Season 2 Episode 6 with Dr. Cari Croghan No BS Concierge Helathcare

Join us as Dr. Cari Croghan shares her journey through menopause, the importance of hormone therapy, and how addressing hormonal health can transform women's lives. Discover practical insights, debunk myths, and learn how to advocate for better menopause care. In this engaging episode, Dr Cari shares her journey from emergency medicine to telehealth, discussing the challenges of healthcare systems, the importance of humanized patient care, and insights into hormone therapy and licensing hurdles across states.

Disclaimer: This is general information and education. This is not therapeutic or medical advice. If you enjoyed this episode please hit subscribe to follow us. You can follow and subscribe to us on Spotify, Youtube, and Apple podcasts 

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Transcript

SPEAKER_06 0:06

Welcome everyone to season two of Take a Pause with My Pals, the podcast where the hot flashes are real, the brain fog is thick. Don't I know it? And somebody walked into a room today and forgot why. Yeah. You forgot why your list was that you were looking for. I got out of bed.

SPEAKER_01 0:26

I'm still wondering why.

SPEAKER_07 0:29

Almost every day.

SPEAKER_06 0:30

This is why, because we are your host, Raquel and I, bringing you real conversations about menopause, midlife, hormones, workplace struggles, relationships, trying to sleep through the night, as we were talking about, and figuring out why we suddenly need a fan, a snack, and a minute alone.

SPEAKER_03 0:50

I mean Or 20 minutes alone. I'm going with 20.

SPEAKER_07 0:53

I'm going to take only one. It's not going to take me that long to figure out what's going on.

SPEAKER_06 0:59

This is true.

SPEAKER_00 0:59

So I'm box breathing can't even be done in a minute.

SPEAKER_06 1:03

No, no. So we'll just tell everybody grab your coffee, your electrolytes, hormone patch, your fan if you need it, and whatever is getting you through the day, and take a pause with Metaphouse. As we are here today with Dr. Carrie Krogan, who is in our middle square. People can see it. I love it. I always sound like the Hollywood Square. It's in our middle square. And um her website is no BS Consorge Healthcare or Concierge, like I like to say, in a Jersey Flair. And uh you've been an ER doc for 20 years, and your website statement that makes it all come true, where SAS meets the science and sanity prevails. So I think that Namaste says it all.

SPEAKER_03 1:52

Yes, it does say it all. And we just love some real life stuff.

SPEAKER_06 1:57

So I say welcome as welcome, and we just are so excited to hear about your journey, how's how the pause is going with you, and how you got to where you are now.

SPEAKER_07 2:12

So fun. Well, thank you guys for having me. Um you guys do great work, and I just love the sense of humor and the realness of it all. Um because I think science will left us behind a long time ago, right? Um we were doing hormones for a while, and then the worst research program ever was like, oh, we're gonna do bad research on the wrong people, and then tell all physicians that they can't give hormones to anybody because you're gonna give them strokes and cancer. And we're not gonna do any more studies on it. So we're just barely scratching the surface. People have been going through menopause for a tremendously long time. Half the population, why have we not been studying this? Um, and I think you know, women got into this thing where we're just not gonna talk about it because it's embarrassing or shameful or uh you had to hide it. And it's like, that's so weird because we're all doing it. So why aren't we talking about that some more? Yeah, yeah, yeah.

SPEAKER_03 3:18

And so I don't know about you guys, but I couldn't hide my crazy. That stuff could not be put on a shelf. Like that needed some attention.

SPEAKER_07 3:26

Absolutely. I mean, when you don't even have the energy for hard pants for three days in a row, like what's what's that about? True. We need to talk about that. You know, our partners need to know about it, our kids need to know about it, our girlfriends need everybody should be talking about it so that you don't feel so alone and isolated, too. Um I think that's so big. And now, like, maybe medicine is starting to finally catch up and do some treatment for it. It's gonna be hit and miss, it's gonna be right and wrong. Like, I'm sure in five years I'm gonna find out that I'm doing it wrong right now, but at least it's something, you know, so that you can talk to your physician, you can talk to your provider. Yes, please. Because like my mom never spoke about it at all. And she had a hysterectomy, ovarectomy, so they took absolutely everything out, including her ovaries, when she was 41.

SPEAKER_03 4:26

My lord. She gave her a Wonder Woman at this point.

SPEAKER_06 4:31

No, oh my gosh.

SPEAKER_07 4:33

Nothing. So all of a sudden, no estrogen, no progesterone, no testosterone, just overnight. And she might not have even been perimenopausal, and she had just had a baby, so like her hormones were all like wack-a-doodle, anyways. She was probably breastfeeding, and so everything was just crazy. And then they're like, and we're gonna take all of this out and not do anything for you. And she never really said a word, and then people would be like, Well, maybe take these pills for a couple of years, and no, give me those back, because maybe you're gonna get breast cancer. Okay, maybe we'll try. So she was just off and on and off and on and off and on, and she was having hot flashes in her sixties.

SPEAKER_03 5:14

Good God. Yeah, so I have two questions. Did that impact more of her health? Like, did she end up with like heart issues or brain issues, or did you notice anything different? Because my mom had a pretty similar well, I mean, not after having a baby, but she definitely had her like her bladder fell out, she had a hysterectomy, she's had two heart attacks. So I've always kind of started putting like trying to connect those dots, but I 100% believe that this is a lack of estrogen in hormones that have, well, all hormones, not just estrogen. Let me clear that up. That it caused all that for her.

SPEAKER_07 5:48

It's so hard to know, right? Because we are our own control study. So, like, what would have happened with our moms if they had not had a hysterectomy or if they had left the ovaries in there so that we still made hormones, or you replaced them as soon as you took it out? It's it's impossible to know, right? I think um, like my mom's bone density is crazy good, but she's also been a contact sport athlete her whole life. And so she has been falling down and lifting weights and getting herself up, you know, since she was a little kid. And so I think that's probably why she's not really having any problem with her bones. Um she definitely had like the bladder stuff where it's been a problem for years and years and years, and she has to go see somebody on a regular basis. Um, and that might have been different if she had had hormones.

SPEAKER_03 6:43

Um I kind of think the same, yeah. Constant UTI. She went into um kidney failure because of the UTI. Yes. And I'm like, oh my gosh, I just feel like all of that could have been maybe not avoided completely, but a hundred percent not as bad. You know, like this is a non-stop thing. Like imagine living the later half of your years, and that's all you've done is just managed your care. Not even like, you know, like longevity to me, like we're working out. We're we have our days, right? We have days where we're like, yeah, yeah, yeah. And then whoa. But I'll take a few days over like every single day in that space. I just can't imagine what that was like for women ten, five, three years ago for that matter, you know?

