Trauma Informed Care with Dr. Traci Kurtzer

In this episode, the girl and her gyno-mom meet up with Dr. Traci Kurtzer.

Dr. Kurtzer is an amazing physician and community advocate. She works at Northwestern in the Center of Sexual Medicine and Menopause and is the Medical Director of Trauma Informed Care and Education at Northwestern.

She joins the ladies to discuss a very important topic: Trauma Informed Care.

They cover what trauma entails in this context, the four R's of Trauma Informed Care, simple steps that physician offices can make to ensure patients feel safe and comfortable in their care journey, ways that patients can advocate for themselves within the doctor's office and much, much more.

The episode also includes an interview with Saunte Harden-Tate, the Community Engagement Coordinator at CAASE (Chicago Alliance Against Ending Sexual Exploitation), detailing what the works they do involves and why it is so important for the Chicagoland community.


Other Links:

Instagram:

https://www.instagram.com/notsoprivatepartspod/


Learn more about our Community Shout out:
Chicago Alliance Against Sexual Exploitation (CAASE)
CAASE – Ending Harm, Demanding Change.

Learn more about our special guest: Dr. Traci Kurtzer

https://www.nm.org/doctors/1710950464/traci-a-kurtzer-md


Resources:

https://www.notsoprivateparts.net/show-notes

Transcript

Jingle:
(Written and Recorded by Raley Mauck)

When you know your body, you feel empowered. Open conversation, safe space, sharing stories, knowledge.  Learning together,  growing and knowing not so private parts.

Just a girl and her gyno mom, let's get into it.

Acknowledgement of Country:

 We would like to begin today's episode by acknowledging the traditional owners of the land in which we created, and recorded this podcast.  The Gadigal people, the Bedigal people, the Potawatomi people, and Peoria people. We pay our respect to elders past and present and acknowledge First Nations people's continual culture and contributions they make to the life of these regions.

 Medical Disclaimer:

 Although in today's episode, we're going to be speaking to a few medical. Experts. Based do not consider this to be personal medical advice.

Tidbit:

 Also, I just want to point out that that wonderful voice that you heard singing in the beginning, that little jingle, was written and sang by my good pal Raley Mauck, and I never get tired of listening to her voice. I hope you don't either!

 
Intro:
 In today's episode, we are covering trauma informed care. People have different associations when they hear this phrase. Some have assumed medical Grey's anatomy type trauma, others presume sexual trauma. But from our very passionate, intelligent guests, Dr. Kurtzer this form of care really encompasses a lot and a lot of experiences and it drives more than just doctor, patient relationships, but really has more to do with how we go about in the world and care for one another.

Any who's...

Interview with Dr. Traci Kurtzer regarding Trauma Informed Care

I am thrilled today to be here with Dr. Tracy Kurtzer, who is an obstetrician gynecologist in the Chicagoland area. She received her medical degree from University of Florida College of Medicine and has been in practice for more than 20 years. We're so thrilled to have her here today with us.

We're going to be talking about a very important conversation, which is trauma informed care.

Just to get started, it'd be nice to hear  a bit about you, maybe where you're from, how you got into the practice,  where you are now with it.

And also just anything that you do for fun, anything that would help us get to know you as a person. That's nice.

I've actually been in practice now for over 25 years. I probably need to update that.  I focus really on Uh, gynecology only, and I work at Northwestern in the Center of Sexual Medicine and Menopause.

I work with,  individuals who are dealing with,  sexual issues, menopause related issues, but in that realm and through that office, I've also started the,  post sexual assault recovery,  clinic.  Patients who've,  Sexual assault experiences through our emergency room,  can get follow up care if they don't have a OB GYN or, or a physician, , that they want to,  or they have nearby or that they want to work with,  on some of the follow up,  care that's needed.

I live in the Chicago,  area. I'm in the South Loop area of Chicago.  Very close,  to Chicago. To the lake, and I really have gotten involved a lot in, supporting community,  actions and advocacy,  in kind of the whole interpersonal violence prevention space, particularly with,  gun violence prevention.

That really is a lot of my spare time is spent on, , doing advocacy work or volunteering or, speaking at events, but on the side, I do also love to garden. I'm really fortunate.  Terrace in our apartment that allows it gets good light.  I'm able to do some of my  gardening love of, you know, growing plants and vegetables and love the summer in Chicago for sure.

You and my mom have that in common. She loves to garden too.

Dr. K, I am so excited to talk to you. When you were speaking, you were quickly were becoming the most interesting person that I know.  This is something that I care a lot about.

I actually was talking to my friends yesterday, about sexual assault.   We were all saying,  it's something I care about so deeply, but it's not talked about often enough.   It's definitely something I'm very excited to learn more about, so.

Thanks for being here. I'm very excited.

Throughout your time in your career,  what do you feel is  favorite aspect of your job or a part of your job that you enjoy? 

I just love so much working with my patients.

I always say I'm so lucky because I have the best patients and I know a lot of docs feel that way too.   I just really get a kick out of,   Getting to know what their lives are like and,   having, you know, humorous things that we,  I just feel like using humor a lot   just kind of helps to lighten sometimes some really heavy topics and I just really feel like if I could just spend my whole day as a physician, just sitting in the office exam room and talking to my patients and,  doing their exams and figuring in things out and helping them and I didn't have to do all of the other stuff, then I would be in heaven as a, as a profession.

But luckily, I get to do that most of the time.   Yeah, that's what really keeps me going really is my patients

Why did you suggest talking about this topic? Because for context, anyone listening, I reached out to Dr. Kurtzer when I heard she might be interested to be involved and be a guest on our podcast and asked what she'd be interested in talking about.  This was one of the topics.  It's something in my huge brainstorm that I've done about things.

that didn't enter my list, even though, but now that it's on my list, it's something I really, really want to talk about.  I'm wondering what made you want to talk about this topic and why is it so important to you? 

I think it's not talked about enough. It's  a relatively new, but very popular term you hear thrown around, but a lot of people, they don't really know what that means.

Like you talked about trauma informed care and they're like, but  what does that actually mean on the ground, and how can I implement it?  I think there's a really good opportunity, , to share knowledge. I'm the Medical Director of Trauma Informed Care and Education at Northwestern.

So that's, of course, part of,  my job is to try to educate others on, , incorporating this care.  But, you know, in a bigger, like, a public health perspective, it's about also improving,  equity in care.   I think that's something that we should all,  be striving for as,  physicians and as,  just as society is trying to improve access and, and equitable health care for all people.

