Episode #6: What Should I Ask My Primary Care Doctor at My Next Appointment?

In this episode of Your Body, Your Clues, Ahlaam and Dr. Hodan Ali break down one of the most common questions people have going into the new year: What should you actually ask your primary care doctor at your next appointment?

Many people walk into their annual physical unsure of what to say, what labs to request, or how to advocate for themselves when something feels off. In this episode, we guide listeners through how to prepare for a doctor’s visit, what information to track beforehand, like sleep, food intake, and menstrual cycles and the key tests and conversations everyone should be having with their primary care provider.

We discuss recommended screenings and lab work for women ages 18–35, men’s health considerations, and what changes to expect between ages 35–45, when shifts in metabolism, hormones, and energy often begin to appear. We also talk about the importance of staying up to date on preventive screenings and why advocating for the health of our mothers, aunties, and grandmothers can literally save lives.

The episode also tackles a listener dilemma about feeling dismissed by a doctor despite ongoing symptoms like fatigue, bloating, and unexplained weight gain, and what steps you can take if your concerns aren’t being taken seriously.

To wrap things up, we play a round of “Fact or Fiction: Primary Care Edition,” breaking down common myths like:

• “If my labs are normal, I’m fine.”
• “A normal thyroid test means my thyroid is perfectly healthy.”
• “If my fasting glucose is normal, I don’t need to worry.”

If you’ve ever left a doctor’s appointment feeling confused, rushed, or unheard, this episode will help you walk into your next visit informed, prepared, and ready to advocate for your health.

🎙️ Podcast: Your Body, Your Clues
Hosted by Dr. Hodan Ali & Ahlaam Ibraahim

Transcript

SPEAKER_03 0:04

Okay, so welcome back to your body or clues. Um Hi Dr. Husan. We are back with another episode.

SPEAKER_00 0:12

We are still back.

SPEAKER_03 0:13

This is our third episode. Three is my favorite number.

SPEAKER_00 0:15

So we made it to the third one. Or we're now on the third one.

SPEAKER_03 0:19

Yeah, got it through. Um, so today we're gonna be talking about all things what I should ask my primary care doctor, especially for annual visits with the new year's coming up. Um, and so my first question to you is how can individuals prep for the appointment? Um, and how should that appointment look like? Because I think it's different from like my experience with you and like other doctors and stuff like that.

SPEAKER_00 0:41

Um yeah, so um you should have an annual screening. I think the other thing is not too many people are doing their annual screening, and especially in our community, um, we have certain risk factors that we have to be um aware that we have them and always be screened and be prevented prevention focused instead of disease responsive. So um a couple of things. When you're going for your annual visit, right? So this is your opportunity. Your provider has a little bit more time, not a lot, maybe 20 minutes or maybe 30 minutes, depending on the practice. So it's not a lot of time, but that's enough time for you to be able to, if you're prepared, to present yours um, you know, yourself and you know, kind of express what you've been feeling. Because this is the opportunity um to for you to have a you know establish a relationship, get your provider to know you, because it is a relationship, right? It's one of the most important relationships you're gonna have is with your medical provider, and it has to be number one, a relationship that you feel comfortable with, right? So if you're getting anxious going to see your medical provider, you need to switch. You need to find somebody that you feel respected, seen, right? Um, so that's number one. Number two, um be prepared, okay? So your body, your clues, you're writing down before you even you know go see the your medical provider, you you have a list in your head, not in your head, just actually writing it down.

SPEAKER_03 2:12

So, like, can we do like the top like five things that everyone should know about? Like, let's say for a girl in her 20s, um, going into their annual checkup, like yeah, you should know what your bowel movements are.

SPEAKER_00 2:22

Um 100%. So, yeah, so that we'll get to that to those in a minute. But I really want to set the stage for people so that they know when they're in that room, it is their time. Yes. Like, if you're not empowered by that, you're not gonna be able to get the most out of your visit, right? I want our people to understand, like, there's no fear in that. There shouldn't be a fear factor, right? Um, yes, there's a power dynamic in medicine. It always been, it always will be, but things are changing, and you as a patient, um, if you show up prepared, people respect that, right? Um, the world is not created nice, and not everybody will treat you the nice, right? And some people will see you a certain way, no matter what. Maybe dismiss you. If you're a female, you get dismissed even more often with your symptoms, right? If you're a certain color, a certain community, a certain kind of person, you may be seeing this is this is how I got into this business. I was mistreated in medicine, right? Like it is a lot of um people of color who feel that way who understand, and women too now, right? Like a lot of uh clinicians are understanding how we've been experiencing medicine has not always been kind and exhaustive, right? So that's number one, understanding what your dynamic is in that relationship. And if you're not feeling comfortable at any point, you need to start transitioning. But if you're good with your provider, this is what you need to be doing before what while you're getting you're getting your annual care. So, number one, jot down things that you've been feeling over the past couple of months, six months, whatever, if things that stand out to you, okay? Because you are your you know your best ambassador, right? The clinician who's in that room is gonna ask you generic things. Well, you're not generic, you're you, you're special, there's you know, it's not one size fits all. So if you come and you tell me a list of things that you're concerned about, I am obliged medically to actually respond. So you need to understand that if you tell me you've had a palpitation, I need to make sure I do X, Y, Z, right? So it's very important. It's what you communicate with your medical provider that puts a medical responsibility on them. But if you don't say anything, then there is no onus, there's no ownership of that. So that's number one. You know, account yourself, reflect how your health has been, what you've been eating, what you've been not eating, what you're sleeping, what you're not been sleeping, what you're exercising, not exercising, those are all important because your annual physical is not about disease. Your animal annual physical should be about prevention, right? And screening and getting ahead of the game. Right? We're not gonna sit and wait for disease to come. Yeah. That's how I see my patients. Okay. So, in order to do that, um, so you're coming prepared, you know, you're like, hi, Dr. Hola, I'm here, whatever, you know, and you know, we talk about how you've been, you know, we do basic stuff like, you know, blood pressure, um, the physical exam, listen to your heart, do listen to your lungs. Those are basic things, right? Then comes the tests, yeah, right? What am I doing for different age groups?

SPEAKER_03 5:38

So the first group is.

SPEAKER_00 5:39

For the first group is 18 to 30.

