Navigating a Broken Healthcare System: 85

Hello everyone. Welcome back to the Heal, Nourish, Grow podcast. Today I have with me Susan Salinger, which I had to kind of, you'll notice when I read her intro, I had a little giggle because it, her dog is actually named J.D. Salinger after the famous American author. So I got a big kick out of that. But anyway, Susan is joining us today to talk about her book. It's called Sidemind and it's all about how women can, first of all, the issues with navigating our current healthcare system and how women can learn a few things that can help them. Better navigate it for their families, for their own healthcare. And I don't want to say too much about that because Susan's going to tell us all about it. But before we get into that, Susan, I read your official bio, but I would love if you could share with people your, just your little bit of backstory about your health, how you got into this, you know, wanting to do this research with women. And because it's in your bio, 81 years old, I mean, that's amazing that you did this work at a later time in life. So I'm just really curious to hear like what lit your fire to want to interview people and write this book?

Well, you know, it was, it was a long journey and it was serendipitous to a certain extent. Many years ago, I mean, when I was like in my 20s or 30s, I agreed to have some exploratory surgery that I was positive I didn't need. I was on hormones. I think it was for osteoporosis. Even that young, I can't remember anymore. And I was doing fine. And the doctor said, well, hey, you know, there's this new medication. It's even better. Let's try it. And I'm sure, you know, what the hell. So I tried it and then I started some vaginal bleeding and had symptoms. And so I said, I better go back to the other medication. This isn't agreeing with me. And he said, no, no, no, no, I'm sure it's not the medication. I've never had anybody say that before. We— and he did a bunch of tests and everything was normal. And he said, we really need to do exploratory surgery. He was really worried about it. I know he was looking for ovarian cancer. And if he'd been right, I mean, he would have saved my life. But he wasn't right. And they— we did the surgery even. And I was just— I knew I shouldn't have done it. But anyway, I was fine. Okay, end of story. Life goes on. And then many years later, after my husband and I sold our business, I mean, you know, 30 years went by, but I retired and that lasted maybe 2 or 3 seconds. I'm the wrong woman to retire. It didn't work. So I went back to work. I mean, I've told you it was a long story, but all I could get into was anthropology. Everything else was closed. So I just— I took some classes and I thought it would be really fun, which it was. I loved it. And some of the— I did for one of the classes, I did a project on women who had hysterectomies. Why hysterectomies? I've never had one. I don't know. But that's what it was. And a couple of them had actually agreed to the hysterectomy surgery, even though they didn't think they needed it. In fact, they said that they were sure their symptoms were just premenstrual. Menopausal. So, but nevertheless, they too agreed to the surgery. And that really triggered my memory. And I thought, oh my gosh, as women, how do we make our medical decisions? Why do we do this to ourselves? I mean, in my own case, I could have investigated. I mean, I could have gotten a second opinion. I didn't. I could have done some research. I didn't. I could have waited a week or two and gone back on the old pills just to see what happens. I didn't. I mean, I just did it. And that's what these other women had told me about their hysterectomies. So that's really how I got into the book. I started doing some research and I, I actually what I did is I interviewed about, I think, I don't know, 50, 60 women and discovered what they had in common, all with different diseases. But I was interested in their behavior and, you know, did they get second opinions? What happened at their doctor visit, that kind of thing. And I found, you know, several things we all have in common. And there it is. Wow.

I don't know. So you— I am guessing that your publicist, maybe she did or didn't read my bio. I would be curious now to know that, having heard your backstory, because I had a hysterectomy at age 32. My goodness. And yes. And Unfortunately, I had a lot of pain and it was a little bit slightly more clear-cut, not totally clear-cut, but what you're saying right now is totally taking me back to that place and the decisions I made at the time and how it really seemed to be the right thing. And yet in retrospect, and that's often the case, right? We can't always know until it's down the road.

It's a wonderful thing, but it can be so destructive.

Yes, for sure. I mean, you can't second-guess yourself a million times, yet you can. So I'm really happy that you're providing this as a resource because at some point, maybe a future podcast, maybe I'll go into all my decision-making process because it is— there's a lot of nuggets, I think, to be had there. And I think certainly the second opinion is probably one of the most important.

