Beyond the Prescription

You can also check out this episode on Spotify!

When Caitlin Murray’s 5-year-old son Callum was diagnosed with leukemia in 2016, her world turned upside down. She started blogging to keep friends and family informed about his treatment, and what began as a medical missive became an outlet for share about life, love, and parenting.

Callum beat cancer, and Caitlin’s star kept rising. As the main character of the wildly popular Big Time Adulting Instagram page and podcast, Caitlin has captured the hearts of parents everywhere with her raw, relatable, and hilarious commentary about raising kids.

On this episode, Caitlin sits down with Dr. McBride to discuss social media for grown-ups; learning to trust your gut; and the heartbreaking hilariousness of being a parent.

So listen, learn, and laugh with Caitlin. She is living proof that humor is healthy.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, review — and enjoy — the show!

Transcript of the podcast is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription," the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts. Our stories live in our bodies. 

[00:00:35] I'm here to help people tell their story, to find out, are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at https://www.lucymcbride.com/ and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So, let's get into it and go beyond the prescription. 

[00:01:03] There are influencer moms on social media with their perfectly curated family life on display, and then there's my guest today, Caitlin Murray. Caitlin created the wildly popular Big Time Adulting Instagram handle and now has a podcast of the same name. It all started as a way of keeping her friends and family abreast of her son's progress as he was treated for childhood leukemia. And it has grown exponentially over time as an outlet for Caitlin to share her thoughts on, as she puts it, life, love, and parenting. 

[00:01:37] Caitlin is arguably the funniest and most relatable mom on the internet. Her content is the refreshing antithesis to the Pinterest-perfect family imagery. Her humor makes her audience of stressed-out parents feel seen and heard. It's her authenticity that has made her wildly successful and someone I really admire. Caitlin, thank you so much for joining me today. 

[00:01:59] Caitlin: Oh, my goodness. Thank you so much for having me. I'm super flattered to be here with you because we originally met via the Gram and I reached out to you to be on my podcast. And I found you because I was doing a lot of homework on COVID stuff in terms of the risk analysis of masking children in school, which was really something that I was feeling impassioned by at that time. And I was just so pumped to come across such an accredited doctor who spoke really well from both sides about the reality of the situation. And when you said yes that you would come on my podcast, I was like, "Ooh, I gotta tighten my s**t up right now." 

[00:02:45] Dr. McBride: Oh, my God. That's hilarious because when you asked me, I'm like, "Oh, I gotta tighten my s**t up right now."

[00:02:50] Caitlin: So, yeah, but I'm psyched to have developed this online relationship with you and see you a little bit in real life via Zoom. 

[00:02:59] Dr. McBride: Well, I feel like I know you. And that's, I think, your gift to your audience, is that you let us into your world, you let us into your interiority. And I think what connects to you and me is the fact that neither of us are willing to put up with a lot of BS, whether or not it's because you are a mom of someone who's had cancer, whether you are just born with perspective and wisdom, or whether or not you're just learning as you go like we all are. 

[00:03:28] The appeal in my mind of your content is this relatability, authenticity, and humor that allows people who are watching you to feel like we're okay. And that's the title of my newsletter is, "Are You Okay?" I mean, no one's really okay. Which is not to say we're all mentally ill, we're all broken people.

[00:03:46] It's to say that it's on a continuum how we manage our everyday lives, how we manage stress, how we manage mood, how we manage relationships with food, alcohol, our spouses, our children. My goal as a doctor is to help people be a little more okay tomorrow than they are today. And so, when you see someone like you on Instagram who's real and authentic, it's very appealing and refreshing. 

[00:04:09] Caitlin: Well, thank you. I really appreciate that that's how you view it because I'm actually a shallow b***h behind the scenes. 

[00:04:17] Dr. McBride: Well, I know that. And I'm trying to just cover it up for my audience, but there you go. Like, that's what you are, you're funny and you're real. And I'm gonna guess that you have insecurities like we all do, and you wonder sometimes like, "Wait, maybe I am a shallow b***h." I mean, Instagram is a weird place, right? 

[00:04:36] Caitlin: Totally. Yeah. I think it's a place where people second guess themselves constantly just by scrolling along. And it's this over-inundation of information and ideas and stuff that kind of like what you were saying, am I okay, or are we okay? And, like, no, nobody's okay. But that's also okay. Like, that's fine. So, don't overthink it. Just be yourself, right? Because you only get one shot at this whole thing to just be yourself. And what a gift. 

[00:05:06] So, starting my page, becoming really vulnerable in a public way is difficult. It was hard to do that at first. And now I am so much more comfortable with it because my audience size has grown and that's validating in itself. So, I feel compelled to continue oversharing all the time. But it's one of those things where when you let your guard down and you make yourself vulnerable, which I try to do, people really can sense that, the realness of what's happening in life and that you're not preoccupied by the b******t. Like, let's just get to the point. 

[00:05:45] Dr. McBride: Yeah. And I think social media has allowed people like you to do that because maybe you have an intrinsic confidence or just sense of self that's stronger than others perhaps. But I think there's a lot of fear about revealing our true selves, certainly publicly and even to our own friends and family sometimes or to ourselves. 

[00:06:06] There's a hesitancy to really look inside and acknowledge uncomfortable truths, realities about our lives, about who we are, and then Instagram highlights how perfect people are able to present themselves and then it can deepen any preexisting insecurities. So, I think what I'm hearing you say is that the vulnerability you are presenting outward to your audience is also reinforcing to you of the magic of vulnerability for your own self. 

[00:06:40] I'm guessing that you're a little bit like me in this way. The glue of my friendships with women in my life is shared vulnerability, and honesty, and truth. It's not a hey, one-upmanship, it's not a competition. It's, like, it's being real. Because first of all, who wants to be around other women who are like, "Oh, I'm so great, and look at my kid, they won this award." I mean, at the same time, my friends are people who can celebrate my wins with me too, and cry with me at the same time. 

[00:07:11] Caitlin: But all that stuff is also like, it'…

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In honor of Mental Health Awareness month, we welcome Dr. Samatha Boardman. Dr. Boardman is a New York based positive psychiatrist who is committed to fixing what’s wrong and building what’s strong. She writes the popular newsletter called The Dose and is the author of Everyday Vitality, a book about leaning into our strengths to bring about positive change.

Historically, psychiatry has focused on the diagnosis of disease and the treatment of individuals with mental illness. Positive Psychiatry takes a more expansive approach, focusing on the promotion of wellbeing and the creation of health.

Dr. Boardman is passionate about cultivating vitality, boosting resilience, and transforming full days into more fulfilling days. Today Dr. Boardman sits down with Dr. McBride to discuss finding wellness within illness, strength within stress, and how to live with anxiety rather than being defined by it. Dr. Boardman is here to help!

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts.

[00:00:33] Our stories live in our bodies. I'm here to help people tell their story to find out whether they are okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter through my website at lucymcbride.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.

[00:01:01] Today's podcast guest is Dr. Samantha Boardman. Samantha is a positive psychiatrist, a clinical assistant professor at the Weill Cornell Medical College in New York, and the author of a book called Everyday Vitality. It's a book that combines her research as a clinical psychiatrist in New York to help readers find strength within their stress.