SPEAKER_07 7:29

Well, and so I mean, I still have friends now and they know what I do for a living, and they still are like, I'm just gonna tough it out. I'm like, it's not toughing it out. You're like setting yourself up for failure in the future. So you're feeling crummy now and toughing it out, and you're also setting yourself up for failure later. So, like, why wouldn't you feel better now and set yourself up for good things later? Like more comfortable sex, no urinary tract infections, like no hot flashes, better mood, less brain fog, like more muscle mass, better fat distribution, all of the things that you kind of want, yes, right now. And maybe you're not gonna get a heart attack later. Maybe you're not gonna fall down and break your hip with your urinary tract infection and fractal fragile bones. Like, there's all these things that it's like, uh I don't really think that and like I am a stubborn, tough it out kind of lady. Like, you don't go to med school and residency and then spend 26 years in the emergency department without without being stubborn as hell, right?

unknown 8:36

Correct.

SPEAKER_07 8:36

And think about it. But I'm like, yeah, I don't think this is the right thing to do for me now or for later. So yeah, that tough I did tough it out. Yeah.

SPEAKER_06 8:49

Like I don't know what the the end result of when people are like, oh I'm just gonna t what do you expect at the end? Like a metal, like to put on your like grave site, you know, like she toughed it out without hormones.

SPEAKER_07 9:01

Okay and had a big ol' MI at the age of 63.

SPEAKER_06 9:05

Like you know, yeah. I don't understand what what you think you're gonna get by toughing it out.

SPEAKER_03 9:11

Like And the amount of struggle that you see women toughing out is just like I I can't I personally can't unsee it. I'm like, but you do realize like this is something you could avoid. And they're just like, oh my god, it's just horrible, then this and that, and I don't know why I'm doing this, and I I can't understand why I'm doing that. And I'm like, have you not listened to me for the last like I don't know, two years?

SPEAKER_07 9:37

Yeah. And by the way, we're usually pretty empathetic people, us women. You're making everyone else around you crazy too. Like if you are sexually intimate with a partner, that's probably not going great because you're dry and it might be painful, and now you're like avoiding them and they're feeling like, oh, she doesn't love me anymore, or what you know. There's like so many things where it's like your life could be better, and the people around you could be living a better life too. Like maybe slightly less crazy with your boomerang kids. I'm just trying to say, because they are difficult. Um, but like maybe you would go back down that road pokey. We're not.

SPEAKER_06 10:17

We're just gonna girl, we can do whatever. I just I love the whole boomerang kids, yeah.

SPEAKER_07 10:22

Yeah. Yeah. Your colleagues, your coworkers, your girlfriends, your like your dental hygienist when you're, you know, because you're cranky, because you're not sleeping. Oh, because there's hot flashes and you have this massive cortisol surge at like 318 a.m. every night. Stop doing that. Like it's not nice for you, it's not nice for the people you're dealing with. So why would you have to do that?

SPEAKER_03 10:48

And I think for some women it's like taking them back to like it's they're reverting back to old habits, you know, so they don't know how to deal going into this, and they hadn't really had any coping mechanisms prior to this. And so they go back to old habits. So whether that be drinking or, you know, staying out too late or whatever it is that you used as you know, eating too much, like you just were like a sugar binge. I don't know, you know, but like those are the things that automatically make it worse, and so they go back to that, using that as like my comfort, and like this is what my nervous system recognizes, and then it's all hell. I mean, this is total chaos.

SPEAKER_07 11:24

Yeah, that's not functional.

SPEAKER_06 11:27

No, and it is true what you say about that, because you know, you like I would have wine and got home from work, and especially like on in the summer, like, oh, we'll go out on the deck, have some wine. Oh, you know what? Let's have another glass of wine, and then you know, I'm up at 3 a.m. and I'm just like, oh, and you start investigating what's going on metaphysical, you know, alcohol makes source. I'm like, I don't know how that be.

SPEAKER_00 11:52

Like, it's a wine, it's a wine, you know?

SPEAKER_06 11:56

And then I got wine that had like 80 calories. I'm like, okay, I'll just drop the sugars, you know? Like let's try to get the calories out. Still up the three. And finally, I'm like, okay, Mayor, how long, like you said, were each other's like case study? How long are you gonna go proving that alcohol is a problem and you can't sleep because the alcohol is so infuriating. So now I'm on the, you know, not that I get anything from it, but I'm on the zero proof shout out to that website and finally found a wine that doesn't taste like apple cider vinegar. Oh, I know. It took a while. I mean, it was like I I felt like I was uh, you know, Goldilocks trying out every wine that, you know, non-alcohol, you know, no alcohol, but I was like, oh, this smells like wine, this is gonna be good, you know, swirling it like, oh, it does have legs, you know, like doing the whole thing, like taking and I was like, it's apple cider vinegar, I'll cook with this next time, you know, like oh my god. But you you have to realize that, yeah, you can't go back to the what you used to go back to as you know, forms of coping, because that's also then affecting your sleep and everything else. So I sleep now like a champ.

SPEAKER_07 13:19

Yes, zero proof.

unknown 13:21

Thank you.

SPEAKER_07 13:22

I love that.

SPEAKER_00 13:23

And your progesterone.

SPEAKER_07 13:25

And your progesterone, I know. It's like, mm-hmm. Get that 200 milligrams in there.

SPEAKER_03 13:29

Amen, sister, right there. That's the one. That's the sweet spot.

SPEAKER_07 13:34

That I have had so many patients who were like, Yeah, I mean, I guess the testosterone and estrogen are great. But the progesterone, like they're like tearful. Because I'm like, oh, because you haven't slept in three freaking years, and now you're like, Oh my god, I just got a solid seven and I don't even know what to do with myself. I'm manic. And I was like, get used to that.

SPEAKER_06 13:54

Well, it was like when you you know, first being a mom and you know, your baby slept through the night and you woke up in the morning in sheer panic that they were like gone. You know, you go running in and you're like, oh, they su that's how it felt the first time that I slept through the night after taking you know progesterone for like a couple days. I'm like, oh my god, am I alright? It's it's six o'clock. I I messed up. I didn't hear that. I didn't make my grocery list and my shopping list for Christmas dinner in April.

SPEAKER_00 14:27

Think about the way the microwave was invented at 3 a.m. What the hell's happening around here?

SPEAKER_06 14:32

What is this is great? Like, so for yeah, for people that don't want to, and I'm like, this is the first thing that you you really you you won't regret it. Well, I don't regret any of my um tea that I have, but I really love my um progesterone. It it really helps you sleep like a 35-year-old.

SPEAKER_07 14:52

Yeah, I I totally miss perimenopause. Um by the time I decided to ask about it. Um my doc drew like one FSH, didn't have anything to do with my cycle, didn't actually test my estrogen testosterone, but didn't test any of that, just one single hormone, which is kind of like checking your pulse right now.

SPEAKER_06 15:16

Yeah.