You know, it really is. It's probably, well, maybe the second most important chapter in the book because as women, we— well, men do too, but women really hesitate to get second opinions. We don't want to be rude and we don't want to hurt the doctor's feelings. And, and, and I mean, we have 100 reasons. It's also a pain in the neck. I mean, let's face it. And you're not feeling well, you know. So now, now I'm saying, I know you don't feel good. I know it's a pain in the neck, but get in your car and go do it anyway. But that is what I'm saying. And I'll tell you what I learned, which I did not know until I did the research for this book, is that there's about 30, 40, maybe even 50,000 diseases out there. And those are the ones we know about. I mean, COVID's probably, you know, 40,001 because there are a lot of diseases we don't yet know about. But, you know, for a doctor, a diagnosis is pretty much like looking in a haystack for a needle in a haystack. So many of these diseases, their symptoms mimic each other. I mean, if you go, you have pain in your leg and you get your leg X-rayed and it's broken, that's a no-brainer. But if you go in and say, I'm tired and I have no energy and I'm irritable and I have no appetite, I mean, those symptoms they can fit 29,000 of the 30. Yeah, it's, it's a really difficult thing. And the other thing I learned, and this is all why we should get second opinions, is a lot of— I mean, as people, as doctors, we all see what we expect to see. So the same symptoms will be stomach problems to a gastroenterologist, stress to a psychologist, joint issues to a rheumatologist. And they may be right or wrong. I mean, it's just we see what we expect to see and you tend to diagnose what you see most often. So, I mean, a second opinion is really a very important thing to get when it's something serious like a hysterectomy or like the, the exploratory surgery I had.

Yeah, absolutely. And so you were doing the anthropology courses and in the— it sounds like in the process of that you heard from some people that brought these feelings up again. Did you use those people in your research? I think you said you interviewed like 60 people. So where did you find— once this ball got rolling, how did you find the other women women to talk to?

You know, it turned out to be fairly easy, actually. I went to support groups and once I got through the— to the— I had to— what I must have emailed. I'm trying to think back. I emailed the people that were leading the group. And once I got into the first one or two, it snowballed. I mean, Jane knew Joan and Joan knew Janet and, and, and, and. So that's how I— that's really how it developed. And since I did it by disease, because I had interviewed women who had endometriosis, so I went to that support group. Fibromyalgia, I went to that support group, etc. And then I decided I needed— the women I interviewed were mostly local for me in California. And so then I decided I needed more geographical diversity. So I put together some focus groups and got women just over Zoom from all over the country. And that was, that was really helpful. Wow. It wasn't that— it wasn't as difficult as you would think, actually.

Well, and I think because when you find the people, like you're saying, going to support groups, those are people that are obviously now quite invested in their health and healing. And so I'd imagine that they're just excited that somebody is willing to listen to their story and to try to help others down the road.

We're so generous. They truly were. In fact, right now for, for book 2, I've been interviewing women that have had heart attacks, and the generosity from Women to women is just, I love doing it. I just love it. It's fantastic.

Yeah. And I think you seem, I just, the little bit I've known of you today and just chatting beforehand, you just have a way of, you know, putting people at ease, which is really great. And I think that that will lend itself very well to your research.

It does. It actually does. I really learned, and I actually learned it the hard way, the secret to good interviewing is, for the kind of interviewing I'm doing, is never to interview people you know. Because it stopped me. I did it with— I thought, well, you know, I've had a couple friends that have had whatever it was, and it doesn't work because I found myself hesitating to ask stuff because they're friends. It's none of my business. But interviewing gives you the right and the legal and moral obligation to ask anything you want to, you know. It's like, boy, I'm an interviewer. It's wonderful.

Well, not only that, I find one of the most gratifying things about this work of, you know, I'm doing a totally different kind of interview when I talk to people for the podcast, but it's kind of like people approach me and they'll say, well, what about this? And it's like, oh, I've been researching that before and I want to know more about it. So very selfishly, sometimes I agree to the interview, you know.

Sure. That's what I was— exactly what I would do. It's great fun.