[00:01:24] I met Dr. Boardman through a mutual friend. I started reading her book and listening to her talk on Instagram, and it was clear that we had a common interest in helping people marry mental and physical health. Today on the podcast, we will talk about when is therapy not appropriate? We'll talk about medication, we'll talk about Zoom versus in-person therapy, and we'll talk about leaning into our strengths as opposed to focusing on the negatives. Welcome to the podcast, Samantha. I'm so happy to have you.

[00:01:53] Dr. Boardman: Thank you so much. Thank you for having me. I'm a huge fan.

[00:01:57] Dr. McBride: So today, Samantha, I'd love to talk to you about many things. One is your definition of health. What does it mean to be healthy? So let's just start there.

[00:02:07] Dr. Boardman: Great place to start. And so I think my definition of health has really changed over the past 20 years. Like you, I went to medical school and then I did a psychiatry residency. The definition of health for me then was the absence of illness. And what I thought of myself as doing my role was to make people less miserable as a psychiatrist.

[00:02:30] And I've gotta tell you, I got pretty good at misery along the way. But one day I was actually fired by a patient who said, when I come to see you, we just focus on what's wrong with me. We don’t really focus on what's going on, what's wrong with what's going on in my life?

[00:02:47] And she was right. I was so fixated on symptoms and dialing down the issues, dealing with conflicts in her life and that type of thing, and less focused on what makes life meaningful for her, what she enjoys doing and where she finds purpose. It sort of woke me up and I ended up going back to study applied positive psychology, which was sort of the opposite of everything I had learned in medical school, in psychiatry residency.

[00:03:14] I studied optimism. I studied resilience. I studied post-traumatic growth. All these data-driven experiences that were really absent in my education and so much that had been focused on pathogenesis, which is the study and understanding of illness in switching over more to salutogenesis, which is the creation of health.

[00:03:36] So this is a really long-winded way of saying, I think of health as so much more than the absence of illness, and I'm deeply interested in how we can help people create wellness within their illness and strength within their stress, and add vitality even into their very busy lives. And as you know, when we ask patients, what's most meaningful to you?

[00:03:57] What do you care most about with your mental health? Or your health in general? People say, I want to have a good day. I want to feel energetic. I want to feel strong. I want to be able to give back. I want to spend time with friends and family and those types of things, that's what salutogenesis is—creating experiences of health and joy and meaning and vitality and energy for them in their everyday lives.

[00:04:24] Dr. McBride: It's so important because just like you discovered along the path of your training and clinical work, I too realized that my job isn't just about helping people not die. It's about helping people live. And it's not enough to tell people at their annual physical, “Hey, your labs look fine. Get a little more exercise, eat a little healthier, and I'll see you next year.” Not dying is good. But what about living? What about having agency over our everyday lives the 364 days a year that you're not in the doctor's office? And what has always struck me since I was a pup of a medical student is that self-awareness is like ground zero for our health.

[00:05:14] When we are able to pull the curtain back on who we are as people to understand not just our genetics, but really our stories and how our stories inform how we feel—literally our body parts—and then how we organize our everyday behaviors and thoughts around the narrative that we tell ourselves, and that's really why I became in interested in mental health and why I find your work so compelling is because I think we're having a moment in our culture where mental health is more acceptable to talk about; where people are more empathetic about mental illness.

[00:05:55] I still think we don't have a great understanding of what mental health is. And to begin with that we all have it. And I wonder what you think about this concept of everyone having mental health and it's just on a continuum versus mental health versus mental illness. And then secondly, to what extent do you think just mere self-awareness is an important ingredient in having mental health?

[00:06:25] Dr. Boardman: Both [of those are] awesome questions and I think that kind of you have it or you don't is this binary, and really limits us about either you're mentally healthy or you're not. And I think that's sort of the way I was trained. Not to be critical of my training, but that was either: you need to be hospitalized or you don't, you're ready for discharge… and not kind of looking at all of those other factors that you look so closely at.

[00:06:51] They kind of give you and provide for you even this scaffolding around you to help you make better choices, to have more better actual days in your week. And this idea that how do you find wellness within illness? And it's something Dr. Ellen Sachs was the one who first I heard speak about this and she was a graduate stude…

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Did you know things like sugar-free gum, Advil, or simply eating too fast can cause gas and bloating? Everything we put into our ecosystem affects our gut health.

Our gut often reflects our emotional health, too.

In today’s solo podcast, Dr. McBride explains the practical framework she created to help patients conceptualize their health, integrating medical evidence, the patient’s story, and real life.

She calls it the FOUR “I”s:

* Information & data = the elements of our health that we can measure and see.

* Inputs = everything that we put into our health ecosystem.

* Infrastructure = the vehicle (i.e., the skeleton) that drives us through life.

* Insight = the process of laddering up from self-awareness to acceptance to agency over our health and well-being.

It turns out that this framework can help explain and trouble-shoot common gastrointestinal woes.

Health is about more than the absence of disease. Health is about having awareness of data and the stories we tell ourselves, acceptance over the things we can't control, and agency over our life.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

Intro: Hello and welcome to my home office. I'm Dr. Lucy McBride, and this is Beyond the Prescription. Today it's just you and me. Every other week this season, I'll talk to you like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as a process of self-awareness, acceptance, and agency.

[00:00:28] In clinical practice for over 20 years, I have found that patients generally want the same things: a framework to evaluate their risks; access to the truth and data; and tools and actionable information to be healthy mentally and physically. We all want to feel more in control of our health. Here, I'll talk to you about how to be a little more okay tomorrow than you are today. Let's go.

[00:00:56] Today is a deep dive into gastrointestinal health. There is no possible way I could cover every crevice of the vast amount of knowledge we have on the gut, but I will focus on common things I see and common causes for gastrointestinal distress that often are missed. You may remember from a couple of months ago that I explained in detail the visual representation of how I think about patients.

[00:01:26] I call it the four I’s. It's a two by two grid. Imagine a box with four squares in it. And today what I want to do is talk about the gut and how the different I’s inform gastrointestinal health using some patient examples, things that I see commonly in my office. You can listen to that 15 minute podcast about the four I's for more of a dance remix version of the concept. But briefly, the four i's, are this: the top left square is information. Information and data. Things we can measure, things we can see like lab tests and colonoscopy reports. The top right corner is inputs; things we put in our body from kale and quinoa to alcohol and recreational drugs.

[00:02:15] The bottom left box is infrastructure. Our skeleton, literally the skeleton, literally the vehicle we drive through life, the container of all of our parts. And then finally, the bottom right box is insight. Awareness of the stories that we tell ourselves. Awareness of how our stories manifest in our bodies, and our understanding of our mental health, our anxiety, our moods, our relationships with food, alcohol, each other, and so on.

[00:02:45] So let's talk about a common complaint I see. I don’t think a day goes by in my clinic where I don't see someone who has gastrointestinal complaints like bloating, irregular stools, gas or abdominal discomfort. Now the list of possible diagnoses for these complaints is vast, from diverticulitis to colon cancer to I ate a hot chili pepper. 

[00:03:11] But common things are common. That's a very favorite expression that doctors use all the time. And so I wanted to go through how I might conceptualize thinking about the diagnosis or how to help a patient troubleshoot these symptoms when it's sort of bread and butter. Take a middle-aged guy who comes in complaining of bloating, gas, and irregular bowel movements.