It's also really, Important right now because we have a workforce in health care. That's really  a challenged, right? There's a lot of burnout. There's a lot of people who left from the pandemic.  and trauma informed care is not just about how we care for our patients. for our patients. It's about how we care for each other as co workers and colleagues.

And really, it expands beyond that. I mean, trauma informed care is your interactions at the grocery store. It's when you're driving,  frustrated driving and  how you interact with people and kind of recognizing,   what are they dealing with today? Right? Like if they're behaving in this way, instead of,  what's wrong with them, maybe what happened to them.

And it just setting that whole different context with all of your interpersonal  relationships and interactions with people, I think could really lower a lot of the conflict in general that we. Deal with it adds to our stress, right? So it becomes kind of a circular phenomena.  So that's why I think it's so important I mean clearly in health care is so important because we're dealing with people in a very vulnerable state You know with illness or injury  Whatever they're coming to seek help for so we need to be Really clued into it, but it also has to do with how can we build resilience and our Workforce and just in our you know communities and society as a whole 

I want to tell a little interesting story that happened to me this week,  I think what a lot of  Healthcare folks first hear about trauma informed care They think it specifically has to relate it to someone with a history of sexual trauma or has been sexually assaulted So And it's a little more than that.

I had surgery on a patient this past week. She was elderly and her son was there to accompany her and he seemed really angry and I could tell he was angry at me or angry at the world.  They were back in today and I first asked her, I said, your son seemed really, really angry. What's wrong?

And she told the story that,  when his grandfather went in the hospital and had a surgery that went well, he died later that night.  He was given a medication that he was allergic to.   As part of our pre op medications,  I had prescribed, or my office had an anti inflammatory  , that we give before surgery to help prevent non stop pain.

The pharmacist told them that it was a sulfa drug and that it was an allergy and was prescribed incorrectly, which is wrong.  Right  so he was very angry at us that we have described the wrong medicine and he was angry at hospitals in general, because his grandfather died in the hospital. And so I just asked him to talk about it today.

Can we talk about what happened, that there wasn't an error, and I understand why you're upset because you really thought we almost killed your mom with the wrong medicine. 

Just that you never know people's story. I feel like that's what you were talking about, Dr. K. You can see people and what they're presenting to you, but you don't know what happened to them earlier that morning, earlier that week, in all of their life.

You gotta be meeting people with,  with empathy.  You're only acting this way for a reason. I really don't think people get out of bed and just lash out  for fun, for no reason. I feel like it's always coming from where, I'm sure it takes patience, it takes patience to have a lot of empathy sometimes, but,

  Trauma informed physicians who really want to practice this,  you have to be  like  Denise was there, right?

She recognized she was paying attention to the situation and she recognized that somebody was Was struggling in the room, right? It wasn't her patient, but part of trauma informed care is our patient, our patients and their family, right? And caregivers too.  Instead of turning away from it, like our instinct is like, well, I don't want to deal with that.

I don't want to bring up or open up a can of worms. But it could be so critical because if that was not addressed and talked through by just opening the door to have that conversation. Who knows?  That. Individual then is holding that trauma from, you know, the prior family experience and every single medical interaction is going to be impacted

there on not trusting us because he thought we made a mistake.

And, yeah, my first instinct was like, oh, this guy is such a jerk. Like, he's just. Nasty to me, and I don't even know him.  I just met him.  And then I said that he asked about what was going on.

If more physicians do that, it makes it, it makes it easier for all of us if we approach,  patient care that way, because it's going to then, You know, building that trust and openness for having those hard discussions instead of putting up the walls and defensiveness about it, then it's going to help the next person.

And you're going to be helped if somebody does that with,  patients before you to 

question. I see a lot of times and  some physician  Facebook groups where someone say, Hey, I've got a kid going to school at Northwestern and I need to find a doctor for them who's, provides trauma informed care.

  What do you think that means when you hear that to  the average person or the average physician? 

Yeah. I mean, I think most people, they think. They hear initially the word trauma, and they immediately go to thinking of, like, some type of,   trauma surgeon or somebody who deals with, major injuries or traumatic events from violence or,  accidents or things like that.

But  it is hard. I get that question a lot because it's not like there is a listing. There's not a certification process, right? I think it's more about how do we incorporate this into our, education as part of maybe continuing education or training the next generation, which is something I like to focus on, the up and coming, physicians and other health care professionals that are coming out to,  Start just right from day one because it's going to make their lives and careers, you know better as well.  There is data showing that  not only is patient  satisfaction with their care and also feeling engaged and empowered in their care, but also,  healthcare worker satisfaction goes up when trauma informed care principles are  instituted.

Because it feels like you have more of a relationship, like a human to human relationship.  You're both trying to have a holistic form of care, rather than if you're feeling like there's a power dynamic or it's one sided, I feel like if I'm ever at the doctors and I get the sense that sometimes I know this is fabricated in my mind, but they think they're better and smarter than me and they're in control.

They're going to make the decisions.  I feel disempowered because  The world tells me to trust them because they went to school, they studied all of this, but  sometimes I feel like, you want to be involved in the conversation, you want to feel comfortable, especially if you're talking about your body, which  is very personal.

I feel like you want someone you can feel comfortable with and if you're comfortable, then I feel like the doctor's comfortable. And like you said, everyone feels better.

  I want to ask you about the trauma part of trauma informed care, just for those  that don't know about what the definition of trauma would encompass.

What do you think of when you're talking about trauma?

Yeah, so beyond,  illness and injuries, of course, can be,  some of the traumatic events, but it's so much more expansive.  We know that,  most of us have been impacted by traumatic events in our lifetime, but,  the way,  and I'm going to reference, Annie Lewis O'Connor, who's one of, like, the original,  folks up in Brigham Women's who kind of started this concept of trauma informed care.

I'm going to reference the kind of categories that she puts them in, because I, I use the same.  There's basically  our collective  or, historical trauma.  That really comes from who we identify as, right? Like, our families of origin. You know, ethnicities, do we come from parents of our parents, immigrants, do we come,  from a situation of maybe,  a refugee,   situation,  family   from slavery, from the Holocaust, right?

All of those things that we  historically,  carry with us, plus our identities, right? Our gender, our race,  things like that. So even if we haven't been directly discriminated against or impacted in a traumatic way because of those factors, the fact that other individuals, because of those same identities or associations, have been targeted or traumatized is a source of trauma for us.

So that's just what we  carry inherently in us because of who we are, who, where we come from.   Then there's also in that category, things that happen kind of generationally. So we just went through a pandemic.  The generation before that didn't have that maybe level of a mass,  event where so many people died and within a year period.