SPEAKER_07 15:17

Right now. Like it changed, right? I was like, and so wait till the morning just ridiculous. And they were like, Yeah, it's fine, no menopause at all. I'm like, okay, I guess I'm just this I'm crazy, and this is what age is, and I'm just gonna be this this person from now on that I don't even like. Great person, that's awesome. And so I just ignored it, and then I was on vacation with um a friend of mine who is probably three to four years younger than me, I would say. Um, and she's married to a guy who's nine years younger than her. I think that's the age difference. And uh she's like, So are have you started hormones yet? And I was like, No, I don't really have an IUD. I don't really know what's going on with my periods because I don't have any. Um, and she's like, Oh, I got tested and got pellets, and 72 hours later said to my husband, You better get your funky butt in to get tested and get on some testosterone because we got some stuffed to get to and I was like, What? What are you even talking about? And one of our old coworkers is double boarded and see, so he was doing, he is doing um a hormone clinic. And so I texted him and I was like, uh, it might be a little perimenopausal, I'm not sure. And he's like, Well, if you're not sure, like let's just I'll just send your labs in to be ordered, and then if there's something abnormal, then you can come in. I don't want to waste your time. I was like, oh my god, sounds great, fantastic. And so I got the lab results and I was like, I don't know how to read these. Because I mean, we don't order hormones in the emergency department. I was like, oh, I guess I just don't know how to read these. Whatever. And so I texted him and I go, It says my estrogen is non-detectable. What is that? And he's like, because it's zero. And I was like, But I'm a girl.

SPEAKER_00 17:07

I have estrogen.

SPEAKER_07 17:09

What? He's like, oh no, you're like past menopause, you're not doing anything, your pituitary gland is like, go, go, go, go, go! And your ovaries are like, like they're just dead and buried.

SPEAKER_03 17:21

And I was like, I picture mine like that.

SPEAKER_07 17:24

Yeah, like just shred like crazons that have been in the bag for too long. Those guys.

SPEAKER_06 17:29

That if you like click them, it's like dust would come off of them.

SPEAKER_07 17:32

Yeah, absolutely. They'd kind of crumble a little bit, get brittle. And uh he's like, Yeah, you're you're done. I was like, so I just missed the whole thing. He said, Yeah. And I was like, oh my god, in retrospect. Yeah, I had a decade of just becoming someone that I really, really, really did not like. Yeah. And so I pellets, and I was like, I was like Phoenix Rising. Holy smokes.

SPEAKER_03 18:03

How did it show up for you at work where you're just like, I can't do this one more second? I have somebody right now I'm working with that's just like, she's been there for 20 years. She's like, I can't stand it. I just want to go be a Walmart greeter, and I'm like, okay, let's talk about this.

SPEAKER_07 18:17

Yeah, I mean, I still kind of would like to work at a nursery and just water things and not talk to anybody. Yeah.

SPEAKER_03 18:23

But just kind of like with that face, Raquel.

SPEAKER_00 18:30

Yeah, totally. Just I can hear the music in my head.

SPEAKER_07 18:32

Yes. Good menopause podcast. Sprinkle in a little Motown music.

SPEAKER_01 18:39

Yeah, yeah, just listening to her. I love her.

SPEAKER_07 18:44

Yeah. Yeah. Doo op girl. Yeah. Oh yes. I mean, it changed it changed my life. Like it gave me energy and it gave me hope and it gave me some control over what was happening. Like, I just felt like I was completely out of control because my body wasn't doing anything I wanted it to. Um, and I really don't even think my symptoms were severe in the scope of people who suffer, you know. Um, but yeah, I I got the pellets and they're supposed to last like 14 to 16 weeks, depending on your physiology. And I would feel great, and then they it would just dump me off a cliff. And I like in the middle of the day, middle of the night, I would just gain like 143 pounds, and I just couldn't even move. And depression and just aching, and I have chronic pain anyway, so the chronic pain would be so much worse. And um, so we played with it for like two years, and finally he goes, You are burning through those pellets in like 10 weeks, and so you're gonna have to get on something that you take every day. Um, so the pellets are great if you can dial in exactly what you need and like set it and forget it for a couple months, fantastic. But I just couldn't do that. I wasn't like staying steady. I'd be like way up here, and then boom, like four hours, just awful. Um so yeah, I everybody is different, right?

SPEAKER_03 20:16

Everybody, everybody's body is different, and that's one thing. Like, I feel like I have those conversations so often, people are like, Well, what works for you? I'm like, Well, what works for me is not necessarily gonna work for you. Like, that's a like I'm here to give you information so you can have those better dialed-in conversations with your provider, but I, you know, I can't tell you what's gonna work because there's not like magic wand out there that we've heard of.

SPEAKER_07 20:40

Yeah, that's right. I mean, I again I think the science is super duper duper far behind. It is something I also think that we're not good at giving feedback for what our symptoms are. Like, you know, I'll have patients that are like, oh, you know, I have some hot flashes, and so I just wanted to, and I'm like, how's your sleep? And they're like, What? How's what? I'm like, yeah. So sleep, you're supposed to be doing that every day? They're like, no, I don't even know what that is. And I'm like, how's your sex life? And they're like, don't even, I don't, and I'm like, oh God.

SPEAKER_03 21:11

Putting that up in front of my husband.

SPEAKER_07 21:13

I'm like, it's so much more than hot flashes, people. Like, yeah, yeah. Can you think clearly? Can you sleep soundly? Can you do you have thoughts of sex and want that? And can you can do it without pain? Do you have a bunch of urinary? Like, all this stuff, and people just don't they don't want to talk about it because why?

SPEAKER_03 21:33

I think people feel old, and like you're gonna feel a lot older if you don't get in front of it.

SPEAKER_06 21:39

I know, but even though, like how you said, like, you don't know how to describe it, like I have a similar um situation timeline with you. Like I was going through a parametopause, didn't know it until I was coming out of the doctor's office and I read my chart and it said met with a postmenopausal woman, and I'm like reading the paper and I was like, who? Who is that? Who's that person? Postmenopausal. Who the hell? Menopause? What the hell is menopause? Where did the peri go? You know? But it's like I would go to the doc and I'd be like, oh, the skin on the top of my legs hurts. What in the hell are you supposed to do with that? Like, but I was like, my body aches. You know, I'm looking up fibromyalgia. I'm looking up like MS. I'm like, oh, I can balance on one foot. Okay, I'm telling you. But I didn't know how to like describe what is so he told me though that to help my uh skin on the top of my legs that hurt to go on a macrobiotic diet, which did nothing but give me gas.

SPEAKER_02 22:43

So Is this the cabbage? Okay.

SPEAKER_06 22:45

It was the cabbage. I ate more cabbage. Oh, Carrie. I ate more cabbage then. I think every time my husband saw the cabbage come out, he's like, Are you making that soup again? And I was like, Cabbage for everybody.

SPEAKER_00 22:57

It was like our over moment. And you, and you, and you.

SPEAKER_06 23:01

It was it was horrible. But I think like you don't know how to go, you know, you go in with like one symptom that you concentrate on, you forget about everything else. Like you forget that you're not sleeping and that you're getting really irritable, and because it's like my whole body hurts, and you're never ever saying anything like sexual or anything like that.

SPEAKER_03 23:24

So it's because you're not connecting the dots.