[00:03:32] When I think about the top left square, that information, I want to know, what do his lab tests look like? If he's over the age of 45, has he had a colonoscopy? Because 45 is the age where we start screening colonoscopies. By the way, if you have a family history, you should start earlier. So I want to know what's going on internally.

[00:03:52] What's his information? For example, if his lab tests show that he has hyperthyroidism or liver enzyme abnormalities, or a pancreas problem or celiac disease, that may directly inform how I'm going to recommend treatment. In other words, the data and the things we can measure are very important. So let's say he had a normal colonoscopy.

[00:04:14] Let's say his liver tests are normal, his pancreas is normal, his gallbladder is normal, and his blood counts show no evidence of infection or inflammation, and he's negative for celiac disease. So those are just some broad brush stroke tests I might order. I also might not order tests because sometimes it's a simple solution, but let's say that his information is normal.

[00:04:35] Then we'd move over to the inputs. That's the one I'm most interested in. When people have these kinds of complaints, I want to know, how much alcohol do they drink? What is the cadence of their eating? Are they eating a lot of processed, greasy food? Are they consuming a lot of sugar? What's the level of acidity in their diet and how fast do they eat? People who eat fast often swallow a lot of air and can get gas in the colon. Do they drink a lot of soda? Do they chew gym? Sugar-free gum is notorious for causing gas and bloating. So I would do a thorough history of what the patient's inputs are. What are they putting in their ecosystem?

[00:05:15] Sometimes people can get gas and bloating from taking too much fiber. I think most people know that fiber is healthy and fiber can help with digestion. But if people escalate the dose of their fiber intake too quickly, that can backfire and they can get bloating and gas. This is a common phenomena. The other thing I would ask in the input department is, are they taking any supplements or vitamins? Because even though supplements and vitamins are considered natural, sometimes they contain fillers or the supplement itself can accidentally cause bloating and gas. Magnesium, for example, which people often take to help them sleep, can cause diarrhea. 

[00:05:50] It’s important to think about all the different things you put in your ecosystem and how they might affect your digestive health. One of the most helpful interventions I find for patients with this kind of complaint is to keep a food journal. It sounds really boring and it sounds kind of onerous, but writing down every single thing you eat is kind of an interesting exercise.

[00:06:12] People often connect the dots between their digestive health, their mood, their energy, and their bloating and gas when they look at the things they're eating. It's really interesting how mindlessly we consume foods, supplements, vitamins, and how little attention we pay to the things we pop into our mouth all day long. So I would suggest writing things down if you haven't done it already and you have this complaint.

[00:06:35] The next quadrant I would look at is infrastructure, our skeleton. So it's not uncommon for people who have a bum hip, a bum knee, an aching back to pop an Advil, to take Tylenol, to take supplements that are over the counter that they think will help with their achy joints an…

You can also check out this episode on Spotify!

On this episode, Melissa Urban talks candidly with Dr. McBride about her struggle with drugs—and how her recovery stemmed from creating healthy boundaries around food, substances, and interpersonal relationships. 

Her latest book, The Book of Boundaries, is about the importance of setting limits on relationships and choices, and putting ourselves back in the driver’s seat of our health and wellbeing.

Melissa is living proof that health is about laddering up from self-awareness to acceptance to agency of our body and mind. 

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast or at https://lucymcbride.Substack.com/listen.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

Dr. McBride: [00:00:00] Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription," the show where I talk with my guests, like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight. Our stories live in our bodies. I'm here to help people tell their story and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at lucymcbride.com/newsletter and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.

Today's guest has been on the New York Times' bestselling list six times. She is the creator of the Whole30, which is not just a diet plan. It's a way to rethink our relationship with food. Melissa Urban joins me today to talk about overcoming addiction and the lessons learned in recovery that inform how she thinks about food, nutrition, body image, and the boundaries we set in our everyday lives. Melissa's newest book is called "The Book of Boundaries," published in October 2022. In it, she describes how we can say yes to things we need and want and no to things we don't to put ourselves back on the driver's seat of our health. Boundaries, in my world and in hers, provide the groundwork for improved health and well-being. Melissa Urban, thank you so much for joining me today.

Melissa: [00:01:48] Thanks for having me. I'm excited to chat with you.

Dr. McBride: Here's why I wanted to have you on the show. The way you talk about boundaries and the importance of setting limits on our relationships, our choices, is so important to how we show up in the world, how we relate to food, how we relate to alcohol and other substances, how we relate to other people, and how we feel about our own bodies that it's really at the core of what, in my opinion, health is. 

[00:02:17] Health, as I introduce in this podcast, is about self-awareness, and it's about acceptance, and it's about having agency. And having agency, in my opinion, includes knowing what we need and knowing what we don't need, which is driven, ultimately, by knowing our value and our meaning and our purpose. So that is a wide lens with which to open the conversation and for me to ask you, Melissa. How do you, as an expert in nutrition and eating and health, define health yourself?

Melissa: Well, that's a big question to open with. You're just going right for it.

Dr. McBride: We're going to go right from the top, and then we're going to get granular.

Melissa: [00:02:57] I had to do a piece recently for Oprah Daily where we talked about the concept of wholeness and what does wholeness mean to me, and I think that that can relate very nicely to this idea of what health means to me. So I think, very often, we look at health through a very narrow lens, and often, when it comes to diet culture, it's through the lens of body size. I mean, they are just absolutely equated that the smaller your body, the healthier you are. If you take a step back from that, maybe you're looking at health from the perspective of, "What does my diet look like? Do I have a movement practice? What does my sleep look like?"

[00:03:31] But even more than that, there are so many different factors that make up this concept of health or wholeness. I'm looking at it from a physiological perspective. So, do I have the energy to do the things that I want to do in my life to keep up with my kid, to do the recreational activities that make me happy? Do I feel satisfied from a personal development standpoint? Do I feel like I'm working on myself and I have the time and capacity to do some self-awareness or do therapy? Do I feel like I have a spiritual practice, whatever that looks like? Whether I'm connected to God or the universe or just my own highest self, am I cultivating that spiritual practice? Do I have social health? Do I feel like I have good connections with other people in my community? Do I feel like I have support? Do I feel like I'm not isolated?

[00:04:16] I think there are a lot of different aspects of health. You have to look at them from a position of wholeness. You can't just look at any one aspect, because one aspect can be going very, very well, but if all of the others are falling behind or you're not paying attention to them, to me, that doesn't feel particularly healthy or feel like thriving.

Dr. McBride: You couldn't have said it better, and it dovetails exactly with the way I think about health. It's not about the absence of disease. It's about the integrated sum of different components. It's about nutrition, body mechanics, self-awareness, which includes awareness of our medical vulnerabilities, which are often genetic and environmental, and it also includes, as I said earlier, that sense of agency. When I think of agency, I think of the ability to execute on goals that are yours and only yours. That's a luxury for a lot of people to have the opportunity to grow and to personally grow health-wise, grow professionally, grow relationships. But I think agency can also be on a really small level, feeling more in control of our everyday habits and even our everyday thoughts.