SPEAKER_03 5:41

So yeah, let's say someone's from that age group, 18 to 35, they're in their annual checkup, they went through everything, they talked to their primary care doctor about how their year went, what tests should they make sure that they're getting at the annual visit?

SPEAKER_00 5:53

So, this is why family history is so important. So we all need to document our family history. We Somadis are not good at that. Okay? It's very important because it determines what I screen you for sometimes.

SPEAKER_01 6:07

Yeah.

SPEAKER_00 6:07

Right? So if you have a history of diabetes in your family, if you have a history of cancer, if you have history of prostate stuff, right, for for men, if you have a history of cardiovascular disease, that puts you at a different box than someone who says, Oh, my fam is, you know, healthy, no problems, you know, my grandmother is, you know, 97 and she has no chronic disease, right? Like, versus my mom had had three bypass and she is 55. Yeah.

SPEAKER_03 6:37

That is a you know, it happens. Yeah, it's like so, it's like, but also in our community, like I think because of language barriers and stuff like that, people don't know. Like, there's different words that their parents say for other health issues that may not understand.

SPEAKER_00 6:48

Yeah. Um, and listen, there are things that you can help yourself. The world is not perfect, and not everybody that you come across, whether it's in education, healthcare, the grocery stuff, whatever, there are always challenges. But if you are prepared and understanding uh what you need to do to help yourself, it's better, right? So, number one, we'll do like a general CBC. Very, very important, right? Like you just want to see how your hemoglobin is, how your you know blood composition is. So that's pretty sad. I think most people get that. Um, you get a CMP, okay? Complete metabolic panel, because that'll look at your kidneys and all that stuff. You need to know that. You also need to look at what your liver is doing, right? Like, because again, why if your provider says, oh, that is not a standard or whatever, well, you let them know that you come from, you know, a background where some of these things you have high risk. So many Somalis have chronic Heb B, right? Like, which affects your liver. So reason why annually you should have a liver check, right? Same with um cardiovascular uh disease. Many black people have higher risk for cardiovascular uh diseases. This puts you at a risk, right? Um, so from that perspective, if you share your family history and your background and you advocate for yourself, you should be able to have these basic stuff coupled.

SPEAKER_03 8:11

And is it true if the doctor for some reason says no, I don't think you need that test, is it good to tell the doctor, can you please document that in my chart that there's a refusal of tests?

SPEAKER_00 8:19

Absolutely, right? Um, and the you know the the clinician can refuse, but if let's say you have you know high risk for cardiovascular disease, as one of the big ones that I get is oh, um, they're not doing a complete panel of lipid and cholesterol panel. Well, if your dad had a heart disease um or even an MI at age 50, you put them well sure your medical provider is checking all the uh cardiac uh tests for you because you have a direct link to someone who's who's had a cardiac event, right? If somebody in your family is, if your mom is diabetic, your sister has diabetes, or your uncle has diabetes, like they should be checking your insulin, uh, fasting insulin, uh insulin resistance, because that is a predictor of whether you're gonna become uh diabetic, right? So that's the other thing, too, is most of our community has has metabolic disease, right? So that helps you, you know, like to let your provider know, you know, my whoever XYZ has is, because then that is a direct explanation why you need to be tested. Because again, we are wanting to do what prevents, not respond to disease, right? Like so screening is a very important in that uh uh perspective. And a lot of people that um when I do my talks, people are like, well, they're not answering that or they're not allowing me to do my test XYZ, right? Is because we're not able to present the right information so that the provider is able to justify because in the end, half of my day is spent justifying why I'm ordering these tests because the insurance companies don't want to pay for nothing, right? But if you have the right documentation, thyroid panel is another one that people need to be doing, right? But then again, you know, people just check TSH. A classic example, I had a patient just the other day, TSH was normal, but she has Hashimoto's, right? So I do an extensive panel, but I'm able to justify that if you've got fatigue, hair loss, weight gain, you know, constipation, all those things, those are justifications for these tests. So understanding um what your risk factors are, right? Presenting your symptoms. So you should always get uh a complete um iron panel too, right? Because why? Again, we have a risk factor for H. pylori, we have, you know, um a lot of iron deficiencies in our community.

SPEAKER_03 10:50

So making sure you get tested for the complete iron, because your iron can be normal, but you may be on your way to iron to anemia because Yeah, it's very hard uh being someone who never had iron issues and used to flex and used to make fun of other people who had an iron, and now I am in that predicament. Right? It's a very tough situation.

SPEAKER_00 11:09

It really is. But that's the other thing too, is um never settle just for an just iron level. Yeah. Because iron level is not a true reflection whether you are deficient or not. She has for ferritin. You gotta check for ferritin, you gotta check for your T I B C, right? Um, and then you also need to check your binding capacity, which is the the total um binding capacity, right? Because what even happens is that you might have enough iron in your body, but your body's not able to absorb it. It's not in circulation, right? So that's why the different panels tell you what is actually what is actually happening with your iron.

SPEAKER_03 11:51

Okay, and then in that age group 18 to 35, um, are there any additional tests, especially for women that they should be take uh taking?

SPEAKER_00 11:57

So I'm not even done yet. So STI screening, this might be a little whatever, but this is very important. Okay, no judgments, no nothing. Like you need to test yourself. Even if you're married, even if you're married, yeah. Right? Very important, plenty things, right? So um pre premarital stuff too, right? Like get yourself testing, right? Um, SCI um checks, make sure HIV, all that stuff, hepatitis checks, right? That should be also in your annual screening. A HEP panel because again, we come from a uh uh endemic area, that's another language word that you need to use endemic, right? We come from an endemic region, therefore some of these things things are legitimate under that uh exposure, right? Um and then for women who are in their childbearing ages, right? So again, checking your vitamins, actually for men too, vitamin D, vitamin B12 and folate, making sure that you're you're not nutritionally deficient. Okay. Um so for the women part specifically, making understanding that like not all folate is the same. And we have uh now a whole issue with autism in our community. Okay, and some of that may be our women are not able to metabolize folate, which is really critical for brain development, right? Uh, neurodevelopment, spina bifida, all that stuff. So if you have mutations in some of these genetics um uh genes, then you may not be able to, even if you take supplementation, because we tell women take folated and all these things, if you're not metabolizing, then it's not gonna do anything. So I'm always checking for those genes for women in that age group because again, we want to same for men too, right? Like we need to also make sure that you're healthy, is you know, if especially if you're trying to have kids, it it's not only on the women, yeah, right?

