a hard time because she said some things that people reading as negative about the country, whatever; but she was intelligent, she was smart, she was speaking out. So I reached out to them and said, “Look, can we do a photoshoot with her? I don’t know whether her husband is going to run or not. We don’t know if he’s going to get win any of the primaries or whatever. But I could make a deal where if he doesn’t, we’ll still do the story. We’ll put it inside the magazine, and if he does, we’ll put it on the cover.”

They said fine, and I went to photograph her in Chicago. The hilarious part is I was not planning on taking a photo with her, and my photographer who is a very jaded guy from California comes in, first time I ever saw him wearing a suit. I was hysterical because he’s usually in jeans and sneakers, right? So he dressed up for this interview. So he says to me at the end of the shoot, he says “Do you want a picture with her.” And I was like… I mean I literally had no makeup on, I wasn’t even wearing a bra to be honest with you that day [laughs] and I was like “Oh my God, alright, whatever.” So I stood next to her and she put her arm around me, and literally, I’m in her armpit. I’m so small and she’s so tall. And he’s says to me, “Oh, let me go get a crate to put you on.” He walks away and I feel this rubbing on my back. I turned around and I’m like, “Who is like rubbing my shoulder?” And it’s her! I thought, “Wow, this is like really amazing!” All the way through, the reason why she did three more covers with us is her PR people – she had a couple of them – would always say she would remembered that first shoot.

At the end of all of our encounters, even when she was First Lady, I would go to do a handshake – I’d put my hand out for a handshake, and she would always come in with a hug.

Dr. Barb: Nice. Yes, she’s got great style in every sense.

Lesley: Authentic. Authentic.

Dr. Barb: That’s a great word for her.

Dr. Barb: Our conversation with Lesley was covering so much territory, we let the interview continue to roll. Look for part two of this episode.