Posture & Purpose With Dr. Michelle Carr Frank
Welcome to Posture and Purpose where both healing and community come together! An inside look into Carr Chiropractic and Dr. Michelle Carr Frank.
Posture & Purpose With Dr. Michelle Carr Frank
How A Breast Surgical Oncologist Builds Trust, Teams, And Better Outcomes
Fear has a loud voice, but facts are stronger. We sit down with a breast surgical oncologist who turns complex decisions into clear choices—explaining how screening, genetics, and modern surgery work together to deliver high survival and a better quality of life. From the first mammogram to long-term follow-up, we walk through what actually changes outcomes and what’s just noise.
We unpack the essentials: when to start screening if you’re average risk, how family history really shifts timelines, and why MRI isn’t a shortcut for everyone. You’ll hear the difference between lumpectomy and mastectomy without myths, the role of oncoplastic techniques, and how expectations shape recovery. We also dig into advances that make care easier—long-acting pain control, outpatient pathways, and soft knitted prosthetics.
Genetics takes center stage with BRCA and beyond, showing how expanded panels influence surgical planning, radiation sensitivity, and family counseling. We talk candidly about full-body scans, incidental findings, and the anxiety tax of overtesting. Movement and posture get real attention: early stretching, scapular opening, and lymphatic care reduce stiffness, axillary web syndrome, and lymphedema. A multidisciplinary approach—radiology, pathology, medical and radiation oncology—keeps decisions aligned with NCCN guidelines while staying personal and humane.
If you’ve found a lump or you’re putting off a mammogram, this conversation gives you a next step and a team mindset. Early detection turns a crisis into a plan; access pathways like self-referral screening remove barriers; and local support groups add strength you can feel. Subscribe, share this with someone you love, and leave a review with your biggest breast health question—we’ll bring your questions to future episodes.
Where's your background with your education? Where did you get your schooling?
SPEAKER_01:So I am originally from California, San Francisco Bay Area, born and raised there until I graduated in San Francisco. Yep. Went all the way off the coast though for undergrad. Went to Howard University in Washington, D.C. Wow. And then I went to LA at UCLA. Charles R Drew is where I did my medical school training. And then I went back to the East Coast, Pennsylvania. You'd like to travel.
SPEAKER_00:Welcome to Posture and Purpose, where both healing and community come together. Make sure to subscribe on Apple, Spotify, and YouTube. Let's get into this episode with Dr. Michelle Car Frank.
SPEAKER_03:Hello and welcome to this episode of Posture and Purpose. Today I have Dr. Shonda Griggsby. She is a breast surgical oncologist here in Lafayette, Louisiana. And I would like to pick her brain about all the many hats that she wears and how she helps all the people in our community. So welcome, Dr. Griggs, for having me. Thank you so much. Thank you for being here. So tell us what led you to this pursuing general surgery and a subspecialty in breast oncology?
SPEAKER_01:Good question. So that was um I am a person who likes to do things with my hands. I learned that from the time I spent with my dad building things, making things, um, in science projects. And so then as I grew and grew up in life, I I figured I wanted something with my hands. And so then um healthcare kind of became uh the place I landed, and it was because of different experiences. Um, friends who had been in car accidents, I got to be able to see their plastic surgery journey, for example, or um, and so then I told my dentist, surprisingly, that I was thinking about doing medicine, and somehow I thought about anesthesia. So that was where I started, and then he let me work with a pediatric anesthesiologist that would come to the dentist um to uh to do stuff with kids. So I did that for some summers while I was in high school and then high school? I know so young, that's great. And then I ended up just kind of diving into what more of healthcare was, and um and then I landed on surgery, I think more so because of the technical skill set and the ability to build and do and take and I don't know and put stuff together. And I've kind of always thought the puzzles were great, and so that's just really where um I think it spawned from. Yes. And then when I got into young age. From a young age, and no and my mom always asked me, like, there's nobody that I can say told me to do that. I kind of just decided I was gonna do that, and that's where I went. And then um I got into general surgery residency and uh started to spend a lot more time with um people being diagnosed with breast cancer. A lot of my people I worked with, the nurses and the staff that I um spent a lot of time with. Um and so I started to get more and more involved in what breasts look like and building a breast program at the surgical hospital that I was at, and um and then did a couple months at Sloan Kettering just to get an idea of what it like that that big research, you know, very um strong uh breast program that they had and spent two months there, just kind of understanding that and and I felt like that was where I wanted to be. I like people, I want to take care of people, but want to get to know them for a long time. So I feel like that was where uh breast surgery became a part of my dream. And it's I'm here now. Now I know you wear many hats.
SPEAKER_03:Can you tell us some of the other things that you're involved with?
SPEAKER_01:Yes, so I um I'm actually uh the associate regional medical director for Australia Laugh Regional Medical Directors, uh, medical doctors in the clinics, and so I do a lot of oversight of of employing our physicians and APPs within our which are advanced practice providers, so nurse practitioners, physician assistants, uh CRNAs, um, and uh that's a big part of what I do, um, it's part of half my job. So um sounds like a big job. It sounds like a big job. It is a big job, but I enjoy both uh my breast surgery and and my my administrative roles, and um that's been kind of my journey for the last eight years.
SPEAKER_03:And how does your your background as a general surgeon shape the way you approach breast cancer services or kre breast cancer care? Because general surgery is broad. So I know you said you spent some time at a research facility. Um two months doesn't seem like a lot of time. So was it just something sparked a passion in you to do this?
