8: Hormone Health And Happiness, A Transformative Path With Monica Bell

Monica Bell [0:01 - 0:17]: I really love Adam Grant's quote when he says, improve ourselves, don't prove ourselves, don't keep proving ourselves, improve ourselves. And I just love that. And I think that's where we have to come from with asking better questions, right?

Paige Nolan [0:17 - 4:17]: Hi, I'm Paige Nolan. Welcome to. I'll meet you there. A place where heart centered conversations are everything. Living what matters is the truest thing, and sharing the journey is the best. Hi, everyone, and welcome back. I've been wanting to share a conversation with y'all about health and wellness and especially hormone health, but I haven't wanted to rush into that topic. There's so much content out there. I know that you've seen it and you've heard it, and I find that it can get very overwhelming sometimes. It can even get confusing and contradictory and it can feel noisy. So I had to get very clear about my intention with this episode. I want to empower you. I want to support you in getting healthier. And for me, it's really about inviting you into a better conversation with yourself about wellness. Once I was very clear about this intention, then I knew exactly who my guests would be. Today you're going to meet Monica Bell. She is a board certified acute care nurse practitioner with her doctorate in nursing practice and over 25 years of nursing experience. You're going to hear Monica's point of view when it comes to wellness and hormone replacement therapy and feeling good, especially in midlife, but actually feeling good at any age. I met Monica in 2018 when I was in Salt Lake City, and she attended one of my live what matters retreat days. She needed help growing her business and balancing family, and she wanted to get very clear about her direction moving forward. So we started working together and we've continued our partnership ever since. It has been amazing to watch Monica align her life with what matters most, and today she runs her own medical practice. She specializes in bio identical hormone therapy, individually tailored for men and women to achieve optimal health. I can tell you firsthand, she loves her work. She is passionate about what she does. And Monica has been learning and talking about hormone replacement therapy. A short name for that is HRt. And I can tell you firsthand, she loves her work. She's passionate about what she does, and she's been learning and talking about hormone replacement therapy, HRTA, for many, many years, way before it entered our mainstream media outlets and bookshelves. In our conversation, Monica talks about her personal story and path to serving people's wellness. She talks about how we can become better advocates for our own health and she educates us on HRT. We don't get too much into the details of the treatment, but Monica does give us some important historical context about why there's been anxiety around this kind of treatment and what we can do now to find out if HRT is for us. Monica helps people feel good every day. She's committed to problem solving and listening, and she shares how we can show up for ourselves and improve our wellness. I so enjoyed meeting Monica here, and my hope is that you will hear something in this conversation that will empower and support you in your own wellness journey. Enjoy.

I want to start with your story, and I'd love for you to share with us what health and wellness meant to you even in your childhood home. Like your earliest memories, if you grew up around healthy people, if you grew up in a conversation around exercise or nutrition. The reason I like to start there is I'm so intrigued with the foundation of people's lives when they end up living a life that's so aligned with what matters to them, and that is you. I know that what you do and wellness is so important to you. So I'm curious, what were the early messages that you got around wellness?

Monica Bell [4:18 - 4:37]: Well, I definitely didn't grow up in a family that wellness was even a topic. I mean, I grew up with a mom, a single mom who worked full time. And so I was thinking about this other day. Oh, my gosh, I think we ate fast food probably three days a week.

Paige Nolan [4:37 - 4:38]: Oh, yeah.

Monica Bell [4:39 - 5:26]: It was so new at the time. You know, it was exciting and it was easy and, of course, easy for my mom, who was stressed working, you know, so, I mean, we didn't even talk about it in this conversation. Wasn't. Certainly wasn't in my family now talking to patients. Now, I know it was a conversation in some other families, but it certainly wasn't in mine. You know, my mom was not making buckwheat pancakes, you know, and asking me to not eat sugar, you know, we had Twinkies and, you know, in my lunch and peanut butter and jelly sandwiches, and we just didn't really talk about wellness at all. And my mom certainly was never an exerciser and didn't really have that example of wellness.

Paige Nolan [5:26 - 5:40]: Yeah, it was definitely not the topic then that it is now. I remember going to McDonald's on the way home from school before I would go home and eat dinner, you know, just because it was fun. You met up with your friends there.

Monica Bell [5:40 - 6:20]: Yeah. And there was no talk about, like, oh, we should do that in moderation. And we shouldn't really eat that every day. And no, was definitely not in the topic of being unhealthy. Anyway, I remember when the big gulp came out in our family. It was so exciting. We were going to get the big gulp. I think at that time it was maybe 18oz or something. Could we drink it all? That was the big thing of soda, which is such a different conversation than we're having now, and certainly a different conversation than I'm having with my own children, you know, and when they grow up, it'd be interesting to hear what they say.

Paige Nolan [6:20 - 6:25]: What about exercise? When did you. When did exercise become a part of your life?

Monica Bell [6:25 - 6:39]: Yeah, I think that was probably my first insight to wellness, is I loved to exercise in first runs that were like, oh, my gosh, I feel so good, this feels great. And of course, running continues to be a part of my life today.

Paige Nolan [6:39 - 6:40]: Did you run in high school?

Monica Bell [6:40 - 6:41]: Mm hmm.

Paige Nolan [6:42 - 6:42]: Yeah.

Monica Bell [6:42 - 6:51]: And got a lot of positive reinforcement from sports in junior high and high school and just felt so much better when I was busy and with sports.

Paige Nolan [6:51 - 7:18]: And, yeah, that address, that was the same way. Yeah. Exercise for me was definitely the portal into feeling good in my body. Food has come later, and for me, like, much later. You know, I'm just starting to put the dots together. Like, I think I started in my late thirties to be like, oh, I should sort of stop drinking regular soda, you know, now I'm 49. Me too. Me too. I have a better conversation with myself about it, but it's totally a work in progress for me.

Monica Bell [7:18 - 7:24]: Yeah. I mean, I think in high school, I drank a coke, a candy bar, and a bag of chips most days.

Paige Nolan [7:24 - 7:25]: Yeah.

Monica Bell [7:25 - 7:32]: But I did love exercise. I did love exercise and knew that my body just felt so much better when I was exercising.

Paige Nolan [7:32 - 7:42]: Yeah. And what about medicine? That interest in pursuing it professionally? Was that a high school thing, or did that come later where you thought you could go into that field?