Melissa: [00:05:21] I agree. You know, when you say agency, I immediately think about self-efficacy, this idea that, like, I feel as though I am able to accomplish the things that I want, and sometimes that involves, if I think back to my recovery and the serenity prayer, giving me the patience to accept the things I can't control and, leave them out, but recognize that, for the most part, I do have control over how I choose to respond to those situations in that I usually or almost always can have agency. And again, there's an element of unacknowledged privilege in that statement alone, but we'll just say that agency, to me, does involve this aspect of self-efficacy and recognizing the things that I can't do while making strides on the things that I can.

Dr. McBride: [00:06:02] At the risk of repeating myself on this podcast, and my listeners may be, like, "Oh my God, there she goes again, talking about the serenity prayer," the serenity prayer, like, it's kind of the final common pathway of so many different conversations I have with patients, whether it's about parenting, like, letting of the fact that your teen doesn't want to talk to you right now and accepting that's normal for their age, and leaning into the opportunities, you have to talk to them when you're driving a car and it's quiet and there's no eye contact, to managing your addiction to alcohol, accepting you don't have control and leaning into the parts of your life that you do have control, finding joy and pleasure in other places and asking for help. 

[00:06:40] I’d love to, therefore, pivot to the conversation about your addiction and your health, because you grappled with addic…

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How often do you think about your skeletal health? Too often, we take mobility, absence of pain, and physicality for granted—that is, until we are sidelined.

Whether we’re nursing a torn ACL, an arthritic hip, or an osteoporosis-related fracture, even temporary immobility can alter our physical and mental health. It can threaten our sense of self.

Health is about more than the absence of pain or disease; about more than just treating the physical symptoms of a condition. Health is about taking a holistic approach to wellness and recognizing that we are the integrated sum of complex parts. Health is about having awareness of data and the stories we tell ourselves, acceptance over the things we can't control, and agency over our life.

In today’s solo podcast, Dr. McBride discusses the importance of caring for our skeleton like we do our cars—taking it to the shop when it breaks down, and providing regular maintenance.

She gives three examples—including herself!—of people whose physical injuries force them to reckon with their health

How do you care for your skeleton? What can an injury teach you about your health? What is the relationship, for you, between mobility and mental health?

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast or at https://lucymcbride.Substack.com/listen.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

Dr. Lucy McBride: [Intro] Hello and welcome to my home office. I'm Dr. Lucy McBride, and this is Beyond the Prescription. Today. It's just you and me. Every other week this season, I'll talk to you like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as a process of self-awareness, acceptance, and agency.

[00:00:28] In clinical practice for over 20 years, I have found that patients generally want the same things—a framework to evaluate their risks, access to the truth and data and tools and actionable information to be healthy mentally and physically. We all want to feel more in control of our health. Here, I'll talk to you about how to be a little more okay tomorrow than you are today. Let's go.

[00:00:56] [Episode] Hello, everyone and welcome to my solo podcast. Today we're going to be talking about skeletal health and what happens to our bodies and minds when we are out of commission. Today is the final game of March Madness, and I don't know about you, but I am pretty obsessed with March Madness. I love how it signals the beginning of spring.

[00:01:14] I love the friendly competition of all the brackets, and my family's pretty obsessed with the games. I am no basketball aficionado, but I really enjoy looking at the athleticism, the strength, and the grit on the courts. I also can't help but wonder what these guys are gonna look like when they're patients in their fifties, sixties, and seventies, for example, when they've had a lot of overuse injuries and they show up in the doctor's office, perhaps like mine.

[00:01:40] I think it's important we acknowledge we each have only one skeleton that drives us through life, and we cannot trade in our skeleton like we can our Honda or our Prius. We can only take care of it the best way we possibly can. We can only do maintenance. And I think it's interesting. Many of us take our cars to the shop to rotate the tires, change the oil, align the axles—more than we take care of our skeletons or take them into the shop.

[00:02:06] And by the shop, I mean to a physical therapist or other body. Okay, so why does this matter? Why do we need to think about skeletal health? Why do we need to think about injury prevention and why do we need to treat our skeletons at least as well as we do our cars? The short story is this: our skeletal health is foundational.

[00:02:26] A couple of months ago, I unveiled the visual representation of the way I think about patients’ health. I call it the four I’s. It's a two by two grid, and the way I think about health is that we are the integrated sum of these different components, these four I’s that intersect and that really talk to each other all day long.

[00:02:48] One I is information and data. The second I is inputs—all the things we put in our ecosystem. Another I is infrastructure—our skeletal health, the container that drives us through life. And this is what we'll focus on today. And the fourth I is insight. Our self-awareness and our understanding of how our story lives in our body.

[00:03:08] In this ecosystem, I have assigned an entire quadrant just to skeletal health. That is because our skeletons are essential and foundational to our whole health and the way we move our physicality directly affects our medical information. It also affects our insight and self-awareness, so it's essential that we care for the bones, the muscles, and the connective tissue that carry us through life.

[00:03:33] When these systems are going well, we tend not to notice. When we're walking, jogging, swimming, lifting our grandchildren, putting luggage in the overhead compartments and playing bridge, knitting, gardening, and living our lives without any discomfort or limitation, we tend not to notice. We tend not to pay attention to our skeleton.

[00:03:56] We end up taking it for granted and thinking it is going to be there for us whenever we need it. But guess what? Every now and then we blow a gasket. Every now and then the muffler starts rattling before we even blow the proverbial gasket. And what I see in my office is people who are experiencing pain, discomfort, limitations in their range of motion, limitations in their quality of life and their ability to do the things they want to do.

[00:04:22] And in the case of people who have exercise routines who are managing their cholesterol or their heart health, or their mental health with exercise, being sidelined has major, major consequences. It affects our physical health, our mental health. It can affect our sleep, it can affect our whole sense of self.

[00:04:39] Let me give you three examples. I have a number of patients who are student-athletes. Either they play high school sports or college sports. And you know, these young athletes are very accustomed to being strong, fast, nimble, and not limited in their ability to perform. And so when an injury happens, It can be devastating. Not only can they experience pain and disability, they can also experience a crisis of identity. Particularly as kids tend to specialize in sports earlier and earlier these days, their identity can very much easily get wrapped up in their sport and their performance. I have a patient who's a young woman who plays collegiate soccer at a very high level, and when she tore her ACL—which is an important ligament in the knee—in her season, she was devastated.

[00:05:26] She was experiencing quite a lot of pain after her surgery and was having a difficult time rehabilitating her knee. Unfortunately, the orthopedist was giving her more pain medicine—more Percocet—and that was making her feel more blue, more disconnected, and she came into my office wondering what to do.

[00:05:43] I'll give you a second example. An 80 year old patient of mine broke his femur. The femur is the thighbone, and he broke it because he fell and he has osteoporosis. Now this man was an incredibly proud man. He'd had an extraordinary career doing diplomatic work overseas and he had taken great pride and joy in caring for his beloved wife who had died three years prior from Alzheimer's. Mobility to him was not just about getting exercise, which he was good about doing to manage his heart health. It was also about socializing with his friends. It was about playing cards with the guys once a week. It was about ta…

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If you are a parent searching for answers — or a teenager yearning for tools to understand yourself better — look no further!

Dr. Lisa Damour is a New York Times bestselling author, podcast host, clinical psychologist, mother, and all-around brilliant human. Her new book, The Emotional Lives of Teenagers: Raising Connected, Capable, and Compassionate Adolescents, is an essential guide for parents and teens looking to make sense of their emotional distress, complicated feelings, and current climate of fear and anxiety. 