SPEAKER_03 13:58

So much research is now coming up. A lot of the reasons why people have horrible pregnancies is because of the men. So the guy you're sleeping with should be healthy before you give him a baby.

SPEAKER_00 14:06

Exactly, right? Like, so we've been putting a lot of um pressure on on women alone, right? Um, and then the other thing too is um cervical screening, right? So you you need to get your PAP smear done. If you're active and you have a partner or whatever, you need to get tested. The minimum age is 21. And then if everything is normal every three years, that is the recommendation, okay.

SPEAKER_03 14:30

Especially in our community, especially in the black community in general. There's a high rate of uterine and like cancer and stuff like that.

SPEAKER_00 14:35

100% a lot of fibroids. Um, one of the reasons why you need to check your hormones, really particularly closer to is we have a lot of menstrual uh uh irregularities, um, amanoria, we've got that's like people who don't get their periods, we have um PCOS, we have like all kinds of things, right? So people who are gaining weights for no apparent reason, their periods are fluctuating, you have insulin resistance, underlying cause. Now we know PCOS is not a hormone issue alone, it's a metabolic health issue. Um, so you need to make sure that you're getting that holistic view of um, and then anything comes back, obviously you need to take the next step. So that's uh both men and women getting your um you know your basic labs done, um, checking for STIs and S T Ds, check your liver, check your kidneys. If you've got diabetes and the so this is for the healthy person. So if you've got other things like hypertension, diabetes, all that then you also need additional testing. Got it. Okay, which is separate water. Right now we're just talking about healthy people.

SPEAKER_03 15:44

And so for 18, the group in 18 to 35, those are the tests for both men and women. Um if someone has like additional like symptoms, for example, they go into their doctors with fatigue, you know, brain fog, um like gut issues, is there other additional labs that they should ask for at their annual screening?

SPEAKER_00 16:01

Yes, absolutely. So if um bloating, gut uh, you know, um brain fog, uh indigestion, constant uh constipation, weight gain, all those things, definitely there's additional screening. Like H. pylori is one of them, right? Getting tested for that. If you have chronic um, you know, acid issues and that kind of stuff, make sure you're fully being investigated. Again, one of the reasons why you need to be having full um vitamin uh uh testing, right? Nutritional testing, because if you're having those things, you're likely you're not utilizing, especially if you have chronic H. pylori infections, right? So, again, document all those things, write all those things down. Also think about the community that you come from. What are the some of the things that puts us at a higher risk? People information is very readily available these days, right? Find out what you particularly in your what it runs in your family, right? And we gotta make a habit of talking to your parents, talking to our grandparents, like what people like right now, like I know in my family, my brothers are at risk for prostate cancer, right? I have my grandfather who died from prostate cancer, I have my uncle who died from uh prostate cancer. So we need to understand that. So my brothers have a higher risk, yeah, right, of prostate. And it runs higher, and I'm gonna be talking about that for the men. For in the in the next age group.

SPEAKER_03 17:22

Yeah. Um, okay, perfect. So now we're gonna go to the age group 35 to 45. And I have not Alhamdulillah yet, inshallah. I'm gonna get there soon. But at this one, I hear everything starts slowing down. You know, this is when everyone starts getting a little bit of weight, the metabolism's slow. I do not look forward to that. Yeah, um, like you know, things are changing. What should folks ask in their annual screening to their doctors? What should the conversation look like for that age group?

SPEAKER_00 17:43

So for sure, um, obviously, the the average stuff, CBC, iron panel, tired issues, um, vitamin B12, vitamin D, those should be standard. Like nobody should be having conversations whether we're gonna do that or not. Okay, you're gonna add definitely diabetes screening. I would actually emphasize diabetes screening at the very because now we're seeing, like I think I told you the other day, eight-year-olds I have who are diabetic, yeah, cholesterol, right? Like metabolic health. So we are seeing it in very young people, and again, make sure you're getting the whole panel for diabetes workup. So it's not just your fasting glucose or your A1C. Make sure you're getting your insulin, uh, fasting insulin done, because that is a predictor of if you're gonna be a diabetic or not.

SPEAKER_03 18:28

Another thing in our community, I think in general, people like common people think, Oh, I don't, I'm not really a sweet teeth person, so I can't get it. Yeah, I was a savory person, I was told as pre-diabetic, and like a lot of young people in my group like naturally sled into the pre-diabetes category. Yeah, it's lifestyle. If you're not moving as much, if you're eating a lot of like carb-heavy foods, if you're not, if you're stressed, if you're there's other things like, but it's not just because you eat sweets all the time.

SPEAKER_00 18:48

It's not, and even you can be thin too. People there's think like people somebody has to be obese to no, you can be skinny dude, gal, and still have diabetes, high cholesterol, and all that jazz, right? So you need to make sure, again, the whole point of an annual visit is what? Prevention. Yeah, getting ahead, right? So if I if I do someone's insulin, uh fasting insulin, and it comes back 18, 19, but your fasting glucose is five or your A1C is whatever, five, at that point you're good. But your insulin resistance is telling me that in a few years you're gonna develop diabetes.

SPEAKER_01 19:28

Oh, okay. Right?

SPEAKER_00 19:29

So it really is a better predictor.

SPEAKER_01 19:31

Yeah.