So that's a trauma that we all. We don't know it, but we all carry with us.  I think another example of that is generational trauma that I didn't experience growing up as a child in school is the fear of gun violence that, you know, younger kids now are dealing with. And so that's. Those kind of things, right, that can  kind of be triggering for us if we see something happening to somebody else who looks like us or who we relate to in some way.

Then there's,  more of the interpersonal violence,  the more obvious,  things,  sexual assault, physical assault. Human trafficking, domestic violence,  but even the more subtle forms of that, discrimination, biases,  workplace abuse, things like that,  bullying in school. So those are those interpersonal experiences sometimes that are  hidden, they can happen in the classroom.

Workplace that can happen in, you know, homes, but even out in the streets, having an interaction,  with somebody that's,  not a positive,  interaction.  Then there's other things that are just a little bit more like the personal things that really just happened to us. And that's where we usually category adverse childhood experiences.

So some of the,  personal history that we carry.  Then what we're dealing with in our day to day lives now are social determinants of health. So when I walk out of the door from my home, am I in a safe environment? Can I  have access to healthy food? Can I get the health care I need?

Do I feel like supported in the community where I'm at,  in  my current living and working environment?  Am I dealing with illnesses or injuries or pain or  substance use, you know, issues or self harming  issues,  that are traumatizing to me. And then there's, in response to that, we go access help and care and there's healthcare trauma.

And that's a big part. And I know Denise, you said people often just kind of,  pigeonhole,  the kind of trauma to sexual assault. And that's huge. You know, epidemic proportions in our country, but honestly, when I started this work at Northwestern, about 75 percent of the patients I would see,  to help them with their gynecologic exams, it was because of a past history of,  sexual abuse or assault.

I would say now it's about.  25 percent of the patients I see and the other 75 percent are medical trauma patients that have dealt with traumatic experiences at the doctor's office. 

I wanted to ask you about that, Dr. K. I'm so glad you brought that up because  I don't have a stat to back this up yet, but just from my own personal experiences of talking with people.

I have more of a trusting relationship with doctors. I don't feel fearful to go to the doctor's office, which  I think that my historical experience or past experience, but I do know from talks with friends that a lot of people feel very uncomfortable going to the doctor. Don't want to be going to the hospital, hate being in the hospital.

If you're going to the hospital, you associate that with someone being sick or maybe death or grief. But what do you find  in your work about why do you think there's this uncomfortability around medical examinations, or like you said, this medical trauma?

Well, I think,  a small percentage of that is intentional.

Honestly, I think most of it is unintentional. It's just not having that, consciousness or awareness of  the difficulties and struggles that our patients are dealing with.  I think also a little bit of it is are. Education, right? And how we're groomed to be perfect all the time and have all the answers and be problem solvers.

And we're very good at that, right? We're trained to be those,  people that are going to come in  and know, the answers and try to solve problems for people. And so, It's hard for us, particularly those of us who are in fields where we're not always going to be able to cure or solve that person's problem.

We want to help them, but we might not be able to completely solve everything. And there's going to be times, too, where we get it wrong. And we're really, unfortunately,  trained to not  be, or the expectation is that we can't be wrong.  So I think if we really Right. Yeah, right. And so I think if we really step back and say, like, I'm here and I'm going to.

Kind of harken back to what you said earlier about how you want to feel empowered and  that you're not being talked to. If we change as physicians our role as, we are kind of the guides, right? Like we do have this incredible base of knowledge and experience and we want to impart that, but it's not us telling people what to do.

We are letting them,  come to that,  Realization with our guidance, right? So I look at it really as we're more of a team as opposed to I'm instructing you what to do. Right? And I think for physicians who may be realized that they can't.  Solve that problem. They unfortunately, instead of just saying, I can't solve this problem or I was wrong.

And let's try this instead.   Unfortunately, we put up a defensive. mechanism, right? And then we turn and push our patients away. Like now you go see the other specialists. I can't help you anymore.  So that's one sense of a lot of the trauma experiences I've seen from patients is that their doctors basically ultimately just  got frustrated, right?

And gave up on, on them and didn't  continue to work as a team,  maybe not be able to solve that problem, maybe not be able to cure that problem, but can we at least make life better for you day to day? 

Yeah, and obviously sometimes we really, the patient does really reach the end of what we are able to help them with.

Sometimes we have to send the specialist and say, hey, I've tried things I know that can fix this problem. It's not working for you. Let's take the next step.  But I find in my,  conversations,  I ask them why a lot,  especially if they don't want a treatment that to me seems like a really good one.

Right. And

really common is IUDs or a intrauterine device, not just for birth control, but,  for, let's say, heavy bleeding in a woman in her 40s. Right. I really period and she doesn't want a hysterectomy. She had an ultrasound. The uterus looks normal. Other physicians have told her. Oh, yeah, it's all normal.

There's  no cancer, no growth there. Yeah, but you're anemic and you're  fatigued and you're hemorrhaging.  Let's try and fix that for you. What can we do?  Let's talk about the IUD or surgery. Oh, no, I don't want anything. In me, no foreign body, I would be making you really unhappy.

And I'm like, that's,  that's your choice. But  can we talk about why? Can you help me understand why that was so scary for you or so unpleasant for you? Let's just help me understand where you're coming from.

Another approach there too, is for empowering voice and choice is our patients really teach themselves a lot, right? Like, so much is accessible now on the internet, and that's,  that's a mixed bag, of course, right? There's a double edged sword, but I think they do come in, and I think a lot of times, we just need to give them the chance to voice, you What they would like to do first, and then we say, well, you know,   that's absolutely sure that is one of the options, but here's some other things you might want to think about that maybe you didn't realize were out there.

And right there, that just kind of shifts a little bit of the dynamic of,  trauma informed,  approach to that discussion where you're still giving guidance, you're still imparting information,  but.  The patients kind of had their chance to express what they would like to do, and in that discussion, they may even tell you what some of the barriers are, right?

Like, well, I thought about an IUD, but,  this is the barrier, because maybe it's something you can,  help them overcome or whatnot. 

I want to go back to, you were talking earlier about sometimes, Doctors can get defensive and this is the way they were taught and brought up this perfectionism  because I'm wondering how would someone learn how to be a trauma informed care provider?

Is this something that's taught in medical school? Is it something that's coming in in the future or do doctors have to take their own initiative to learn about it? If it's something that they care about,  how are doctors learning about this?

Yeah, I think right now it is, it's all, you know, kind of self education and I'm trying to, learn more,  at the medical school level, I think there is.

