Hot Flash: Experiencing menopause in medicine

When contemplating issues of diversity and inclusion, medicine needs to consider menopause. A commentary in CMAJ argues that discussion about and, where needed, accommodation of menopause is a necessary step toward providing women physicians with a supportive and comfortable work environment.

On this episode, Drs. Bigham and Omole speak with the lead author of the commentary “Hot Flash: Experiencing menopause in medicine.” Dr. Marie Christakis is an OB-GYN at St Michael’s hospital in Toronto. She has completed a fellowship in Menopause and Mature Women’s Health at Mount Sinai Hospital.

They discuss why there has been little discussion on the effect, and potential burden, of menopause on mature- or potentially peak-career women physicians. And they explore what needs to be done to better support physicians through menopause.

Drs. Bigham and Omole also speak with Dr. Kim Wynd, an anesthesiologist who practices in Peterborough Ontario, about her experiences during menopause. Dr. Wynd began having symptoms of perimenopause in her early 40s at a time when her practice was thriving. 

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Transcript

Dr. Blair Bigham:

Hi, I'm Blair Bigham.

Dr. Mojola Omole:

And I'm Mojola Omole. This is a CMAJ podcast.

Dr. Blair Bigham:

This episode, we're going to discuss the commentary in the CMAJ, “Hot Flash, Experiencing Menopause in Medicine”. So, Jola, this is an area that I admittedly have not thought very much about. I don't know. Have you thought much about this at your age?

Dr. Mojola Omole:

What are you trying to say, Blair, that I'm getting close to menopause?

Dr. Blair Bigham:

No, I mean because you're not close to menopause. I'm just curious. Is this something that's on the minds of women? Because I had never thought of it.

Dr. Mojola Omole:

I'm actually probably closer to menopause than not. I have thought about it because I've seen, being in the operating room I tend to run hot in general. And so for me, when I've seen other colleagues who are experiencing menopausal symptoms, I have noticed it and I was like, it's going to be a rough few years when that time comes. So I definitely have thought about it, but I've never thought about it past that. So this is why this commentary is just really fascinating and eye-opening.

Dr. Blair Bigham:

So today we're going to be speaking with one of the co-authors of the commentary, but first we're going to speak to someone who will give us a first person account on going through perimenopause as they were undergoing life as a busy physician. 

Dr. Wynd as an anesthesiologist in Peterborough, Ontario. She began feeling the symptoms of perimenopause in her forties, at the time when her practice was thriving. And on a side note, I actually worked with Dr. Wynd when I was working in Peterborough. And I remember some of the experiences as she was going through these menopausal symptoms and discussing them with her. Kim, thanks so much for joining us.

Dr. Kim Wynd:

Oh, well, thanks for having me.

Dr. Blair Bigham:

Kim, can you tell me about the early symptoms of perimenopause for you? When did you first notice that things weren't as they had been?

Dr. Kim Wynd:

It was probably when I was about 44, 45 and I started noticing just a change in my menstrual cycles. I've been one of those people that never really had a very heavy flow to my menstrual cycle or really anything that was between four and five weeks. And then I started just getting much heavier flows.

Dr. Kim Wynd:

The truth is when I first started getting the heavier flows and lasting longer and then shorter duration between three weeks to five weeks, and then sometimes six weeks and then back to two weeks, I actually thought that it was something a little bit more abnormal, whether there was something going on for me from a endometrial standpoint. So I actually went and talked to one of our OBs because I was concerned about my heavy flows, because they were really quite heavy. I was so young at that point to be getting such a change in my menstrual cycles. So I actually thought that there was something more sinister going on.

Dr. Blair Bigham:

You were worried about cancer?

Dr. Kim Wynd:

Yeah. Yeah, I was. And I think working in the OR, I think we end up tending to see those people who, yes, have D&Cs because they've got heavy flows, but you automatically go well, yes, but it's been such a change that it was something maybe more serious. I was also having some night sweats that I thought too. So I thought what is going on here? So I was a little bit concerned about my hematology and all of that stuff. So, didn't really have many people to talk to, but certainly working in the ORs, I was able to talk to our OB people on the cuff.

Dr. Blair Bigham:

What were their thoughts straight off the bat?