So what did you find when you were talking to— you said you kind of did it by disease, but across all of these diseases, was there any kind of consistent thread that you found between groups? So it didn't matter what their disease was, but there was kind of maybe an overarching theme, or was it all different depending on what it was?

Oh no, there was some definite overarching themes. In fact, that's what I was looking for, were the overarching themes. I wasn't interested particularly in the disease. I was interested in the behavior and the decision-making that accompanied the disease. And I figured my hypothesis was that as women, we probably make our decisions in fairly similar ways. And we do. I mean, I was right. The first thing, for example, that I discovered was that we all, as women, we put ourselves last. There was a research study done where researchers gave women a list of 5 things to prioritize. Who would they care— what would they take care of first? And I think it was like 80% of the 100%, even if the women said first they would take care of their children and then second, they would take care of their pets, which I loved. And, and third, they would take care of their elderly parents. And as an elderly parent, you know, I did not like reading that, but there it was. And fourth, they take care of their partners. And last but not least, fifth, they would take care of themselves. And I found that so many of the women that I talked with had put off going to the doctor they had their— they had a project due at work. Their kid had a play at school they had to go to. There was lunches to make, whatever. So by the time they got to the doctor, some of them, a minor issue had become a major one. And I think that that's a real downfall. And then, as I said earlier, a lot of them hesitated to get second opinions. And, you know, if you have an autoimmune disease like fibromyalgia or lupus or endometriosis. I mean, it can take up to 8— well, let's say 7. I think it's 7 to 10 years to get a diagnosis. So you certainly can't just go to one doctor, have him or her tell you that it's all in your head and then go home and feel bad. And that happened to a lot of women. Fortunately, some of them also went to as many as 5 or 6 doctors. And those doctors really, you know, there's not— I guess what I'm saying is there's not always a definitive test and a diagnosis is not always a definitive thing. It's not that easy, as I said earlier. So second opinions are critical.

Did you find— and this, this is a little bit off topic, but I think not as much as maybe on the surface it seems— is that there's this trend now towards more concierge doctors, which of course not everybody can afford that, and also a trend towards more functional medicine type of practices. So I'm curious if any of the women that you talk to So it's very common that what you said, because medicine is so siloed, like you said, gastroenterologist for your stomach, you know, cardiologist for your heart.

Right.

But did anybody find a doctor that was more holistic and that was more of a functional approach? Did that seem to help their outcomes or the way that they were able to make decisions at all? Or have you not run across that yet?

I did not run across that. And I think partly it was timing. And it took me about 10 years to write this book. I mean, part-time, obviously.

Oh, wow.

But so the women I interviewed at this point, 'cause the book came out in 2022. So that was, let's say, 10 years ago. And concierge medicine, as I recall, did not exist at that time. Functional medicine probably did, but it was not nearly as popular as it is now. And concierge medicine's expensive. It really is.

Very.

And functional medicine, I've been on several podcasts where the doctors were functional medicine doctors. And that's— I've never been to one, but it certainly sounds like a good thing to me.

Yeah, it seems like it would help that process in some way. That's why I was curious. And like I said, I don't know if it's relevant or not, but it might be something to keep an eye out for because they're kind of more focused on the whole system. So maybe even though you were having a problem with, say, your stomach or whatever it was, and say maybe it was more female-related than gastroenterology, maybe they could work that out sooner somehow. I don't know. But that's just— that's my own theory.

Well, and I'll tell you how it is related, because I think it's really important. One of the things I talk about in the second opinion chapter is if you do get one, and of course I hope you will, you want to go to a doctor who's totally different from your primary doctor. What I recommend in the book is if your doctor was trained at the Mayo Clinic in Minnesota, go to somebody who was trained at Stanford in California. I mean, you want a very different opinion. You want you want to know what all the other possibilities could be. And we see what we expect to see. So if you go to a doctor in the same office or even a doctor that your doctor recommends, it may be because they met in medical school and had similar training. And that's not what you want. You want different training.

That is— that's an amazing and very good, like, actionable takeaway for people listening to this podcast is that it definitely Number 1, get the second opinion. And number 2, having it be somebody totally different, I think is amazing advice. What were the other things that women had in common?