SPEAKER_01:Um I would say um, so when I was in high school, one of my friend's sisters was diagnosed with breast cancer right after she graduated law school. So young, 37, 40, you know, um years old, and didn't really do well. She she didn't survive and it was a very quick process, and so I think that always stuck with me in the back of my head, I think, um while going through general surgery residency. And then for me it's the relationships, the building of relationships, and I'm just a very big, you know, I feel like you could be a jack of all trades or you could be good at one thing, right? And so I enjoyed general surgery. I enjoyed doing thyroid surgeries and all the things that general surgery had to offer.
SPEAKER_03:Right.
SPEAKER_01:But I also thought about my personality and and what I felt like I was gonna give the most to. Um, and so breast surgery became that that thing. So in general surgery residency, I spent that time learning about it, understanding it, going through the imaging side, so learning how to do the ultrasounds, the biopsies, and um looking at imaging with the radiology team. And then when I went to Sloan Kettering, it was for uh again understanding do I need to do a fellowship or not, right? That was the other part. My general surgical training, I did all the breasts. So that includes the breast cancer part, the plastic surgery part, because we didn't have anybody besides general surgery residents, no fellows. Um, and so I did a lot of that, and then I said, yes, I should probably do a fellowship. So then I went up to uh Beaumont, which is now Corewell Health in in Michigan, and did a one-year fellowship in breast surgical oncology there. And then I came down to Lafayette, Louisiana and started practicing as a breast surgical oncologist here, and and and that just really stemmed from wanting to make a difference in the breast world and um going to a place where I felt the diagnosis rate was pretty high and um and and I felt like I could make an impact of all the things that I had learned um and bring it to the community and it's not for everybody. No, it's not for everybody.
SPEAKER_03:You know, I mean it you can be a general surgeon, yes, but it takes a different uh personality. You have to have that relationship, like you said. Yeah. And what do you wish every woman out there understood about breast health before they ever need you?
SPEAKER_01:Yeah. Good question. Um, I think the biggest thing that they um should focus on is just understanding the screening and prevention part, right? And then knowing your family history, because I think that plays a bigger role than we ever thought it would. And over the years we've learned so much about that that I think genetics is a big part of what we do, and I think it will be where we go in the future as far as how we treat and manage diseases, and I think we'll have much so in breastwork, we already have a lot of good outcomes, right? We've a lot of research is uh is in breast, and um the the survival rate is extremely high, right? And I think that's the first thing I'd like to tell people the survival rate is really high. The point though is finding finding it early, right? And so but the treatments have advanced so much that it's getting more targeted towards the type of biology that's within the cancer itself, and that is gonna be a big game changer over time, and it already has been, um, as far as response to therapies and how what people do, right? So I always tell people the first thing is know what screening is, get screening done, finding cancer early saves lives, and the survival rate for breast cancer is extremely high. So fear is something that I understand people always have. Sure. But the goal is to get it out and to move on with life and and and and not dwell in it. Face the fear, I think face the fear. Um because I think a lot of people don't want to face the fear of yes, I have the word cancer. The C word is a big word. Right. The unknown too, like what's ahead. What's the head?
SPEAKER_03:What what do I have to, you know, um fight with this challenge on this um and what life has brought to me. So what about benign breast conditions? How do those differ um from other uh situations that might need cervical intervention?
SPEAKER_01:Yeah, so essentially essentially um there's a wide span of benign diseases that people will come across. Some of them are cysts, they cause breast pain, right? And and we do a really good job of trying to help people understand what that breast pain is and what's about and and how to manage it. It could be a bra fitting, like a bra fitting appropriately. Um, it could be using some topical anti-inflammatories. I tell people you have arthritis medicine, it's called Voltaire and gel, it works great for breast pain. Um, and so just understanding breast pain and then understanding benign lumps, right? Because lumps are scary, bumps are scary, right? And so you as a younger person tend to have a lot more breast changes happening as we go through different hormone cycles throughout our aging. Um, and so you might have more of what we call lumpy bumpy breasts, right? And so how to be aware of what that feels like, it makes an exam kind of difficult, I think, when some people are doing home self-exams.
SPEAKER_03:Sure.
SPEAKER_01:Uh, but I think just being aware of those benign lumps and bumps that do exist, also making sure that you're aware we do do ultrasounds to make sure they are benign, because we do see cancer in younger age um individuals. But um, you know, there's a lot of different benign processes out there. Some of them might put you at higher risk, some won't. Um, and so our job is to make sure that we educate somebody on what that is. And so if someone has a biopsy done that shows, let's say, some atypical cells, what does that mean? You know, what does that mean for me? And what would I recommend and do? What would I do from an imaging perspective? And what would I do from a management, either surgery or not surgery, but maybe I'll give you medication to lower your risk. So um that is just where we we focus on. We have a um benign breast clinic as well as a high risk breast clinic that are run by our um physician assistants that are that are I pretty much educated and taught, I guess, from the ground up. But I think that um that helps us to to gain help educate our patients on what to res uh what to expect from their results and what to to make of them and and how does that impact what we what they do going forward. Going forward.
SPEAKER_03:And where um where's your background with your education? Where did you get your schooling?
SPEAKER_01:So I um originally from California, San Francisco Bay Area, born and raised um there until I graduated. San Fran. Yep, went all the way across the coast though for undergrad. Um went to Howard University in Washington, D.C. Wow. And then I went to LA at UCLA, Charles R. Drew is where I did my medical school training. Um, and then I went back to the East Coast, Pennsylvania. You like to travel. Um, where I did my general surgery residency for a six-year training, and then I went to do a one-year fellowship in breast surgical oncology, and then that was in Michigan and came down here. So I've kind of been all over the place. Um, where do you call home? Well, now this is home. Between here and California is home. Okay. And my parents are from Louisiana, from Freeport and Monroe area. Um, they live in California still, but they come visit me all the time, and they are here all the time.