Dr. Kim Wynd:

Well, they were actually very supportive. They brought me to the women's health center because it was quicker for them to do what they needed to do. They took a history, and Dr. Pakenham basically just reassured me. She said it's probably nothing, and she did my hormone levels. And then when we got them back, she sent me a text, just with the actual results of my hormone levels and I was like, "Okay, but what does that mean?" Because I didn't really understand what that meant-

Dr. Blair Bigham:

I would have no idea?

Dr. Kim Wynd:

And she's like, "Oh, well it means if you want to get pregnant, you better come in and we better start doing some hormone injections so that you can actually have children." And I was like, "No, thank you. Don't want children. Planned that my whole life, no children for me. But thank you for letting me know."

Dr. Kim Wynd:

Then where to go from there really was with the heavy periods because it was actually affecting a little bit of my life just because all of a sudden had these heavy flows and you weren't feeling very well. From that standpoint, I didn't really have a lot of the other symptoms at that point. I had the odd night sweats, but it was really more the period flows that were the problem. So I eventually went and she's like, "If you want to worry about the flows and let's just give you a Mirena. So I went out and purchased the Mirena, but never found the time to actually get it placed, which is a sad statement on my schedule.

Dr. Blair Bigham:

Kim, it's funny. I think a lot of physicians experience changes in their bodies and immediately gravitate towards these sort of catastrophic diagnoses or worst case scenarios. With menopause being so common, looking back, why don't you think menopause came to mind first? Why do you think you gravitated towards some of those more sinister diagnoses?

Dr. Kim Wynd:

Again, I think it was just my age. I do work with a lot of nurses and there were nurses experiencing it, but they were all more towards their late forties, early fifties when they were starting to experience the hot flashes. So I think a lot of it was just experiencing the D&Cs that we see and the hyperplasias that made me focus that, and we never really talked a lot about how early menopause can be and those changes can cause in menopause. So I just automatically went there.

Dr. Blair Bigham:

As those changes continued. What did you find most difficult or most incompatible with your work as an anesthesiologist?

Dr. Kim Wynd:

I think it was really the hot flashes that were quite bothersome to me. I was always one of those people that tended to run cold and I remember even thinking, oh, this is going to be great when I hit menopause because I'm finally not going to be cold in the OR. But I wasn't actually experienced, I didn't really get ready for that experience of what a hot flash was and how just this heat consuming feeling that you get. For me it was in the pit of my stomach and you could feel this kind of whelm of heat coming and you were just like, "Okay, the sweat's going to start. The sweat's going to start." And then all of a sudden the sweat would start and I'd be pouring sweat.

Dr. Kim Wynd:

Then all of a sudden the sweat stops, the heat stops and now I'm feeling cold because I was soaked and the OR environment hadn't really changed at all. It was still the right temperature. There were multiple times that I would ask people, did anybody change the temperature in the room? Because I just didn't believe it was me. I believed that because in the OR that we work at, we have horrible temperature regulation to begin with. But it took months for me to realize that no, this is actually menopause and it took me a while to really understand what that meant. The sweating and the cold… that definitely affected me during the day. It's a bit of a benefit for me because I'm an anesthesiologist. So most of my patients are asleep, so they don't see me necessarily going through that. I would say sometimes when I was putting in IVs, I'd be like oh, okay. I'm feeling really hot. And they'd look at me and they'd see me flush. And they're like, "Are you okay?" The odd time, most of the time people are a little bit more scared so they don't really focus on that. 

Dr. Kim Wynd:

But it was the nighttime sweats that I think I found most disruptive because I wasn't getting sleep. I'm a pretty light sleeper to begin with. And even before this all happened in my thirties, I would be one of those people that would wake up every two to three hours. But it was pretty much every half an hour that I was getting night sweats and it would be blankets on blankets off, sweat. My dogs wonder because they sleep in the bed, wondering what's going on. My husband asking me if everything's okay, poor guy ending up having lots of blankets on him and lots of blankets off of him at the same time. And then waking up just not feeling really rested. Just constantly being in a little bit of a fog and you know again, as physicians, I think we're used to working without a lot of sleep sometimes, but I just never felt really fully rested.

Dr. Blair Bigham:

How long did your symptoms go on for?