Monica Bell [7:42 - 7:52]: Yeah, I mean, I had no, I mean, I just wasn't even thinking about my. I don't think, you know, reading my journal is definitely a lot of boy and drama talk.

Paige Nolan [7:53 - 7:54]: Looking back, normal. Yeah.

Monica Bell [7:55 - 8:41]: Was not very deep or insightful at all. But anyway. But I did. In my junior year of high school, my best friend Nancy said, I'm going to do this medical assisting class, which was brand new to our school. We could sign up and do that. And so I said, well, might as well sign up with you to do that. She hated it. I loved it. And then I just kept going from there. My senior year, I ended up doing medical assisting and then just got jobs right in high school as a nursing assistant and knew I was going to do something in the medical field. But it wasn't until about a year into my college education that I decided that nursing would be what I would go into.

Paige Nolan [8:41 - 8:46]: And what was it like to be a nurse in those early days, your first days on the job?

Monica Bell [8:47 - 9:03]: Yeah, I remember my first rotation as a nurse's aide. Of course they put you in the nursing homes. And I just loved it. I loved my conversations with the patients. It was really connecting with those patients. I just loved it.

Paige Nolan [9:03 - 9:26]: Yeah, that does not surprise me. I can imagine you sitting there and listening well, and also listening. I mean, you and I have talked about that as a theme in your practice, and we'll get more into how you started your practice. But I love hearing that you knew or you were noticing early on that you like to listen. Cause I think that's such a huge part of the art of what you do now. So the seeds were planted.

Monica Bell [9:27 - 9:36]: Yeah, well, I don't know if I knew. I loved listening at that time, but it was not in that insightful, for sure, in my younger years, but.

Paige Nolan [9:36 - 9:41]: And where did you go from there? Did you get into a general practice or a hospital rotation?

Monica Bell [9:41 - 9:56]: My first job was a nursing assistant in a rehab facility, which, of course, I loved stroke victims and spinal cord injuries and loved that. But my first job out of nursing school was in the operating room as a surgical nurse.

Paige Nolan [9:56 - 10:15]: Take us through how you decide to get into hormone health. So your base is western medicine. You're educated, you're getting all this insight into patients. What are you learning about patients that intrigues you and leads you to pursuing this, what you've done now, which is open your own practice.

Monica Bell [10:15 - 10:36]: Yeah. Well, after nursing school, I decided I had my babies and then went back to school to get my nurse practitioner and felt incredibly selfish to do that at the time. But I really wanted to continue my education. And, you know, my husband was like, well, I don't really know why you'd want to do that. Isn't, you know, being a nurse good enough?

Paige Nolan [10:36 - 10:36]: Yes.

Monica Bell [10:36 - 10:58]: Again, going back to school really loved connecting with patients. But during my nursing school or during my nurse practitioner school, my mom passed away of a heart attack at age 61, which then led me to wanting to work in cardiology. And I was lucky enough to get a job in cardiology. And right after.

Paige Nolan [10:58 - 11:02]: Was this while you were still in school, did you have the job in cardiology?

Monica Bell [11:02 - 11:35]: No, I just did my last year of training with them while I was in school, and then they offered me a job after I finished schooling, which I was super grateful for, and, of course, wanted to learn everything I could about cardiology and what could I have done to help my mom? And how can we prevent this from happening to other wonderful women and men, of course, too. And so during that time, it really wasn't the preventative medicine that I was kind of hoping for. And I think that was my true guiding light through school, is wanting to prevent illness.

Paige Nolan [11:35 - 11:36]: Yeah.

Monica Bell [11:37 - 12:12]: Instead of. We were doing a lot of band aid health. And I think that's what modern medicine as we know it is excellent at emergency care and, of course, sick medicine and taking care of when you are sick, boy, we can get you better. But is your quality of life better? How are we going to prevent this heart attack from happening in the first place? So not a lot of teaching for people either. Like, what was a good lifestyle? It was more, take these medicines, be compliant. See you in a year.

Paige Nolan [12:12 - 12:19]: Yeah. As you're experiencing those conversations, is it in the back of your mind, like, I would do this differently?

Monica Bell [12:19 - 13:03]: No, not really. I think in the back, what was going on at the time, too, is I would have. I remember one patient coming in and asking me, she was on hormone therapy, and it was our practice at that time to tell people that they were at a higher risk of heart attack and strokes with hormone care. And she said, well, I'm not going off my hormones, but tell me the safest hormone. So went back, started researching on our resource pages, up to date with the other cardiologist, and kind of came out and say, hey, well, there are some safe options to hormone therapy. So of course we told her those options, but it got me thinking, like, well, maybe we don't have this story, right?

Paige Nolan [13:03 - 13:04]: Yeah.

Monica Bell [13:04 - 13:47]: You know, about hormone therapy. And then at the time, I was also working at the malay free clinic and seeing a lot of middle aged women who were struggling, like, oh, my gosh, my skin is so dry, or, I'm depressed. And those are the compliments, the complications that they were telling me or the complaints that they were telling me, they weren't really severe. But then once I started thinking about menopause and what were the symptoms of menopause? I wasn't in menopause at the time and started asking them, well, wow, what is your intimacy? Like, how is your vaginal health? How is your mood? Then they just started unraveling. It's like, oh, my gosh, you don't need to put more lotion on. You need hormones.

Paige Nolan [13:47 - 14:00]: Yes. And when you started seeing that, was there a way to prescribe hormones to them in that current position or did you have to leave that position and actually go start your own practice?

Monica Bell [14:01 - 15:11]: Yeah, certainly not in cardiology. That wasn't our place. But in the malay free clinic, I was starting to learn how to, but again, I had no idea how to prescribe hormones at that time. It's something we certainly never talked about in our schooling in my nurse practitioner school. So just by doing my own research and learning. And then at the same time, my husband came to me and said, I think I need testosterone therapy. And I was like, well, that's going to give you a heart attack. We don't do that. And then of course he goes, no, really look into this. I think you really need to check this out. And so I started reading it, and then along with all the women I was seeing at the free clinic and then also in the cardiology clinic and just starting asking not better questions, just different questions. Right. Are you having erections? Are you able to have intimacy? Are you able to, you know, are you having hot flashes and night sweats and poor sleep? So it was through that that I was, started doing research, went to classes, started going to all sorts of hormone conferences. And then, of course, when I would go to a hormone conference, I would come back and tell some of my colleagues or friends what I was learning and of course, get a lot of pushback at the time, like, what are you doing? Why would you do that? We don't do hormones.

