The Whole Pineapple

Why do some identical twins have different fingerprints?

Oh the 90s, era of the Hale-Bopp Comet and the Human Genome Project in science. Mapping the human genome was A Big Deal, and everyone from then-President Clinton to your high school biology teacher was pretty excited.

The genome project eventually led to the lesser-known but also very important Human Epigenome Project — health impacts beyond our genetic code. How are we impacted by environment and behavior, in addition to (or despite) the effects of our genes?

Ruby and Anne are having this critical nature/nurture conversation with Kent Thornburg, PhD, Professor of Medicine, Division of Cardiovascular Medicine, School of Medicine at Oregon Health & Science University (OHSU).

Just FYI, Dr. Thornburg's list of credentials, accomplishments, and accolades are far too long to reproduce here, but you can learn more about him and watch his Tedx Talk on the OHSU website: https://www.ohsu.edu/people/kent-l-thornburg-phd.

We have so much technology, so much information — why are we sicker and with lower life expectancies than earlier generations? Because technology is a tool, much like a hammer. You can build with it, but you can also destroy. We've actually caused epigenetic changes through processed foods, decreased physical activity, increased stress, and other poor choices.

Learn what the science of epigenetics actually studies and what we've discovered so far (including that fingerprint-twin question). And learn to take action that can help you be healthier and pass on better health to future generations.

Learn more about Dr. Thornburg at OHSU and from the resources listed below, and of course, find Ruby and Anne and more episodes of The Whole Pineapple at https://thewholepineapple.com/.

Kent Thornburg at Tedx Portland

George Fox Journal: The 100-year effect with Kent Thornburg

You Are What Your Grandparents Ate: What You Need to Know About Nutrition, Experience, Epigenetics and the Origins of Chronic Disease, By: Judith Finlayson, Forward by Kent Thornburg

Pregnant While Black: Advancing: Advancing Justice for Women's Health in America

Link to Amazon

Guest contact info:

Bernadette Battilega (Kent Thorburg's assistant): [email protected]

If you, like 113 million other people, watched the Super Bowl in February, you probably saw singer Rhianna's pregnancy announcement reveal.

While Rhianna's excitement about being a mom is understandable, it's kind of tough for those dealing with infertility to be involved in the celebration – especially when they aren't expecting it.

So how do you handle triggering situations? If you found yourself dealing with big emotions in the middle of a Super Bowl party, what did you do? And how do you handle it when someone unintentionally asks you a hurtful question about your own family building?

In this episode Anne and Jamie Mammenga talk about how to gently, politely extricate yourself from a situation where you don't feel safe or supported. Whether you went to get more nachos you really didn't want, or remembered a task or meeting you urgently needed to attend to, Anne and Jamie said to give yourself permission to walk away.

It's OK to tell a white lie, it's OK to cut someone short, it's OK to suddenly get much more interested in the score, it's OK to enlist a sympathetic friend to jump in and help you remove yourself. It's also OK to treat this as a "learning opportunity" for a person who clearly isn't being sensitive to others — replying with "That's an odd question to ask" is also completely fine.

If this conversation has you back in one of those unpleasant moments, we gotcha. Jamie leads us on a really lovely meditation exercise that will re-center you and help you chase obtrusive thoughts away.

Hear more from Jamie and from The Whole Pineapple podcast from our website: https://thewholepineapple.com/.

If you haven't yet listened to the longer episode with Ellen Trachman, please do. In that episode, Ruby, Anne, and Ellen talked about many of the larger legal issues surrounding assisted reproductive technologies (ART).

In this snack, hosts and guest are tackling specifics around frozen embryos: who do they belong to, how did the Dobbs decision change the laws, do people need to be shipping their embryos to states that are more aligned with their needs and beliefs?

The future of ART and legislation around genetic materials such as frozen embryos is very hard to predict, says Ellen Trachman, so it's important to keep up to date on changes as best you can. There are legitimate concerns here, so it's important to know what your state legislators think on topics such as reproduction — and what they're likely to enshrine in state law.

There is cause for cautious hope. Even some of the most restrictive states where privacy and choice are concerned are making efforts to preserve fertility choices.

That said, legislators are not health care professionals (no, you can't "move" an ectopic pregnancy from the fallopian tube to the uterus). It's important that legislators understand the ramifications of the decisions they're making at a legal level, so if you're interested and able to do some advocacy and educating, take a look at options for activism in your state.