Dr. Kim Wynd:

Oh, the hot flashes really ... My last period was March 2020, so just when COVID was hitting. Then I think they were going on for about six or seven months before. And I had talked to the obstetricians about getting some HRT and of course never got around to getting it for six or seven months. And then finally I got it. And that's when the symptoms, the HRT really helped. I hardly get the hot flashes. And if I do, I'm not sure if it's just a change in temperature. Do you know what I mean? Like it's not really that same kind of gut feeling of, okay, here's something coming and what's about to happen.

Dr. Blair Bigham:

Did the HRT kick in pretty much right away?

Dr. Kim Wynd:

Yeah, actually, I would say within the first couple of weeks it was remarkable at just how much better I felt, just generally speaking. I don't know whether it was the sleep or just all of the other hormonal things that were happening. But certainly I felt, in hindsight, I never much thought about it, but in hindsight I think it even helped with my moods and my ability to just focus on just a general wellbeing.

Dr. Blair Bigham:

I had a question for you. So you making a decision to take HRT, did it ever weigh on you in terms of the risk of taking HRT? How did you balance that?

Dr. Kim Wynd:

Well, I'm kind of one of those people that grab the lion by the tail and I want to live my life as full as I can. And if that ends up shortening it, but I'm living it to the fullest, I'm willing to take that risk, because it just made such a difference to me emotionally, physically, and really from a work standpoint, I'll be honest. 

Dr. Blair Bigham:

How did you feel differently at work?

Dr. Kim Wynd:

Well, it was the sleep. It was really the sleep and that sweating. It's very distracting and you get really chilled and there's really nothing you can do about it except grin and bear it, and that's pretty much what I did. It's not easy to get out of the OR, and I don't think I really got distracted other than standing there going, whew, I'm really hot. This will go away in just a second, but it would be. And especially with lead, when you're wearing the lead for x-rays, it was just very uncomfortable. And yeah, that's how I dealt with it at work. Grin and bear it. Pull up your bootstraps.

Dr. Blair Bigham:

Sort of a common theme we hear on the podcast. It's funny, within our own culture, we don't always have the ability to have space to speak about our own health issues or our own struggles. Did you find that there was a point in time where your symptoms were so bothersome that you actually thought about taking time off? And do you think there would've been space to have those conversations or did you feel that you just had to sort of keep trucking along?

Dr. Kim Wynd:

It's funny. I don't know whether the symptoms were that I were feeling from an emotional liability standpoint were due to the menopause, due to the lack of sleep, due to the hormonal changes. I definitely felt very overwhelmed during that time and things did get better with my hormone replacement therapy, but I don't know whether that was also just things were getting better in my life, because I was starting to take more control of my life.

Dr. Kim Wynd:

I never felt that the hot flashes put me in any danger during the day or that my fog was so much that I couldn't do my job, but I just felt very irritable. And whether that was from the sleep or not lack of sleep or all the other things going on, I honestly can't say.

Dr. Blair Bigham:

Got you. Where did you find the most support for what you were going through professionally?

Dr. Kim Wynd:

From the nurses, actually. They really were a very big support for me and also I saw them going through it just because you would see my nurses putting ice bags out on their neck and having to talk about whether we could keep the room temperature down because they were always running a little bit hot and feeling horribly guilty when I said yes, but my patient's cold, so I'm sorry, but we can't necessarily do that. So that's where I got most of my support from.

Dr. Blair Bigham:

Do you think this is something that we need to talk about more openly within the culture? I know that there's a lot of allowances for when you're pregnant. I was in the same OR as you and I found that the nurses pretty much just babied me around my pregnancy. Do you think that if we talk more openly about it, there'll be more support, not just from our nurses, but also from our physician colleagues?

Dr. Kim Wynd:

Yeah, I would hope so. I think there's such a stigma between women's health issues related to their menstrual cycles that I don't know whether they would. It's much more acceptable to be pregnant and have issues than it is to have horrendous endometriosis and have horrendous pain and require painkillers and talk about it. And having been somebody who in my younger years had horrible period cramps, I remember having to deal with that, but you just have to go through it.

Dr. Kim Wynd:

But I certainly think if there would be a culture about openness, yes. I think it probably would help, mostly diagnosis, mostly helping people get through it. And yeah, I guess I'm so open about everything that it was hard for me to really not be open about it. So I've never really felt that I couldn't just express myself, but I do see, and I do think there are a lot of women that don't, because they're afraid of being undervalued or judged. Whereas from my standpoint, this is who I am. But that's how I approach things. So I do think that yes, for a lot of women, I think it probably would be very helpful to have a bit more understanding from their colleagues.