Paige Nolan [15:12 - 15:19]: Why is there that battle between that push pull, that tension that you're describing? What is that about, do you think?

Monica Bell [15:19 - 15:57]: For the most part, I think we can say the typical things like, it's what we learned, and it's hard to unlearn what we've learned. I remember asking another cardiologist, like, wow, this guy's on testosterone therapy or this woman's on hormone therapy. And then and discussing their case, I was like, oh, well, we don't do that. But I didn't ask them, well, why don't we do that? Yeah, how do we know that's true? Yeah, you know, it was just more of what they said and who they were was undetermined, other than, you know, the women's health initiative, which we could, you know, which caused all sorts of damage to the hormone therapy world, especially for women.

Paige Nolan [15:57 - 16:20]: Yeah, maybe it's fair to just in your summary, I know there's a lot out there right now, a lot of content out about the women's health initiative, but in your mind, will you give us, for the listener who might be unfamiliar with that, you know, the research that came out, will you give us a summary of how that kind of colored hormone replacement therapy.

Monica Bell [16:20 - 16:48]: Yeah. In 2002, the Women's Health Initiative came out, and then it, the study was women on hormone therapy, and it was abruptly stopped due to concerns about breast cancer risk. And then one arm of the study was stopped, and then the other arm of the study was stopped later on for risk of stroke and heart attack. Of course, by 2006, most of the findings of that study were found to be very biased and, you know, they were mostly retracted.

Paige Nolan [16:49 - 16:49]: Yeah.

Monica Bell [16:49 - 17:36]: So, but of course, in 2002, what made the media was hormone therapy causes cancer. Stop it. I remember the Time magazine cover was that it was just very sensationalized. And I think it's easy to say things that are bad with this new weight loss medicine. Ozempic people are like, oh, it's terrible. And if we had one study that came out that showed some negative harm, that may stop this whole industry itself, too. But that's basically what happened in 2002. Prescriptions were on the rise for hormone therapy. Women were finding that this was incredibly helpful. And then that study came out and, boy, just slammed it shut without asking a whole lot of questions. Yes.

Paige Nolan [17:36 - 17:40]: Do you feel like the research now is asking different questions?

Monica Bell [17:40 - 17:41]: Yes, definitely.

Paige Nolan [17:41 - 17:42]: Yeah.

Monica Bell [17:42 - 18:25]: And I think we're also finding, able to look at that data better and find, and again, finding what the women's health initiative did tell us is that synthetic progestins aren't necessarily the best thing. And there's other options out there. And again, there's so many wonderful podcasts right now talking about the complications of that study. And I think probably one of the best resources that I have about and what I tell my patients to read if they have questions, and because that's still lingering, that fear. And, you know, and I'll certainly hear even patients come tell me that their primary care are quoting the women's health initiative, which shouldn't be quoted when you're discussing hormone therapy.

Paige Nolan [18:25 - 18:25]: Yeah.

Monica Bell [18:25 - 18:30]: You know, it's just, it was a billion dollar study gone. Not great.

Paige Nolan [18:30 - 18:31]: Yeah, yeah.

Monica Bell [18:31 - 18:32]: It wasn't well done.

Paige Nolan [18:32 - 18:46]: Yeah. And what role, now that you're in your own practice, what role does research play in the, these conversations that you have with patients? Tell us about that moment when the patient comes in and you're trying to find the right treatment.

Monica Bell [18:46 - 19:03]: Yeah. So, I mean, I think, you know, and this kind of goes back to me even starting my practice because I came from a very traditionally grounded, rooted background, very vetted in evidence based medicine. I mean, every paper you did, every suggestion you had have to be based on evidence.

Paige Nolan [19:03 - 19:04]: Yeah.

Monica Bell [19:04 - 19:42]: So it took me probably two years of reviewing the literature and going back, because, again, I would go to these conferences and say, oh, wow, look at all this evidence for hormone therapy. And then I'd come back and tell some of my colleagues, and they'd say, oh, that's not right. That's bad. It's like, oh, my gosh, then I'd be scared. And I go back into the research, and I'd go back and I was like, okay, no, we have this story wrong. We have this story wrong. I'm reading the research articles and randomized controlled trials and seeing the evidence. So I was able to ground myself because I was scared to start a hormone practice, you know, based.

Paige Nolan [19:42 - 20:33]: Because I understand why. Yeah, it's against the grain, and there's a lot of energy and anxiety and fear around it, which is one of the reasons I wanted to have you on, is because I feel like you represent the conversation around it from a little bit of a, you know, a perspective that's above the fear and the, we can really get into the weeds around. We have to go through menopause, and it's going to be terrible. And I find when what I've learned from you and hearing about your practice is getting above it into wellness and asking better questions, and you seem to really have that balance of, you're based in research, as you said, in evidence, and also you're willing to challenge some of it and follow your intuition.

Monica Bell [20:33 - 21:21]: Yeah, because a lot of the things that they, I mean, really, the Women's Health initiative is the cornerstone of negative information on. There's probably maybe five articles that kind of show some negativity, but a lot of them are, you know, not randomized controlled trials or association studies. They're kind of grasping at straws to show some negativity. But the vast majority of the evidence is very, very positive. And so now, can we say it was 10,000 women? No, but, you know, when you look at, as in a collective, it's incredibly powerful with the risks are very minimal. And I think that's just what frightens women, is they'll hear the risks and they will say, well, you know, the risks of hormone therapy, it's like, well, let's talk about the risks of not doing hormone therapy.

Paige Nolan [21:21 - 21:21]: Yeah.

Monica Bell [21:22 - 21:33]: Yeah, I think those are, you know, and it's the weights and the balances and, and that's where I feel like, as practitioners. And we have to tell the patient, here are the risks, here are the benefits.

Paige Nolan [21:33 - 21:33]: What.

Monica Bell [21:33 - 21:37]: And then, you know, intertwine that with what are their goals?

Paige Nolan [21:37 - 21:38]: Yeah.

Monica Bell [21:38 - 21:49]: Do they have a goal to have better intimacy with their partner? Do they have a goal to sleep through the night? Do they have a goal to have mood stabilization?

Paige Nolan [21:49 - 22:08]: I think one of the best things people can do, and you'll have to tell me if you agree with this or not, but I always tell people to keep a note, you know, keep like, track your physical sensations, your experience, just like you would if, if you wanted to lose weight and you were going to try a different nutritional path. You would start by writing down everything you eat.