SPEAKER_06 23:27

You're not connecting the dots, and that does then extend into you getting the help because you're like you leave there and you're like, okay, never heard menopause or perimetopause or anything.

SPEAKER_03 23:38

And any kind of pause for that matter, I'm just gonna be honest. Yeah.

SPEAKER_06 23:43

Did you look at yourself in the pictures of the 10 years? Like I did that, and like you know how they come up on your phone like this year, like five years ago or whatever. I don't recognize myself during that time. And I guess nobody nobody else did because I my hair kept getting shorter and shorter. And I would say to my husband, You didn't think this was an issue? He was like, I wasn't gonna tell you anything. And I'm like, I look like a 12-year-old boy with this baseball hat on. There's no hair. Like, is is and he was like, No, I was and I'm like, Were you afraid of me then? He's like, Yeah, yeah, pretty much. And I was like, Oh, okay. So you look at yourself in the pictures leading up, and you're thinking like I I was just thinking, like, ooh, I don't I don't look good there. I don't and you just push through.

SPEAKER_07 24:33

I totally agree. I mean, I think I run into, you know, the people that I worked with in the emergency department every once in a while still, or we'll get together or whatnot, and they're always like, you are aging backwards. What is happening? And I'm like, no, I'm just not aging at four times the normal speed because I was not treating menopause and I was in the emergency department, killing my soul. Like, you guys are still in it, and so you're still just lightning speed ahead, hurting yourselves. Really? Like, that's what's happening. It's so bad for your body, it's so bad for your soul to have that profession in the first place. And then, like, when I left the emergency department was when I found out, oh, I totally missed perimenopause. And like, yeah, like weird fat distribution. I also had virtually no hair, Mayor. What the hell was that?

SPEAKER_06 25:29

No, oh my god, Carrie, it's so true. Like, and I would say, and you know, now I have somebody that I go to that she would tell me, like, no, we're not doing that. But I had somebody and she was like, sure, you want me? And I was like, Yeah, like I'm getting like I'm hot at night, like I'm I'm just, you know, like no, no, like hot flashes that during the day that I was told, I would just like sweat through my sheets at night and thinking, like, damn, the air conditioning is not working. I'm getting fat, you know, and I was like, just cut it all. And and she did. And then I was like, and you get in the car and you're like, holy shit, she listened to me. Yeah.

SPEAKER_07 26:05

Thanks for validating my request.

SPEAKER_00 26:10

We're all trying to fix that two strands.

SPEAKER_06 26:13

And it was like, you know, uh my shampoo lasted, I think, literally. Six months. Six months, because I'm like, where did my hair go? And you know, everybody like my husband's like, that do you when you ask somebody how does it look, and they say, How do you like it?

SPEAKER_03 26:30

That is your first indicator right there. That they talk, they're just about to tell you that it looks like it's a good thing. They are just well trained though, also.

SPEAKER_07 26:38

Yeah.

SPEAKER_06 26:38

Like, what do you mean? Like, oh, I I I love it, right?

SPEAKER_07 26:40

And he was like, then As he's like leaning back a little bit.

SPEAKER_02 26:44

Even with the eyes, too, little closing. Like, let me see if it looks better smaller than that. I don't know what the right answer is.

SPEAKER_03 26:53

Yeah.

SPEAKER_07 26:54

I know.

SPEAKER_03 26:54

I have a look on my husband's face a few times.

unknown 26:57

Yeah.

SPEAKER_07 26:57

I had a partner during those years, like five of those years we were together. We lived together for three of them. And I kind of think, like, oh boy, he got a real sour version.

SPEAKER_00 27:10

Like, I don't want him back. Just to be clear.

SPEAKER_07 27:15

Yes. Like, I don't want to redo There Needs to Be No Mulligan, but I do kind of feel bad that he probably got the worst version of me. Like, I I mean, no, absolutely not. It wasn't until, you know, I got replacement that I was like, I did not have to feel like this. I didn't have to go through that. And then I think, like, ooh, what damage was I doing to my heart? And like, you know, I've had some weight loss and a definite redistribution. Like that visceral fat that I was carrying around, that is not good. My sugars were all over the place. Like, you know, what kind of did I screw up my bones in any way? And I'm not going to be able to recuperate that, you know. Those are the things I was thinking. I was like, oh my God, I just did this for a decade and screwed myself in my 80s, hopefully. Damn it. Like, what was the point of that?

SPEAKER_05 28:12

Uh-huh. Yeah.

SPEAKER_07 28:13

So frustrating. Um and it's frustrating that the healthcare system is such that your primary provider or your gynecologist has like seven minutes to sit down with you and figure this out with you, right? Yeah. Because, like, oh, I have a 15-minute visit. It's like, no, you don't. You're going to be in the room, someone's going to take your vital signs, go over your meds, register you. Your pervader's going to come in for like six or seven minutes, and then they're going to go out and do the prescriptions, do the orders, do the paperwork, and you're out of there. Like, you can't go through this in six or seven minutes because there's so much going on.

SPEAKER_03 28:54

Like, I remember like effective.

SPEAKER_07 28:58

It's it's not effective for anybody. Like, patients don't get to get their thoughts together and get them out and get them addressed. Um, and God forbid you bring up more than one thing in the ER. Like immediately. When how about I'd be like, nope, you're here for this. That's right. I have 42 seconds. No, absolutely not. And don't try and pull that as we're like wheeling you out. But I thought I would mention.

SPEAKER_01 29:25

You're fine.

SPEAKER_07 29:27

Off you go. Oh my god. Yeah.

SPEAKER_06 29:29

Because I know that is, yeah. I'm true.

SPEAKER_07 29:33

Yeah, I I think when it was about the time I had brought up, like, I think I might be parametapasal, and I looked at my gynecologist, I was like, this is really weird. And I've brought it up to my primary too, and I don't understand it, but my left nipple itches 24-7.

unknown 29:51

Yeah.

SPEAKER_07 29:52

Like, I am surreptitiously like hitting myself with my phone. I am pinching myself. I am rubbing like really sharp things. Open there, Donna. Right?

SPEAKER_06 30:05

So mine was also the left breast. I have no idea.

SPEAKER_00 30:09

What in the world?

SPEAKER_06 30:11

I wish I have no idea. But I can tell you put more calorie lotion on my body than I knew that what to do with, and they still do make it, and I came out like that pink teletelby. Here I came out. My husband's like, you alright? And I was like, I just itched his left breast.

SPEAKER_07 30:32

Yes.

SPEAKER_06 30:33

Tear at it.

SPEAKER_07 30:34

I am surprised my nipple is still on there. Like, I would just be right? Oh my god. Like one squeeze before you get out of the car, like the last, like, so maybe you might make it a few.

SPEAKER_03 30:55

Developed an allergy to sunscreen during perimetopause, thank you. Because now I can't keep my skin safe and I'm gonna look old because I can't wear sunscreen. I put sunscreen on this weekend because it was warm. My legs itched so bad yesterday. Like I literally was like at some like a chamber meeting or something, and I'm like a cricket. Squeaker, squeaker, squeaker.