You can find Ellen Trachman at her website, https://www.trachmanlawcenter.com/, and as always, hear more episodes and learn more about Ruby, Anne, and Seattle Reproductive Medicine at https://thewholepineapple.com/.

Resources mentioned:

I Want To Put A Baby In You podcast: https://iwanttoputababyinyou.com/

Ellen Trachman's website: https://www.trachmanlawcenter.com/

https://www.facebook.com/iwtpabiy/

https://www.brightfuturesfamilies.com/

Is sperm from sex "donated"? Welcome to a crossover episode with podcaster Ellen Trachman, host of I Want to Put a Baby in You. Lawyer by trade, reproductive technology advocate at heart, Ellen Trachman is the founder and managing attorney at Trachman Law Center LLC.

Ellen founded her firm in order to bring dedicated and compassionate legal representation to those wishing to build a family or to help others to build a family through assisted reproductive technology (ART). She co-founded the Colorado Fertility Advocates, a nonprofit group dedicated to supporting Colorado families and fertility advocates.

The laws around reproductive technology have never been simple, and they are becoming increasingly tangled as politics encroaches on health care. It's important for everyone to understand what's happening and how it may affect access to ART.

Some cases Ellen's seen included a birth mother who was being considered a "surrogate" for her own child and in danger of losing her parental rights. In another case, the state sued a sperm donor for child support. And whatever you do, if you plan to use a sperm donor, don't have that donor "donate" their sperm in the … traditional manner, because sperm from sex isn't considered a donation. Ooof.

For those who may need assistance from reproductive technologies, or who may have genetic material already in reserve (eggs, sperm, or embryos), recent legal changes may already have impacted the choices that are available to you. How do you protect yourself and your genetic material? Will you need to move to another state simply to build the family you've always hoped for?

This is an incredibly important episode for anyone who is interested in or in need of ART. Please share and find ways to get involved locally, if you are willing and able.

You can find Ellen Trachman at her website, https://www.trachmanlawcenter.com/, and as always, hear more episodes and learn more about Ruby, Anne, and Seattle Reproductive Medicine at https://thewholepineapple.com/.

Resources mentioned:

I Want To Put A Baby In You podcast: https://iwanttoputababyinyou.com/

Ellen Trachman's website: https://www.trachmanlawcenter.com/

https://www.facebook.com/iwtpabiy/

https://www.brightfuturesfamilies.com/

Puberty in reverse – Welcome to menopause! Like those tumultuous adolescent years, you may feel like a tourist in your own changing body. And it's not necessarily a fun destination, with hot flashes, mood swings, weight gain, and the longer-term dangers of osteoporosis and increased heart disease risk.

But are we thinking about menopause all wrong? In this episode, Ruby and Anne welcome back TWP alum Dr. Michelle Tollefson. Board certified OB-GYN, professor, advocate for lifestyle medicine and women's health, and co-author of PAVING a Woman's Path Through Menopause and Beyond, breast-cancer survivor (and thriver) Michelle Tollefson knows how dramatic the effects of menopause can be.

Even worse, there's not much out there in terms of good, science-based information to help women navigate the changes in their bodies.

Menopause is a profound change — it's not just the end of periods — and women can begin the process much sooner than they think. Knowing that, women can start preparing for menopause much sooner; this can, for many, make the transition easier and healthier. And for those already in the thick of it, it's not too late — there are ways to ease the physical, mental, and emotional impacts.

The "PAVING" in the title stands for physical activity, attitude, variety, investigation, nutrition, and goal-setting. These tools, plus the PAVING "STEPSS" (stress reliance, time outs, energy management, purpose, social connection, and sleep) really can help women experience menopause in a healthy, supported, goal-centered way.

Maybe menopause isn't something to dread, and maybe there's more joy to be had than the ability to wear white jeans any day of the month?

Learn more about Dr. Tollefson, the PAVING process, and the whole team behind it at https://www.pavingwellness.org/. And as always, please listen, rate, review, and SHARE the podcast with others you think can benefit as well. You can find more about hosts Ruby and Anne and Seattle Reproductive Medicine at https://thewholepineapple.com/.

Want to learn more about the Seattle Reproductive Symposium in April 2023? Early bird pricing through March 27 at seattlereproductivesymposium.com.