Monica Bell [22:08 - 22:09]: Right.

Paige Nolan [22:09 - 22:58]: You know, I tell because I find that even I have two teenage daughters who are 17, and I was talking to them about their health and their cycles. We were just on vacation together and just starting early. Like, no one talked to me about that. Young, you know, like, notice how you feel. Notice how your body moves through a cycle so that you can start to understand your own rhythms and patterns. And then I hear what you're saying is having a goal, which is, again, I didn't know to do that, but I think the sooner we can do that and no matter how old you are, but just if that is something that, if nutrition and wellness and feeling good is something that's on someone's mind, it's like, get curious about it and write it down so that when you go into your practitioner, you can say, this is what's happening.

Monica Bell [22:58 - 23:45]: Right. And I think we can get so sidetracked by their agenda. What is your practitioner's agenda for the day? Is it just a wellness check instead of, and then of course, getting discounted for wanting those quality of life be. The thing I would tell patients too, is if you have a concern, and it is a quality of life that concern, better sleep, better mood, better intimacy, that it's okay and that you be listened to and it should be addressed. And there are things that we can do to address that instead of saying, that's normal, that's menopause. This is how women age. Yes, and men age, you know, because they certainly have their issues as well.

Paige Nolan [23:45 - 24:32]: So what do you see in your practice? What keeps you motivated? Tell me the before and after of some, either men, women, any patients who have really inspired you that keep you in this, what I consider an art. I always tell you this. I think it's an art more than a, you know, just do this and this equals this. So I think that's another reason why people get intimidated by it or mystified by it because it's nuanced. But it starts with being observant and introspective, tuned into your own experience, and then, as you said, advocating for yourself and deciding that you deserve to feel good. It's really hard to fight that status quo and say, this is just how it is. This is how it's going to be.

Monica Bell [24:32 - 24:35]: Right? Go home, start eating better, start exercising.

Paige Nolan [24:36 - 24:44]: So you're living through these moments of it can be better. Can you tell us some of those? Tell us about the betterment that can happen in people.

Monica Bell [24:44 - 24:47]: Oh, my gosh. Well, first of all, I feel like I have the best job ever.

Paige Nolan [24:48 - 24:49]: Oh, I love hearing that.

Monica Bell [24:50 - 26:07]: The work is just humbling, and it's just so powerful and simple all at the same time. Right. And usually people come to me after they've been to their primary care, after they've been to an acupuncture, wherever they've gone to a variety of practitioners before they end up on my doorstep, unless they've had a friend say, oh, you should go see Monica. But most of the time, they're pretty. This is my last hope to feel better, and I'm not feeling well. So a lot of women and men come in at that stage of their life. They're not sleeping well, and, of course, having many typical symptoms of hot flashes and night sweats. But, you know, some of my favorite stories are women who come in for maybe one thing, like when a patient came in and said, oh, I'm having a little bit of vaginal dryness, and I'm a little cold at night, and I'm a little. But everything else is fine, and I'm doing great and I'm feeling great. But, you know, maybe I could do better. And then you start hormone therapy and they'll say, wow, I didn't know I could feel so good. Yeah. I didn't know how bad I was feeling until I felt good again.

Paige Nolan [26:07 - 26:33]: Yes. And it's finding that treatment, that's the balance between the different ways that all those symptoms interact. Combined with labs, which is a big part of your practice, and combined with listening, is that how you see it, where it's all these different data points coming together in a way that's different than speaking with a general practitioner or general physician?

Monica Bell [26:33 - 27:06]: Yeah, I mean, we certainly have. We have patients fill out a pretty big questionnaire before they come in. So we are asking things like, have you had loss of muscle? Little things that maybe they hadn't thought about, you know, mood irritability cold, dry skin, and, of course, vaginal dryness. And all the typical symptoms you'd think about in a postmenopausal hot flashes, you know, headaches filling past their prime brain fog. So we get that list. And so I'm primed when they come in to know what their suffering looks like.

Paige Nolan [27:06 - 27:07]: Yeah.

Monica Bell [27:07 - 29:23]: And then what their pain points are. And then, of course, we do labs and we look at their labs and then listening how they put that together. When did these symptoms first start? If they started in your mid forties, that's most likely a hormonal problem, and we can address those. Now, if they've had anxiety, depression, poor sleep since they were a teenager, probably not something I can really help them work on, but I can help set expectations at that point, too. And what are realistic expectations of the hormones combined with what they are? So we look at their labs, we look at their story, and then just listening to how they put that together and listening to what feels right in their body, and then, of course, telling patients the options. And I think that's a big part of what my job is, is to be educated in every type of hormone possibility. Explain to them what are your risks and benefits with this particular hormone therapy. And then it's their job to tell me which one feels like it's going to fit right for them. And when they do that, usually they'll say, oh, a patch feels better to me or a cream feels better to me. Or other times I'll say, I really think you should do your hormones vaginally because you're having such dryness. That would be my first recommendation. Or I would maybe do this therapy because it's the best for libido. But again, it has to be a shared decision making. I love that statement. I just, you know, it has to be shared, because if I'm talking to you, Paige, and I say, okay, I want you to do. This is the only hormone that I believe in. You know, this is my favorite, you know, because there are certainly practitioners that way. This is the only hormones that we do, or this is the only way I'm going to do them. I say, you're going to do that, page, and if it doesn't feel right to you, there's no way you're going to be compliant. You know, you may try it, but the likelihood of you being compliant and getting the best results out of that medication are pretty weak.

Paige Nolan [29:24 - 29:24]: Yeah.

Monica Bell [29:24 - 29:50]: So you have to feel, we have to listen to our patients. We have to listen to what feels right to them, because, again, you know, your body and patients know they're. Even if they're not. Even if they're. Like you mentioned. And I think this is the way I was when I was younger, too. And I love that you're teaching your girls to be more connected with their bodies, but. And a lot of women are not in tune with themselves, other than they know they felt terrible.

Paige Nolan [29:51 - 29:52]: Yes.

Monica Bell [29:52 - 30:14]: But they will have an intuitive sense, what feels right to them. And, you know, and that's. I try to not be as biased, of course. You know, I'll say, okay, we don't want you to use synthetic progesterone because that increases your risk of breast cancer. So I don't prescribe that one. But all the rest, the risks and benefits, the risks are really minimal.

Paige Nolan [30:14 - 30:15]: Yeah.