SPEAKER_00 19:32

Same with cholesterol. So when you have cholesterol screening uh uh lipid panel being done, make sure you ask for um LP Lita A and LIP um Apo B. Those are like so good cholesterol, bad cholesterol, LDL, all that stuff people are familiar with, right? So but now we are we have advanced so much that we can look at the different particles of LDL because not all cholesterol is bad. We need to look at some of the particles that stick to the walls. Okay. Um, so again, if you tell your medical provider you have high risk for cardiovascular disease, they have to check that. Right? So if in your family diabetes, high cholesterol, um you know, heart disease, blood pressure, all that jazz is present, then let your provider know that that is a justification to be able to get those tests done. Okay, so that's um the other one that often people don't know what to do is check your inflammatory markers because insulin resistance and inflammation is the problem. Those two are the problem. It's not the cholesterol that's the issue. I'm gonna say it again. It's the inflammation that is the problem. Okay? What happens when your body is inflamed? Your arteries get um damaged. So the nice smooth cholesterol running around your arteries now gets bumps into a very rough, edgy artery uh wall. Okay. So is the cholesterol the bad thing? Or is the fact that your arteries are so inflamed that they're now sticking to the cholesterol? Because cholesterol is vital for all our hormone, right? So we focused on the wrong things. Reduce cholesterol, reduce cholesterol. Well, reducing cholesterol and it's causing other problems. Yeah. So you need to check your inflammation markers. So uh CRP, okay, and ESR, those are the two and homocysteine. Okay, so asking for your inflammation markers, so you're inflammatory markers, C reactic protein and ESR. I'm blanking on the ESR, but check on the ESR as well, and then also um high sensitivity CRP. Okay, okay, um, because those are like an indication that your body is. In inflamed mode. If you're in inflamed mode, your higher uh chance of uh metabolic disorder, your higher chance of autoimmune disorders, your higher chance of uh mental health issues, like it is all connected. But we don't have to check because you know people are not reporting the symptoms that they're having, and uh people are not aware that this is these are the tests that they should be having, right? So um the time when people get these tests done is when they're acutely ill. And again, I'm not waiting until your ESR is so high that you're hurting. How about we look at your ESR? If it's trending in the wrong direction, then we know we need to do something, right? The other thing too is there's a lot of good evidence around understanding your numbers, your own numbers. So lab tests are what? A representation of a of the general population. The general population these days is a sick population, it's not good. It's not good. So you don't want to be normal in that population, right? You want to be normal for you, right? So my blood pressure is always like 100 over 60 something. I have, you know. If all of a sudden tomorrow my pressure starts to being 120 over 79, that is high for me. That's not abnormal, but that's high for me. Do you understand? Like that is, you know, so I need to note that. So you have to track your own numbers, right? You from your CBC to your inflammatory markers to your thyroid, like a hlam should know what her numbers are. I always have charted across the board.

SPEAKER_03 23:45

Yeah, I think the new uh like all of my charts and stuff, they show you your last screening and stuff like that. But I even recommend printing it out because I know people change hospitals and stuff. Have a highlight. This is where I was last year, this is where I'm this year, last year, and also document, like you can kind of tell the years you're kind of more stressful and stuff like that.

SPEAKER_00 23:59

But 100%. So understanding your own numbers, right? Like and not always thinking you need to be uh marked against someone else. Yeah because my normal may not be your normal, yeah. Okay, so um, and again, liver, kidneys, all that stuff. Again, we're checking for H. pylori. We are what endemic society. We need to check. So we need to check because again, untreated H. pylori, chronic H. pylori, long-term problems.

SPEAKER_03 24:26

So this is a group 35 to 45. They get the same tests as the other age group, but the only thing we're adding is a diabetes, for example. Um, and heart screening inflammation markers, inflammation markers. Um, and that's just basic healthy person. Healthy person. Um, and so okay.

SPEAKER_00 24:41

But what are we doing? We're doing screening. Screenings. We're not chasing disease, we're trying to get ahead of the game, yes, right? Yeah, and trend and following that our trends, our own trends, yes, not Ahlam's trends or Hodan's trend, but you're on.

SPEAKER_03 24:55

I also, I don't know if this is hard about to say, I always say this, and I don't know if it's trouble. I actually I think we should be offended when you're told you are normal, healthy in an American society. And this thing is an American. Because when I look around, I don't want to look like I know everyone started looking skinny and stuff, but I know people's mom- No, no, I think it's like I know but a lot of the people are still kind of. I think everyone should aim to like be very healthy and like your own numbers because the society where nobody, everyone's not healthy, like from our leaders to like everyday people, like everyone's sick. So you shouldn't celebrate that you're kind of okay in a sick society.

SPEAKER_00 25:29

If you're let's I'll give you some numbers. If you are in your 30s and average weight, whatever, your blood pressure, if you're happy at like 120 and over 75, that's still okay. But you shouldn't be okay with that. You should, you know, like um figuring out like and of course looking over time, right? Um because that is the average for a sicker, more um you know, a more sicker society, right? Like, and I say that in a very respectful way. I'm not saying like I mean the evidence and the numbers are there, like most of us, um, 70% of people are chronic um illness and obesity, one of the two, right? Like, so it's you know, it's out there, and there's a reason why. And it's a it's like genetics is a part of it, but the majority of his lifestyle, right? The reason why America has an epidemic of chronic illness compared to some parts of Europe, or most of Europe, I think, compared to the the difference is the lifestyle from what we're eating and how we're not moving, yeah. So um, so in that age group, really um add the metabolic health um as a key test, making sure you're checking for your inflammatory uh markers because again, from diet to stress, right? Um, and anxiety and all those things. And then also, are you taking medications? So you need to, if you are taking medication, you need to let your medical provider know because that sh impacts, you know, like what tests we do and that kind of stuff. If you're taking supplements, document that too. Supplementations are also treatments. People think it's candy, it's not.

SPEAKER_03 27:21

It can also impact your medication that you're taking.

SPEAKER_00 27:23

Yes, there's a lot of you know, uh interactions, right? Like simple as ginger, simple as you know, uh bambelmo. You know, if you're on certain medications, they can um you know impact. Yeah. So you gotta let people know that what you're taking.

SPEAKER_03 27:38

I also think like when it comes, like earlier we're talking about if you're anxious about going into your doctor visit and stuff like that. I think naturally, as an anxious person, or like people are just scared of finding out and they think, okay, it's better if I don't know. Um and like I think people have not been told or have heard a lot of stories where people like reversed issues or like actually fixed problems before it started. Because I think we just hear, okay, someone got to their diabetes and they're on this lifelong medication, but we don't really talk about a lot of preventative health. So I think that's what a lot of people are scared and stuff. And I think now our second discussion is cancer screenings. And I think the same mindset exists where it's like, I know people who go, Why would I go and look for problems? I'm okay.

SPEAKER_00 28:13

I'm not, you know, but it's like you should, it's better to find out than not only that, you find out find out earlier, you can treat well because we're really getting good at uh treating, you know, uh some of these hard um diagnoses, right? More than we are the chronic illnesses, by the way. Okay, um, like prostate cancer, right? Like really high number of cure rates, right? So, but um if if if you're not looking, if you're not you know getting tested, then you know, by the time the disease shows up and that you're actually symptomatic, it might have gone to your bones in other places, right? So um in the population that we're talking to, we have a high risk, our men have a high risk for prostate. Okay. So you need to get your PSA done. You also we also need to get people to doing their colonoscopies in this age, right?