OK, we have to start off with a caveat here: If you did a 23andMe or similar genetic test at home, no medical professional can use the results to diagnose or treat a medical condition. The test may indicate something really important, like you're a carrier of cystic fibrosis, for example. But to start treatment or make any medical decision, the result must first be validated through a clinical, diagnostic laboratory.

In this snack, Ruby, Anne, and guest genetic counselor Rachel Donnell tackle the question: What's wrong with a commercial test? Answer? There's nothing wrong with it, as long as you treat it as a fun way to learn more about yourself, and NOT as a medical diagnosis.

To begin with, at-home tests are likely nowhere near as rigorous. The test just isn't as sophisticated as a medical test, and commercial tests may not come with a professional who will sit with you and go over the results. Interpretation of the results can be as important as the results themselves — what are the full implications to you and any future children?

Rachel describes how these tests are often far less accurate than medical tests, so please, have fun with them, but don't use them as a basis for making important decisions about your health. If information comes up that concerns you, follow up with a medical-grade test from a healthcare professional.

And please, don't assume that just because the test claims you're not at high risk for heart disease or some other concern, that you're "safe." Continue to discuss everything with your health provider, no matter what that at-home test told you. OK?

We know people are relying on these commercial tests already, so we hope you'll share this episode with others.

​​Find more about Rachel, Ruby, and Anne at Seattle Reproductive Medicine (seattlefertility.com) and hear more episodes of The Whole Pineapple at https://thewholepineapple.com/.

Rachel Donnell is back! However, unless you're up on your genetic-testing-of-embryos science, you may want to hold off on this episode until you've heard the bonus episode ("56.5") released a few days before this one. It gives you some background information that will make this episode a lot easier to follow.

In this episode, Ruby and Anne are talking with one of SRM's genetic counselors: Rachel Donnell. Rachel is a certified genetic counselor with 7 years of clinical experience in the infertility setting and a whole lot of experience explaining genetics and genetic testing to patients.

Why are counselors necessary? Testing has never been a simple science, but it's gotten increasingly complex in recent years as technology has made so much more possible. When someone comes in for IVF, they may be recommended testing to screen for abnormalities in their embryos. Rachel helps patients understand why they might (or might not) want to test, what the tests involve, what the results mean, and what their choices are.

Sometimes the result is an embryo with mosaicism. What is it, and what does it mean for the health of the pregnancy and the health of the baby? Well, with a name like "mosaicism" you can probably imagine it's a pretty complex picture. For those considering IVF and PGT (preimplantation genetic testing), this episode can really help you understand mosaicism and what it might mean for the embryo.

More about Rachel Donnell: Rachel has a bachelor's degree from the University of Missouri and a Master of Medical Science in Human Genetics and Genetic Counseling from Emory University School of Medicine. At Seattle Reproductive Medicine, she counsels patients seeking PGT for aneuploidies and inherited genetic conditions. She is also involved in the American Society for Reproductive Medicine and was the Past Chair of the Genetic Counseling Professional Group.

Find more about Rachel, Ruby, and Anne at Seattle Reproductive Medicine (seattlefertility.com) and hear more episodes of The Whole Pineapple at https://thewholepineapple.com/.

PGT or "preimplantation genetic testing of embryos" – even the name is complicated. But, as we're having a genetic counselor come in to talk about testing and what the results mean, we thought a little primer on the science would help everyone understand the longer episode better.

And who better to help us than the genetic counselor herself? We'll give you her full bonafides with the full episode, but Rachel Donnell is a certified genetic counselor with a Master of Medical Science in Human Genetics and Genetic Counseling and more than seven years of clinical experience under her belt.

Best of all, we're in for a three-for with Rachel: this bonus snack to help us get ready for the full, then a full episode on mosaicism, and finally, another snack on the far side on commercial genetic testing (think 23andMe). It's a lot of science, but Rachel's job is — literally — helping people understand genetic testing. She's very, VERY good at it.

In this bonus snack, Ruby, Anne, and Rachel talk about the categories of possible genetic diseases, the different kinds of tests, what testing can reveal, what testing can't reveal (or guarantee), and what patients can do with the results. They also talk through the process, so patients can rest assured that testing is safe for the embryos.

If you're considering PGT or if it's been recommended to you, this is a great way to add to your understanding of what the testing involves and what testers are looking for. As always, we hope you'll share it with anyone you know who can benefit!