SPEAKER_03:Are they coming in for the holidays?
SPEAKER_01:They're not this year. My n my niece and nephews are gonna go visit them, and so they're everybody's going to California. So um we kind of go around between there and I guess California. Take turns. Yeah, yeah, exactly. But yeah, so been kind of over the globe. I've I've met a lot of good people.
SPEAKER_03:We're so lucky to have you here.
SPEAKER_01:It's been a great journey, and being here has been great. I've I've enjoyed the community, the people, the culture, and it just I enjoy the patients that I take care of. It's it's a very special community, it's very special.
SPEAKER_03:Absolutely. And you know, people we talk about facing the fear. What age um should someone I mean, this is such a big thing. Oh, oh, I don't need to get my first mammogram until I'm 40. Uh, but what age and risk factors should guide someone's decision when getting screenings?
SPEAKER_01:So um the first thing I always tell people, you know, that's where history comes into play. So if you have no family history that you're aware of, uh, but breast ovarian or any other cancers, to be honest with you, we we our high risk program actually looks at all risks that includes colon cancer risk. But um if you have no risk of the breast ovarian, for example, the main issue that we kind of focus on from a breast perspective, then you're probably at what we call average risk of breast cancer. That's usually one in eight women, so 12% risk, roughly, give or take. So usually that's a screening start about age 40 at the present moment. Um, so we recommend screening age 40 from the American Society of Breast Surgeons, American College of Radiology. Um, the uh United States uh Proventive Task Force will say a little bit differently, maybe starting at 45, but consider starting at 40. But the rest of us are pretty hardwired. Okay, okay. I just wanted to make sure I got my numbers right. Okay, okay. Now, if you have um family history, uh we always recommend doing a risk assessment, whether that is through your Obi-Guyne's office or your primary care if they do perform it. Or you're more than welcome to go online. We um have some online platforms that will let you kind of put your history in, mostly focusing on menstrual cycle, when it starts, um, how many uh children you've had, live births, age that starts. And then adding family history into that definitely will bring about some different history, some different risk, I guess, profiles depending on how young the person was in your family and and where they were. So, you know, mom, their aunt, your aunts on either side. Um if you've had cousins from an aunt that has, you know, if aunt and the cousin have cancer, then it's the same, you know, mom and dad, mom and daughter. That's concerning. So we like to understand that. And then um, and if you have any biopsies in your past, sometimes biopsies, just having a biopsy can actually up your wrist. And so we're looking at all the information to determine whether someone should have something done earlier. So if you have a first-degree relative, which is your mom or your sister, um, with a diagnosis of cancer, we want to know what age. Because then let's say you have somebody diagnosed at 35, then we may tell you you at least want to start your your screening mammograms at age 30, but you might want to be um you might be eligible for MRI of the rest by 25. So it's just some of those things that we can educate on, but it also it just depends on a lot of those kind of factors that I just mentioned. So um we we take it to we take all that into account when we see people um come through the door, but we can all fill that information out so we can understand where we're starting from.
SPEAKER_03:Yeah, it's like putting together pieces of a puzzle, a roadmap with genetics, because you know, we can't pick our genes. Nope. We we gotta, you know, play the handword dealt. Right, right, right. And so you we talked about tools like uh mammography, ultrasound, and MRI. So someone wouldn't go straight to an MRI unless there was some type of family history? Generally. Generally, okay. And how do you advise women who are anxious about mammograms? And they're scared, and they want to avoid screenings out of fear. We talked about that a little bit, but is there some push? How do you get that through to them?
SPEAKER_01:It's tough. I don't always win the battle. I'm gonna be honest with you. I don't always win that conversation. My ultimate goal um is just to tell people, you know, I a lot of times the fear of screening is the pain, you know, right? Mammograms can be painful in the sense of the compression and things. So I always tell people just communicate with your your mammotech, the mammography tech that's doing your mammogram. Like let them know, hey, look, I'm trying to get through this mammogram. I didn't have the great experience last time, and um I'm I don't want to have the same experiences. So you just let them know ahead of time, and I think you'll find that the mammographers are very accommodating to that. They they don't want to hurt people. That's not the goal, right? Right. Um, the other thing is you know, people don't want to know, right? Not knowing doesn't, and tell people not knowing doesn't prevent it from growing and doing what it's gonna do. So what we hope to do and what we find the most the the most um the best outcome is finding it early, right? Small, I don't want you to feel it. I don't want to wait for you to feel it. If you're feeling it, maybe not the best. Obviously, we do have advancements in healthcare and we and the people do okay. It's just we prefer not to have we prefer not to feel it. We we prefer to find it on imaging. Or not find it. Or not find it at all. Exactly. Um and so it's just really trying to talk through the fears. My my biggest goal is to sit down and communicate about the fear. Again, I go back to don't sit in the fear, let's talk through it, and and I'm hoping that through that conversation we ease we ease that fear, right? And so um I spend time having those conversations. Um, you know, radiation exposure and things like that come up often. And I'm like, look, we live by airports, we live in a place where there's radiation exposure every day you go out to your house, and so the amount of exposure you get for one mammogram does not even equate to the amount of exposure you get on a daily basis. So I understand that fear, but it's really not something that we can say is is true in the sense of causing cancer. I mean, at this point, because you have people who have never had imaging done before, and here they are with the cancer before they show, you know, at age 37, right? Yep, risk beneficial. Right, exactly. Risk benefits, definitely.