SPEAKER_03 29:11

35 to 45. So I think 40 to 15.

SPEAKER_00 29:13

So again, all of these things you need to know your family history, correct, right? So the average um, let's say colonoscopy, right? So 40 plus. Um, if you have a first relative, you need to get screened earlier. If you have symptoms, like blood in your stool, abdominal pain, all that stuff, you need to make sure you're getting your colonoscopy done, right? Um so that's one. Prostate. Black men have a higher rate, higher risk of prostate cancer. Right? Just the genes of the genetics. So I said to you, in my own family, my grandparent uh father, a couple of my uncles died from prostate cancer. You know, my brothers, my cousins, I'm always telling them, get it done. Yeah, my husband, the same thing.

SPEAKER_01 30:06

Yeah, right.

SPEAKER_00 30:07

So it's a very simple like blood test, yeah, right? So it is included into your uh testing. So you find out what your numbers are and you keep track of it every year. Perfect. Colonoscopy. Start at age 40. If you have a higher risk, go down. Go down. Talk to your provider. Okay. Um what about for women? Mammograms? So mammograms every one to two years. If especially if so younger age, if you have a first relative, like a sister, a mom, whatever, who has breast cancer. Okay.

SPEAKER_03 30:42

What age could they start to get their mammogram son if they do?

SPEAKER_00 30:45

So, I mean, so that's a relationship you need to have with your medical provider.

SPEAKER_03 30:49

Okay.

SPEAKER_00 30:49

Right? So, like let's say you're 35, you came to see me, um, and your mom died of breast cancer, depending on which type of bread, because some of them are very, very um, you know, invasive and and and um like fast growing. Um, there's genetic markers that we can test at. So it all depends. Yeah, right? But usually the recommendation is 50. And this is the really growing cancer that especially women uh of color need to focus on. Yeah, right.

SPEAKER_03 31:17

Also, um, even at your annual checkups and stuff, everyone should do their own or ask their doctor to do a breast check.

SPEAKER_00 31:23

It's not even like, yeah, so you should do your own breast check, right? When you're showering, when you're relaxed, you know, just kind of go around and make sure there isn't anything that should not be there. Yeah, it shouldn't be painful, it shouldn't be discharged from your nipple. Your nipple should not look different. Yeah, um, it should not be like cracky and that kind of stuff, right? Like, so you need to understand how to do self-pressed exam, those are really important, okay? Um, so we talked about mammogram, uh, bone density. This is something that we don't really talk about a lot. Bone density is really, really important, especially for women. Because what happens? Estrogen declines as we age. Astrogen is bone protective, it is muscle protective. And as we grow older, we see women, by the way, I think it's like age 30, whatever, we we start losing um one to three percent of our bone density over year over time.

SPEAKER_03 32:20

Okay, so and sometimes it I heard as expedited if you have kids and like you're losing calcium and stuff.

SPEAKER_00 32:26

Yes, if you've been on birth control pills. Oh god, right? So there's a lot of things that puts you at, and what happens is that by the way, the number one killer of older women are is hip fracture outside of heart disease. Right? So the evidence is there. We need to you get your annual uh DEXA scan done. It is part of your uh annual screening, and is it's good to know your numbers and you can track it. Um so that's that's one the the DEXA scan. The mammogram we've talked about, obviously blood pressure, diabetes, cardiovascular risk, and all those things. Yeah, very, very important at this time.

SPEAKER_03 33:02

Yeah. Paps me, I think it's for everyone, but like usually at that age as well. Well, absolutely. Yeah, yeah. Okay, that's perfect. This is good to know. Okay, so now we are gonna um before we go to fact and fiction, we're gonna go to 60 plus. Um, what tests and uh or like 50 plus, sorry. Uh 50 plus. Is there another question before that is for women who are menopausal, do they have additional screening or tests they should be taking? So this is the thing.

SPEAKER_00 33:30

Yeah, perimenopause and menopause is now really a hot topic in women's health. Yeah, medicine has failed women generally, and any clinician, self-respecting female uh medical practitioner will tell you that. Okay. Um in general, women's research in medicine is like something about like five percent. The money that's spent on research. Inclusion of women in research has just been recent. Never mind if you're black. Black people get one percent of I think uh research money, and even lower if you're a black woman. So you put that together, right? Like medicine is informed by the results and the outcomes of um white middlemen, white middle-aged men.

SPEAKER_03 34:28

That's why it's so important when you see like all these wellness influencers coming out with stuff like saying this works, that works, a lot of the research they're citing before. Yeah, it's not us.

SPEAKER_00 34:36

It's not work because again, genetics, environment, experience, all those things make a difference, right? So when it comes to women as we age, right? This is a whole new area that like people are now struggling with. Like, how do we manage? Because we have not been managing. So this is actually life-changing for me. This is how I ended up in this functional uh space. Three years ago, I started like my whole body just gave up. Before that, I mean I wasn't like super athlete, but I was good. Alhamdulillah, like I was functioning, I was exercising, I eat well, general, like everybody else. Then perimenopause came. And like literally, it was a sharp, sharp drop. Um, I gained weight, my bones started hurting. Like, literally, I couldn't sleep through the night. I started having palpitations. I was a classic perimenopausal symptom. You get palpitations, hot flashes, hair falling out. I started alhamdulillah, I've been blessed with good skin. Yeah. I started having pimples. Um, I developed psoriasis, right? Autoimmune. Like, and I'm like, what is happening? Yeah. Because nothing significant has changed. The stress level, whatever. I mean, this it's been normal. Anyway, so I went to my primary, really true story. I went to see my primary care. I said, I don't know, I couldn't sleep at night. Anxiety, I became a nightmare to my family. Literally, like, you can talk to my kids and husband, and everybody wanted to flee. Like, literally, rage all the time. And I think it's something that our community really needs, especially families are breaking apart because of that. And people are not partly because of that. Partly because of that. But I think it's a it's something that we have not really talked about. And and I'm glad that what you brought that up now, right? Perry menopause.

SPEAKER_03 36:30

Is it like your gluteal phase all year round? Is that what you're doing? Is it gluteal phase? Like, you know how somebody's raging? Yeah.