Well, one of the things I noticed is that they all— how do I say this? Women talk to doctors differently from how men do. And a lot of the women I talked to, really, when they told the doctor their various symptoms, they went into all the feelings and all the emotions that they had. About how tired they were and how irritated they were, etc., etc. And when a man goes in, they're much more succinct, much more objective. They don't want to whine or be accused of whining or thought to be whining. They don't want to act like a baby. Whereas women— and I am totally guilty of this— I pour out the whole story. I not only say that my throat hurts or I broke my leg, but it's affecting my whole life and and here's how. And I think that that can distort the doctor's diagnosis. For one thing, and this has happened to me, my, my physical symptoms have become secondary to my emotional ones, but I went there for my physical symptoms. So I, without— I didn't mean to, but I distorted and lost the focus of the visit. So that's happened. And men, men have better luck with that because they are more succinct. And then the other thing that happens is the doctor then says, well, you're upset, so I think you're probably depressed. Let's try an antidepressant. Well, if I broke my hip, an antidepressant is not going to do me much good. And so not only did I distort the diagnosis, but the prescription is inaccurate. And then I go home and I feel bad. I mean, and that's how it goes. And I think a lot of that comes from— or not a lot of it, but much of it does come from how we describe our symptoms. I think it's very important to stay on topic. I do think we need to talk about our feelings. I don't mean that we don't, but at the same time, we need to be careful that we don't lose sight of the physical symptoms that were there for in the first place.

Yeah, that's another great piece of advice. Would you recommend— I mean, like you said, so women need to talk about their feelings. Maybe they need to talk about how they're feeling with whatever the health problem is with their friends or a therapist. But when they go to the doctor, what would you— could you see like maybe making a list of the symptoms or what do you feel might help them get the most out of a visit that would be more directed?

You don't know this, but you just inadvertently asked my very favorite question. I'm so excited. And I will tell you why. I have very specific tips, tips that I strongly believe in when you go for your doctor visit. And I'm going to list them if that's okay, because—

Absolutely.

One of the most important parts of the book. The first thing you want to do is go in with a written list a written list of your symptoms. And I say written because if you don't have it in your head, because if you're at all like me and I get anxious and everything I wanted to say goes right out. So I have a written list and I've prioritized my symptoms so that I make sure that what I think is most important goes first. And the other thing I like about a written list and a doctor actually told me this, I hadn't thought of it. But she said, the doctor I talked with said that she loves it when patients come in with a list because if she looks at it and she sees it's prioritized, but if she thinks the priorities should be the other way around, she has the opportunity to rearrange the list and what she thinks is most significant. And that's really important. So that's the first thing. You go in with a written list. And the second thing that I think is really important is to ask the doctor once you get your diagnosis, for the clinical name of your disease and to have them spell it for you. Because if you, again, if you're like me, I can't spell, I won't even discuss my spelling.

But now that you have an English degree, I have a master's in English.

But now that I mean, I have spell check. I don't even, you know, I think I have a brain anymore. Exactly. But seriously, you want to, you absolutely want to know how to spell it because I'm going to the back of my book and I'm going to sidebar for a minute. The back of the book has a terrific resource section. It tells you— yeah, yeah. No, the back of the book inside. Yeah.

Oh, I see. Yes.

Oh, yeah.

Here we go. Directory. It's a whole— yes, a whole list of all these things at the back.