Components of trauma informed care that are incorporated into some of the other educational,  things that are being done, but it is not, certainly not a requirement across the board for medical education,  nationally.  I think it's going to be very,  dependent on the institution itself   unfortunately, but  it is an area that I think hopefully we'll start seeing more about because there are,  groups who've been publishing more on trauma informed care and trying to, hit all of the different specialties because it really is across the board.

I mean, of course, I'm OB gyne, Denise, you're OB gyne. So we inherently,  Learned some of this because of how sensitive the exams are that we have to do and  the exam part of trauma informed care, but as I've mentioned here, trauma informed care is from the, when the patient walks through  the door.

The environment they're in and the reception and,   or the triage nurse in the emergency room all the way through,  the checkout person, or even the schedulers, I would say, having some trauma informed care training is important as well, you know, so I think it's. It really needs to be a more comprehensive, but we're not there yet.

Yeah. Cause I was going to ask you who is involved, but you just took the words out of my mouth. It sounds like every  single interaction you have from the time that you reach out to the doctor's office to coming into leaving,  everyone's involved.  We talked about that at this office.  We're making an experience when this person comes in and we're all a part of the experience, even if we're not going back there in the room with them and giving them advice.

Yeah, and we talk about most patients don't want to come see us. It's not like idea of a great day.   They don't want to come in. They don't want to pay their bill. Nobody wants to be a doctor.  Nobody wants to come and see the doctor.

No one wants to get undressed. Nobody wants to sit on an exam table with your legs spread and have a stranger. Okay, so they're already coming in.   With an idea, it's not going to be the most pleasant experience. So what can we do to help

that apart?  I wanted to ask about what patients can do or  individuals  to  advocate for themselves, because I understand that  yes, a lot of the onus can be on doctors to be giving appropriate care, but how can we advocate to get the care that we wanted?

How can we know, this is someone I want to be working with? And what permissions do we have to be like, no, I don't like you. I don't like working with you. I was wondering if you have any advice just for patients on how they can advocate for themselves. 

Yeah, I think it's hard. It's really hard, right?

Because just like we've been trained to be perfect and have all the answers, patients have unfortunately historically been told just to listen and don't,  ask a lot of necessarily ask a lot of questions like that, or intervene,  in the process. But I think,  Even up front,  you might just get that sense from how the communications and interactions go with,  the staff,

if you're having staff that sound like they're,  super frustrated or unhappy, that's probably not going to be a great office to be,  seeking care in.  Once you're in,  the exam room setting,  you can absolutely, if you have any past experiences where you have had,  a traumatic experience, or you're just feeling uncomfortable,  that day, you have the right to express that   to the medical assistant, nurse, whoever is doing your vitals or checking you in, the doctor,  coming in.

it's really. Helpful, actually, for us to know that up front.  Because we can make adjustments then, right? If you're physically uncomfortable in some way, well, we don't want somebody coming into an exam that we know already is going to. Upload their stress level already at level eight out of ten because they're cold or they're hungry or  thirsty so if we can just make sure  comforts there, but that's something that we won't always  You know won't always be asked but you have the right to express that and try to make yourself more physically comfortable right off the bat  and then  I think,  typically we're not coming in and just doing an exam right away.

There's that interactive piece where we're talking to you and asking questions and trying to figure out why you're here. Or if you're coming in for an annual exam, just how are things  going? And that is an opportunity to that. If you feel,  somebody's not making eye contact or really listening to what you're saying or,  you just are getting uncomfortable.

That's terrible. You know, feeling about it, you have the right at any time to say, you know, I'm just not feeling well today. I think I'm gonna,  pass a reschedule and leave the situation. Don't feel like you, once you're in that room, you have to,  Proceed and get through the rest of the exam.

If you're getting any feelings that you're not  having that rapport or certainly any,  spidey sense that this is not a good,  fit for me, then  trust, trust your gut  and,  make an excuse yourself and leave the situation. 

I have some patients who, when they first come in, they don't want to be examined on their first visit.

And I know that sounds like it. Would get negative comments from other people in the office, like, well, how are we going to take care of her if she won't get a dress? Well, let's see what's going on. And if she wants to talk today and I'll say, I can't. Give you a firm diagnosis what's going on with you, because we're not doing an exam today, and that's okay, but let's talk theoretically about it.

Sounds like this could be 1 of the things going on with you. Here's choices you might have for treatment.  Do you want to come back another day? Perfect. No, so just it's okay not to get unjust on your 1st visit. Exactly. You want to get to know your doctor better and that's totally fine. So true. And I do a lot of my visits now, especially if there's, a known history of trauma involved.

I will do that. Some of the beauty of what came out of the pandemic is the telehealth capability, right? So establishing rapport where you don't have to have somebody come into a physical environment where we know they're already going to be. stressed because they've had bad experiences before and then meeting a whole new,  doctor for the first time and talking about something really uncomfortable for them.

So sometimes doing those stepped in,  visits is so helpful for patients who dealt with trauma before,  either like Denise did.  Just sitting down in the office and just having a conversation, visit it first, and then it's a great opportunity too,  for those, or telehealth,  however you do it, just to even go through the steps.

For preparing for an exam, one of the techniques I teach is called a walk through, and it's basically like where you are kind of doing the staging, right, for,  uh, Play  you  know where what's going to happen so I can tell a pateint like if they're sitting in the room and we're just talking about it.

So when you come back for your exam,  I'm going to be sitting here. We'll have you on the table. I'll get you set up in the stirrups and you can just actually do like a play by play about what the steps are. Of the exam, you can even maybe and then I'll do a speculum exam. You know what a speculum is, right?

And maybe it's their first exam. You don't know, right? So you can show them the equipment. You can show them with the pap. I've had some people just feel with the little pap. brush feels like, because these are all unknowns. And the more we can give patients a sense, particularly traumatized patients, a sense of control, like, okay, this is familiar.

This is familiar. I know this, I know this. It's going to help them not fill in those gaps with fear.  Because that's again, kind of an empowering thing because they have the knowledge and know what to expect next.  Then we can force reinforce it when they come into the office. We,  we talked about this last week.

Remember now I'm gonna have you get up and, and put your feet in those footrests and  have you scoot down. So then it's just kind of reinforcing it. And that helps to build memory,   solidify those positive memories. Like this is something I know and I accomplished it

Dr. K, I'm smiling so much because I have two really good doctors in Sydney.   One thing I do, because  it makes me feel better, is that when I go in, I always tell whatever doctor I'm seeing, this is kind of how I like to have it done. I don't know why.

But I want you to tell me everything you're going to do.  Like you said, I really like learning stuff that makes me feel like I know more now so I always make a point to tell my doctors  if you can explain everything before we do it, I'll lay there is still.