SPEAKER_03:And what do you I know you mentioned plastics? So, what are the biggest misconceptions about breast cancer surgery? Okay, we all have an idea of what that means and what that looks like. But can you take us down that down?
SPEAKER_01:Yeah, good question. So um I think some misconceptions that I always like to address are when we're doing cancer operations with reconstruction, it's reconstruction. It is not cosmetic in the sense of the word. We hope that we get to a space where it it looks and feels as normal as possible. But remember, we have I told people we have removed something, created an empty space, and we're trying to fill that space back to at least have a shape and a look that is normal. It won't be reconstruct, it won't be cosmetics, right? It's not like we're gonna keep your breast intact and then we're going to put an implant to enhance something that's already there. We are going to try to replace something that we have taken away. Like I have taken that away, right? And so um I try to get people to wrap their mind around that part. Um I do think um from a surgical perspective, certain people might choose a surgery thinking that it's gonna change the overall outcomes. And a lot of time I tell people the risk of a cancer coming back, whether you keep the breast, do a mastectomy, which is taking the breast, generally it's probably close to being almost similar majority of the time. And it's not zero just because you've taken the breast and mastectomy. So those are some of the conversations I like to have with the patients because it's different. I tell people when we take the breast, it's different, it's gone, it's you're you don't have sensation. I just want people to be mentally prepared for that change. Sure. Because it is a change, and it's it's different versus uh what we call a lump ectomy where I'm just taking a lump of tissue out and your breast is otherwise shaped and looks the same. And um but it's those are two different things and they take two two different psychological tools.
SPEAKER_03:I was gonna ask you about men. I mean you're a therapist as well.
SPEAKER_01:Oh yeah, it's a it's a it's it's it's a psychological tool that I think people sometimes aren't all the way prepared for.
SPEAKER_02:Yeah.
SPEAKER_01:And I do try to make sure they are prepared because it's different, and you'll have people who don't realize that they have a belly that they've had, and it's some of those conversations, and I try to mentally prepare for those if we're gonna do a bigger operation. And then reconstruction, you know, we use it in um people who are getting what we call lumps. I I I believe in the um what we call an oncoplastic reduction. So someone who may be large breasted um who's gonna get a lumpactomy. We can then do the reduction of lift for those patients if they come out really pretty and they they look good, and we've been able to take a good margin around that cancer, and um, but I say put your best back in a pretty envelope. Now that is a good operation, right? We don't put into corn, you're not getting a big flap, what I call flap surgery, which we'll talk about in a moment, but it's just it's a pretty operation and it does do a good job of what we need to do. Um when we talk about um reconstruction from a mastectomy where we're gonna take the entire breast, then you're talking about a different type of you know, process. Is that process going to be implant-based and then the risk benefits of implants? And then is it gonna be a flap procedure which I just mentioned where we're taking tissue from someplace else on your body and putting it in to fill a gap in the breast? And that could be two different outcomes, two different risk um recoveries all different, right? So um, you know, weighing those pros and cons, right? And so um, I always make sure people are weighing all the pros and cons, kind of really have a true understanding of what they're getting into with others, whichever way they choose to go. And I'm a believer, like you you would find a lot of um breast cancer surgeons in in our society. We talk about um you know, mastectomies are something people think they need, but not necessarily what they do they need it, no. But I'm also kind of the spec the mindset of it's a personal depend, you know, personal choice when it can be. I say when it can be because sometimes it's not the best option overall for whatever the situation is.
SPEAKER_03:But um it's such a personal surgery. It's a personal surgery.
SPEAKER_01:It's a personal surgery. I feel like um while we as physicians can try to put our yes science. Is a part of this and we we're not supposed to quote unquote treat anxiety, right? Like with surgery and things. I said, but um, I'm also a quality of life advocate, so whatever quality of life makes sense for the person. Like if you lose sleep every night, if you lose it, right? The mental aspect of it is such a part of womanhood, right? I mean it's so personal. It's so personal. So I said just I I try to take a personal approach to that um with the patients so that we're not we're making decisions together. I'm not making decisions for them. We're just I'm I'm here to give you information, talk through the information with you, and give you my feedback. But at the end, the ultimate choice is generally theirs.
SPEAKER_03:So what have you seen? What changes have you seen with recovery since you've been practicing new technologies or new uh procedures?
SPEAKER_01:Um we've definitely um probably moved more to a true outpatient, meaning people go home the same day from a lot of the procedures that we do when we normally would keep them for several days. We recognize that um you know, lumpectomies, we tend to send people home. Mastectomies were the ones we kind of kept people overnight, didn't keep people overnight, but um the uh the the pain medication we gave is better. The we we use longer acting locals that can be, you know, can numb things and kind of you know make that recovery process better. Um we've learned certain medicines that work during certain surgeries that impact nerve pain, you know, and so those are just some of the things we learned over time to allow people to recover at their homes. Because sometimes it's not the best recovery when you're not at your house, but you know, right?
SPEAKER_03:You can relax. You can just, you know, just let loose and relax. Oh yeah, yeah.
SPEAKER_01:And just learn how to like um communicate with patients about their post-op care. So um, if somebody's gonna have a mastectomy and they they can't use their arms as much, I'm like, get a recliner and we talk about all these things, help yourself get out of that bed without or out of the bed, out of the chair, without using your arms, there's a risk to bleeding and all those kind of things. Um new things that our cancer survivors are doing. Um we have a company called umidant knockers that make um like breasts that are made out of a certain type of yarn, and they are a company that's nonprofit that as somebody's healing, they're not ready for a bra or prosthesis, for example. But they are like comfortable, soft, and you can put them in the bra while someone's healing.