How to do your research, how to find a doctor, how to find a good hospital, etc. So please check it out. But you want to be able to go home and if you have access to a computer and look up your disease, does it feel right to you? Are the symptoms that Google or whoever you use lists, is that what you have? How does this feel to you? And then the other thing, when you get a diagnosis, you want to say to your doctor, what else could this possibly be? And if you— if they blow you off, if they say, oh, nothing, I'm sure I'm right. One of the things that actually, again, a doctor taught me to say is, I know you've had a lot of experience with patients who have symptoms like mine. Have they all had disease X, or did some of them perhaps have something else? And again, you want the name and the spelling of that diagnosis as well. And then go home and do your research and look at my book and I'll tell you, I think I go to the Mayo Clinic a lot. I go to Cleveland Clinic because they're good for heart. It tells you in there. So let's see. So what have I told you? I've told you to get a written list, do your research, of course, get second opinions. We've already done that. And the thing that I also think is very important is to reframe in your own words what you've heard the doctor say. And that does two things. It gives you the chance to make sure that you heard correctly, and it gives the doctor a chance to be sure that they spoke or said what they meant to say. I mean, we all misspeak. We're all people. So you want to make sure that when you leave the office, you fully understand what you've been told. And I think if you do those things and take— oh, the last thing is take somebody with you if you can, because again, like me, I don't hear very well. I mean, physically I hear fine, but emotionally I If they're saying something I don't like, I shut down. So that, that's those— if you do those 4 or 5 things, you really focus the visit. Hopefully you'll get exactly what you need. And I think that that's— so many women leave the doctor's office, more people leave the doctor's office. I mean, this is a research statistic. More people leave the doctor's office not fully understanding what's been said. And you can't do that. I mean, it's your body. You don't want to take a treatment for a disease that you're not sure you have, don't understand, etc.

So, yeah, not only that, but you'll— even if you heard it correctly, sometimes you'll go and I think one of the things that you said there that's amazing. I mean, you know, people have this hate on Dr. Google, but Dr. Google is amazing. You need Dr. Google.

Right? Right. It is amazing, truly. And also there's— and there are even more sophisticated sites. Some of the stuff on Google, for example, is inaccurate. I mean, you have to be careful, but if you go—

especially now.

Well, yeah. And if you go to the Mayo Clinic or something of that caliber, your chances of getting misinformation are probably less than 1%. And I made that up. I don't know, but I'm assuming. Right.

When I would say one thing, people know my love of PubMed and reading research studies. And we were talking a little bit before, having gone to graduate school, I have a now I'm not like the best person in the world at it, but I'm certainly probably better than average at reading a study, being able to understand it, knowing if it's a good study. The one thing I would caution people with, with reading studies and looking at studies is don't just look at the title and look at the conclusion, because quite often, sometimes what they say in the conclusion, the data doesn't actually support that, which is quite interesting.

Interesting.

Well, you know, scientists try to keep bias out, and some are better than others. And then also, if you go to the end of the research article, it'll say if they have any conflict of interest and sometimes about their funding, which if they say Cheerios is healthier than an apple, right, you might want to check those conclusions and see who's funding them.

And so many studies funded by drug companies. So be really careful. Absolutely. That's important. And I think incidentally, talking about drug companies, I think that it's really important to research the drug you're given or the prescription. Oh, yes. Don't just take it. And let me tell you a quick story. I mean, in a way it's a silly story, but it makes my point. I've never had any pain. Don't ask me why. I'm just lucky. And so, but I'm 81. Shit happens, if you'll pardon the expression. I wake up one morning and I have a sore thumb and I thought, oh, well, okay. So I let it go, but then it stayed sore. So because I've done all this research, I'm now highly neurotic. I've turned into a hypochondriac. So I decided maybe it was bone cancer. So whatever. My kids said, well, Mom, why don't you start with an arthritis doctor? So I go to the arthritis doctor and she said, yes, you know, you have arthritis in your thumb. Here's some medication for the pain. I mean, it wasn't that bad, but okay. And I said, well, you know, I'm on Lexapro for for depression. I just lost my husband and I need to take the Lexapro. Does it interfere at all with my depression medication? And she said, no, no, not at all. So, okay, great. I take the prescription, I go home. But because I'm now so neurotic, I look it up and, you know, she was mostly right. There was a 1% chance that it would interfere with my depression medication. But on the other hand, the 1% chance was a chance of a brain bleed. So, you know, it's only 1%, but I was not willing to risk a possible brain bleed. Somebody's going to be the 1%, right? So I wasn't— I mean, we're talking about a thumb. I got 9 other fingers. So if worse comes to worst, I mean, it just wasn't worth it to me. So my point is, by doing the research, I was able to evaluate the risks and benefits for myself and make a decision. And I threw out the prescription, obviously. But I mean, you can't always do that if it's chemotherapy. It doesn't matter what it is. If you have to have it, you have to have it. But for something like a thumb or whatever, I just got off a statin because it was interfering with my blood pressure medication. I couldn't figure out what was— I just wasn't feeling right. And, and again, I looked it up, which the doctor didn't know. And so he just said, well, throw it out. So I did. But I'm— that's why it's, you know, I think the message of the whole book really is it's your body and you got to take charge of it. And yes, the doctor will tell you what to do. And most of the time they're right. I'm a firm believer in medicine. I truly am. But that doesn't mean that I give up all my power and all my research ability to double-check, to be sure. And most people would have said, well, you know, my thumb really hurts. Maybe I play tennis and I really need to have my thumb fixed because my forehand is suffering. I mean, I don't know. But that wasn't me. So it's a personal decision as well. And I think that being in charge of yourself is just critical.