SPEAKER_00 31:20

It's just like, oh my god, oh my god!

SPEAKER_06 31:22

And I come home and I'm like telling my husband I've got my hand all the way down my pants, and I'm like Yeah, it's like things that you would like if you saw somebody doing it, if you saw, you know, you're making you're just talking, but doing this, or you reach for your hand, you're trying, and they're they know what you're doing. But so like they don't see that I'm trying to but I'm smooth, I'm smooth like butter. It's horrible, but you know what? Nobody tells you that, right? It wasn't until I read, I was like reading doing the research that one of the 57 plus symptoms itching, and I was like It's buried at the bottom in like five red. Like literally, I was like, huh. Interesting. And I would ask other women, I was like, Do you have any like my uh one friend that I work with, she was like, Oh yeah, like my left top of her foot. And she was like, How about you? And I didn't really know her that well, and I was like, No.

SPEAKER_07 32:26

See, and there you go. You did not validate her, Mare. Shame on you.

SPEAKER_06 32:30

I said, Oh, I yeah, I get that. Like sometimes itchy, yeah. But I was like, I'm not gonna, and then every time she sees me walk down the hall like itchy nipple.

SPEAKER_07 32:40

Yeah, right?

SPEAKER_06 32:42

Maybe not.

SPEAKER_07 32:42

Maybe not.

SPEAKER_06 32:43

CC is you're over there doing this.

SPEAKER_07 32:46

Yes. Let me just reach for the let me just reach repeatedly for this thing over Yes, yes. Yeah, yes. I could not, I mean, and my poor dermatologist, we went to med school together, and I was seeing him for other things, but I definitely was like, could you please? He's all, oh god, like I don't We're friends. Please don't. I don't really and I'm like, but I don't, it looks normal, and I don't understand what's happening to me. And nobody like primary, gyne, derm, nobody could and it was years. It's probably like three, three and a half years with this thing. And then hormone replacement therapy, and like a couple months into it, I'm like, you know what I'm not doing is trying to remove my nipple with my fingernails. Interesting. Not creating a triple. I know. Oh how charming. That's wonderful. I had no idea. None. So weird.

SPEAKER_06 33:46

That is that is definitely one of the perks. If not, you know, everything else that goes with the perks of HRT, but that I agree with you. Just having peace with your skin.

SPEAKER_05 33:59

A little less itch.

SPEAKER_06 34:00

A little less itching.

SPEAKER_07 34:01

Oh my goodness. It's so rude.

SPEAKER_06 34:04

It's so rude.

SPEAKER_07 34:05

There's a uh dermatologist in Reno who has her own sunscreen line, Raquel.

SPEAKER_01 34:12

Do you know about this? I don't, but I'm gonna need to talk to her because I can't I cannot walk around itching all summer long.

SPEAKER_07 34:21

Yeah, I know. It's just me. I mean, at least it's raining today. Um I would I would look it up. You can get on Instagram and she might actually even um answer you. I think Dr. Hovenick, Whitney Hovenick. Okay, okay. And uh but her her sunscreen line is called Spooge. And there is no end to my joy about that. And then I think the one for your face D E W me. And I'm like, we haven't met, but we are friends.

SPEAKER_00 34:57

I can't absolutely be like at the pool with my spooch.

SPEAKER_07 35:02

Yes. You get Spooch all over me. Do you have my do me? I need my doom. I need to be done. I'm going out today and I need to be done.

SPEAKER_06 35:12

Yes. That I I love that when people do have a product or that can do, or or like even you, you know, your tagline of where sass meets science and sanity prevails. Like you know that they're that is a person that, yeah, they are my spirit animal. They have humor, and you find humor in saying names or doing whatever approachable.

SPEAKER_03 35:35

You know, like I like I'm like, okay, this person's on my level because I know when I walk in and a provider's like looking down, I'm like, oh, this is gonna go nowhere. You know, we're gonna have to go rounds, and I'm still gonna walk out pissed.

SPEAKER_07 35:48

Yeah, let's start off this relationship in a truly contentious matter. We're gonna get a lot of stuff accomplished.

SPEAKER_03 35:54

Yeah, like great job, dude. You went to 50 years of freaking school, but guess what? I was living my life at the same time, so that's amazing. Let's go ahead and have the conversation because we're both humans.

SPEAKER_06 36:03

Yeah. Is that about what made you start your um online? Virtual.

SPEAKER_07 36:10

Um, well, so actually pre-COVID, I knew that I couldn't do emergency medicine the way I was doing it, as much um, as many shifts as I needed to do. And so uh a good friend of mine who was in med school with me had started working at this telemedicine startup company.

SPEAKER_05 36:29

Okay.

SPEAKER_07 36:30

And um, she and I went and had a beer, and I was like, what is this thing that you're doing? And so I was like, oh my God, that's the way medicine should be treating patients, is we've got an hour to talk about all of the things. And I was like, they'll pay me to talk to a patient for an hour? Like, if you're if I'm dealing with you for an hour, that's because you've died like four times, and we're just trying to get you upstairs with some vital signs. Like, you should never see me for an hour. I couldn't even imagine it. And I was like, oh my God, that sounds so luxurious. And I'm an extrovert. Like, I want to talk to people, I want to talk to most people, not everyone.

SPEAKER_01 37:11

Agreed.

SPEAKER_07 37:11

And so I looked into it um and I started working for them. And then COVID happened. Well, and so um there was lots of time differences because there were very few people in the hospital, but the people who were there were dying and super duper sick. And so it was like we had weird shifts, and so I was doing more of the telemedicine stuff um for financial reasons, and then like it was the perfect storm. Like, we still had didn't have any vaccinations. I had been inoculated innumerous times, and my skin was falling off because I was showering like three times a day. Yeah, and I had like I had different colored go bags where I knew like this one doesn't come in the house, this one can come into the hospital, but not into the department. This one is like the hot bag that like never leaves a department and all this stuff. And it was just my kid was going back to school. Um I was living with my boyfriend and his kids at the time who were doing completely remote. I thought I was gonna kill my you know octogenarian parents with COVID, and I was just like, I can't do this anymore. I I I had one of the worst weeks of my entire career altogether. Um, got in a fight with like an 83-year-old guy with a walker, got called the N-word, got called the B word. I was like, come on, people, I'm done. I I gotta go for a little while. And um then I kind of got the like perspective. I'm like, oh, this job is killing me. And it's super unhealthy and dysfunctional. Got it. I'm so glad that you realized. If that week had not happened, I would have tefted out, Raquel, because like you know, whatever. I can withstand anything.

SPEAKER_03 39:00

Right. But should I think about it? How it could have gone. You could have gone, you would still be sitting there, still be miserable, and not making any changes. You know what I mean? You've done a lot for yourself, so that's why you're aging backwards.