Dr. Mojola Omole:

For sure. Now I'm scared, but you know, that's okay.

Dr. Kim Wynd:

Jola, you take everything just like I take it. You'll be fine.

Dr. Mojola Omole:

I know but I remembered actually it was also in Peterborough. One of the assists, we were in between cases and she was changing and she was drenched and I was like, "Are you okay?" She's like, "Menopause." And I was like oh God, this is not going to be fun. So I think that it is definitely something to that. We have to have more compassion in general in medicine to each other.

Dr. Kim Wynd:

Yeah, I think so.

Dr. Mojola Omole:

That we extend to our patients. So we have to also extend it to each other.

Dr. Kim Wynd:

I think there are also cooling things for people, especially in the OR that they can wear, isn't there? I think there's cooling gowns and whatnot.

Dr. Mojola Omole:

Yeah, there definitely is. But I think obviously no one thinks about it because men aren't affected by it. So therefore it's not there, but yeah, maybe part of that is also advocating for ourselves. Right? Like they probably didn't think about nursing rooms until somebody said, Hey, I need to breast ... I have to pump.

Dr. Kim Wynd:

Yeah. Yeah, no, that's very true. And I do think a lot of our nurses are going through that. I know a couple of our nurses had a very difficult time in the ORs, at least, especially when you're all scrubbed in. So first female surgeons that are going to undergo menopause, I think it is going to be very challenging for them because it's hard for them to scrub out when they're sweating and then you've got to worry about dripping sweat in your field.

Dr. Kim Wynd:

And that's just from that standpoint. Now if you're running your own office and you're having your symptoms, how are you going to deal with that and your patients, so yeah. And procedures can be challenging and you can't really just say, excuse me, I got to pop out of here for a second or at least you don't feel you can.

Dr. Blair Bigham:

Kim, thanks so much for taking the time to speak to us today.

Dr. Kim Wynd:

Oh no. Thank you.

Dr. Blair Bigham:

Dr. Kim Wynd is an anesthesiologist in Peterborough, Ontario. 

Dr. Blair Bigham:

As we mentioned off the top, our discussion today is inspired by a commentary in CMAJ. Dr. Marie Christakis is an OB GYN at St. Michael's Hospital in Toronto. She's completed a fellowship in menopause and mature women's health at Mount Sinai hospital. And she's one of the authors of “Hot Flash: Experiencing Menopause in Medicine”. Marie, thanks for joining us today.

Dr. Marie Christakis:

Thank you for having me.

Dr. Blair Bigham:

We just heard about Kim's experience going through menopause as a busy physician. What sorts of experiences have you heard about from your female colleagues experiencing menopause?

Dr. Marie Christakis:

That's a good question. I think that a lot of my patients talk about the fact that they have quite severe symptoms and sometimes they don't feel that they have someone they can talk to about it. Menopausal symptoms can range between vasomotor symptoms, so hot flashes and night sweats, which can interfere with sleep, but sleep difficulties can also be isolated. Women can experience more anxiety, other mood changes.

Dr. Marie Christakis:

So I think that all these symptoms can certainly impact your work life. And often women don't feel that they can voice these concerns. I think within medicine, as we talk about in the commentary, we don't have a lot of information about what are the specific struggles of women physicians. And I think that's something that we really need to understand.

Dr. Blair Bigham:

A fellowship in menopause. I haven't heard of that before. What inspired you to go down that training pathway?

Dr. Marie Christakis:

Yeah. You know, I think that menopause is a really important stage in a woman's life. I do have a masters in public health and, from a public health perspective, North American menopause practitioners and, including myself, we view menopause as a time where you can really impact a woman's health. You can supply preventative care, you can assess their cardiovascular risk. All these things are really important and sometimes neglected.

Dr. Marie Christakis:

I think that it's a new wave within medicine and looking at mature women's health and recognizing the importance of mature women's health is maybe newer thinking. But I love looking after menopausal women. I find that, often, it's such a gratifying experience because women will come in and have this whole constellation of symptoms and feel that their life is really falling apart. Their relationships, their work life, everything is really strained.