Yeah, that's, that's another excellent point because quite often I think people, you know, it would be great if we could just take a pill and there was no side effects and the pill fixed things. But the problem is there are side effects and there are interactions and you've got to— whatever the problem is, is it, is it bad enough that you need to go down that road yet? Like I have osteoarthritis in both knees and pretty bad, actually. And, but the, but to this point, I'm functional on a day-to-day basis without— it's an amount of pain I can live with and it's fine. And so I would much rather just live like that for now than, you know, do a risky surgery or take drugs that could possibly have these other side effects. And I think you're exactly right. It, it stinks because we think we want to go to the doctor just to tell us what to do and let's be done with it and I'll be fixed. But you can't, unfortunately, you just can't do that with your own health. You've gotta dig in a little bit and make some hard decisions.

I had the same experience with, I went to the doctor, I have now, so I'm just getting old, suds, I have to tell you. So now I have a bad shoulder. So I went to the doctor and he said, well, you know, you have rotator cuff issues. And again, it's minor. I haven't taken anything. I just wanted, again, I wanted to make sure what it was and they did an X-ray and okay. And he said, well, don't you want surgery? And I said, well, you know, I think I'll just start with the Tylenol. Phenol. I mean, you know, I don't need— I mean, wow. You know, that was— we went from A to Z. So I think again, it's just— and I said, no, thank you. And, you know, he said, well, we're surgeons. And I didn't say, but I wanted to so bad, you know, well, your mother must be really proud of you. But, you know, it was silly. But anyway, so went home. Shoulder still hurts, but oh well, you know.

Yeah, well, and like you said, and just making sure that it's not something more significant. Like, I'll, I'll tell this story that's relevant to what— because how, how, you know, we trust doctors, but yet you need to be careful. So my dad had cancer for many years, and it was in remission. He was doing really well, and he had— he's always been super active, weightlifter, golf, all the things. And he had been having a lot of hip pain while playing golf, and they, you know, he went to probably the orthopedic guy was the first thing he thought of. And, and I, and so like you said, it's a hammer, it's a nail. It's an orthopedic guy. Well, you've got a hip thing. We're going to send you to PT or whatever. Anyway, the long story short is that it ended up being a recurrence of his bone cancer and he had bone cancer and he's having a problem with his bone and that's not the first thing that they thought of. So it's just really, yeah, you've got to be really careful and you've got to be an advocate for your own health. And the fact that it didn't dawn on anybody, probably including my at the time that this was a potential recurrence, it's kind of mind-blowing to me.

You know, the upside and the downside of doing all this research is now everything occurs to me. I've been interviewing with heart attacks and I'm walking around every time now I get a stomach pain, I think, oh my God, it's good and it's bad, let me tell you.

So Susan, you've got— you've talked a lot, and I, again, I didn't get to read the book yet, so you probably answer this in the book, or if you haven't, maybe it's a question for future. But so women in particular are very bad about this because they're always putting themselves last. But for the people that they do put first, their loved ones, their parents, their partner, their children, was there also advice in the book for how to advocate for those people in their lives, or was it more just focused on kind of this putting themselves in the backseat scenario?