Lisa sits down with Dr. McBride to discuss the recent CDC data on teen mental health and common misconceptions about anxiety, distress tolerance, and how parents can help their teens cope with the ups and downs of adolescence.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast or at https://lucymcbride.Substack.com/listen.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight. We are the integrated sum of complex parts.

[00:00:32] Our stories live in our bodies. I'm here to help people tell their story, to find out if are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at lucymcbride.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.

[00:00:56] So let's get into it and go beyond the prescription. 

[00:01:03] Today on the podcast, I am thrilled to welcome Dr. Lisa Damour. Lisa is a New York Times bestselling author, Podcast host, clinical psychologist, and Mother. Lisa's latest book was published earlier this year. It's titled The Emotional Lives of Teenagers: raising, connected, capable, and Compassionate Adolescents. This book is an invaluable guide for parents and teens to help them make sense of their complicated feelings and how to navigate emotional distress.

[00:01:35] Lisa is a wonderful resource in this current climate of anxiety, fear, and uncertainty, and I'm thrilled for her to join me today. Lisa, thank you so much for joining me on the podcast. 

Lisa: Thank you so much for having me. I'm delighted to be here. 

Dr. McBride: There's so much I wanna talk to you about. I wanna start with the word anxiety.

[00:01:55] It is a word that is thrown around a lot. It's a word that we need to have in the vocabulary of our lives because. As I say to patients all the time, anxiety is part of the human condition. If you didn't have anxiety, you would walk into traffic. You wouldn't turn your term paper in on time. You would not run from danger.

[00:02:18] But anxiety is such a commonly used word that I think it almost gets watered down, if you will, or it's such a commonly used word. It gets misunderstood. And what I love about your work, Lisa, is that you’re helping shed more light on what the word means. You're helping people normalize anxiety, not to be afraid of it.

[00:02:38] And so I'd love to ask you first. Tell me about the anatomy of anxiety and talk to me about what it actually means. 

Lisa: So this is a tricky one because there's not a lot of places where the vernacular term for an emotion is also the same one we use for the diagnosis. And I think anxiety gets hard in that way, right?

[00:02:55] For depression, we have sadness and depression, and we can make those distinctions more cleanly, even though of course people do use the term depression in a fairly elastic way. We do actually talk about healthy anxiety using the same term that we could use to talk about unhealthy anxiety. But even there, that's where you see that psychologists make the distinction that both are real, both healthy and unhealthy anxiety.

[00:03:18] So in the simplest terms, what we think about with healthy anxiety is that it is exactly as you described it in A Gift from Evolution. It is our internal threat system. It alerts us when something's not right. In my second commercial book I—which was called Under Pressure: confronting the Epidemic of Stress and Anxiety In Girls—a huge amount of that book is about helping make these distinctions and helping parents and their daughters understand how this works.

[00:03:45] But healthy anxiety is a huge part of being a safe person in the world. We only consider anxiety to become unhealthy or to warrant a diagnosis under two conditions. One is if the anxiety is present and nothing's wrong, that to the degree that it's a threat alert system, it should only be alerting us when there are actual threats.

[00:04:07] So we become concerned if a person is feeling an ongoing sense of anxiety, but there's nothing for them to be frightened of. The other time that anxiety arrives or kind of crosses the threshold into a diagnostic category is if the anxiety is way out of proportion to what's wrong. So, if a kid has a term paper that's due and is late on it, they should feel some anxiety that is actually valuable to them, that will motivate them to turn the paper in or get it done.

[00:04:36] If they're having a panic attack over that, that's too big, it won't be productive to them. It won't be useful. And so some of our work in caring for people who suffer from anxiety is not actually trying to rid them of the anxiety. It's actually trying to get the anxiety to arrive in proportion to the threat.

Dr. McBride: [00:04:55] It's such a good way of describing it. What I've learned over time and what I try to convey to my patients is that it's really about, as you said, trying to calibrate your level of vigilance to the moment, and that is, that's really lifelong work for most people. They don't always recognize it. I think that like what I see in my office is the physical manifestations of anxiety, particularly on the heels of the three year collective trauma we've been through; the cognitive distortions that arise when people are experiencing anxiety; and then the natural human instinct to try to numb this uncomfortable feeling. And so where I can be most useful and, I would imagine this is the case for you in your clinic, is sort of normalizing for people the anxiety.

[00:05:47] If you did not have an emotional experience of anxiety, vigilance, fear during the pandemic, for example, I'd kind of wonder what was wrong with you. Like if you were just kinda like- oh, this would be unusual, a virus, whatever. It's a virus. People are dying unexpectedly, and we're closing schools and rearranging our entire lives.

[00:06:12] And so I think as you so elegantly say, and describing your book, Lisa, the mere normalization of anxiety is helpful and, one of the reasons I think is because people get so anxious that they're anxious. Again, as a recovering, anxious person myself, I've learned that anxiety can be a signal, oh, there's something going on and maybe I need to recalibrate this feeling versus letting it take over my thoughts, feelings, behaviors, and then all of a sudden I am in the backseat of the car riding the speed bump.

Lisa: [00:06:48] Yeah, I mean I think one of the things that we're up against right now in the culture is there's some confusion about what actually constitutes mental health. And that's part of why I wrote this book. So often being mentally healthy is equated with being calm or relaxed or at ease or happy. 

[00:07:08] And you know what we know as psychologists is that that doesn't really enter into our assessment of mental health. Lik…

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Our stories live in our bodies.

No one knows this better than Dr. Suzanne Koven, a master storyteller and primary care doctor at Harvard Medical School. In caring for patients for 30 years, Dr. Koven learned that patients are more than a set of organs.

“There is nothing that I can think of, there is no kind of testing, there is no sort of physiology or pharmacology that is more essential to clinical skill than the ability to elicit, interpret and communicate someone else’s story.”

It turns out that Dr. Koven has a story, too. Despite her accomplishments and accolades, as a young woman Dr. Koven felt like an imposter—a surprisingly common sentiment for career-oriented females. Her memoir, Letter to a Young Female Physician, is a series of personal essays that reveals the importance of identifying negative self-talk. The book is a must-read for women physicians and for anyone experiencing self-doubt. It’s also part of the reason she became the inaugural writer-in-residence at Massachusetts General Hospital in Boston, helping other physicians explore the art of listening, writing, and authoring our own narratives.

On this episode of Beyond the Prescription, Dr. Koven discusses with Dr. McBride how her own process of self-discovery improved her own health. Her humility and humor are just what the doctor ordered.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast or at https://lucymcbride.Substack.com/listen.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The transcript of our conversation is here!

Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription." The show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight. That we are [00:00:30] the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, to find out, are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at lucymcbride.com/newsletter and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So, let's get into it and go beyond the [00:01:00] prescription. 