SPEAKER_03:And that's local?
SPEAKER_01:That's local. So there's a local group and there's a you know a um a national group um that we that we work with, and they supply our office with that. And I think that is you should see some of the patients' faces when you're like they're like, I'm I'm still healing, and I'm like, so we go get them and they're like, Oh you know, thank you. And it's it's it's very um just those small things.
SPEAKER_03:So small things make a huge difference.
SPEAKER_01:And Survivors have done great stuff. They have a Survivor who made a company with nipple tattoos that are like the Pasys, the like kind of like um like the tattoos you used to use when you were a kid, where you would put the thing and the water would go on top and it would just sit there and it would be there for like two weeks. Yeah. So she made a 3D nipple tattoo that they can stick on and keep on for a couple weeks and and I mean just the mental the all the things it really is, and realistic expectations.
SPEAKER_03:You know, they have to know look, this is not gonna be fun. The career we're gonna face it head on, and we're gonna be here for you every step of the way. Absolutely. So, how does a breast surgical oncologist collaborate with other medical oncologists? Because I know you're a surgeon, but how does that work alongside other oncologists, radiologists, pathologists, radiation oncologists? I mean, there's just such a team behind what you do.
SPEAKER_01:Team approach to everything, and that's the the one thing that we we preach. So we call ourselves the multidisciplinary team, right? So we all across the disciplines use radiology, uh, medical oncology, surgical oncology, radiation oncology, all involved. So what we work to build is um that process and we're working on building that now actually um at our clinic where we have people who meet certain criteria that need to see all of us as providers, and how do we do that in a day, right? In a time. Um and so that's kind of what we call our multidisciplinary clinic. And so that is something that we work across. We have tumor boards where we talk about all the patients that have had cancer diagnoses. Um we talk about their pathology, imaging, uh management. We use our guidelines. So a lot of us follow NCCN, which is our cancer network guidelines that are kind of national, nationally um provided and given and take a lot of different people's inputs from across the nation. Um, and we use those kind of guidelines to judge kind of where we're going from a treatment perspective, and um, so we talk about the patient's care and what who needs radiation, who needs medical oncology from the sense of chemotherapy, or um who can take a aromatase inhibitor pill or tamoxafin or whatever that is for uh risk reduction after surgery or after um final treatments. And so we have a big group collaboration that talks about all the patients' care together. Um and um And how often do they meet? We meet uh every other week right now, and then we have um I'm on two, which is tricky because we have so I essentially go to a breast what we call breast tumor boards every week. Um but it's uh it's a group of providers coming together who take care of all the patient globally, and um we talk about each person and go through all the images and make sure we're all on the same page and well being that you don't sit down or sleep because you do so many things, how do you stay healthy?
SPEAKER_03:What is your favorite outlet to get out and just release some of the stress of all these things that you do?
SPEAKER_01:So there's two outlets for me physical activity. So like I like to do kickboxing, it's one of my um favorite things to do. So um I have kickboxing in my action in my house. Um you have to bring it home with you. Yeah, I have to bring it home. I get up too early now. I used to be able to go early in the morning and come back home. No, I have to do it in my house now. But um, I do have my home gym and things that I use. And I have two dogs, so my dogs keep me pretty busy. My little fur babies. Um, what what kind of dogs? They're cock-poos, cocoa, um, cocoa spaniel and mini poodle mix oh Piper and Prince, both males. So they keep me busy and going and laughter, and they're hilarious. Um, so that's my physical kind of stress relief. And then my other mental really stress relief is I like to paint. So I like to do art and build things and create things and so I like to paint all the time.
SPEAKER_03:You're still doing it from childhood. You watch dad do it, and now you're doing it as a career.
SPEAKER_01:But you have that outlet artistically, so that's that's cool. So make different canvases and work on sculpting things and just random stuff like that. But um that is my own. Everybody needs an outlet, that's for sure.
SPEAKER_03:What role does genetics play in determining a surgical plan? You mentioned we briefly touched on genetics, but could you go into that?