It was neither. I mean, it was actually— it was focused on—

on—

on— how do I say it— on a woman as a patient. But I do recommend that as women, as I said earlier, we take somebody with us. And of course, we also should go when one of our loved ones goes to the doctor. We should go with them as well. And I think it's okay. I mean, I think you need to advocate for somebody. Let me think about how I want to say this. Well, I mean, for example, I was reading an article. This has nothing to do with me or my family, but there was a woman whose dementia was getting worse. I forget where I read this. And she was with her daughter and her daughter's— the doctor said, well, you know, it's just like it was or whatever he said. And the daughter said, no, she's much worse. You don't see it right now, but at home she did this and she did that, you know. So I think it is really as as a, as the guest, as the accompanying person, you can, you can set the doctor straight if they need it because you, you know, and the woman, the woman didn't know, but the daughter did is my point. That was a—

No, that's an excellent point. I mean, just have an example of that too that, that I could share is that my— I haven't actually talked about this on the podcast yet, but my husband had triple bypass surgery in November, and he— we had gone into the, in the, into the emergency room because he did have pain a couple days in a row. But he was telling the doctor about some things, and I said, I said, what did you tell him about how you've been having that heartburn that you keep talking about? For, you know, we're in the— they were in the ER. Well, it turns out what he had been calling or thinking of as heartburn was a symptom of his heart not getting enough oxygen, obviously. So me having been there really redirected the conversation and the outcome pretty quickly because they were like, well, pain under your rib, that's really not like a heart attack. You know what I mean? They were just kind of confused by the whole thing. And then here it turned out he had a very serious problem that I don't know how long it would've taken him to dig into all that, you know?

Right. And if the, if, if he had been a woman, it, women, uh, really have to wait much longer to get a heart attack diagnosis. I mean, I'm an expert on heart attacks right now for the next book. But let me just say to all of the women out there, if you do think you're having a heart attack or even if you're unsure and you go to emergency and they say, no, it's a stomachache or no, you're depressed or whatever, ask for an echocardiogram. That should give you a— that or blood test so that they will be— that way it will really determine whether your heart's under stress because women do get misdiagnosed a lot when it comes to emergency room heart attacks. That's another thing.

Yeah. And yet it's still the number one killer for us as well as men. Is, isn't that correct?

Absolutely. By far, as a matter of fact. I think it's—

Well, Susan, you mentioned the new book. Do you, before we, I would just wanna be respectful of your time before we start to wrap things up. Do you wanna, or can you share a little bit about, I mean, you said it's about women and heart attacks, anything that you're seeing like initially, or do you need more people to talk to if anybody hears this and they have you know, a certain experience, should they get in touch?

I'm okay. It's actually— the book is on gaslighting, and I want to talk a lot about it because women are gaslit more than men are, and it's a very popular topic right now. And so the way I'm handling it is I talk about gaslighting a lot, and I talk about it in terms of heart attacks, which is what I've been interviewing, and in terms of chronic pain, and going to be in terms of autoimmune diseases, because pain and autoimmune in particular are where women get gaslit very, very frequently. So anybody out there in chronic pain or anybody out there with autoimmune diseases where they've been gaslit, I would love to hear. And of course, I also want to hear some good stories. The last chapter of the book is going to talk about what a good story looks like, you know, how the doctor visit should go. And I've already heard a couple of those with heart attack, the heart attack women I've interviewed.

So, well, that's good to hear. So they're not all negative. That's, that's very good.

Not at all. Not at all.

Well, if people— oh wait, I do have one final thing, and this is completely— I almost forgot because I also loved, I also loved this when I read your bio, that you said that you powerlift in your spare time. So how did that get started?

Actually, it got started in my 40s because I was told I had osteoporosis, which is what the problem had been in the first place, if you remember. But in any event, they were— in fact, they told me it was so bad and I don't know if I've never broken anything yet, but they said I could be one of those women that stepped off a curb and, you know, everything shattered. So I got—

oh my goodness.

Yeah. And then she said that they told me that the doctor was a woman and she said, you know, you really need to do some walking and some resistance and, and yet. So I started weightlifting. And I mean, I got to say two things. I hate it and I love it all at the same time. I get so damn bored, I can't tell you. But yet here I am. I'm 81. I'm in really good shape. I'm strong and I haven't broken any bones. And whether that's probably mostly good luck, but nevertheless, I haven't. And if you saw me walk, you'd think I was, you know, I don't— I'm not bent over and I don't walk slowly. I walk like a person, you know, a normal 50-year-old woman. And I do think that without question, it's due to the weightlifting. I really do. It's kept me strong and straight and I feel good about myself, which at 81 can be tricky. I mean, honest, it can.