Today's guest is the kind of doctor I aspired to be when I was a young girl. She's someone I actually wish I had known along my arduous journey in medicine because she's a real healer and I could have used her. Suzanne is a primary care doctor. She's been practicing at Harvard Medical School and at the Mass General Hospital for over 30 years. She's now doing really important work as the inaugural writer in residence at the Mass General Hospital, as an essayist, [00:01:30] writer, and someone who conducts workshops and panels, talking about narrative and storytelling in medicine, women's health, and mental healthcare. Her essay collection was published in 2021. It's called "Letter to a Young Female Physician." I think many of us look back at our younger selves and think we have some pearls of wisdom, some advice, and that's what Suzanne is doing now for us, for me today. Suzanne, I needed you back when I was a [00:02:00] young pup struggling to find my way in medical school and residency. It was hard as a woman, as a pregnant person, and as a person who struggled herself with perfectionism and imposter syndrome. I'm so excited to talk to you today. Thank you so much for joining me. 

Suzanne: And I'm thrilled to be here, Lucy. I needed me when I was young too. 

Dr. McBride: Tell me about that. What was it about your youth that made you need someone like you are today? 

Suzanne: Well, [00:02:30] when I wrote the New England Journal essay "Letter to a Young Female Physician" that became the title essay of my book, what I did was the essay is framed in the form of a letter to my younger self, my younger self as an intern 30 years earlier. And I had a couple of things I wanted to say to that person, which I didn't realize until later were actually quite related. But the first was that 30 years later [00:03:00] there would still be sexism, misogyny, and lack of gender equity in medicine to an appalling extent. And the second thing, perhaps more personal, was that I had spent decades, really starting in high school, perhaps even earlier, very much accelerating in medical school and residency thinking that I was a fraud, suffering from what has been called imposter syndrome. Though I didn't know that term [00:03:30] early on. And I wish that my current self could tell that self, that in fact, I was not an imposter at all. And one of the great pleasures of zooming around the country and abroad and talking to young women in medicine and some not in medicine, has been bringing that message to them now. So, I couldn't do it for myself, but it's very gratifying to be able to do it for others [00:04:00] now. 

Dr. McBride: Imposter syndrome is so common, particularly in women, not just in medicine. Can you break it down? Describe it to me. How do you define imposter syndrome? 

Suzanne: So, imposter phenomenon, as it was originally called when it was described by psychologists in the '70s, is a feeling of internal phoniness, or it was called intellectual phoniness. And it was originally described as occurring most [00:04:30] often in "high-achieving women." I think we all know that it's really part of the human condition. Everybody has it to some extent. The way it looks, I think, for women, particularly say, professional women, is this, you are sitting in the conference room, you're sitting in the auditorium, you're standing around the bedside, and you're thinking, "I'm the one here who doesn't belong." It's like the old Sesame [00:05:00] Street song. "One of these things is not like the others." You think, "Well, maybe my classmates, maybe my residency mates, you know, say that they're struggling, that they're overwhelmed, but they're not really overwhelmed or they're kind of normal overwhelmed. Me, I'm different. I am an utter fraud, and it will only be a matter of time before I'm found out." 

In fact, I remember as a young attending [00:05:30] when I was teaching on the wards thinking, "Well, thank goodness these rotations are only a month long." Because if I stayed 31 or 32 days, they'd realize I actually didn't know anything. I'd have gone through my entire repertoire of knowledge and then, you know, forget it. I'd never make it to day 35. And there's another aspect to imposter syndrome too. It's this false belief that [00:06:00] if only I get some form of external validation, if I get into that Ivy League school, if I get that plumb residency, if I marry that particular person, if I get this promotion, if I get this prize, if I lose this weight, if I get this income, then this feeling will go away. 

It doesn't work because it's always a matter of applying an external fix [00:06:30] to an internal problem. And in fact, the prizes, the brass rings, if I may, mix metaphors only kind of throw gas on the fire because the higher you rise, the more of an imposter you feel. I don't think I was ever more impostery than when I was chosen to be a chief medical resident at Johns Hopkins. The third female in 100 years, the only woman who had ever been married or had a child [00:07:00.518] and held that position. And I spent the entire year thinking, "Well, today's the day," and the day never came. 

Dr. McBride: It's incredible, Suzanne, to think that you as this incredibly talented, educated, wise person thought, "God, they really blew it by picking me. And they just have no idea what they'r…

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Three years after the World Health Organization declared the COVID-19 pandemic, we have widespread population immunity against the virus. But no one is immune to accumulated fear and uncertainty.

On this episode, Dr. McBride talks about where we are now and what to expect with COVID. She discusses various topics including

* the transition from pandemic to endemic

* rapid antigen versus PCR testing

* treatments, including Paxlovid

* the recent Cochrane review on masks and mask mandates

* vaccines and immunity

* what to expect in fall 2023

* addressing our pandemic story

Finally, Dr. McBride argues that recovering from the distress of last three years requires understanding our unique risks and risk tolerance—and appropriately reckoning with vulnerability.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

Hello, and welcome to my home office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription." Today, it's just you and me. Every other week this season, I'll talk to you like I do my patients, pulling the curtain back on what it means to be healthy, peeling back the layers of everyday medical problems I see. In clinical practice for over 20 years, I've found that patients generally want the same things, a framework to evaluate their risks, [00:00:30] access to the truth and the courage to face it, and tools and actionable information to be healthy, mentally and physically. So, whether it's managing weight, cholesterol, cancer, or mental health issues, we all want to feel more in control of our health. Here, I'll talk to you about how to be a little more okay tomorrow than you are today, and how to be healthy from the inside out. Let's go.

Today is a little ditty about COVID-19, my friend and foe for the past three years. Something you have probably thought quite a lot about, that has probably occupied a fair amount of real estate in your brain and in your everyday life for the past three years. Let's talk today about where we are now, where we have been, and where we're going with this virus. It's the three-year anniversary of the World Health Organization's declaration of the pandemic. That was on March 11th, 2020, and over the last three years, we have learned so much. We have [00:01:30] learned about the virus, about immunity; we've learned about how to protect the most vulnerable among us.

We've also learned about ourselves. We've all had to reckon with grief, loss, uncertainty, and significant vulnerability. So, let's take a minute to talk about COVID itself. We'll talk about symptoms, testing, isolation, the vaccines, boosters, and where we might go from here. Okay. So, first of all, [00:02:00] let's acknowledge, COVID is here in perpetuity. It has now been woven into the fabric of our everyday lives, whether we like it or not. It is endemic. Endemic means hospitals are no longer overwhelmed from COVID-19. It means that the vast majority of people in this country and around the world have some sort of immunity to the virus, either from the vaccine or from past infection, and that we have widely-available vaccines and therapeutics. Endemic does not mean that we are done with COVID-19. [00:02:30] No, no. COVID and COVID risk are something we will have to reckon with here on out.

What's happening with the virus right now? Well, the virus is here. In D.C., I'm seeing a couple patients a week with COVID-19. They mostly have typical cold or flu symptoms and are doing generally very well with at-home remedies like Tylenol, Advil, hydration, and rest. Now, some of my patients have been sicker, like patients who are older, who have underlying health conditions, like lung disease, for example. But it's important to note [00:03:00] that they're as sick as they probably would have been with another respiratory virus—one that we have known about since pre-pandemic times. For example, flu, RSV, metapneumovirus, parainfluenza virus. In other words, we have seen these kinds of respiratory viruses since the beginning of time, and COVID, in the vaccine era, has been added to the list of viruses that we will now be susceptible to, and for whom it is particularly potentially dangerous for people who are at higher risk in general.