Monica Bell [30:15 - 30:24]: Even premarin, which is pregnant horse's urine, is not, you know, it's not bio identical. Right. So it gets a bad rap, but it's still a pretty good hormone.

Paige Nolan [30:24 - 30:25]: Yeah.

Monica Bell [30:25 - 30:42]: So. And of course, you know, you have to. And I rarely prescribe that. I don't think I've only prescribed that once in my practice. But again, we have to listen to the patients and kind of try to put that all together. What are their goals? How do they feel about it? And being educated to the types.

Paige Nolan [30:42 - 30:54]: Yeah. It's so powerful to think of it that way and to offer that up to people who are listening, because I think just as you're describing listening to the patients, we have to listen to our bodies.

Monica Bell [30:54 - 30:54]: Yes.

Paige Nolan [30:55 - 31:46]: And you're describing that we intuitively understand our bodies. And I agree with that. And also, there's a way to get more conscious about it. You know, there's a way to get more intentional about it. And I think as women, we're just not socialized to say, is this true for me? You know, that's not the earliest messages we get are more about caring for others, you know, and putting others needs before our own, to the point where I would describe myself as completely self ignoring, you know, like, when my kids were little, this is such a silly example, but, like, I would always be holding my pee. Like, I would never go to the bathroom on time, you know, which is actually really unhealthy for you. But I would only go to the bathroom when it was, like, right. For everybody in the family for me to go to the bathroom. Maybe that's an extreme case, but I know that there's women listening who can relate to that.

Monica Bell [31:46 - 31:46]: Yeah.

Paige Nolan [31:46 - 32:17]: You know, and it's just the simplest switch, but it's so difficult to challenge your autopilot. And to say, oh, I have to take care of myself. I have to eat first, or I have to. I mean, so silly. It's like that airplane, you know, put your mask on first. But I think why people use that analogy so often for women is because it's so instinctive. It just drilled into us to put the mask on other people first.

Monica Bell [32:17 - 32:18]: Right.

Paige Nolan [32:18 - 32:46]: And so I think a lot of your practice and you educating your patients is about that, like tuning in, becoming an advocate for your own health. What do you feel like? Is wellness like now that you've heard all these different symptoms and you've seen people get better and you're clearly inspired by that? Your face lit up when you were talking about how much better, how people can feel good in a way they didn't think was possible.

Monica Bell [32:46 - 32:47]: Right.

Paige Nolan [32:47 - 33:03]: So now that you have all that, you know, experience, professional experience and personal experience in your own life, what can we do to stay well? And what is wellness, in your mind, the healthiest people that you know, or the healthiest version of yourself? What does that mean? What does that look like for you?

Monica Bell [33:03 - 33:08]: Yeah, I mean, I think wellness is different to. That's a very individual question.

Paige Nolan [33:08 - 33:09]: Yeah.

Monica Bell [33:09 - 34:08]: You know, wellness to me is being able to go on our annual girlfriend Teton hike, you know, and I gotta be stay up or else I'm gonna hear it from them, you know, so. And go backpacking with my boys and, you know, that's wellness to me, is staying fit enough to live, you know, a vital life for what I define as being vital. You know, I think my sister has a different. She has a different vision for herself and patience, too. And I think we need to also be respectful and so, you know, trying not to be judgmental of someone's wellness path. What is their idea of wellness? Is it, you know, continuing to golf 18 holes, you know, into their nineties, or is it to just be present with their grandchildren or, you know, very sedentary life? And that's fine, too.

Paige Nolan [34:08 - 35:11]: Yeah, it's so true, and it's so hard. The closer you are, whether it's a child or a young adult or a spouse, the closer you are to that person. It's like, oh, they're doing that thing. You know, I work with a lot of couples, and it's like, oh, he has that habit, or she has that habit, and it's giving people the space and knowing that you can only really have your own experience of wellness in your own body. And it's that boundary of, like, how much can you impact or influence somebody else's choices. I've told you this before, but Boyd is way healthier in his diet than I am. So I'm eating chips and salsa, and I consider the salsa like a vegetable because it might have tomatoes in it. And he's like, oh, my gosh. And he gives me a lot of space, which I'm so grateful for, but I still know how he feels and he will support me when and if I decide to eat better. I mean, I don't eat terrible, but that is definitely an area that I could improve upon. Do you have an area in your own life where you feel like you could be healthier and how do you handle your limitations of your own wellness?

Monica Bell [35:12 - 36:18]: Yeah, absolutely. I mean, I think same as you, Paige. My diet is, again, you know, I went from, you know, mentioning that I had a coke and bag of chips in a candy bar most of my life every day, but. And I think I drank coke until mid thirties, you know, so same. Yeah, I think, you know, diet has been a struggle for me, and I think it's just, you know, maybe a product of what I grew up with, too. I mean, we were a processed food family and easy foods and have a super, super sweet tooth, so. But it's funny. I'll tell people that know me now, and they're like, what? I can't believe that you're like, you're always bringing a salad to lunch and leftover vegetables. But I still view myself as having this diet just needing to be fine tuned. I heard a nutritionist say one time that when she changed to be vegan and someone asked her how long it took her to become a vegan, and she said, seven years. And I really like that answer because, and that's kind of my strategy, is I look back, okay, you know, when I was 30, I was eating a bowl of cereal and a coke for breakfast.

Paige Nolan [36:18 - 36:22]: I get it. I get no judgment from me to.

Monica Bell [36:22 - 37:38]: Now trying to eat a very, you know, I would say, I think most people would consider I have a very, you know, healthy diet. But again, it's always a struggle to make those right choices and try to think, okay, my goals are, and I know I need to make sacrifices today to get to tomorrow to prevent chronic illness. Right? So we have to make that payment today, and we have to make those better choices today. So I, you know, I'll set a mantra. Like, last year, my little diet mantra was greens and beans. So I was like, every day I want to try to eat a cup of beans and a cup of greens, so. Or two cups of greens. So that was something I tried to really focus on. And when I was doing my little journaling in the morning and thinking, okay, how am I doing this week? Well, I've done terrible. I haven't done it at all. So maybe next this week I'm going to be better. And so I don't definitely, I try to definitely, I encourage this with my patients too, to just not really get down on themselves when they haven't committed fully to something. Just better is better. Small changes today will be, you know, if you can make a small change every year, it's going to be have a profound, you know, ten year outlook. So do you talk to people about.