As a butterfly, I won't move. But if you don't, I'm going to feel like, Oh, what is that? We didn't talk about that. What's happening now? I, it fills me with fear and I think it works because the last time I showed up to this, this was like a gum disease doctor anyways, when I showed up to his office, he was like, okay, pop quiz.

What do you remember from last time?  Oh my gosh, you remember that I like to learn and to know the steps and he went, yeah, I wrote it down.  I read it before I came  you lead me through what we're going to do today. And in a way I felt like a little kid but it worked.

It was making me feel so much more comfortable.  Also the fact that he took to heart what I had said, went along with it and to that, he wrote it down.   So we didn't have to redo that every time.

It also, I'll just add in, it gives you an opportunity, right, to have that control to consent or not.

Right? Because then you ask the doc, we can say, does that all sound okay to you or does anything make you feel uncomfortable? And then it gives that person a chance to say, well, I really, I don't like the feeling of like metal. Do you have plastic speculums or anything? You know, all those things, but it basically, it just helps.

Or I don't want to do that part of the exam. Can we just do this part next time? Because sometimes,   maybe we don't absolutely have to do that part of the exam. Can I maybe do some imaging or, you know, other testing instead, if it's really going to be that traumatic for somebody?

Are there ways we can think outside the box to maybe get the information we need? 

For some of our in office procedures, Tracy, one thing I've started doing recently is to,  Go through the consent at the visit before, so I think what's been really common that we would do is like, say, someone needs an endometrial biopsy or a biopsy of the lining of the uterus.

We'll explain to a patient, oh, you know, you're, you have this abnormal bleeding, your ultrasound is abnormal. Here's why we need to do biopsy. And we might say something like, it's going to it's kinda like a pap smear. We look inside, find your cervix.  Insert a little device, like a coffee straw, collect cells.

Okay. But then they come in the day of the procedure and you give them this printed consent form that has lists of complications and what could go wrong and blah, blah. And so then they're just like. Throwing that at the visit, and then they just sign it and now they're scared. Oh, my gosh. It said I could have a uterine perforation.

I could get an infection. So I. Prefer now to give the consent at the visit before.  And say. Let's get you prepared here. I want you to read this over. Let me know if you have any questions about it. Take it home with you.  They can come in feeling more relaxed at the time of the actual procedure.

Does that make sense to you?

Absolutely, right because it gives them not at that moment. They're not sitting on the table already undressed Or whatever. I mean, that's some of some of the situations people experiences They're getting this information and then they feel like they're trapped and they haven't had a chance to really process or think about it or change their mind.

Ultimately they have the option to not do the endometrial biopsy at the end of the day. It's their body, their choice to do that. So having it earlier just takes a little bit of that, pressure and maybe feeling that somebody can't get out of the situation at the time, which adds to their trauma.

You spoke about consent. I was wondering how important is consent In the medical profession, and how can you involve it, let's say  you're a doctor who's going to give an exam or an M. A., how can you involve consent in your visits with patients? 

I don't think it, it has to really add that much time, honestly, and it doesn't have to be,  written.

But again,  it's working as a team with your patient, right? You're working collaboratively. So it can be just as simple as, again,  I always do things very repetitively.  So not everybody has the opportunity to do that. But let's say you're just meeting a  patient and this is your first visit and you haven't done any of that.

Yeah. Prep work ahead of time with kind of the walkthrough you could even just at the time  you know are you okay if we go ahead and start your exam? Do you feel comfortable with doing that today right that kind of gives somebody an option like oh? I don't have to do it today. I can do it another day.

So right there. That's an opportunity for  consent, a yes or no, or can we do it some other time? And then,  with the steps of the exam, just before you do them, just let somebody know. So I'm going to check your thyroid, and you can even,  show what that looks like. So I'm just going to do a quick check on your thyroid.

Is that okay?  Yes. Okay. All right. Okay. I'm going to have you lay back to do the chest exam. Is that okay?  Right? So it just  adds one extra step because we're already telling people what we're going to be doing next in the exam. So it's just the, is that okay with you step of the process? And it's really as easy as that.

It would put so much more control back in you. Because I think I would probably say yes, yes, yes, to all those things if I trust the doctor, but it's the sense that they care enough about my opinion to ask if that's okay. Or if there's certain parts of your body that, for whatever reasons for you, are sensitive and are off limits, and I'm sure if you told the doctor, actually, no, I don't want to do that, they would move on.

It's just being asked. Right.

Yeah. And I think there's also times where there are particular, but let's say somebody is coming in,  to see you for  endometriosis. I'm thinking what Denise works with a lot, probably. Right. And you know that they're,  they have a lot of symptoms like bloating or,  abdominal discomfort, but you need, you're going to do your exam,  for your pre op or whatever.

You could even just say, for the.  Preoperative exam, these are the things I'm going to be,  checking on and part of that would be just pressing on your tummy to check,  for your liver size and make sure there's no,  masses anywhere.  Is that okay with you?  And as I'm doing the exam, if it's uncomfortable, just let me know and I'll stop, right?

Like even that other steps, so areas that are particularly sensitive, gynecologic exams, um, Transcribed by https: otter. ai  I may have gotten consent to do that, but I'm going to also give that next step of it, which is if at any point You need me to stop just tell me to do so and I will stop what I'm doing and we'll regroup Right.

So if you get to a point where you think right now It's going to be okay because we've all had patients like this. I know you have   Denise where  they so want to get through their gyne exam, you know,  accomplish it because they need to because it makes,  everybody happy, of course, but   halfway through they're uncomfortable and yet they,  grin and bear it and try to get through it.

Well, unfortunately, that's just reloaded the brain with kind of negative,  negative connections with that pelvic exam because they, they Pushed through it and we pushed through it for them. But instead, if you back off and stop it, just kind of  sit with it for a second.  Let the nervous system calm down again.

Maybe let the muscles that got all tense calm down again. Sometimes,  then you can actually go back and accomplish it. But if you pushed through that first time and didn't stop  it's just going to really.  Layer the trauma and pain association with those exams and that's unfortunately what I think a lot of the patients I see now is that  layering they might have had some initial, yes, like a sexual assault, but then it was actually the repetitive trauma from the follow up exams and care that layered it to a point where now they can't even they start,  Crying or shaking, even just laying on the table, thinking about it.

You reminded me of  Val's sister. She, one time she,  on her brand new bike, it was a little bit big for her and impaled her leg on the right. On the handlebar, so she has this toll in her leg.  It's a Friday night. And I was going to head to the ER and I decided I remember there was a plastic surgeon who had a surgery center.

