My Aloof Vagina, A Cheeky Guide to Perimenopause

What Happens to Our Vaginas As We Age & What's Estrogen Got To Do (Got To Do) With It? What Happens To Our Vagina & Our Skin If We Don't Stay Hydrated? Why Is Good Circulation Essential To Our Vulva? With Guest & Pelvic-Floor Specialist Dr. Wendy Chorny

• MAV Martha • Season 1 • Episode 11

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Martha talks with the informative & entertaining Dr. Wendy Chorny about the aging vagina, what that means, why it happens & how you can sustain the hydration &  health of those delicate tissues, and:

  • What do the Lion King (and existential dread) have to do with your perimenopause experience?
  • And what’s really important about being 35 & why might you want to text your young friends after you listen to this?

Dr. Wendy is a doctor of physical therapy specializing in the treatment of pelvic pain, pelvic-floor dysfunction, perimenopause, and other disorders.  She is an educator and author, affiliated with the University of Dayton & currently doing research on Diastasis Recti in Women. She uses visceral manipulation, nutritional education, and an integrated exercise approach in her physical therapy practice. 

https://www.tiktok.com/@drwendy_physicaltherapy
https://www.youtube.com/@Dr.WendyPhysicalTherapist
https://www.instagram.com/dr.wendychorny/

Disclaimer: Though she is a doctor she is not YOUR doctor. As always, please consult a local professional for your particular medical and legal needs and circumstances

- NYT Women Have Been Misled About Menopause
- find a menopause practitioner
- What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities, and You
- Clinical Prediction Rule
- Lichen Sclerosus
- Bunnicula - 1982 TV Special

MAV TIP: Hydration is more than just drinking water. As we lose estrogen, we lose moisture!

Take care of yourself. And take care of your vagina!

Everything show related at MyAloofVagina.com

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Martha:

Hey there here's what's coming up in this episode.

Dr. Wendy Chorny:

When you have hydration in your tissues, a hydrated tissue looks younger. Acts younger. Things younger is younger. without having the proper estrogen and water metabolism, your tissues are going to act pathologically crazy, and you're gonna have frozen shoulder and tendonitis and joint pain, brain fog. I mean, it just goes on bladder infections.

Martha, My Aloof Vagina:

Yeah,

Dr. Wendy Chorny:

So plump and hydrated is the message plump and hydrated.

Martha, My Aloof Vagina:

our plumpness in our bodies. Our

Dr. Wendy Chorny:

our, it's a water loving molecule, you know,

Martha:

Welcome to the My Aloof Vagina Podcast, where we explore the distress and surprise of our midlife transitions. We take menopause seriously, but we don't take ourselves seriously. We believe that learning what to expect in perimenopause can be entertaining. It's inevitable, so we may as well equip ourselves and have a good time. I'm your host, Martha and I have a doctor on this show our first doctor, Dr. Wendy Chorny. You're going to love her. And you're going to love her approach. This is not a dry medical episode. In fact, I have been on the hunt for the perfect pelvic floor specialist to bring on the show ever since episode three, when we talked about incontinence for the first time. And she is it she's the one I needed somebody who brought authority, who knew what they were talking about. Who could talk about a lot of things. But who'd also understand that we're here to learn, but we're also here to have a good time. And we had so much to talk about and we covered a lot. A lot about women's health and pelvic floor health. What do the lion king? And existential dread. Have to do with your experience of peri-menopause. Is WW in your medical chart. And if it is. Is it time to push back? What if the medical system treated, peri-menopause the way it treats pregnancy. Is peri-menopause lowering your self esteem. And what's really important about being 35. And why might you want to text your young friends as soon as you're done with this episode? It's a lot. I know, but you'll get the answers all of them in this episode. So stay tuned. since it's going to be a lot, I want to remind you as always, I've got you. I link to everything and I mean, everything we talk about. In the show notes right there in your app. You don't have to remember the terms she mentions. You can just enjoy the show and circle back later, or visit My Aloof Vagina dot com for things we mentioned anytime. And you can also go there to find ways to get in touch with Dr. Wendy Chorney. This is her first appearance on the show, but I can't imagine it'll be her last. Dr. Wendy Charney is a doctor of physical therapy. Plus she has a lot of related certifications that elevate her understanding of women's bodies. And I've also listed those in the show notes. She specializes in the treatment of pelvic pain. Pelvic floor dysfunction. Postpartum and peri-menopause related disorders and so much more. She is a practicing clinician, educator and author. And is affiliated with the university of Dayton doctor of physical therapy program. And currently doing research on diastasis recti in women. a disclaimer. Though she is a doctor. She is not your doctor. please consult a local professional for your particular medical needs and circumstances.