Find more about Rachel, Ruby, and Anne at Seattle Reproductive Medicine (seattlefertility.com) and hear more episodes of The Whole Pineapple at https://thewholepineapple.com/.

Hosts Ruby and Anne have been talking about IVF for over a year now and recently realized they never fully defined the term! We know you can Google it, but we thought it'd be helpful to hear what it is from healthcare professionals you know you can trust.

And if you're only too aware of what IVF is, but you're really tired of explaining it to others, we suggest you send them a link to this episode, and let Ruby and Anne do the heavy lifting for you. In this short snack, Ruby and Anne talk about what IVF or in vitro fertilization is, and how it works if you and your fertility provider decide it's the best treatment path for you.

IVF might be what most folks think about when they think of fertility treatment, but it's not necessarily the most common solution for fertility challenges these days. There are lots of possible paths for people to take when they're hoping for a healthy pregnancy, both "high tech" (like IVF) or "low tech" (medications to induce ovulation).

We hope this snack helps you (or your well-intended friends and family) have a better understanding of IVF and its place among the many options for fertility treatments.

Learn more — or help educate others — by visiting and sharing The Whole Pineapple website and hearing ALL THE THINGS from Ruby and Anne! (https://thewholepineapple.com/)

https://resolve.org/learn/what-are-my-options/in-vitro-fertilization/assisted-reproductive-technology-myths/

IVF in Washington State | The In Vitro Fertilization Process - Seattle Fertility

https://www.sart.org/news-and-publications/news-and-research/press-releases-and-bulletins/more-than-73-thousand-babies-born-from-assisted-reproductive-technology-cycles-done-in-2020/

What can fertility clinics do to help neurodivergent patients be more comfortable when seeking treatment?

Patients know that advocating for themselves can be necessary to getting the best medical care, but it can be really difficult for some to be understood when they express themselves — hence this very important conversation! Neurodivergent peoples may communicate their discomfort differently, so it's truly helpful if clinics are more educated and neurodiversity-friendly.

For example, offering multiple ways to make an appointment can really help people who find phone conversations challenging. Secure portals, text, emails, etc. — as long as it can be made HIPAA compliant, why not offer it for those who would prefer it?

Have you heard of the "double empathy problem"? It's the belief among neurotypical people that neurodivergent people have difficulties communicating. In fact, says guest Dr. Kristin Chambliss, neurodivergent people communicate just fine with one another. The challenges lie in the space between neurodivergent and neurotypical people. Because neurotypical is the most common communication type, everything else is seen as "abnormal."

In this episode, hosts Ruby and Anne and guest Kristin explore the ways fertility clinics (and society in general) can help make the world a little more empathetic and equitable. Seeing and celebrating our many differences enriches everyone, after all!

Learn more about Kristin Chambliss on her website (https://kristenchambliss.com/), and find more episodes of The Whole Pineapple on the website (https://thewholepineapple.com/) or your favorite podcast app!

References:

The Atlantic: Neurodiversity, Harvey Bloom (1998) article

Damian E.M. Milton (2012) On the ontological status of autism: the 'double empathy problem', Disability & Society, 27:6, 883-887, DOI: 10.1080/09687599.2012.710008

Sasson NJ, Faso DJ, Nugent J, Lovell S, Kennedy DP, Grossman RB. Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments. Sci Rep. 2017 Feb 1;7:40700. doi: 10.1038/srep40700. PMID: 28145411; PMCID: PMC5286449.

Saxena P. Assisted reproductive technology and its Association with autism in children. Fertil Sci Res 2021;8:20-4

Singer, J. (1998). Odd People In: The Birth of Community Amongst People on the Autistic Spectrum: A personal exploration of a New Social Movement based on Neurological Diversity. Sydney: Faculty of Humanities and Social Science University of Technology, Sydney.

Periods & Autism - Chloe Hayden Youtube video

Autistic Doctors International website

From Autistic Doctors International:

Williams, G. L., Adams, J., Bull, P., Cave, H., Chown, N., Doherty, M., Forrest, K., Foster, R., Fricker, R., Godfree, B., Keaveney-Sheath, K., Knight, J., Marrable, T., Murray, R., Shaw, S. C. K., Ventour-Griffiths, T., Wood, J. (2022) More than words: Supporting effective communication with autistic people in health care settings. Economic and Social Research Council. Available at:https://www.boingboing.org.uk/more_than_words/