He was always there late on Friday night. So I called directly. He's like, yeah, bring her in his older gentleman. And he was so quiet and gentle mannered. He kneeled and revealed on the ground. He said, oh, listen, honey. I'm going to take you in the back and I'll clean your leg off and I'm going to put some numbing medicine and she said, oh, I think she's eight or nine, but  how are you going to do that?

And he said, well, we'll use a little injection.  She said with a needle, she says, you're not putting a needle in my leg. It hurts.  It's just that, oh, no, no. If it hurts, you just tell me and I'll stop. She pointed her finger at him and said, no, I know you doctors. You say you're going to stop and you won't.

I asked her earlier, I said, where did that come from? She said, Oh, don't you remember? I had pneumonia and they gave me some injections in my butt and it really hurt.

Yeah, you were like three, but  also when you're a kid,

I feel like your first shots and kids are held down that you can even internalize some of that   she probably got it from some of that.   I remember when Peter got his first shot and we held him down and they jabbed it in him. That's scary. Looking back,  of course, hindsight is 20, 20  , but she was, she was like, Oh, you doctor say you'll stop it. You really won't.

I will say there's times where I guess when I teach this is like If you see a patient, if they're saying that, or you're seeing them go into a trauma reaction, which I'm happy to talk about too,  just one part of the education is learning how to recognize trauma reactions in our patients, because there's no point in talking or doing anything procedurally at that point, because  they're in a different zone and not able to really give consent at that point.

What I always tell people is if,  if it's feasible to do so, right, like, if it would be safe, because you can, obviously, if you're in the middle of a procedure,  you can't necessarily just  stop because if,  somebody's bleeding or something, you need to be able to,  Make sure you're taking care of them.

So there are times with procedural things where we have to acknowledge that we won't be able to stop. But a gynecologic exam, we can absolutely stop. Right? We're not doing anything procedural based.

Then you just talked about a word that I'd never heard before  of recognizing  the trauma response.

Yeah, trauma reactions. Yeah, so that is, there's the four R's of trauma informed care, right?

Realize,  knowing there's the prevalence of it, right, so I think that's the R for realize,  recognizing trauma reactions in our patients and each other, responding by integrating, this information and knowledge into our procedures and practices of care and then resisting re traumatization.

We're talking about recognizing trauma reactions or trauma and  if somebody is really highly traumatized,  what's happening is there's physiologic trauma. Changes that are happening to their body, right? All these, they're getting warning signs like danger warning signs that they're going to be hurt or harmed in some way.

And our brains very quickly, our, our reflex, you know, primordial part of our brain, when we sense that we might be in danger, sets off this whole cascade of hormones and neurotransmitters that go through our body,  to prepare us for that fight. Light or freeze response that most people have heard of, right?

Basically some of the hormones that are released are adrenaline, right? So that if we needed to run away, we have our energy to for that,  cortisol, which releases glucose into our system. So we have the energy to, you know, fighter or run,  opioids are released. It's kind of the body's way to kind of pre.

medicate, if we're anticipating some pain,  and then oxytocin, a very familiar hormone to,  Denise and I from our days   back as OBs back in the day. So oxytocin is  the bonding hormone that's released during, breastfeeding. And I think the rationale behind that is it's also kind of a little bit of a feel good hormone.

We're getting these ones that are getting us ready and prepared to fight  or,  run away, but also to,  premedicate a little bit as well, those hormones. Then what we see when we're talking to our patient is  we're not going to be measuring all those levels, obviously, but we may see some trauma reactions in them.

The ones that are on the more severe side are what's called disassociation, which is basically when somebody goes into  an altered state. So they are not, they might be looking beyond you. They're not really responding, maybe to your questions   answering appropriately or staring off into space.

That's what I was talking about. If you have somebody who's in that kind of a react  response state, they're in a, they're in a different zone. They're not in the here and now with you. And so anything that you are doing or saying to them is not going to register. And at that point, Your exam is now not really consensual anymore because that person is not there present to consent to it.

That's why at that moment, if you have somebody that you sense is going into a disassociated state or even a more extreme. Form of that is where they're actually having flashbacks while you're examining them. You have to stop immediately and you have to then work on techniques to get them back to the here and now.

Some grounding, breathing types of things to see if you can  get them back to normal. Out of that state and then,  back with you. So those are, that's like an extreme form.  Less extreme signs of trauma reaction would be shaking, trembling,  withdrawing from touch, like those reflex kind of reactions.

I'm thinking of  panic attacks. 

Yeah, feeling like panicky, like anxious, like I need to get out of here looking at the door. Things like that would be other signs.

We've just recognized the trauma response  and then was respond.

The only other thing I would add that just to make sure it's clear is just to recognize like intersections of trauma and that we certainly see,  that there are. Communities and groups of people who are disproportionately impacted by trauma because of how they  intersect with each other.

a good example of that is,  LGBTQ youth, right? They may,  Deal with maybe feeling rejected, potentially from family or community,  they end up  with housing instability that increases their risk for maybe interpersonal violence.  And then they,  seek care and have.

Healthcare biases.   It seems like it gets very layered for them.  Understanding that as well is really important in our realization and trying to really work towards equity of healthcare.  The responding is by  taking some of this knowledge, and looking at your own Practice setting or,   whatever you do, how do you interact with people and how can you acknowledge that,  if there is  frustration or anger or, sadness,  some, People come in and they're overwhelmingly in a grief state.

What can you do to support them better and not feed into the anger and conflict?  There's actual techniques that are out there and I don't know if we have time to go over,  all of them today, but there's things that you can actively practice.  I'm coming from the standpoint as a medical,  provider professional, if I have a patient who's  very angry with me,  it's going to be very tempting for my body to go into that defensive mode and or anger mode or, Blame mode, right?

Well, the reason you're not getting better is because you didn't do this, this, and this, but instead pulling back and recognizing that  what this person's dealing with   is highly traumatic to them. They are not getting better. And yes, their own behaviors may have played a role in it, but let's instead try to problem solve and Think about how can I maybe help with the barriers for that patient that is keeping them from, getting to the gym or changing their diet or,  taking their medications or.

Affording their medications, right? So all those trauma experiences, I think we just need to think of when we're having our just day to day interactions with our patients, but with everybody and then. The other,  piece of it that I think we could really make a big difference in, in health care and is being instituted, not recognizing that it is a trauma informed care practice, but a lot of institutions are doing more screening of social determinants of health and screening.