Dr. Marie Christakis:

And with counseling and their decision making around what treatment they'd like to pursue, they often come back at a three month follow up and they feel so different about everything in their life, because there's such a cascade effect from many symptoms. For example, if you can't get a good night of sleep, then that devastates you.

Dr. Blair Bigham:

We've talked a lot about the individual impact of menopause on women. Build the bridge for me to public health. What are the stakes of menopause at a community level?

Dr. Marie Christakis:

Yeah, I think specifically in this commentary, we outline three different reasons why we think it's important to recognize menopause in the workplace and the menopause experience of women physicians. I think from a really important broad picture perspective is that there's an increasingly large subsection of physicians who are women in the age group that will experience menopause. In 2019, 25% of women physicians were between 45 and 54. And if you look at overall 11% of Canadian physicians are women physicians in this age group.

Dr. Marie Christakis:

We also know that if we look at premenopausal physicians, women outnumber men. So this is going to become a growing concern over time. The second thing is that corporate research has shown that there's a substantial cost to employers that's associated with menopausal symptoms, that's related to the perceived decrease in workability and absences from work.

Dr. Marie Christakis:

And so we feel that we're not certain because this hasn't been explored properly really, but we feel that women physicians, they could have quite a big impact on the healthcare system and healthcare expenditures. And it's important that we look at how this is playing into our overall Canadian healthcare system. The third thing is that we want women to feel supported and comfortable at work. I think that menopause fits into gender, age and disability discrimination discussions. So we want to make sure that women who maybe don't feel that they can advocate for themselves are recognized, that we are checking in and looking to see whether accommodations are necessary.

Dr. Blair Bigham:

You mentioned that menopause is sort of a neglected circumstance in terms of the research and the literature. Why do you think it's so under-researched and received so little attention?

Dr. Marie Christakis:

Yeah, that's a good question. I think that the first thing is that menopause in the workforce, specifically menopause among women physicians, perhaps may not have been well-discussed in the past because, as physicians, our culture tends to be that we value high productivity and sometimes these types of concerns can be seen almost as a weakness. So perhaps in the past, when physician wellbeing was not at the forefront of discussions, that a lot of these topics may have been glazed over or almost made the butt of a joke instead of really trying to stop and understand how this stage and this gender-related life stage can really impact a physician's work and life.

Dr. Marie Christakis:

I think that's one big piece, but menopause in general, unfortunately I think there is a bit of a generational issue with recognizing that these symptoms, maybe you don't have to suffer through them, if they're really impacting your quality of life, that you can seek help, that you can put yourself first and try to feel better. I think across the board, menopausal women sometimes are caught between a lot of commitments in their life and maybe don't put their health first.

Dr. Mojola Omole:

I think that's the story of women's health, is that when you're younger, you're supposed to suffer through really painful periods. It wasn't until I was older that… it's not normal to not be able to go to school because your period is really painful. So it seems to kind of fit with women, when it comes to women's health, that there's that overarching theme that you're supposed to suffer.

Dr. Marie Christakis:

Yeah. Yeah. I think you're right, that there is a gender-specific lean here and that's kind of what inspired this commentary in the first place was that a colleague of mine, Dr. Andrea Simpson, published a piece about pregnancy and maternity leave and paternity leave and how we need to be thinking about this specific stage and how it impacts a physician's career.

Dr. Marie Christakis:

Then it got us thinking, but what about menopause and the profound impact that this can have on a woman, especially in medicine, where women are self-employed and we're really relying on our colleagues to create a system that protects us in these situations.

Dr. Blair Bigham:

Seems like, at best, it's not really on people's radars. At worst, it's stigmatized and turned into a joke sometimes, like you said. What sort of intervention or change do you think is most critical at this point in time to start chipping away at those troubles?

Dr. Marie Christakis:

I think that the first step really needs to be that we ask women physicians about their experiences and understand what struggles they may face, what they are looking for in terms of a culture change or accommodations. And also to ask women who have gone through this, what their experience was like. I think that understanding women physicians and their specific concerns is first, but also how does this fit into the broader healthcare system and other women within healthcare, in other roles, like nurses and physiotherapists and other allied health.

Dr. Marie Christakis:

So I think that's the first thing, but we do need to change the narrative on menopause in the workforce. I think we need to identify that this is an issue of equity, diversity and inclusion, and menopause should be part of the conversation. When we're educating learners and healthcare managers, we need to include this when we talk about issues of workplace inclusivity.