What about Paxlovid? [00:03:30] So, Paxlovid is the oral antiviral medication that is FDA-approved, and appropriate for patients who are at particularly high risk for serious COVID outcomes. Who do I prescribe it to in the spring of 2023? The truth is, not many people, because at this point in the pandemic, most people have had COVID-19. Most patients, at least my patients, have had the vaccine, and that protection, that hybrid immunity, the combination of vaccine-induced and infection-acquired immunity, is marvelously protective against serious COVID outcomes, such that Paxlovid is not really necessary. Paxlovid has some downsides as well. So, when the upsides are minimal, and the downsides are not zero, it's worth a conversation to explain, not to hang our hat on Paxlovid as a panacea, and more importantly, to have confidence in our own immune system, and the marvelously effective vaccines, to protect us when we need it. Do I still prescribe Paxlovid? Absolutely. It's just a nuanced discussion, and one that the headlines really can't capture.

So, what about booster shots? Are we going to need a booster [00:04:30] shot every fall, like we need the flu shot? Well, the short answer is we don't know. Right now, public health agencies are predicting that they'll roll out an annual COVID shot like we do the flu shot. And this fall, when we're indoors, in crowded, poorly-ventilated spaces, we might need a booster shot. But that's not based on any particular science. It's based on the emerging evidence that there's a seasonal component to COVID, like there is for so many respiratory viruses. What that projection is not based on is the clear evidence that everyone will absolutely need a booster in the fall. That would not be accurate to project. In fact, right now, in 2023, immunity from the vaccine and from past infection continue to do a marvelous job at protecting us where it counts, preventing severe disease, and mitigating but not blocking transmission.

Remember that the vaccine can no longer protect against infection. The current variants, which are Omicron sub-sub-variants, are so highly contagious [00:05:30] that they outskirt the antibodies made by vaccination and from past infection. What that means is that you can get 3, 4, 5, 10 vaccine doses with the current vaccine formulation and still get COVID-19. You're just very unlikely to land in the hospital, and your symptoms will be mitigated if you've had a recent vaccine or recent bout of COVID itself. So, when people talk about waning immunity, that refers only to the antibody levels that inevitably and normally fall over time, three to four months after a shot or after an infection. If our antibody levels did not wane after exposure to a vaccine dose or a virus, our blood would be a thick milkshake full of antibodies. So indeed, those antibody levels go down with time, but our immunity against serious outcomes is lasting. How long will it last? We don't know. But at least for right now, people who have had vaccine doses for their age and underlying health conditions, [00:06:30] and/or who've had COVID itself, are not landing in the hospital from COVID-19 more than they would have from other viruses at this moment.

Are people still being hospitalized for COVID and people dying from COVID-19? They are. And these are people who are our most high-risk patients. They are also patients in the hospital who have so many underlying health condition…

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Family dynamics are complicated—but what happens when you learn that you have dozens (and possibly hundreds) of siblings?

When writer Chrysta Bilton’s mom decided to build a family as a gay woman in the early 80s, she employed a sperm donor. This man also played a role in Chrysta and her sister’s life as “dad.” But he continued to donate to other women—in secret—for almost 10 years. Chrysta learned this shocking truth from an article in the New York Times. On this episode, Chrysta joins Dr. McBride to discuss family secrets, shame, her unconventional coming-of-age story, and how all of this affected her mental and physical health.

Chrysta’s critically acclaimed memoir “Normal Family: On Truth, Love, and How I Met My 35 Siblings,” is available now.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The transcript of our conversation is here!

Dr. McBride: My family is everything to me. I think a lot about how they're like me and they're not like me. And there are many ways they're not like me, that they're so lucky not to be like me. And there are things that I've inherited from my parents that I'm grateful for, and there are things that I would maybe tweak a little bit. But I think all of us need to recognize how much we have in our genetic profile that we take for granted sometimes, and then [00:00:30] how much we're capable of change even though we may think we're just genetically programmed to be, you know, forgetful or not ask for directions when we're lost. 

I guess my point is it's good to reflect on where we came from, it's good to reflect on where we're going, and it's good to kind of sketch out in our minds where we fit in our family dynamic because that informs a lot of our daily health habits, the way we think, the way we feel. And today's guest is [00:01:00] such an important example of someone who's reflected deeply on what it means to be part of a family that became a lot bigger than she ever knew. 

Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription," the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. [00:01:30] As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts. Our stories live in our bodies. 

I'm here to help people tell their story, to find out are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at lucymcbride.substack.com [00:02:00] and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So, let's get into it and go beyond the prescription. 

What defines a family? What are the ingredients for healthy family relationships? What happens to us mentally and physically when family secrets are kept, and then when they are revealed? These are some of the important questions Chrysta Bilton explores in her critically acclaimed memoir, "Normal Family: [00:02:30] On Truth, Love, and How I met My 35 Siblings." 

In it, Chrysta describes how she learned that she has dozens, if not hundreds of siblings, the offspring of sperm donor Number 150 from the California Cryobank, and how she has reckoned with her past to better understand herself, what is nature, what is nurture, and how she cares for her mental and physical health. Chrysta, thank you so much for joining me today. 

Chrysta: Thank you so much for having me. I really admire [00:03:00] what you're doing with this podcast. I'm so grateful to be here. 

Dr. McBride: I appreciate that. And I wanna start with your mother who sounds like a real character. I mean, I kind of loved her from the minute I learned about who she was. She was a lesbian in the early '80s, desperate to have a family when a lot of sperm banks wouldn't even let gay women participate. So, tell me what she did. 

Chrysta: Yeah. They wouldn't allow gay women or single women for that matter. So, it was a different time. I think we forget how [00:03:30] far we've come, at least in certain parts of the country, in terms of homophobia. But in the '70s and '80s, even '50s and '60s, when my mom was growing up, everyone was closeted at that time. When she decided she wanted to have a family in her 30s after getting sober from drug addiction and, you know, dealing with a whole host of other stuff from her chaotic upbringing, what she wanted more than anything was to have this family. But she didn't know a single gay person who had had kids. 

You know, she knew women who were in marriages who were maybe on the side exploring their sexuality, [00:04:00] but she didn't know a single person who had set out to do this out in the open. And, you know, I describe a comical journey that she has to trying to find a father or, you know, a sperm donor for her kid. 

She starts with this place called the Repository of Germaninal Choice, which in the early '80s was this...basically this traveling salesman type man with a briefcase who she'd read about in the "LA Times" or "The New York Times" who'd come to your home with a binder filled with what he called, like, Nobel laureate sperm donors. And you'd flip through these [00:04:30] anonymous men with no pictures and she picked a mathematics prodigy. And that was gonna be my sperm donor. 

And she tried to get pregnant and she didn't. And then she got spooked and hired a PI to get a photo of this would-be mathematics prodigy. And this very unattractive professor photo came back and she was like, "You know what? I need to know the father of my kids and I want him to be good-looking." These were her criteria for what she wanted. 

So, she went on this manhunt and my very handsome model, musician, actor, [00:05:00] man who would become my father walked into a hair salon in Beverly Hills and she was like, "That's it. That's the one." And she took this man to lunch and paid him $2,000 to give her sperm. And I refer to him as my dad, not a sperm donor because after that initial transaction, my mother realized that, you know, she was filled with shame about going about having a family in this different way. And she felt like maybe she was depriving me of something by not giving me a dad. So, she then paid this [00:05:30] man to play a role in my life and I knew him as dad. 