Patients to see what really is their environment.  If I'm instructing them on this particular diet, do they have access to get what I'm telling them is going to  help their diabetes get better  do they have access to a gym so they can do those   workouts or a safe environment so they can do those workouts.

Incorporating social determinants of health screening in.  Institutions, but even in practices actually can be really helpful, too,   the goal being preventative public health and,  Everybody's feeling about that is different because, of course, there's going to be people who are very subspecialized and they're really just there to fix that broken bone.

But even in that scenario, if in the care setting it's recognized that somebody isn't sure if they can put food on their table that night, how are they really going to heal from their broken bone if they don't have good nutrition, right?  I think having that Knowledge and resources available.   Doing the self education, if it's not provided for you through your institution, or if you don't have access to  social workers, where can I send somebody, where are the food banks?

Where can they get meal vouchers? What is the emergency line for,  It's our location.  If somebody  is not going to be housed that night, where can they maybe try to access help? It's an imperfect system. We have a lot of failures in our. you know, systems of care nationally, but it's not that there aren't any resources available.

Self educating ourselves and being prepared to help our patients in a more holistic way is going to actually help them heal better for whatever the condition is that we're seeing them for. And it's going to make You know, our success rates go up higher too. So it's win win all around.

Like I said, having that. approach and having that  basis to how you think about and care about patients and being prepared for it  actually lowers your stress because it's really,  it's hard for us when we have patients that aren't  healing or are getting re injured or,  re traumatized over and over again.

And we feel, it makes us feel like we're not, Doing our jobs or that we're powerless. So by having some of this in place, and if we were all working together, all healthcare providers  and Professionals doing this just think about how much better all of our lives would be like all of our professional lives

one thing I've noticed, the more you ask patients ahead of time, it helps you predict what treatments they're not gonna be able to comply with for practical reasons. Right. So I'm doing a lot more hemorrhoid care now and  it was really easy to say, oh well, sitz baths  taking a bath with Epso salts really helps.

Then realizing that not all my patients have bathtub,  something simple that a lot of us might take for granted. They may live in an apartment where there's only a shower, or they're sharing with many, many family members. So the bathtub itself is not hygienic and you don't want to get in there with the wound.

I would no longer say now, hey, go get some Epsom salts. And  take a bath twice a day for 10 minutes. My 1st question is, do you have a bathtub?  Can you get in a bathtub? Is it one that you can use?   So now I've educated myself that I can't assume people have bathtubs. 

What we don't recognize is when we tell patients that, and they're listening to you, and they're like, okay, doctor, yeah,  but it's actually, that's part of the re trauma.

We don't, we're not doing it intentionally. We're trying to help them, but just the fact that right there and then they know that  they are being Instructed to do something that they're not going to be able to do is it's painful for them, right? Because it just reminds them of what they don't have so right there.

We just kind of loaded on trauma

I also think as we're all learning, I think sometimes it can be hard and people can be like, Oh, we have to make all these changes. We have to be so woke now, but I think it's okay to realize that we're all doing a lot of unlearning.  We were all put in this world. We're living in a society.

I think we've all taken in a lot of this. collective learning.  I think what you did is good that you probably before just said, go home and take a bath, but then you caught yourself. And I feel like the big thing is that people think it's such a hurdle to get to where we need to go that why should I even start?

I think if you're doing little things  we all have bias, but I think the point is catching it. And thinking, Oh,  I just noticed I do this. I'm going to make an active choice now to try not to. I'm sure I'll mess up. I'm sure tomorrow I'll once again, say, Oh, get in your bath and then think my mistake, sorry, do you have a bath and just self correcting?

Something I feel coming across naysayers is that  it's too hard. Like, how are we ever going to be perfect at it? You probably won't be perfect at it in the beginning. It's  giving yourself the grace to try. To change your ways,

and I don't think anybody's  perfect, and I absolutely Many many times still make mistakes myself, so I'm always learning  ways that I can do things better With my patients and as I was saying why I love my patients so much as I learned so much from them, too right, so that's you know part of it is learning from others,

I think we should start to wrap up soon because Dr. K I could talk to you for ages. This is so exciting. I told you at the beginning, this is something I could  talk about forever too. 

Do you believe it's important for women and people to share their experiences with one another  and why,

yeah, I do. I mean, I think it's all storytelling, right, is the way we change things  and learn from each other. Particularly  with this topic,

It's hard if you've had difficult experiences, but when you feel ready and you feel like you're able to, it's good to, be able to  talk about it either, with a one on one with somebody that you,  trust or even more in a,  public forum, like something Like what we're doing here, because everybody's going to learn from experiences that others have had, whether they're positive or negative,   particularly when it comes to health care, women's health care, trauma informed care, there's really so many things that can make that a more positive experience for us.

the more we talk about it. The more it gets out there, then,  our, healthcare professionals are listening to, we do listen to what  our patients are talking about, and we, our goal, we go into medical school because we want to, help people and make their lives better, and a lot of, Things come in and try to interfere sometimes with our ability to do that as well as we'd like to, but  at the bottom, the core of the person that's sitting across from you generally is that they, they want to be supportive and make things better for you.

So they just need to,  learn and hear about,  what your experiences are, are like, and how we can do things better.

Beautiful.  Then last, this can be for all of us is just a general takeaway message for someone who might be listening in.

Yeah, I feel like I  covered it in the last  sentence,

  I take away from our conversation is that encourage women to if there's something about going to the doctor that has particularly been tough for you in the past.  Please talk about it and Dr and I both said that we appreciate knowing ahead of time.

But if someone is.  Hey, I was seeing another urologist for my incontinence and I'm coming to you. I like to ask the why. Are you not going there anymore is, you know.  Could be some simple, like, they retired it could be,  well, they gave me prescriptions for medicine. It didn't help.  Or I was really uncomfortable during the exam.

They had,  some assistant kept walking in and opening the door and I was naked to hear why what they're particularly scared about ahead of time. It's really helpful.

I guess the only other thing I would add is. In the field of, of gynecology, if you are having  Really highly painful exams, or you're not going to the doctor because you've had past experiences for exams and therefore you're behind on screening or you need something checked that you're not comfortable with, is to try to.

Seek out somebody who maybe has trauma informed care or gynecology, maybe  they're listed on their website or under,  the picture that they have, if it's a hospital website, because there are really, really techniques that we can very specifically do to get over that hurdle of the exam. And if we can't do it, of course,  in the outpatient Setting, there's always the opportunity to do exams under anesthesia, but we absolutely can,  I would say 75, maybe even higher than that, 75 percent or more of the time, we're actually able to get the exam accomplished for the, individual so that they're not just,   dreading or worrying about something that could be going wrong.