Dr. Marie Christakis:

And I think that menopausal women should be encouraged to seek out support and treatment for their symptoms, but healthcare leaders need to be able to have a practical but sensitive conversation with women physicians who are experiencing perimenopausal symptoms so that we can ask more about what is their constellation of symptoms and what accommodations they might require.

Dr. Marie Christakis:

I think the fear sometimes is around extended absences. And certainly there may be women who do require a discretionary leave, which is something we do offer to women at other important gender-related stages of their lives. But I think that's going to be a very small number. I think that it's really just important to acknowledge that a woman physician's needs are going to be influenced by her health, her gender identity, her life stage, and just creating a different environment for that.

Dr. Blair Bigham:

Mary\ie, you're clearly very passionate about this. Thank you for helping to combat the taboo and shed some light on this with your commentary. And thanks so much for speaking with us today.

Dr. Marie Christakis:

My pleasure. Thank you for having me.

Dr. Blair Bigham:

Dr. Marie Christakis is an OB/GYN at St. Michael's Hospital in Toronto. She's the lead author of the commentary CMAJ entitled, “Hot Flash, Experiencing Menopause in Medicine.”

Dr. Mojola Omole:

So Blair, off the top, you had mentioned that this is not something, for obvious reasons you have thought a lot about. After we've talked to both Kim and Marie, what are you taking away from this conversation?

Dr. Blair Bigham:

I guess for me, Jola, there's two things to take away. First of all, I don't think I have ever been in any way aware that my colleagues around me, be it in allied health or nursing or other physician colleagues, might be affected at work by menopause. It's just not something that I would be aware of. And so this has been really enlightening for me and hopefully allows me to be supportive and an ally for people who are going through menopause and having symptoms at work who feel they just need a little bit of support in whatever way that happens to be. Then I put my clinical hat on and I wonder, oh, I'm sure there are people who come to work at the hospital, as patients, who are presenting with symptoms of menopause, maybe, and thinking they're having some other condition.

Dr. Blair Bigham:

And so I wonder how can I support those patients and how can I build early menopause into my differential. Those are sort of the two takeaways that I get first from that.

Dr. Mojola Omole:

Yeah, and as for me is that oftentimes when we talk about equity, diversity and inclusion, and we talk a lot about race and gender parity, but this is actually a big issue when we talk about gender parity. Naturally people are like oh, someone's pregnant, let's accommodate them, but no one thinks about this for when you're menopausal. I actually just feel really inspired by these younger generation of physicians, I guess I would be considered one of them, but I feel like they're younger, who are just really exploring what inclusion really means and how to include everybody into the conversation about are you having a great quality of life in your job.

Dr. Mojola Omole:

Because for some people, these symptoms could be debilitating and that becomes also like a disability issue. So I was just really inspired that we're having these really frank conversations and really pushing the conversation to what is physically also happening to us as females, as physicians.

Dr. Blair Bigham:

It really builds on that sort of inequality between women and men in medicine. And we've had a couple of episodes now where we just seem to get deeper and deeper into the weeds of how ingrained it is, the culture of medicine to advantage male physicians. Listening to Kim's story, her instinct was to think she had malignancy, her instinct was to truck on, as she said, and not reach out for help. It sounds almost serendipitous that she overheard conversations in the operating room from some of the nurses where she said, oh, maybe this is a conversation that applies to me.

Dr. Blair Bigham:

So it really does just seem so taboo, like so many other issues that women face in medicine.

Dr. Mojola Omole:

Yeah, and I think that when we talk about accommodations, and Marie really pointed that out, it's not all about taking time off. It's just creating a more comfortable environment to work. And it's maybe having different shifts, like we accommodate for pregnancy. After a certain point, I stopped doing call when I was pregnant. And it's saying when someone is going through some severe symptoms, it's having a bit more of accommodations amongst the group that you work with to make it easier.

Dr. Mojola Omole:

Also just having an open and receptive environment for you to talk about what you're going through instead of feeling that you have to go through this alone.

Dr. Blair Bigham:

Absolutely. That's it for this week on the CMAJ podcast. Thanks for listening. Be sure to share or like our podcast, wherever it is that you download your audio. It really helps us spread the word. I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. And until next time, be well.