SPEAKER_00 36:34

Raging.

unknown 36:35

God.

SPEAKER_00 36:36

Like I'm not sure. Good luck to everyone in my life. Honestly. I was talking to a good friend of mine who's a who's a physician, and we're just having dinner one night. She's like, you know, well then, um, and we'll talk about this, right? Because that's, I mean, this is our life now. So she's like, I was on a plane, and she's like, Oh, my husband, you know, we're talking. And then she goes, all of a sudden, she goes, something happened. They were like somebody irritated her on the plane, and she lost it. This is a white woman, right? She's Muslim, but she's a white woman. And um, of course, privileged, she's a physician, all of that, but her husband's brown, and um she's like, Well, then I went into rage. I said, Oh, and they they almost were trying to sedate me on the thing, and then I realized afterwards I didn't need to get help because I realized like how I was like she, of course, you know, there was some other issues, but she said, I have never felt such rage. And she goes, I know, and I know as well, there was a day where I just actually blew a gasket, like I was literally out of control, and I just couldn't get it. Like, that's not my normal predisposition.

SPEAKER_03 37:39

And is it just like that's just normal for women to go through?

SPEAKER_00 37:42

Not everybody, but many women are experiencing again. We've never talked about it.

SPEAKER_03 37:47

Oh like I don't know what my mom's, you know, but also I think now that we're discussing it back in the day, I think they were scared to discuss it because you just get put thrown to a psych ward. That's it.

SPEAKER_00 37:56

Because nobody hysteria, women's, you know, again, I medicine has not always been nice to us. But, anyways, so then I went to see my primary. I actually ended up in the emergency because I thought I was having a heart attack. Went through the whole thing, saw a cardiologist. Best heart shape ever. No problems, alhamdulillah, you know? And then my bones, like, I couldn't make it up my stairs, the stairs in the house. Like, and at night I was throbbing, whatever. I went to go see, and I did an MRI, everything came back normal other than inflammation. And he's like, We're gonna put you on cortisol injects. I'm like, no, you're not. It's fine for those who need it. But I was like, I'm not doing that. Then I realized this is what medicine has to offer for women. Like, I couldn't tie my bra. My like literally, when they talk about frozen shoulder, it it exists. This is and this is like now 30, 40 years of our lives because we're living longer. So, anyways, I looked into it and I said, I can't go on medication, I can't do injections, all these things. And then I looked into functional medicine, and a whole different world presented, and I started doing it for myself. Um, I talked to my primary, we, you know, alhamdulillah. I have a very good primary who listens to me and we were able to do, but that's me privileged, right? Um, and you know, so what women do, what do they need to do? Number one, there was a you know, the standard thing is well, we can only call you menopausal if you haven't had a period for one year. No. If your symptoms that I've talked about, if you have, that's an indication that you're and you're in that age. From 35, by the way, you could start having early menopause prayer menopausal symptoms, right?

SPEAKER_03 39:42

I also read that a lot of women like Gen Z and like millennials are having early menopausals because we got our periods earlier.

SPEAKER_00 39:48

Absolutely. So what what are good predictors? Early menarchy, right? Like so having your uh periods early is an indication. A lot of young black females are now having. I have children who are eight, nine years old with their periods. I just my heart breaks when I hear that, right? Or when I see that. But anyways, that those are the facts. So those young ladies, babies now are gonna end up having uh parametopause a lot sooner. Also, risk for other things as well in terms of uh uh uh cancers and stuff like that, right? So if you're 35, 38, 40, your alarms uh in terms of body clues, all of that should be going off, right? A lot of the changes that you're gonna experience is because estrogen, by the way, estrogen is not just a sex hormone. It is not just recre, you know, uh um what do you call it, fertility hormone. Estrogen really in every receptor in our bodies, from brain to heart to joint to muscle, like you name it your gut, your skin, all of it have estrogen receptors. And we have not accounted for that in medicine, right? So people get put on what uh uh antidepressants, like literally the hysteria you're talking about, right? Like people think, oh, right? But again, um, yes, your your estrogen is gonna drop, your progesterone is gonna go first, all of these uh imbalances is gonna make your life very, very imbalanced, right? So it's very important, like if you're in that age group, you do a lot of self-education, understand your symptoms, write them down, right? Get tested, but to really be considered perimenopause, menopause, it's no longer it should not no longer be about you need to be not menstruating for a year. Because a lot of women have missed periods. Like I started having you know, three, four months, no periods, and then it comes, and then all and I've been like that for um several years now, right? But so what I did was not only did I change my lifestyle, I started thinking taking um hormone replacement therapy, bio-identical hormone, which is not like the um uh birth control pills, right? Those are synthetic. Those are synthetic. This is like bio-identical, literally the lowest dose. It it actually has pre prevention in terms of cancer and all those things. I was able to lose the weight, I was able to sleep, I was able to my joints are fine, I can exercise, I can do like literally it changed my life. And obviously, I started taking supplements and vitamin D and all those, and I exercise regularly. Yeah, I started lifting weights because muscle is protective of bones. Not only is it healthy and for um metabolically good because the more muscle you have, the more you can burn fat and and and all that stuff, but it is also protection for women. Women, we need to start getting stronger.

SPEAKER_03 42:45

Especially if you're under the age of 30, start working out now because that's actually you're you start losing after 30.

SPEAKER_00 42:50

Yeah, it's harder to um to build when you're at my age, right? When you're younger, less than 30, this is where you need to really establish good habits in terms of lean muscle building. Yeah, we're not about thin, like thin is not it. Yeah, if you're thin naturally, good for you. I have never been a size zero and I will never be. But you want to be strong, yeah, right? You want to have muscle lean muscle. You don't want to be skinny fat. You can be skinny and be very sick. Yeah, people need to understand that.

SPEAKER_03 43:23

But also, a lot of people think like weightlifting makes them bulky. I've been weightlifting since 2021. I'm a very slim person. I got I lost over 30 pounds by weightlifting. So it's like it's possible to keep a very nice, ideal body without being bulky. You could get bulky if you want to, but that's like my new hopefully in a six months, you know, I might go through a bulky.