SPEAKER_07 39:12

I I honestly think that's a huge part of it is having some semblance of a cortisol fluctuation because for like 26 years, my cortisol was just here. It never came down. There was no anxiety, there was no panic. Because if you're redlined all the time, you don't feel that. Um, yeah, super unhealthy. And so I actually picked up another telemedicine gig at that time and stayed home with my kid and like, you know, didn't I got vaccinated, all that stuff, and I was planning on going back and I just couldn't do it for about a year and a half, and then I did go back because I am stubborn and stupid, and I did that anyways, but different story. But I really liked the telehealth stuff, and at that point, my kid was in high school, and I didn't really want to be missing all of the games and the practices and the stuff on weekends when I'm usually in the ER. And yeah, um, so it's kind of like that perfect storm of you have an alternative to go to, and this does not look very good anymore. So um, but then for my own podcast and my own practice, it was the culmination of, frankly, like this like women sitting around, women who know a ton about a ton of things and just this massive village and resource of information. And we would get together and you know, solve our own problems and like, oh, I'll send you his number, oh I'll you know, link you up with her. And we're like, we should have a podcast so that people can like learn the things that we're learning. Like, I'm not I'm not a CPA, I'm not an attorney, I'm not a dentist, I don't know any of this stuff, but like we just show we just shared so much good information. And um finally it was I was with a partner at the time who was like, just start seeing your own patients for hormones. Like people will talk to you about their dry vaginas and about their itchy nipples, and he's like, You are the person that they will actually divulge that information to so that you have a more accurate assessment of their symptoms so that you can treat them properly. Um, and so that's kind of how that all started. And then the social media thing came on, I was like, What are we doing? Nobody wants to hear this. People wanted to hear it. So there you go.

unknown 41:29

Yeah.

SPEAKER_03 41:30

People want to hear it because they're in the same space. They do. Yeah.

SPEAKER_06 41:34

You know, when you said about how that week was the worst, you know, I read somewhere and I became as soon as I read it, I became an instant believer in it that they said, like, if you need to make a change and you don't do it for yourself, the universe will make it so hard for you that you have no other choice but to stop doing it, right? And so it's like, you know, because yes, we're from the generation that you're selling topic out. You went to school for that. Like, that's you know, I've been a governor for 38 years, like, and yeah, it's toxic, it's exhausting, but it's like, no, but this I'm gonna, you know, keep at it, and that's what you do. But there are like I have so many times that I'm like, yeah, universe, I hear you. I hear you because you know you are able to, and thankfully that you listened and didn't push through it and are now doing something that I am sure many women, myself and Raquel included, love talking with you, and they're so if we were your patients, it would just be so I don't know empowering and great. And I would be like, and your left breast itches too.

SPEAKER_02 42:45

Because you humanize the experience.

SPEAKER_06 42:48

Yes, you humanize the experience, and that's what is missing out there. So I I thank you for that.

SPEAKER_07 42:54

Same, same. Yeah, I never wanted to be the doc who walked in the room and did the like looming thing, right? Like, and I hate that. I hate that too, you know, and and if it makes you feel any better, physicians that see me do that too, and I'm like, oh, please, motherfucker, are you kidding me?

SPEAKER_02 43:12

Like, I already as a doctor and I think the same thing. I'm like, you put your pants on the same way I do, my friend sit down. Exactly. Sit down.

SPEAKER_07 43:22

No. You threw your back out putting on a sock three weeks ago. Just don't even please. As it like, I get that I am here for your help. Do that. Don't sit there like you're better.

SPEAKER_03 43:35

Shall we? Yeah. So annoying.

SPEAKER_07 43:37

I can't I have zero patience for that. And especially like people don't realize that in the emergency department, we end up getting to know almost every single physician in the community because like you're calling everybody. I have your patient, I need your help. You know, they need the, you know. And so it's so interesting that people are like, Well, I heard he's a super good surgeon. But he's just a jerk. And I was like, yeah, so go see somebody who's just as good a surgeon and who isn't a jerk, and I'll give them like two or three options. It's like, you don't have to put up with crappy bedside manner. You just don't.

SPEAKER_05 44:12

Like and don't.

SPEAKER_07 44:15

Because frankly, it's not good for your recovery either. Like, you want to have validation, you want to be on this is teamwork, you want to make sure you're working together and that you can talk about your itchy nipple, and that will be received as a we should look into that instead of just okay, I'm just not gonna pay attention.

SPEAKER_03 44:33

Because we just talked about cortisol, which has always been up here, and that's exactly where my cortisol goes every time I get some stupid response. I'm like, Really? Yeah. And then we have to go into this whole fight and this whole flight and this whole thing, and then my mind manifests this whole like front to to stop, and I'm like, oh great. So what are we doing here? We're gonna dance.

SPEAKER_07 44:55

And then I'm gonna think about this conversation at 3 18 a.m. for the next two nights.

SPEAKER_03 45:00

And what I should months.

SPEAKER_06 45:02

I mean, that's the horrible thing too. Like, I I know um I I can't be the only one where you will talk yourself into the conversation and like, well, if they say this, then I'm gonna I'm gonna say this and I'll respond to that. Like you talked it, you have it already, you know, and then you go in there and they don't give you any responses that you had already prepared for, and now you're like, uh, uh, uh thank you.

unknown 45:28

Yeah.

SPEAKER_06 45:29

I was like at 318 for the last five days I've been preparing myself, and evidently it was not enough.

SPEAKER_03 45:37

And at 318 after that conversation, I'm pissed because I didn't get out what I wanted to say. They didn't argue back how they I thought they were supposed to. Right, right, right.

SPEAKER_07 45:48

See, maybe improv classes is where it's at. Maybe that's you know, so you're like on your toes, I'm ready. It's a it's a yes and situation. Yes and and yes, so yeah, maybe that'll work. It it is just a contentious, and it's not supposed to be. It's you're supposed to be on the same team. Um, but man, when you're not working together, yes.

SPEAKER_03 46:16

Yes. I flex through it so many times that I'm thinking, like, okay, I walk in and I say, I have XYZ going on, and then you know, I don't I don't really get but you know, that's seven minutes, and it's like hard to say because how can anybody be again? How can they be accurate or how can they be effective if you're not able to look into other things? Because yeah, I might be presenting as menopause, but it could be other things. You know, you hear women come in all the time and they're presenting with menopausal symptoms. Yes, they absolutely could be in menopause, but it could be a host of other things. They could have overdosed on supplements, so they're in like some kind of a liver failure. They could have, you know, they have heart palpitations, but that could be at some other kind of like heart disease. Like these things need to be investigated a little bit further, but also treated with a menopause treatment, you know, whatever you choose. Like I that's obviously between women and their providers, but like I just feel like there's more to the picture, and the seven minutes or fifteen minutes is not doing anybody justice. The provider and or the patient. That's right.

SPEAKER_06 47:17

How we do it, I think, is always backwards to me. Like I try to be proactive and you know, you but you can't get your lab work. Why are we going to the doc and then getting our lab work? And now we're not gonna see them. We're just gonna get a message on how our lab work was. I'm always like, I will like email, like text them, like you can like ask your provider, and I'm like, hey, can you order me all of my lab work before my appointment that I'm coming in next Thursday? So that way we can discuss the lab work. But it's like, oh well, I want to, you know, see. You do the same lab work every year.