Paige Nolan [37:38 - 37:45]: That as it coincides with their hormone replacement therapy or with their weight loss program? Oh, absolutely, yeah.

Monica Bell [37:45 - 39:25]: I mean, it has to be part of the conversation because, you know, we cannot out hormone lifestyle or we will just have different expectations. Like, okay, you want to gain muscle mass? Well, I can give you testosterone and estrogen and progesterone, which will all help the muscle function and muscle building. But unless you're feeding it and exercising it, it's not going to help that much. You know, what we do outside of hormones is probably at least 80 and you might even argue 90% of it. You know, so what we're feeding and how we're moving our body, you know, we need to feed. This is the way I think about it for myself too, and tell my patient, we need to be feeding our body fuel. That is good fuel and high quality fuel. And as we get older, we just, you know, like we see our kids and I think they could probably take a hamburger and french fries and get every little bit of nutrients they need from that. Just because their bodies are so young and able to kind of distill that nutrition down. Their bodies are very efficient at that, taking what they need, getting all the vitamin A or whatever they need out of that happy meal. But as we get older, our bodies are less efficient and so we just need to be more thoughtful about what we're feeding ourselves. And so just trying to feed it more whole foods and natural foods. And I think we can. This is one peeve I have in the wellness space is you have to be keto, you have to be vegetarian, you have to be something. It's like we don't really have to be any of those things. We just try to do better.

Paige Nolan [39:25 - 39:27]: Yeah, better is better.

Monica Bell [39:27 - 39:28]: Yep.

Paige Nolan [39:29 - 39:56]: I want to go back to what you said earlier, that your mom passing of a heart attack in her early sixties inspired your career path to some extent. Do you feel now, at this point in your career, having gone on your own, do you feel like you've made that impact that you have sought to make? Do you think your mom would be proud? Are you still inspired by women's health in this deep, connected way to how it's impacted you really personally in your life?

Monica Bell [39:56 - 39:58]: I know she would be so proud of me.

Paige Nolan [39:58 - 40:00]: Yeah, I know she would be, too.

Monica Bell [40:00 - 40:56]: Have I made an impact on patients? You know, I don't know. I don't know if that from especially a cardiovascular standpoint. I mean, I see markers, you know, it's. I see, you know, when we follow their blood work, their blood sugars get better, their cholesterol gets better, their inflammation markers get better, which we know all reduce the risk of cardiovascular events. And again, the research shows that if we do start hormone therapy early on, you know, within those first ten years of menopause, the risk of cardiovascular events is definitely significantly less. That's my hope, is that we have, you know, I have made an impact on educating women and, you know, I think just educating women, too, when they come into the office and, you know, I always ask symptoms of heart disease in part of my assessment because. And to educate them that it is the number one killer of women.

Paige Nolan [40:56 - 40:57]: Yeah.

Monica Bell [40:57 - 40:58]: Not just.

Paige Nolan [40:58 - 42:11]: This isn't going to surprise you, but I also think of it symbolically, you know, because that's often how I think. But heart health is also just joy in life and happy health. You know, are you experiencing feeling good? And is your heart beating and upbeat, you know, like, uplifted? And I think of your practice and how you stand for optimal health and wellness as contributing to that conversation in a person's life. And so when I think of it that way, I love the way that you framed it around evidence, and it's beautiful. And also it's like having that conversation with yourself and then that leading you to pursue either hormone replacement therapy or any kind of wellness treatment that's maybe outside of the narrow conversation that you've had about your health can contribute to you feeling better in life and having a more. I think you used the word vital earlier, you know, this vitality around you, which certainly impacts people's overall experience, which is what it's all about.

Monica Bell [42:12 - 42:46]: Yeah, it's a wonderful. And I think, you know, in empowering patients that they have the ability to not be destined to their family history, if they do have a big family history of heart attacks or heart disease, that they are not destined for that if they course correct, you know, if we can start living a little bit better ways and not huge changes, just, I think that's a big take home for a lot of patients that they can be just very minute changes that have profound effects.

Paige Nolan [42:46 - 42:57]: Yeah. You know, what would you say to someone who's starting this journey? You and I have talked about this, but there's so much out there about menopause. Menopause is getting its day in the sun finally. This is a good thing.

Monica Bell [42:57 - 42:59]: That's a good thing.

Paige Nolan [42:59 - 43:15]: We met years ago and it just wasn't like this. And you had started your practice, you were already on this topic, and now it's like, it's everywhere. People are talking about it. It's getting funded in a different way than it's been funded in the past.

Monica Bell [43:15 - 44:51]: Thank goodness. You know, I'm so glad. So many big voices, you know, Oprah, Maria Schreiber, like all these wonderful, and then, of course, all the new books coming out from physicians about it and, wow, it's just really powerful and wonderful and to kind to, of course, have people come around to your way of thinking. It's like, yeah, I've been here waiting for y'all, and I think about my mentor, Amartya Scoville, nurse practitioner, who I learned from early on. Boy, she was doing this 20 years ago. I mean, wow, how brave she was to start practicing in that time. But, yeah, I'm so glad it is getting its day in the sun and I hope it continues. It is still frustrating that I still have patients coming to me who've gone to see their primary care and their primary care is dated. Untrue facts about hormone therapy, like, oh, this hormone therapy is going to give you a heart attack and this hormone therapy is going to cause breast cancer. It's like, well, okay, let's reframe. Let's go back. Let's look at first of all, where are they getting the data from? But it's changing. I do see a lot less practitioners giving us a hard time. And especially when patients go to see specialists either, you know, their neurologist, their pulmonologists, urologists, those all seem to be much more supportive of the hormone therapy and understand its positive roles. And so I get a lot less pushback from those specialties than the primary care practitioners.

Paige Nolan [44:51 - 45:02]: And do you feel like the starting place for someone starting to address this in their life is reading, is listening to podcasts I know you and I talked about earlier. It's listening to your body first.

Monica Bell [45:02 - 45:48]: Yeah. I mean, yeah. And I definitely, you know, seeking out a knowledgeable hormone practitioner in their area. And that can be, it's not always an endocrinologist. I don't think there are actually any endocrinologists in our valley that do hormone replacement therapy. You know, a lot of nurse practitioners, but just finding someone that resonates with you and, and someone who will sit down and educate to try to have the most unbiased view as possible on all the hormone therapies. So, yeah, seeking out someone who's educated, and again, educated not in their school system, because that hasn't happened to any specialties. Even obgyns don't get educated to hormone therapy or very limited education to their hormone therapies.