SPEAKER_00 43:41

You don't know how long it takes to get bulky, you need to be doing some serious weightlifting, a lot of protein, right? Um, yeah. So many of us are not in that league. Yeah. If you're on the you know, um bodybuilding league, then that's different. But the kind of weight lifting that we're talking about, even if like strong lit weight you're not gonna build um you know such a like and become you know muscular like that yeah it's not gonna happen men struggle we definitely will struggle too absolutely and they have more like you know um easier ability to build muscle and maintain muscle yeah versus women yeah okay so we're gonna do factor fiction for this episode primary care edition um my first one is if my laughs come back normal um that means I'm fine um so everything's normal no labs can be normal and you feel like us yeah right um because labs are number one I talked about earlier um the lab values are predictive of a general population that is not 100% well the labs that come are not always discriminatory meaning we're not going down enough to see right often the normal labs don't um pick up the labs that we need to do to to to prevent like I said insulin fasting insulin right that's not a routine lab that we do that's why you need to be informed right so um if your labs are coming back and they're normal you need to be more predictive and specific about your symptoms because clearly like I said iron can be normal but you'd be you know deficient right yeah um and you know obviously one example thyroid could be normal but you also may have autoimmune step there's a lot of women actually who who are told their thyroid is normal and then they just go years and they're experiencing all these symptoms. Because we're only checking TSH.

SPEAKER_03 45:39

Yeah that's important because sometimes I have a Hashimoto's and my thyroid is lab like that part could be normal but the other one but your TPOs were yeah like it's insane. The other one I have is I have to wait until something is wrong or I have symptoms to get tested for something.

SPEAKER_00 45:55

So no you should always do your annual um physical and you should always like if you're not yourself again your body your clues right like your bot by the way people don't just get sick overnight unless you've got a viral infection or a bacterial infection like acute things that's different. But chronic illness takes time so you don't wake up and you're diabetic all of a sudden you're not waking up you have you know heart disease all of a sudden or you have hypertension all of a sudden right it is a gradual that's why you need to you know periodically check in especially if things are feeling off and again I think many of us have become so hardened right we're toughen it out.

SPEAKER_03 46:43

Yo soft season should be in you need to be soft right like honestly like also we talked about this but a lot of people are sick and they think their symptoms are normal. Like you talk to everyday people bloating fatigue oh it's just normal I'm just very stressed out right now but it's like that's not normal but look at our culture the ahlam.

SPEAKER_00 47:01

Yeah hard rough tough people right like you know thank god I'm weak yeah no honestly for the most part like our people we just kind of like because again the conditions in life again we're nomadic people genetically we're kind of in that environment you know unless that's why um a lot of our men you know die from uh cardiac arrest right because they're not looking they're not you know like I had a patient and I never forget this patient young um who's 50 so young by any means um and this is like when I was in Canada and he had a family that was you know kids who were really struggling um one of the best fathers I've ever met. Sometimes you don't get a lot of shout outs like there are fathers who are top notch okay this man was one of them he would always be in that clinic with for one child or another or his wife or whatever. I get a phone call one day e evening nighttime he passed he dropped in his balcony they took him massive cardiac arrest I remember I will never forget him. Again because he was always advocating looking after everybody else he wasn't after uh looking after himself and again as providers because we get caught up he didn't he was not again men don't always and this is general men all most of the time are not very astute about their health most men wait until you know things get out of control. Right? So again um it's not he's not the only one that I've seen who've had massive MIs and that kind of stuff and it's because of delayed um treatments or or diagnostic and then treatment. Yeah it's so it's so sad.

SPEAKER_03 48:55

Yeah. We discussed this last episode about constipation about um fact or fiction as long as I go every few days I'm okay.

SPEAKER_00 49:03

No you need to go every day. Yeah if you're not going every day you need to ask why because we're all one off yeah you need to go it needs to go like and this is why the bloating the dyspepsia the acid the the stomach pains the foggy brain right people complain about if you're backed up a lot of this stuff is fermenting and it is having issues uh with your ability to think clearly right um I get it not everybody goes every day but you should definitely be going every two days if you're not going every day and anything beyond that get help.

SPEAKER_03 49:43

My last question is factor fiction if my glucose my fasting glucose is normal I'm fine no your fasting glucose is a snapshot what you need to know is what's happening long term and that's why I said um checking your fasting insulin is a better prediction of whether you're going to have a diet diabetes because it's a predictive insulin resistant and insulin resistant is you know you're pre-diabetic. Yeah so just fasting glucose it doesn't have um is is is good but it's not the uh thing that you're looking for yeah some of my favorite things about this episode I think I realized is the importance of family history like knowing your family history knowing what you're even where you're come from like not just your immediate family like the area you're from and stuff it's so funny because for a long time I thought my grandpa, my dad's dad died of a heart attack it was in my health study like my health chart and everything in the pandemic I was talking to Aba and I was like yeah oh and then I said I have a heart attack he goes my dad did not die of a heart attack and I was like yes he did but I was like oh my god like I every doctor I go to I'm like my dad grandpa dad have a heart attack and I was like I never said that I said you said he randomly passed away um but it's so important to like sit down and like even like with my grandparents or like anytime I see a new family member have a new health thing I add it to I I just have it in my truck my documentation especially if they're younger right like if someone tells you oh my grandfather died when they were 50 yeah my grandpa died in his 40s it makes me so sad now that I'm like closer to my I it it makes me so emotional I'm like whoa people don't die at 40 yeah I I say that with right but I'm saying like that is not the norm.

SPEAKER_00 51:27

Um I mean obviously he did lived in a different time whatever but you know again we didn't know what he died of but generally most likely something to do with heart attack yeah like I mean that is it's not a far jump or cancer or something.

SPEAKER_03 51:42

Yeah it's very important it's very important to talk to your family members talk to your community understand like what things are high and stuff like that. I'm I feel like I'm very well educated on the Somali community and our health issues because of just my natural thing I'm very into especially women like I love talking to older Somali hubos I every time I see a first of all every time I see a good older lady I say what are you what are you what are you doing? What are you doing?

SPEAKER_00 52:02

What are you doing?

SPEAKER_03 52:02

Yeah yeah I'm like like because it's like I want to look like you instead of looks and stuff but it's like you feel and look good and like and that's important.