Thanks so much, Tracy, for spending time with us. Yeah, it

was so nice to see you again, Denise. You take care.

 

Community Shout Out:

Our community shout out for this episode is CAASE. And today I'm here with Sante Hardin Tate, who we've chatted for just a minute is such a fabulous lady. And she's going to explain a bit more about what CAASE does, why it's so important and about her specific sector within CAASE. So hi Sante.

Valerie, so much for having me. I'm excited to be here. 

So I was hoping first you could start off by telling us what does CAASE stand for and also a bit of an overview about what CAASE does. 

Absolutely. So CAASE stands for the Chicago Alliance Against Sexual Exploitation. And I personally and not just because I work here, but I absolutely love CAASE and what we do.

We offer legal support services to victims of sexual harm or survivors of sexual harm. So, that can be in many different facets.  As a survivor, you often need. some support that stems not just to the criminal justice system, but in also other areas that are directly related to being a survivor.  We want to make sure that survivors have that legal support to navigate any of the systems of our judicial branch.

And so that's what we do here at CAASE as well as we also provide prevention education, community engagement work, and policy as well. We are advocates. Fierce advocates for our policy team. And,  often you can find us,  advocating for different policies that can benefit survivors of sexual harm.

I know that you work within the  community engagement team.  What are you  doing within that team? 

Absolutely. So in our community engagement space, we find ways to branch out and to connect with the community externally. So outside of CAASE, we predominantly try and engage the communities on the South Chicago side, South side of Chicago.

excuse me.  Our goal is just to reach for the community, let them know that CAASE is here to support them because the black community is one of the populations that are disproportionately affected by sexual harm. We want to make sure that we're reaching out for them and providing them with the support legally that they may need.

And also because there are some areas that may not have the means to afford legal representation. We want to make sure that they're not forgotten and they absolutely have some alliances in us.  We reached the community on the south side of Chicago. We're branching over into the west side and we do have some times that we're also reaching out to our north side of Chicago as well.

Our goal is just to provide, , also virtual and other events that are in person, but also to attend events in the community to let them know that the CAASE exists and we're here. 

That's so amazing.  I know that there are some reoccurring events or things that happen every month or every year.

Can you speak to some of those in case those that are listening want to get involved or just learn more? 

Yes, absolutely. I would love to see you all at our virtual reoccurring events. They are virtual. And although I know that we may still be,  recuperating from fatigue with zoom, it's always just super convenient to join us wherever you are.

We want you to do just that come wherever you are as you are. And so we have reoccurring events are surviving the Mike reoccurring event. We have 1st, Thursdays of every month with which is our facilitators feedback and we have the 3rd, Thursday of every month, which is our writers workshop. And what we do here at our surviving the my workshops.

is we use writing workshops and writing tools as a means of expression through trauma. Um, we provide a workshop where folks can,  just navigate the trauma of being a survivor. We also want to uplift the LGBTQ plus community.  We,  provide that brave space here at the survivor in a mic. We talk about brave space.

And so we provide that brave space. It's for survivors to come and talk about their experiences and work through that trauma through writing. And then we give you the opportunity to share what you've created in that space on the first Thursday of every month.  You can come, you can share with our workshop facilitator most days locally and share with them.

What you've come up with what you wrote in our last workshop, and we give you feedback on how to improve or possibly utilize that to get more awareness out into the community. So a lot of our attendees have been going on to be published in various.  Magazines throughout Chicago or other things as well.

So it's a great space to connect and to really work through that trauma.

I've been to not a CAASE event, but an event similar to this when I was in university and just that feeling of.

I think one of the big things is that feeling that what you're going through is  personal to only you or you're alone in it. And that feeling of, of loneliness of thinking it's only you  and being at something like this to even see the people in the room, even if you didn't feel like sharing or see the people on the zoom, I feel like it's just a reminder that you're not alone.

Thank you for pointing that out. Valerie. Oftentimes as survivors, we do feel alone. I am myself a 4th generation survivor and we don't talk about it as much as we like, Especially in the black community.

And so being able to provide a space where you can feel seen, you can feel heard is something that not only,  surviving the mic,  values, but also CAASE as well.  We aim to cause or create visibility of survivors that are otherwise invisible and unseen. And so to know that hearing about this space does that for you, it gives me so much hope that it can do that for others as well.

So we love to see folks come out. 

  We also have our monthly let's chat over lunch.  Let's chat over lunch. The goal is for us to discuss the recent events happening in the news that pertain to sexual harm.

And so each month there's a different topic. We talk through it.  We talk about, different, sexual harm that is seen in the media.  In our next Event, which will be September the 25th, which is next week. It's also a virtual event. We would love to see folks,  come out for that one or anyone that happens the 3rd, a Wednesday of every month that is a reoccurring event as well.

We would like for folks to come and just hear those topics, discuss what they're seeing in the media and just provide support as well. It's a great space to kind of navigate and work through some of the things that you may have questions about, or you're not sure about, or you want to learn and discuss.

us or if it just really just bothers you to see that these things are happening. It's a great place to just kind of exert that energy as well.

Are there any other things that you'd like to speak to?

I just want to say thank you for having us here and for the community shout out as well.  Here at CAASE we value, reaching out for our survivors and we hope that to continue to do that work. And so you can find us on our website at,  CAASE.org.  You can also learn more about our staff are amazing staff that we have here and what other services that we provide here a CAASE or how you can receive services should you need them 

Even if you're just going to the website, there's a tremendous list of resources that is available to you or info sheets about how you can support someone that may be going through something like this or support yourself.

 

Community Shout Out:

Thank you so much for listening to this episode of Not So Private Parts, A Girl and Her Gyno Mom.  I hope that you've learned something from this episode or taken something away. I certainly know that I have.  So what can you do to support Not So Private Parts podcast?  You could leave us a rating or review wherever you're listening to this podcast.

This supports our show to reach more fabulous people, and it gives us a little push on those tired days to keep creating.  You could share this show with a pal. We know that not every topic is going to be interesting to everyone, but if you find a topic that you liked and you think someone else might too, share it with them. 

You can follow us on Instagram at NotSoPrivatePartsPod.  Shout out to the wonderful Katie who's been doing a great job womanning that page.  You can head to our website to check out some more information about our incredible community shoutouts and fine episode transcripts.  Roll the credits.  The show was created and produced by me and my lovely mama. 

The gorgeous voice that you heard singing in the beginning was an incredible gal and pal I know, Raley Mauck, and the super cool logo you're seeing was designed by Karin Buffie.