Paige Nolan [45:49 - 45:54]: Yeah, I bet that's gonna change with all this. I would have to imagine this next generation.

Monica Bell [45:54 - 46:52]: Absolutely. It has to be. Yeah, it has to be. But I, you know, I don't know if it's part of the curriculum quite yet. It's still, that's still lagging. But I would suspect within the next five years it's definitely going to be part of the curriculum. We can hope so. And then we have more options for women to seek. And so I think sometimes dispelling the myth, if women have fears about hormone therapy and breast cancer, estrogen matters, is a wonderful book by Doctor blooming, who's an oncologist, and Carol Tavrs, I believe is her name, a PhD psychologist, kind of how did she wrote mistakes we've made, but I've never made them. How hard it has been to revert rethinking about hormone therapy. That was a great book. And of course, there's so many new hormone books out, the new menopause by Doctor Haver. So there's lots of good ways to get educated. I know, and we certainly have a blog with lots of information.

Paige Nolan [46:53 - 46:54]: Yeah.

Monica Bell [46:55 - 47:06]: And all the podcasts right now, I just pretty much loving, just soaking up. I think it's really fabulous. So you become educated of what's acceptable.

Paige Nolan [47:06 - 47:31]: And what options there are and asking better questions. It seems like that's been a big something I've learned from you. And I think you asked them of yourself and of the research and you dig in and it's a good model. And I know you've spoke to it today in this conversation of making sure that we're reflective and prepared when we go in to get ourselves educated.

Monica Bell [47:31 - 49:47]: Yeah. And I think that's the biggest thing I think, is being able to understand and stand your ground as a physician. They are sitting in a very powerful seat and I don't know if they all understand the power of their position, I'll hear patients say, oh, I can't do a hormone therapy because one little thing a practitioner said, or like, oh, you shouldn't do that because you have a family history of breast cancer. Well, that's absolutely no contraindication at all to starting hormone therapy. But it's one thing that they said. It may have been in passing and they may have not even known the evidence behind what they said, and they're in such a powerful position. So again, I think just as a patient going into your primary care, and that's a great place to start, you know, just asking your primary care. And now if they discount you, definitely keep going because there's certainly options out there for you. And don't be fearful of what they say. Obviously, we want to, I'm very respectful to primary cares and absolutely essential to our healthcare. But if they mention hormone therapy and you can say what I would educate women to is ask them, how do they know what they know? If they say, well, we could start hormone therapy, but I wouldn't recommend it because the risks outweigh the benefit. I would ask the questions, what are the risks? How do you know that? Where is that evidence coming from? And would you mind sharing that with me? In my practice I have on file a big stack of articles because that's what's required of me because patients are coming from this scared view of hormone therapy. So I have to share data now with them to suggest that. Now if you go to see your cardiologist and they say, okay, we're going to start you on a stat and we're going to start you on blood pressure. Now some patients will ask, well, tell me, how do you know that? And is this going to really help me and what are the risks and the benefits? But they're not going to ask, they're not going to send you an article or most patients don't say, oh, will you send me an article that supports what you say?

Paige Nolan [49:48 - 49:48]: Yeah.

Monica Bell [49:48 - 49:57]: Because it's just so common. Right. Like that's such a common medication. So I just think, you know, understanding that your practitioner doesn't know everything.

Paige Nolan [49:58 - 49:58]: Yeah.

Monica Bell [49:58 - 50:23]: And that's okay. And we have to, as practitioners, we have to be okay. Same. We don't know. We don't know. But to say things that they don't, you know, like, oh, I wouldn't, that's too risky. Ask, to ask what are the risks they're thinking of and how, where is this evidence coming from? And if they say the women's health initiative, you can say, okay, well, they're definitely not current.

Paige Nolan [50:23 - 50:24]: Yeah.

Monica Bell [50:24 - 50:41]: With the most recent literature. And so then you can say, okay, well, you know, if there's any new evidence, could you share that with me? And again, I've been asking patients this and other practitioners and still haven't seen anything that would change my mind on hormone therapy, you know, so.

Paige Nolan [50:41 - 50:44]: Yeah. Oh, I'm so glad that you mentioned that.

Monica Bell [50:44 - 50:45]: That's.

Paige Nolan [50:45 - 51:21]: I mean, if I would have heard that younger, you know, it's just, it's, again, it seems obvious, it seems simple, but we're not, we're not told those messages early on, and I love hearing you say that. And it's something that I think I can do a better job of. And I know that it's just a great invitation for all of us to know our own power and to advocate for ourselves and for our children and to ask questions that maybe we haven't heard someone else ask, but that question is inside of us and to trust that that needs to be pursued.

Monica Bell [51:21 - 51:37]: Yeah. And I would say if someone tells you something that just doesn't sit well with you, that's a good reason to investigate. Like, wow, that didn't sit well with me. I'm going to look into that further and try. Yeah. And trust just not to get too woo woo. Yeah.

Paige Nolan [51:38 - 52:23]: It's not too woo woo. We could go way more woo woo than that, so don't worry. Yeah. I love everything you've said that was, that's so powerful to ask better questions. And that last thing that we just talked about, I'm really going to take that away. But let's go to intimacy. Something I've learned from you is your passion for sex health. And so I want to just make sure to include your perspective here and get a little bit of your point of view around this important topic. And again, it goes back to what we talked about earlier, like, oh, this is just how it is. This is how it's going to be for the second part of my life. Can you speak to that passion of yours and how you've been able to help people and what we can do to have healthy sex lives, especially in the second part of our life?

Monica Bell [52:23 - 53:14]: Yeah. And I think this is something, I mean, I feel like I learned something new every day from my patients, and this is something I think my patients have really just opened my eyes to. I mean, I've always enjoyed sex, and, you know, sex and intimacy definitely got better for me personally when I started hormone therapy, so it was definitely a personal journey for me, too. But it also is really exemplified and I accentuated in my patients. Just because it comes up is so often in my conversations with patients about the intimacy and just how when they started hormone therapy, because we often start testosterone in our therapy and for men and women, and when we've seen, and when I've seen couples, when they come in together. Now, most couples who come into my office have pretty good relationship because they're coming together.

Paige Nolan [53:14 - 53:14]: Yeah.

Monica Bell [53:14 - 53:24]: You know, so, you know, they're on good terms. But some of my favorite stories are couples after we start hormone therapy. And they say, I never knew I could be connected this way.