SPEAKER_01:Oh, yeah, absolutely. Genetics can play a big role because what we've learned recently or the last couple years is we I call it the Angelina Jolian impact where people really knew about BRACA1 and BRCA2, so our breast-related cancer genes. Um, those are the the big two, the heavy hitters. But there are actually 10, 12 probably that are that are probably more than that actually associated with breasts, but other types of cancers, right? They put you at risk for colon or stomach or skin melanoma. Um, and so that was something that we recognized early on after my arrival here. I mean, I I actually did a quite a bit of uh training in that. That was part of my fellowship training. They had a whole genetics department that um was training physicians as geneticists, and um, and so we spent time in in those clinics to understand the genetics. And so I think coming here that was a big part of what I did as far as assessing risk. But then it's risk plus genetics, so you meet criteria for genetic counseling because there's risk factors that put you at elevated risk that aren't necessarily family, you know, familiar or could be the biopsies that we talked about before. But if it's your family history, that's really where you dive into the really the true understanding of man, this person may have something that was handed down to them that they have no control over, right? Like you said before. And so um we started to go down that road. We already had a genetic counselor on our campus, um, and one of our nurse practitioners, and then we just grew so big in the sense of having people who we would assess for the criteria and you know, working with insurance companies and things, sure, you know, over time. I think being advocates of that has helped many people um drive down costs um and and then increase access to genetic counselors and genetic testing. Um, and so over the years we've definitely grown that program, and we have um two genetic counselors on site for us, um, and one that does only breast, and then one who kind of does all the other uh I guess cancers that we see, because there's again, there's colon cancer-related cancer genes, there's pancreas, I mean, it's a lot. And so um, you know, getting trained in that, trained in genetics is kind of what me and and my partners um who work with me have done. It's such an interesting field. It's so interesting. It's very interesting. And then and I think from a surgical perspective, and when we're how's it impact surgery, is um sometimes, yes, that's when we would do more in an operation um than um if someone with the same disease presented um with maybe early stage breast cancer, for example, that I would say a lumpectomy and radiation would be appropriate for. But if they were at elevated risk for breast cancer overall, then you're talking about maybe a bigger operation, which is a bilateral or a double both breast removal. Um, and then you're talking about ovaries a lot of the times, depending on the gene. Um, you're also talking about radiation risk. So some genes can impact someone's ability to um not ability to have radiation, they can still get radiation, but they know that become more sensitive to it. Um, and that can impact what their skin's gonna do. And so you you know that now. So you and they're so it puts them at risk for breast cancer, but it also makes their skin more sensitive to radiation. So you kind of get you wanna have an understanding of that you're operating because you don't want to say, hey, you're gonna do sulfacy and get radiation. They have to know that that's a risk to do that. Um, that can change and put you at risk for another cancer down the line, right? And so we have to have those conversations and um and then you'll have um cancer risks that put you at risk for some of the more maybe a little bit more scarier um cancers like sarcomas and things. And so you're just trying to make sure you know now I gotta do full body scans on this person, now I gotta check their head to toe con constantly, consistently. Um, and it's not just the breast that I'm looking at and looking at all the things about this person. So I think it definitely can impact what I do surgically and what I would recommend surgically, or what I would at least counsel people on. I always tell people these are recommendations, even if you have a gene and the risk is there, whether it's 60%, 70% risk, it's your decision again that if you want to do the bigger, bigger I say bigger operation, i.e. the removing both breasts versus just a lump. Like you can still absolutely do a lump. If somebody finds out they have a mutation and they're 65 or 70, they're probably thinking, maybe do I really want it? Some people do, some people don't. Everybody's a little bit different. Right. Um, but it's just being aware. And then it's also the awareness that it brings to your family, right? Because if you have a mutation, then your family members might want to understand and know better about what that means for them. Earlier but they can be prevention.
SPEAKER_03:What do you feel? How do you feel about the full body scans? You know, uh pren is it pronova? Oh, yeah. What do you think about?
SPEAKER_01:I mean, I think it's got it's pluses and minuses. Everything has plus and minuses, right? Because we're scanning people to find things, again, creates anxiety. It does, yeah. Um, and again, what you find may or may not be a cancer or you know, it's a it's one of those things that get a little bit tricky. It does, because then you have something else to worry about, but it's really not worth worrying about. Right. So I think about that sometimes with breast MRIs too, right? Because I tell people breast MRIs are very specific. I mean, very sensitive, but not specific to breast cancer. So we might find other things that we bring you back for and investigate that aren't gonna cause you harm. But now like your body senses are up and everybody's kind of anxiety, yeah. Yeah. So I think whole body skins have their place. It's just it's always that anxiety thought in my mind of like, okay, now we're gonna be chasing things when we wouldn't necessarily be chasing, and they may not ever cause you harm. Like, you know, and it's just I know it's but it's look, it's again, people's choices to understand as long as they understand those risks, pros, and console realistically, yes, and you know, take that in. That's the that's the balance. And it's and then it's like, what do you do? Who's gonna follow that up?
SPEAKER_03:Who's gonna, you know, and you know, and but yeah, so and how do you um become, how do I say this, good at delivering bad news? I I hate to to be on a on a on a down note, but no, how does it feel or how did you become better at delivering difficult news to patients?
SPEAKER_01:I don't know if people ever really become good at the time. I wondered if it just do you become kind of immune to it. Never immune. You never at least I can speak for myself, I guess I should say. Never really immune to it. I think um, you know, it's never really easy to give people news that this is not going well or you know, this is where we're gonna end up. Um, and um I think no one ever likes doing that. If someone likes doing that, I probably think we probably should go talk. Um Take a vacation yes, uh talk about that, you know. But I think um it it's never really easy. I don't think it ever gets easy. I don't think you can it's always gonna be based off the person you're talking to because everybody takes that information so differently. So many different personalities. And so I don't even think you can use one one situation to prepare for another because um hard to navigate, hard to navigate altogether, and you you try to figure out how it's like how do you still inspire hope at the same time, right? And that's really where it becomes tricky um for me, because I'm I I feel like inspiring hope is still a good thing. I think people think we talk about this quite often, like going into palliative medicine is not hospice, right? It's just putting someone someone can live in palliative medicine for years just to be aware of like what's happening. So, like someone's breast cancer that is progressing doesn't necessarily mean it's progressing in a rapid space of where they would be not here in in six months, right? I think it's more of a this is what's gonna happen to the skin, this is what's gonna happen to this, but it doesn't necessarily try to harm you that quickly. And so like you're living in that.
SPEAKER_03:Yeah.
SPEAKER_01:Right? But it's still not good news, right? You're not this is not going the way we want it to go, but there's nothing else I can do from a surgical perspective or that I can do from a chemotherapy perspective, right? And so you're trying to navigate that conversation and keep them comfortable in life as they go through life because that life could be as long as time clocks just don't you just don't know.