SPEAKER_00 52:08

So no absolutely and I think the big one that I want to really stress on is as a community we sometimes shame health information. I think it's important that we're able to educate ourselves share information because that's how you prevent somebody from being sick and like now we have a lot of screening and people um being tested and and you know showing positive cancers different types of whatever um yes the screening is higher that therefore we're able to you know um versus in the past people like oh well now we have more cancers in this in the in the in the community maybe true maybe not maybe we're just testing and catching things more um easier and quicker right um like breast cancer my grandmother died of breast cancer at home i her cousin younger woman died of breast cancer right I know several of them dementia is actually a big one that we need to be screened right I didn't I don't think I mentioned that dementia screening for 60 plus for apps even younger because now we're seeing it especially women women have 50% higher of um of dementia than men by the way so we need to this just made me realize I'm the wrong gender I might have to swap. That's it right so dementia is actually one of these things that are uh becoming quite prevalent yeah um Alzheimer's as well as like a third diabetes 100% for 60 plus I don't think we got into it like what are additional tests they should be getting that is that like the more like and the bone density cognitive test um cardiovascular um assessments nutritional assessments because they're not eating well right malnutrition people get older yeah malnutrition happens constipation happens all that stuff because the system's slowing down on the flip side of that is if you are active eating well exercising moving taking care of yourself you know um also like you know our faith has so much benefit that it offers us we're not utilizing right it's when we're talking about chronic illness if you're like praying your five daily prayers and you're fasting and you're you know doing your takbirat and all that those help with stress yeah right stress is one of the biggest drivers of all these things that we're talking about so really going back to that going back to the earth touch and grass people right like we really need to start you know uh going back to like a bit of an organic life yeah right even like being around community like a lot of older people who are around their grandkids and like community are like less depressed and they're like they don't feel as lonely and lowly is another epidemic that causes health issues as well especially for elderly people yeah right so um I think a lot we've covered but I think information is really vital um everything that we say here like again you know I'm not a particular person's medical uh provider but this is how I practice is what I I you know I share with my patients is how I manage my patients you need to develop your own relationship with your medical provider right and um it may not be always easy but it's worth a try and um I think many providers are willing to meet you halfway if you show up yeah for yourself.

SPEAKER_03 55:14

This was very insightful thank you so much Dr. Hart and we'll have all these tests and stuff listed on the show notes as well and you can use it I my thing my hope for this episode was for folks who listen to it and like have a game plan going in and they don't feel like lost and guided. Yeah um because nobody ever teaches us at school what we should be uh feeling or looking at different age groups so but also for me I think it was about maybe our um audience to have built self-confidence around their health and showing up for yourself because everything in life requires you to advocate for yourself.

SPEAKER_00 55:45

And healthcare is one of those things that there's a video a while ago that was going viral of a woman who showed up in the ER and the nurse was sitting there acting like a whatever ignoring the woman screaming that is not a uh it just was caught on tape but it happens more often and we need to start understanding how we should because again it's how you present how you look all those things matter and if you are presenting like you're in charge of you and you know what you need um obviously not being overbearing and rude or disrespectful but it's respected. Yeah show up on time get your notes if you're bringing a yo or Abo or Hoyo whatever know their medications right yeah nothing like you know looking through things and you know a bag of whatever it takes away from your time in terms of um also reporting people who treat you yes and like actually like following up and stuff like that and like advocating for yourself because it's social media has really helped in that people are more accountable now right like um whatever these ratings and all those things but actually you know putting on online and you know so those things help but I think more than anything because not all encounters are bombastic like that right like not all encounters are like such extreme there are the subtle encounters where you're like not that you should not be doing that or you should not be dismissing me like that because there are people who will dismiss you.

SPEAKER_03 57:07

But also it's so funny because I remember I told you this um I had my uh GP, she was a uh Egyptian Muslim lady um and I went to get my quick blood work done and then with her coworker Adam white guy um and he caught the way he spoke to me about my labs that time I had like a panic attack because he made it look like I was gonna have a heart attack. He was like I'm gonna send you the cultural medication the way he went about it was so rude. I was panicking so I was like give me a month or two I locked in because for me I take my la it's bad I I see it as um a report card so I work on it and I'm like it's me against my doctor. So I showed up I was like take my labs I like I I improved and then my doctor was so confused because I was so aggressive. I was so mad and then I was telling her and she was like I would never put you on any medication like you're very young like you could you can correct you'd already corrected her very quickly um but that's good.

SPEAKER_00 57:53

But she was so convenient I told her and she was like that's horrible and then he I seen him again and he was so biased like he was convinced because of my background and the way I look like is the why why you you would not respond to listen a lot of chronic illness the first treat line of treatment unless you're like off the charts but for the most people it's lifestyle modifications right like for six months you should try to you know change how you're living all that stuff it should not be here's the pill you test it X number whatever no if they tell you that you need to run yeah okay because that's not the protocol and that's not good medicine.

SPEAKER_03 58:32

Everyone I know like a lot of young people like I remember made that video about cultural they have they're just like and it's so scary because once you start these medications it's almost hard to get off.

SPEAKER_00 58:40

Well that and that's it and I think prescription medicine has become a scapegoat and a scapegoat not just from the medical community itself but our patients are not willing to do the work. Yeah like like I said you know 15 minutes 20 minutes cannot change your life what can change your life is how serious you take your own conditions and what you're willing to do about it. If you prefer to sit at home and doom scroll and work from home and whatever you know like if you're not seeing sunlight if you're not getting fresh air like you know if you're just whatever Uber delivering your food like so all these tests by the way are beneficial if you're actually gonna do something with them. Yeah. Right? You can get all the tests that you want know all the information that you need to know. If you're not activating if you're not taking the steps required then I mean it's an unnecessary expense as far as I'm concerned.

SPEAKER_03 59:37

Yeah there's no easy shortcut to help then we talk about this almost every episode you have to be willing to do the work. Like as someone I feel like I'm after Brian Johnson I feel like I'm the most tested person in America. I'm always getting a test done I can vouch for that I'm the most tested person in America and I have to do the work y'all every day. Absolutely right but you feel it though I like I think you progress.

SPEAKER_00 59:57

If you were being tested and understanding and I always think you know like in in some I love my culture but we're just hardcore about everything right like or pushing people to I'm always of the opinion of give people the raw data give people the information right like is change requires knowledge yeah right and that's why this you know the medical community we're not very good at actually giving people the information that they need to make change. Yeah so in the end all of this is useful if you're accountable for yourself. Yeah that's it we're done by thanks