Dr. McBride: And he promised her at that time that he wouldn't donate sperm to anybody else, that you and your sister Kaitlyn would be the only offspring, yet he was making a living off of donating his sperm. Tell me about the moment that your mom learned about him not keeping that promise. 

Chrysta: Shortly after the hair salon transaction, she made him swear he would never do this for anyone else. And at the the time, he was just like, "Of course," because it's not like [00:06:00] women were coming up to him at hair salons on a daily basis and, you know, lesbian women asking him to father a child. But then it became more apparent why she was so adamant about this because shortly after that she took him to the California Cryobank, which was just starting at this time, to be tested for STDs and to test his sperm count. 

And he saw a bunch of men walking in and out of donation rooms and he was like, "Oh, now I understand. It's because she was gonna bring me here and she knew I'd get ideas." And he did. So, while he was [00:06:30] playing dad to us, he then donated to the California Cryobank for almost 10 years, 3 times a week. I think he was one of their most prolific sperm donors. 

And we did not learn about this until I was in my 20s. And through a wild series of events t…

You can also check out this episode on Spotify!

Screens have become a necessity of modern life. Whether we like it or not, they inform how we work, play, parent, and relate to other people.

Technology is a wonderful thing. But too much screen time can negatively affect our health. From sleeplessness and agitation to addiction and social isolation, our relationship with tech directly affects our body and mind.

On this episode, Dr. McBride expands on her concept of the Four “I”s. She discusses how to think about screens like we do other “inputs.” Whether it’s alcohol and sugar or Instagram and TikTok, the question isn’t just How much? It’s What is my relationship with the thing I’m consuming?

Maintaining digital hygiene takes work. A healthy relationship with technology requires the same self-awareness that we should apply to everything we feed our eyeballs and brains.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast.

Get full access to her free weekly Are You Okay? newsletter at https://lucymcbride.substack.com/welcome

Please be sure to like, rate, review — and enjoy — the show!

The transcript of the episode is here!

Dr. Lucy McBride: Hello, and welcome to my home office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription." Today, it's just you and me. Every other week this season, I'll talk to you like I do my patients, pulling the curtain back on what it means to be healthy, peeling back the layers of everyday medical problems I see. In clinical practice for over 20 years, I've found that patients generally want the same things, a framework to [00:00:30] evaluate their risks, access to the truth and the courage to face it, and tools and actionable information to be healthy mentally and physically. So whether it's managing weight, cholesterol, cancer, or mental health issues, we all want to feel more in control of our health. Here, I'll talk to you about how to be a little more okay tomorrow than you are today, and how to be healthy from the inside out. Let's go. 

You may recall from a couple of weeks back, I spoke to you [00:01:00] about this concept of the Four I's. The Four I's is a visual representation of how I conceptualize health. Basically, as the integrated sum of different components, health is not just about our cholesterol or our blood pressure, it's about the intersection of our information, our inputs, our infrastructure, and our insight. Today we're gonna focus on inputs. One of the most important inputs into our ecosystem in addition to food, [00:01:30] water, and other substances, one of which is screen time. I don't need to tell you that our screens have become fastened to our persons, and that screen time has become more than just a passing fancy. 

If you will, let's consider for a minute that the way we consume screens is not unlike the way we consume food. Put another way, we cannot survive without food, right? We have to eat to survive. We have to eat for focus, attention, and for our [00:02:00] basic survival, right? You cannot put food on a shelf and live without it. Similarly, in the modern era, it's pretty difficult not to use screens. It's pretty impossible not to look at television, a computer screen, or a smartphone during the course of your regular day. So you might fast for a religious experience, you might take a screen vacation for a weekend. But in general, we need food, we need screens to operate in the modern world. 

So when I'm talking [00:02:30] to a patient about their health and we're talking about their sleep and their exercise and their nutrition, their medicines, their everyday habits, and how those things connect to their blood pressure and their vital signs and their laboratory results, I often ask people about their screen time, just like I ask people about their ingestion of sweets or carbohydrates, particularly if they have diabetes, and we're trying to kind of moderate their consumption. The way I think about screen time is again, like I think about food. It's something [00:03:00] we have to moderate, and therefore we have to think about not only how much we consume, but what is our relationship to it. 

Okay, so let's talk about screens in more detail. Why do I care about screen time, to begin with? Well, because patients come in every day remarking or complaining about things like insomnia, stress, work-life balance, the challenges of caring for children, elderly parents, getting enough sleep, making time for exercise, doing the job of being human [00:03:30] in the modern world. And so, when I'm trying to help patients find more agency in their lives, carve out little bits of time to breathe, appreciate nature, take a rest, take a load off, if you really drill down into what people are doing with their time, there's a lot of screen time that patients would really like to consume less of, and that for their health would be better to moderate. 

So I think the first thing about screen time is to think about how much we're on our screens. [00:04:00] Number two, what are we consuming? And number three, what are the emotions and thoughts that go into the usage? And what are the emotions and thoughts and behaviors, the result from being on screens more than you'd like? What do I mean? Two hours of screen time that is spent connecting with high school friends, doing grocery shopping, laughing at memes that provide brain rest relative to your hectic day is probably a total value add in your day-to-day life. But two [00:04:30] hours on screens where you're doom scrolling, avoiding an uncomfortable conversation with your spouse, staying up too late, and avoiding going to bed because you don't wanna get up and do it all over again, whatever your day might look like the next day, that is probably two hours that is a net drain on your psyche and a net drain on your body as well. 

Just to give you a really clear example, I for one stay up way too late. That's my natural instinct is to stay up late and to sleep late. I'm just a night person, so I have to fight the instinct to be up late [00:05:00] on screens. I will convince myself that I am happier in giving myself a break by staying up late and looking at Instagram, looking at Twitter, scrolling around on various articles, and then I'll look at my clock and it's 12:30 a.m. or 1:00 a.m. and I'm really annoyed at myself, and I continue to be surprised at how annoyed I am with myself despite the knowledge of how much better I would feel if I had gone to bed an hour or two hours earlier and woken up with a fresh mind. 

I'm not saying that screens are evil. I'm not saying that we don't [00:05:30] use them for pleasure and joy and connection with other people. I'm saying that we need to zoom out on how we are using screens and to be honest with ourselves about what they're doing and not doing for us, and to just insert consciousness into this inevitable input into our everyday lives. What we feed our eyeballs and our brains really matters in terms of how much time we're spending on screens. The opportunity costs of simply not going to bed at a decent time to then not wake up feeling refreshed or not going to the gym [00:06:00] to then guzzle down more coffee than you normally would, to then be more irritable during the daytime, to then eat more haphazardly. This is the mundane of being human. 

Health, in my opinion, happens in these mundane moments where we have had too much coffee, we snap at our child and we wish we didn't, and we feel remorseful, and then we get into bed and go on our screens and do it all over again. So again, as I've talked about over and over, health is really about that insight into our everyday behaviors and our [00:06:30] awareness of how we do things that do not serve us. And then the ability to be honest with ourselves and to course correct as able. Am I going to go to bed tonight without my phone in my hand? Maybe, maybe not, but do I try to be…