SPEAKER_03:You just don't know. You don't know when your time is here. So are there support groups that you really focus on or reach out to or direct your patients to emotionally or physically?
SPEAKER_01:I would say, you know, there there are. I think really um there's some of them support groups here locally, there are the larger ones that are kind of out there. It really is kind of what you what's surprising in the breast world to me is that people know so many people with who have gone through Isn't it? It's like um in Louisiana. Yeah, and they make their own support group in reality about what this looks like. But Miles Prairie has a really good one. They meet, um, they get we work with them, they give us calendars, we sit with them a week. They're great, and they help us with the the mastectomy boxes, and we, you know, we pour we we pour ourselves back into them. And um I sit with them on their supplies um committee and a couple of us on the board, but like we work really close with our community. Um we have a lot of the young survivors coalitions, and and that's a because that's a whole subset of different things that people are dealing with at different ages when they're diagnosed. I could tell you, um, you know, those who have those young kids at home, it's it's a struggle. They're trying to figure out how do I say how do I tell my kid, and you're trying to let them navigate, help them navigate those conversations. Um and uh so there's just differences as far as what people need from those survivors' groups at the time which they are diagnosed. Um and so the young survivors coalition, um, there was pink ladies, pink women ladies, there's there's so many different groups here because there's so many people who've been impacted by it. Yes. Um but I think just find those that fit your personality, whether it's faith-based ones that are coming from your churches, and there's a lot of different ways to go about that. But if you um I also tell people if you feel like it's overwhelming to be in those spaces and you really want to talk to people, um, then finding a good therapist of your own is helpful. Um, I tend to refer people to psychology today where they can kind of scroll through and research themselves of who they think will be a good fit and then what their insurance will cover. Now, insurance is, you know, don't cover everything, but I I I try to make sure people aren't my last hope for people is that they're thinking about the financial state of life, which they're gonna think about it, but it's I don't want that to be a reason why they choose or don't choose something that's be an added stress, of course.
SPEAKER_03:You don't want them to have to deal with that. Now, talking about uh reconstruction, how important is mobility, um, posture, those kind of things? Because I see, of course, many, many post-surgical patients and the flexibility, the skin, the muscles, everything as a whole. Yeah. So how does that uh play a part?
SPEAKER_01:It plays a big part. So I think um you're trying to so when someone's getting surgery done, they scar, right? And I try to, you know, explain to them like I need you to be stretching. Stretching is gonna be a lifelong part of your life. It's gonna be there forever. I'm gonna ask you to do it all the time, whenever you can remember. And then when you get reconstruction, it also adds a added layer of complexity because you don't want people doing too much, depending on how the reconstruction is done, because we don't want people flexing muscles, which I understand, but I'm also very aware of I need you to move your arms or to to stretch your shoulders back. I need you to open up your deltoids, I need you to open up all these things, because if you don't, then it leads to problems down the line. You can't lose your arm, you get what we call axillary web syndrome and pain from just so my biggest thing is I give them these exercises to do that. I talk to the pastor surgeons about and say, hey, I'm going to give them these exercises. I'm gonna call them stretches. They're not exercises because that's kind of exercises. I want you to exercise. Go through the motion. We want you to, I want you to stretch, I want you to open up your chest, I want you to, you know. And so we try to make sure that they are aware of these. I said, these are two things I need you to do. Walk the wall and then put your arm in the door and stretch it out. Because I said you need to open up your chest because that's where you're gonna get that tightness. You're gonna always feel tight. It's gonna always want to come back to yeah, but I need you to not come back to that. I need you to open it up like this. And so we continue to have a conversation, but it's a it's a it definitely needs to be way more ingrained. Yes, in chiropractic. In chiropractic. Yeah, I mean, all the things, and you your posture just all in, for example, people who've had a what we call unilateral or a single side breast removal and had a heavier breast on one side, right? Um, that is always something I'm always thinking about because they were already having shoulder and back issues probably majority of the time. And then when you remove the weight to one side, you can only imagine what's happening to their spine.
SPEAKER_03:Right, right. There's such such an imbalance.
SPEAKER_01:So um, I I'm always cognizant of that. I think that's something that as healthcare has grown, and when people try to say, well, why don't we do a bilateral double mastectomy? I said, Well, I can do that or reduction. Either way, I'm doing surgery on one side or the other, right? And so it's because of that part. Like I think you have people have to be aware of the downstream effect of what we're doing. Yes, right.
SPEAKER_03:We're trying to prevent future issues later on down the line.
SPEAKER_01:So absolutely have a hand impact on physical therapy and stretching and and back in chiropractor because it's it's it's very important.
SPEAKER_03:It's it is overall for their uh overall healing time. Yes. What are your thoughts on incorporating complementary therapies? Maybe not alternative medicine. Or lymphatic drainage, lymphatic massage, mobility work, uh in any of those things. Do you have um an opinion on any of those?