SPEAKER_03 47:55

Just order the damn labs.

SPEAKER_06 47:57

Do it, do my hormones, do whatever, so that way I can have questions and we can look over instead of like you walk out, then you get your slip for your labs, and then you're like, Well, I'm I don't have another appointment now, so I'll have to like try to figure out what they like when they're not.

SPEAKER_03 48:14

I just like rescheduled an appointment today because I didn't have time to get my labs, and I thought to myself, no friggin' way am I gonna waste time going to this appointment to talk about the same darn things that we've already talked about. I would have no more evidence. We have no more no more data to look at. So what's the point?

SPEAKER_06 48:29

I don't know why that always like why it can't be like you have to go, like for our insurance, we have to go once a year, regardless of any other time during. You know, so it's like it's a well checkup. Why you can't like get the paperwork, oh here's your well checkup, here's your labs that you should get, and come see me. And then if you don't get it, it's on your responsibility, but you know.

SPEAKER_07 48:54

Yeah, I mean uh initially years ago, a couple decades ago, it wasn't like that. Like you would go in, get a physical, talk about the studies that you needed to get, and then they'd be like, We'll see you in two weeks. But now insurance doesn't pay for that, right? And so it's like now it doesn't make any sense. Because again, like yeah, you're just kind of left in the in the outback, like, okay, well, I just went and did all these studies, and now I don't have any idea what it means. Like, and apparently it doesn't get any better. Like, my mom has like five outstanding studies for this problem she's having with her hand, and she's like, I don't know what any of the answers are. I was like, I'm not in the in the system anymore, so I can't look anything up, and that's a HIPAA violation. But, you know, and so she's like, What am I supposed to do? And I'm like, You're gonna have to make an appointment with the people who ordered the studies, and she's like, They can't see me for eight weeks, and I was like, I'm not saying it makes any sense, but it's so weird to that that's how we're doing it. And right yeah, the system is not set up for efficiency and for the maximum communication between the patient and the provider. It's so dumb.

SPEAKER_06 50:13

It's it puts everybody, it sets everybody up for failure because you know, you're going because you're upset, like you know, you may have like, you know, you're having high sugars or whatever. Okay, well, you didn't take your blood work, so I can't go over what your A1C is, but I'll see you. I'll listen to your pulse and your blood pressure, and now what? Yeah, you know what I mean? Then you have to make another, well, your A1C is high or whatever, and it's like, yeah.

SPEAKER_07 50:41

But see and that's how people end up in the emergency department. That's what I was gonna say. Getting their primary care. And we're like they're like, oh my god, my sugar's 240, and we're like, right on, good job. Bye, like we don't care, you're not in DKA. Like, should you stay there? Absolutely not. But that is not going to impress me. Like, I'm not gonna do anything about it. I'm not a primary care provider, I should not be tinkering with your medications. Your blood pressure's 160 over 80. I'm like, so is mine. Like, whatever.

SPEAKER_02 51:15

Do you see where I'm at? Do you see where I'm looking?

SPEAKER_07 51:18

Look around. Everybody's blood pressure is really high.

SPEAKER_03 51:21

My nipples itching, so get out of it.

SPEAKER_07 51:23

That's right. Yeah. And so it's ch the system is so incredibly broken and so dysfunctional, and nobody gets what they need except for the CEOs that are buying their sixth yacht.

SPEAKER_06 51:36

Right. You know, and then you put in then menopause, it's like, my God, like, forget it. You know, because here where we are on the East Coast, um, testosterone is not for women. I don't know if you've heard that, you know, it's only it's it's for men. Um and I've been denied by uh my provider, and she contacted her other like colleagues and they're like, no. And I'm like, it's infuriating that you're just saying no. Like no. And she was like, no, no, they they don't do that. Okay, so you know, I have to go to an online place to get it, that took forever, and it's like, oh my gosh, like it's just crazy. And then you have to pay these, you know, amounts per month just to have it's it's like this whole big uh circle that just keeps going round and round. Like if your provider would just maybe just think about opening up that box and stepping out and just being like, let's look at this. But you know, you don't have that sometimes, you know, and for me I keep trying to find I have a nurse practitioner that I do truly like her. But it's like she can't do it without a doc's approval. So you're sort of like after that step again. So it's it's infuriating to have the the healthcare be like, nope. Like, like if I had the if I needed insulin, are you gonna deny me insulin? Like, no, 400 sugars, they're okay. You'll be okay.

SPEAKER_07 53:12

Yeah, and the travesty is we're not the ones who made testosterone a controlled substance. Women were not the problem. We weren't even using it, by the way. It was all the friggin' Jim Bro jug heads in the eighties and nineties that were killing themselves by taking tons of injection of testosterone. So then it became a controlled substance.

SPEAKER_03 53:35

I was gonna say for a while it wasn't controlled, right?

SPEAKER_07 53:38

No, not until literally like the late 80s, early 90s.

SPEAKER_03 53:42

Yeah, I was gonna say there was a period.

SPEAKER_06 53:44

Yeah. Those, yeah, I picked things up to put things down. It's like, well, okay.

SPEAKER_07 53:50

Mm-hmm. Yeah, like their test, you know, testicles were this big and they had really bad acne and horrible, horrible, horrible moods and anger problems. But they had really big muscles, and so that was the whole point. And so then, no, not even a little bit. Um and so when I left the emergency department, I was super happy to not have a DEA license that included controlled substances. I was like, I don't have to do this anymore because the process is a little bit different. I was like, I'm never going to give another person a percocet. I'm super happy about this because like in the ER, you're constantly battling people about narcotics. And so I was very happy about this. And then last year I started my own business with hormones, and I'm like, why isn't this system working? And I'm like calling the pharmacy, and they're like, I don't know, I don't see a problem on RN. Well, and I'm like out of my EMR and all this stuff. And I finally realized, my God, it's testosterone, which is a schedule three. Are you freaking kidding me? And so I had to go back and redo my DEA license to be approved for controlled substances again, just to give women testosterone. I'm like, oh, this is the dumbest thing in the world. She already's making her own, by the way. Just not enough.

SPEAKER_06 55:12

So are you uh licensed in PA?

SPEAKER_07 55:16

I am.

SPEAKER_06 55:17

Oh, good to know. Yes, I am.

SPEAKER_07 55:22

Did I just change her dad?

SPEAKER_06 55:26

See, I knew, I knew that we were um spirit nipple animals. Because I knew that. Because I haven't met anybody else going through it that has ever admitted to and I yes, so well, girls, we will definitely have a conversation after that. Because nobody else it's because Pennsylvania is one of like the hardest to to get. They are like it's it was definitely a pain in the butt. Yeah. I don't know if it's because it's like it is stupid, like Keystone State or or what. I I have no, or they let the pilgrims write all the you know the rules and regulations. Who the hell knows? But it was something that people that I know are like, ooh, yeah, we stay away from PA.