I'm sure. And I think it's just amazing that your doctor at the time, 40 years ago, because this is just now becoming a really big conversation in the health and wellness— you might have heard of You know, Dr. Gabrielle Lyon is really big on the women's muscle health movement, and, you know, others out there getting proper protein and prioritizing protein and to prevent sarcopenia, because sarcopenia and frailty in old age is like one of the biggest predictors of poor health outcomes. So I'm just so glad that you had a doctor that shared that with you and that you did.

I mean, I see it in a few of my friends, not that many, because most of them are pretty good about working out, but frailty is really a very significant problem. And also being too thin is a significant problem when you're older, because if you do get sick, you need to have a— you need to have a few pounds cushion so that if you weigh £90 and you lose £5, now you're £85. That's not good. You're better off. I start £120 or £50 or whatever it is so that you have some pounds to lose. That's— I learned that too.

Um, you know, that is another great piece of advice. I always kind of joked around with that with my, um, one of a previous person in my life, and she was probably 85 and she was still trying to go on diets. It was like, I was like, Jane, come on, you need to— because she was— and she was, she was not obese or anything, she wasn't like rail thin anymore, but she was a strong, like, you know, no, you properly properly weighted person for her age and her stature, you know.

Thin and frail is not a goal. Not at least—

shouldn't be.

No, not at all. Not at all.

And I loved— I'm just— so people will go, you got to go check out Susan's TikTok. I don't know if you do this on— I think Instagram was a little bit different, but on Susan's TikTok, before we got on the podcast, I was checking it out and I saw— and I'm trying this next time that I go gym, but she was on a Bosu ball and she does like 5 legit awesome push-ups. So I am totally trying that next time at the gym.

It's called— I think it's probably under my name, but it's Grandma.Gains.

Um, yeah, I loved that, um, name. And we'll put all these links in the show notes, but if people do want to get in touch, what's the best way?

I'm so old, I didn't know what Grandma Gains meant. My, my grandchildren Emma, that's a perfect name. Everybody will know. And of course I didn't know, but my trainer knew instantly. So what do I know? It's true. And I like to share it. I love it.

It's good. You should. It's inspiring. So what's the very best way if people— I mean, people can follow you everywhere, but what are you— what's your most active channel or how can people get in touch if they want to reach out about the books or your research?

Well, the social media, I'm very active on Instagram and Salinger is S-A-L-E-N-G-E-R. So I spell it different.

Good note.

So it's Instagram and TikTok. I think if you dial up Susan Salinger, it'll take you right to Grandma Gains or go to Grandma Gains and there I'll be. At least I hope so. That's, that's the plan. And you can buy the book on Amazon or bookshop.org. I mean, it's in any bookstore they can order it. Wherever. And as you said, it'll be in the— Awesome. But thank you.

And do we have a release date on the new one before you go?

One can only hope. I'm giving myself 6 months to a year to do it. That sounds like a long time, but frankly, the last one took me 10, and this is going much faster. But it's hard to find the people. That's why I said if anybody's out there, maybe put my email. I don't know if you have— you must have it. In the show notes, because if you email me, I'll get back to you, I promise.

Okay, awesome. Yeah. So anybody with stories about gaslighting, any kind of health-related, right, negative or positive scenario, whatever you could, whatever medications, you know, I want examples.

I need examples because I really want it to be personal stories and how we can do it, how we can handle it when it occurs. And it can be tricky. I mean, it can be really tricky to handle.

Yes. So, Susan, I thoroughly enjoyed this today, and I wish you the very best on the next book. And these endeavors that you're taking on right now are just so amazing. And I'm happy to hear all of this.

Thank you so much. Old age can be a really nice time in life. I have to say, it really can. Sometimes it sucks, as I said, but Basically, you know, I like, I like the— my kids are out of the house, my grandchildren are almost grown. I mean, the narcissism, just taking care of myself is lovely.

Well, I love it, and you've certainly earned it. So Susan, um, thanks for again for doing this show, and we'll stay in touch in the future.

Sounds good. Thanks so much for having