SPEAKER_01:With healing is that they're great. Oh, yeah. I think um I think they help with so we deal, you know, we're we're in a state where we have some people who tend to be a little bit more heavy and they can hold on to fluid differently. Um good old Louisiana. Yep, and they can hold on to it in their arms, in their breast. And I think um, and that can create um delays in how they recover down the line. And so I believe in a lot of we actually, so we actually just finally um took two years, but we got our approval for um a lymphatic um measuring machine that could be more consistent. It's called sozo. Oh, but it we we've used it in its younger year form, which would used to be like little probes you would put on kind of like an EKG, but now it's like bioimpedance and kind of understand that, but you can understand it from lymphedema of the legs. So we have like a gynecology oncology surgeries that do a lot of pelvic surgeries, right? And so you can get swelling in your legs. You can anything you're doing that takes lymph nodes from any place can cause a backage and the leak, you know, and the clogging, as I call a backup of of fluid that's now held in your your extremities. Yeah. Um, and so how do we measure those things? And so we actually um finally got approval for the entire system of austener to. uh utilize this machine to help measure. And so that will be um and so we use um lymphatic massage, we we use um lymphatic pumps, we partner with our physical therapy team to to get them work it through. You work it through and um help try to get insurance to cover some of those things. I know I talk about that quite often conversation. But it's just so I believe in that I believe in in reverse what we call lymphatic mapping, trying to find out where the flow is going so we try to preserve vessels and so important. You know the one thing we don't have here which we probably we work on is um lymphatic to venous bypass sometimes when you have just those really horrible lymphatic um misconnections that um lead to really uncomfortable heavy arms and heavy legs or for that matter. But definitely think using all therapy in my opinion is helpful even from um cold caps for chemotherapy and you know things like that to try to minimize hair loss. Yes. All those things I mean it's worth trying. I mean I don't you know sometimes people don't think it works but there's people who might it work great for them. So I'm not really sure if it's just more of an educational thing but we need to like explore your options then there are options thank goodness that we have out here definitely options and so I'm a firm believer in people kind of utilizing all the things at their disposal that they can to help their journey right and and that's important.
SPEAKER_03:And it it's it's very obvious that you're passionate about what you do so that's that's a gift that we have here in Lafayette.
SPEAKER_01:So what is one message that you would like to uh relay to any of our listeners today any man or woman listening that you would like to one message or two or three whichever the one message I always tell people is um we we tend to want to take care of everybody else before ourselves but it is important to take care of yourself so you can show up for somebody else in the way you want to so prioritize yourself get your get your screenings done I'm not just not just talking about breasts you know screenings that are going to help to mitigate the um quality of life impact if something was found later right so that way you can get back to being there for people right it it's you don't want to be hit by something that we could have caught early enough that would have spared the quality of life your ability to to be that person for your for your kids for your for your husband for your for your parents um and so prioritize yourself it's okay to do so people will understand.
SPEAKER_03:Yes and people will understand take care of yourself and you'd be surprised it shows up to help you so well that that's a a a very very important message for sure. So if someone listening today feels a lump or notices a change in their breast and they are in that fear stage what should they do today?
SPEAKER_01:Let a doctor know let somebody know um so that way we can walk you through what the next steps will be and know that you have a team. There's a team always there whether it's whether you've met me before or you know your primary care your Obi Gon your your whoever you have seen let somebody know and let's let's at least see what it is first before we we make an assumption because it may not be cancer, right? I think the biggest fear is that but there's a lot of lumps that that exist that aren't necessarily cancer. So we just need to make sure we know what it is and maybe it's not something to worry about maybe it is but if it is we want to take care of it take care of it quickly so that way it just becomes a blimp in life and you get to move on.
SPEAKER_03:And if someone has found themselves in this situation unfortunately how can they um receive your services?
SPEAKER_01:Oh um yeah so we um you can contact us at um 337 571 1300 and that is our uh breast center number it will get you to our imaging side as well as our breast surgical side but again it's for we're there for lumps and bumps pains if you don't know where to go um we will do an assessment before and figure out what the issues what you need next whether we do ultrasound ourselves in our clinic or um get you to our imaging side to do a mammogram or MRI um and uh we're located on um South College uh right across or right on the same side of Sub City uh diner if ever if you've ever been but um essentially we can we can assess anything we tell people you don't need um referral from anybody I think that is a very big misconception is that you need a referral.
SPEAKER_03:Sure.
SPEAKER_01:And and I think sometimes people do but even if you have a doctor and you call yourself we'll we we'll reach out to them for you and we'll say hey look if we really need a referral we'll we'll figure it out for you. But really you don't need a referral for um an imaging exam. If you need a screening mammogram we do that with self-referrals that means you can bring yourself and we will do a screening mammogram. So we we want to take down barriers to care and um and barriers to timely care.
SPEAKER_03:Right and get the care that that person needs so desperately at that time. So my last question of the day yes is how do you maintain your posture while pursuing your purpose in life?
SPEAKER_01:I would say you know I maintain my posture by um sticking to my morals um doing what's right for people um doing what I would expect someone to do for me is kind of how I approach every everything I do. Whether it's breast yeah being human whether it's breast care or my administrative role um just doing it for the right reason doing making decisions for the right reasons being there for people the way you want them to be there for you and um you know walk in faith in that like that's what I do and so I I want to give my best to everybody all the time and and that's and that's how I maintain my when I have to make those tough decisions or when I have to have those tough conversations and um for patients to to get them through what they need to get through and and I never leave anybody behind. So I tell my patients even if we don't believe or agree on the treatment I still want to see you every every couple months so we can talk through what what you're doing. I want to I don't want you to get lost. Right. And so I say I won't let you get lost is what I tell them. So if you don't call me I'm calling you right now and um we'll buggy to I hear from you and if that means I want to reach out to somebody else I'm gonna find them because I don't want you out there lost.
SPEAKER_03:Mm-hmm and they're very lucky to have your guidance if they are lost. So thank you so much. Thank you for being here today. We've learned a lot I know our listeners have learned a lot and until next time sit up straight stay happy stay healthy and stay adjusted.
SPEAKER_00:Thanks for listening to the Posture and Purpose Podcast with Dr. Michelle Car Frank make sure to subscribe on YouTube, Spotify and Apple Podcasts. Until next time