SPEAKER_07 56:12

I think that's why, I mean, because at one point I think I had 21 state licenses. And it's, you know, based on whatever the company, like, oh, we need the docs to be licensed in these states because this is the population that we're seeing. And so based on whatever my job was at the time, the company I was working for, they would kind of switch things around. Um, there's kind of a core of them, especially since I'm on the West Coast, like I have all the West Coast states. Um, but I hadn't had Pennsylvania, North Carolina, Florida, or Texas for several years. And then getting those took an act of Congress, literally. I was like, what? Why do y'all think you are so special? Like, I'm licensed in 12 other states. What do you how are you different? Um, PA was annoying.

SPEAKER_01 57:01

God, I never understand.

SPEAKER_07 57:04

Yeah. We have to take a national board. So why do we not get licensed?

SPEAKER_03 57:10

Across the board, in my opinion. Like, I don't know. I get I get what you're saying on that. We run into stuff like that too when we're working with you know organizations with tools and training and like getting people into like you know, like the workspace and like HR. Like, there's so many variables, right? Like, how is it so different from state to state? Like, oh, this one's only an ordinance. Oh, this is this. You're like, but you have legislation over here, but you only have an ordinance, so it's not really as priority over here. So it's just like, what? I got it, like, yes.

SPEAKER_07 57:40

That's crazy annoying.

SPEAKER_03 57:42

Yeah, it just would be great to have uniformity.

SPEAKER_07 57:46

Yeah, there's a small compact um in the United States. Yes. Yeah. And I think it came, I think it came out of COVID, because it was like Minnesota, the Dakotas, um, Wisconsin, maybe, but it was like, uh, we have really small population, we don't have enough providers, and we just want to make it easier for you to serve our population, essentially. Um, but like the psychologists, nurses, there's a bunch of other and like the compact is basically the 50 states. And I'm like, why do we not have that when all of our boards are national boards? Yeah.

SPEAKER_06 58:23

Yeah.

SPEAKER_07 58:24

What's the point of that?

SPEAKER_06 58:25

It's very true. Because I know um during COVID, and that's the C word that I refuse to use a lot. It's like, you know, you don't want to, it's like Beetlejuice say it too many times. Oh man, but but the other C word, I'll say it all day, but COVID, no, but oh just said it twice. But um, but that's how like my um a lot of my friends that they went um traveling and that's what saved them because they had the compact license, and once that opened, they were able to then go um anywhere at that point. But you know, up until then you had to always reapply, like you had to I don't know, do you know, like you said, an act of Congress.

SPEAKER_03 59:08

Mayor, you just by the way you said that, we could tell you that you have a little trauma.

SPEAKER_06 59:11

You're just like it is like Carrie understands, like that makes you I yes, whoo! Sweet, nope. Mm-mm. Mm-mm.

SPEAKER_07 59:21

Yep. It's kind of amazing. It's yeah. I mean, because before I'd always been licensed in Nevada and California and then Arizona, because that's kind of where my training was and everything. But then as I started branching out, I was like, what do you mean I have to do your specific two-hour lecture on child trafficking?

SPEAKER_06 59:48

Yeah.

SPEAKER_07 59:48

Yeah. Or or like whatever is specific to this one county in your tiny state.

SPEAKER_05 59:55

Yeah.

SPEAKER_07 59:57

I don't have. That's so bizarre. Especially for telemedicine. Like, I'm not gonna see people who are being sex trafficked. I only see one person at what is what? So, yeah, it was so odd. Um, but they've made up their minds and they're sticking to it.

SPEAKER_03 1:00:12

What is the impetus of that? I don't like why would they have to include that? Did they have a reason? I no idea.

SPEAKER_06 1:00:21

It's on our boards too. Like, you know, when we apply, you have to screw yeah.

SPEAKER_07 1:00:27

So is like I get the the narcotic stuff, I get that. You want to keep up to date on that? That's fine. Like, it certainly isn't getting any better or going away. I get it. But like we have to do that anyways. So why do we have to do your specific North Carolina test? Or and that which is different from the Texas test. And it's like, is this just because you want us to pay $125 to your state every couple of years? Yeah, I feel like that's where we're at, which is gross. Like, yeah, what are you doing? I'm serving.

SPEAKER_03 1:01:01

Yeah, find some ancillary income anywhere else.

SPEAKER_07 1:01:04

Yeah, yeah, charge me more for my license. Just don't make me take this stupid test every couple of years.

SPEAKER_03 1:01:09

Bake it into the damn license. You can wrap your mind around that, right?

unknown 1:01:13

Yeah.

SPEAKER_06 1:01:13

You could wrap, you know what I mean? Like, oh, you want a license in Texas, it's gonna be 250 to renew. You want North Carolina, 175, whatever. You can do whatever and that, but don't make me do numerous things and w and and then wait the the amount of time waiting to to find out and get credentialed and oh god.

SPEAKER_07 1:01:33

Yeah, the hoops are bananas.

SPEAKER_06 1:01:35

Yeah.

SPEAKER_07 1:01:36

Yeah, and I think it you know, it scares people off who would otherwise be willing to be of service to the community. It's like, well, do you want us to help or not? Why are you making this so difficult?

SPEAKER_06 1:01:47

Well, I know that, well, first of all, I have a left my butt off with this episode. I have loved it. And I am so excited that the listeners that are here in PA can actually find help from somebody that we talk with on the podcast because you are licensed in PA. Those are words to uh music to my ears. This is perfect. And I can't, yeah, I can't thank you enough. I could sit here and talk for week.

SPEAKER_03 1:02:18

I didn't even realize it was an hour. I thought when I was like, oh my gosh.

SPEAKER_06 1:02:22

You could grab some non-alcoholic wine.

SPEAKER_03 1:02:25

I'm just gonna sip my tea because it's cold today.

SPEAKER_06 1:02:28

Oh yeah, here we finally are finally now getting some warmish days. But you know, I feel like we could talk forever. So that just means we'll have to have you on again.

unknown 1:02:39

Yes.

SPEAKER_07 1:02:39

I would love that. Heck yeah. You too. I just understand.

SPEAKER_06 1:02:42

Thank you. And now I have to do that.

SPEAKER_07 1:02:44

Tons of fun.

SPEAKER_06 1:02:45

So I would um like to uh we have our little outro thing for the season two. Um, and just like that, another episode of Take a Pause with MetaPals. I hope that today we made you laugh. You found out something new, we talked about everything from nipples to sunscreen. Crickets! I mean, you're welcome, women out there. Yes. And we always like to thank our amazing sponsors, With A Chocolate and Dolce Vita Spa, for you know, always supporting us along with our affiliate partners of Parlor Games, C Nutrition, Isogenics, and Pantry Products. And you can continue to follow us, just hit the follow, guys. It helps is Spotify, Apple Podcasts, and YouTube, and like we always say, don't we, Raquel?

SPEAKER_03 1:03:37

Thank you for listening and see you next Tuesday.