Paige Nolan [53:24 - 53:25]: Yeah.

Monica Bell [53:25 - 53:44]: And it's even better when I was younger. And our connection, of course, just from the time of the marriage together or their partnership together has continued to grow. And now with this added intimacy, it's just, I mean, it blows my mind and it's so fun to see.

Paige Nolan [53:44 - 53:49]: Oh, yeah. And it's so, it's like vitality. Yeah. Like the light in someone's eyes returns.

Monica Bell [53:49 - 54:03]: Oh, it is. And it's just so lovely. And, you know, I had one male patient come to me, and again, they had a beautiful relationship before, but now with them both being on, he was like, I didn't know our relationship could get better.

Paige Nolan [54:04 - 54:05]: Yeah, but it is.

Monica Bell [54:05 - 55:03]: And I see her being more vulnerable with me. And this is a marriage you would have classified as a plus in the beginning. And now she's more vulnerable with him. I thought, oh, my gosh, this is just so beautiful. And other couples, you know, I saw a patient last week and she's like, I can't believe what you talk. You've got my husband talking about, you know, I'm so glad he's talking to you about his sexual function because of course she's like, wow, that's just made our intimacy so much better and so glad that he has someone to talk to about intimacy issues. And I think it's, again, no one's asked those questions. You know, in our clinic, we're asking, you know, how are your, how is your intimacy? Are you satisfied with your intimacy? Are you guys balanced in your intimacy? Yeah, that's a big, important part as well. But it's just so beautiful. And you see this in all couples, two women that I see, their relationship just completely blossomed when we got them on the same intimacy level.

Paige Nolan [55:03 - 56:12]: Yeah, I love that. It's inspiring, because when you hear hormone replacement therapy, oftentimes you'll just think of a woman's life or you'll just think of menopause. Especially now that the conversation is getting the spotlight. And I love how you're bringing it back to relationship and connection and this aspect of life, you know, hormones plays an essential role in this aspect of life and especially in these, you know, long term partnerships and marriages. I mean, sex is the only thing you do with your partner. You know, you can have a deep conversation with a friend, right. You can do a project with a friend, but, you know, in a monogamous relationship, you're having sex with just one person, your partner. And it's so special and it's so important to your connections. So I'm glad that you're, you're bringing us there. That for listeners to realize that hormone replacement therapy and this conversation around your health impacts more than just women in menopause. It's, it's a conversation for everybody, and it's a really important conversation, especially in, in the middle of your life, you know, when things are starting to change.

Monica Bell [56:12 - 56:57]: Yeah. The relationship just, and something about that skin to skin contact, you know, we do that with newborn babies. Right. You want that skin to skin contact. Well, skin to skin contact and later in life is beautiful, too. Now intimacy looks different for everyone, and that's perfectly fine. But to discount intimacy and say, I would just make sure in all of your lifestyle experiments that you experiment with reconnecting that way, you know, and that we don't discount that and say, oh, that's what we did when we were younger. No. And it can really elevate the quality of life and the way you live in our later years. And it's just so beautiful to see and so fun to see. And I just love treating couples for that reason.

Paige Nolan [56:58 - 57:02]: And small changes, like you said earlier, small changes can have these enormous.

Monica Bell [57:02 - 57:02]: Yes.

Paige Nolan [57:03 - 57:04]: Impacts. Better is better.

Monica Bell [57:04 - 57:11]: Yep. And your life is just elevated to a new level that maybe you didn't even think it could be.

Paige Nolan [57:11 - 57:23]: Yeah. So good. Monica, I'm really, really delighted to share this conversation with people, and your voice is so calming and soothing, and I'm just so happy for people to be.

Monica Bell [57:23 - 57:43]: Able to, I could talk about this all day, every day. I really love Adam Grant's quote when he says, improve ourselves, don't prove ourselves, don't keep proving ourselves, improve ourselves. And I just love that. And I think that's where we have to come from with asking better questions. Right.

Paige Nolan [57:44 - 57:44]: Yeah.

Monica Bell [57:44 - 57:54]: Is improve. We don't stand in solid ground that, like, or in a space that you can't question yourself and others.

Paige Nolan [57:55 - 1:01:12]: Yeah. I love it. Improvement. Since my conversation with Monica, I've been motivated to consider my own wellness goals more closely because feeling better is possible. I find Monica's approach to optimal health encouraging and optimistic, and it's because she leads with curiosity rather than drawing quick conclusions. Monica has inspired me to be this way too. There's a real art to taking care of oneself, and in Monica's HRT world, there's an art to finding the right treatment. It's not a one size fits all practice. Curiosity is essential to this art. I learned from Monica that asking better questions is essential to creating a healthier, happier life. This health and wellness thing we do, it's a personal experience. We have to advocate for ourselves and stay open to the idea that we can feel better and or stay open to the idea that we can change and make choices that prevent us from feeling bad in the first place. There's so much to learn and know about what is good for the body, but without tuning in to your own body, it's just information. There's no application of it. There's no change. Monica reminds us to listen, to trust our intuitive sense of what is going to work for us. Don't try and change everything. It's about changing one small thing. It does make a difference over time, and it's so important Monica, thank you for sharing your personal story with us and your point of view in a chorus of voices all talking about hormone health. Your perspective is practical, grounded, open minded and open hearted. I feel so grateful to be alive during a time when we can talk about women's health and sex health and get better at helping all people to feel good throughout their whole lives. Monica, you and your work are part of that progress and we are better for it. To find out more about Monica and optimal hormone health, check out the show notes. As always, thanks for sharing this one with me all and I will meet you here again soon. Thanks to each of you for being here and for listening. I'm so grateful we get to share life in this way. As always, full show notes are available@pageknolan.com dot there you will find a full summary of the episode, timestamps and key takeaways and any resources mentioned in our conversation. If you enjoyed this episode, I'd love if you would leave me a rating and a review. You can do that by visiting pagenolan.com. love your reviews. Really do help people to discover the show. And if you know someone specifically who would enjoy this episode, I'm so grateful to have you all share. I'll meet you there with your friends. Lastly, if you have any questions or comments, or if you would like to share any feedback with me, please email to meet me there. I would love to hear from you. Thank you. To the team that makes this show possible. Podcast production and marketing by North Node podcast Network music by Boyd McDonnell. Cover photography by Innis Casey okay, y'all, that's it for now. I'll meet you there again soon.