Dr. Wendy Chorny:

Let me tell you some nerdy facts So we know that the Vagina and the urethra. Need estrogen. Okay. And if you've ever heard me talk about estrogen, I always like to say estrogen is a water loving molecule and it keeps things plump. So at 35, I don't care who you are, your hormones are decreasing, and your fourth and your fifth and your sixth decade of life, as you go through perimenopause, you hit your one day of menopause, and then your postmenopausal, your hormones are continuing to decrease. And as they. The water-loving molecules go away. So, Here are the fancy words. Estrogen regulates vaginal physiology. That is the smart way of saying what I just said. So then, cause you don't have plump. Yes, it's like filler, you know? So then you have a thinner mucosa. And that thinner mucosa means there's like a little cracks like the Sahara desert in your Vagina. And then pathogens and bacteria and yeast can get embedded in your skin. And then it's a whole thing. It's awful. So then because you have this estrogen issue, it's less elastic, there's less collagen, there is less vaginal rouge, which means your Vagina is not as red. And I will tell you, I absolutely see this, where, vaginal tissue becomes more white. it's kinda like a blanching, like you see on your fingertips. There's decreased blood flow, which means you don't heal as well. And this is my fact of yesterday, so, okay, as we age and we lose the estrogen, the vaginal blood flow decreases. So then of course it's gonna decrease our lubrication for arousal. I don't know why I never linked those two together in my brain.

Martha, My Aloof Vagina:

Right.

Dr. Wendy Chorny:

I mean, I was like, what? Yes, of course, of course. So, You have less estrogen and maybe you had a baby, and so then you had trauma to your pelvic floor, so your muscles are weak, your estrogen is dropping, so you have less plump tissues, and now because you're trying to not leak, you stop drinking water, but your tissues are thinner, you're giving yourself infections. Now you're gonna have to get on an antibiotic, which is gonna destroy your gut microbiome, which is already a shit show because your perimenopausal menopausal, oh my gosh. It's a

Martha, My Aloof Vagina:

And which is gonna lead, I mean, I know not everyone believes this, but leads to depression.

Dr. Wendy Chorny:

No, it's true. So on this tangent, which isn't a tangent, this is a stream of consciousness. Virginian Wolf would be very proud of us right now. So would James Joyce, you know, depression and perimenopause yesterday, the rabbit hole of perimenopause, menopause. I wanted to see the number of journal articles. What were they specifically talking about? Now I've talked about pelvic floors for almost 20 years. I actually know my pelvic floor research inside and out, and anytime a new article comes out, I'm all in it. And I know about this. Traditionally, we talk about perimenopause by itself and not necessarily put pelvic floor and perimenopause together. Uh, usually they're separate articles and they shouldn't be, but. Perimenopause comes up so much into journals with depression and anxiety. It is overwhelming the amount of research for depression and anxiety, which made me feel kind of validated when my hormones shifted, that my anxiety jumped up. But I will say we have been researching anxiety and dep depression in women, and it is real and perimenopause. So you're not crazy at. You're not, these hormones, these sex hormones are protective to us and we lose that protection and now we're vulnerable to infection and inflammation. And inflammation in your brain looks like depression and anxiety.

Martha, My Aloof Vagina:

Oh my gosh. Well, here's, I'll, I'll share this cuz you're not a psychologist. I'm not a psych, I'm not a doctor at all. You're at least a doctor. Um, if you combine this thing with the hormones,

Dr. Wendy Chorny:

Mm-hmm.

Martha, My Aloof Vagina:

Along with existential dread. Right. And, and, and evidence that we are going to die someday. Right. Because as we get older,

Dr. Wendy Chorny:

Which is horrible. It is true. We, it is the circle of life. I learned that from the Lion King.

Martha, My Aloof Vagina:

Yes. The Lion King taught us the circle of life, so, Media is showing you how old and decrepit you are and, and the youth culture. And so you're comparing yourself. So all the stuff that happened at once, you go from plump and you know, shiny to the shift at the same time that your gut microbiome and the hormones are creating, um, the conditions for anxiety and depression. No wonder that is such a common perimenopause.

Dr. Wendy Chorny:

Right.

Martha, My Aloof Vagina:

situation.

Dr. Wendy Chorny:

fresh hell is this? And PS I found a book called What Fresh Hell Is

Martha, My Aloof Vagina:

Oh, Is it

Dr. Wendy Chorny:

talking about? This? Yes. Well, you know what? I think I I think I, think, I have read it, but I haven't read it recently, so I think I forgot that content. But it does come on all at once. And let me tell you some other nerdy things that talks about this. The way our culture treats it is quite horrid. Now I'm from Ohio, and in Ohio we have our sports and people are fanatics, and there is a little known university known as the Ohio State. So people outside of Ohio, when you put the Ohio State, they are just like, oh my goodness. Why? The emphasis on. Because there's Ohio University and they want to make a difference and show that they are the, the Ohio, the Ohio State in the research prior to mm, the nineties. It is the perimenopause. The perimenopause. But what's fascinating about the perimenopause is they don't. Want to call it a disease process. They call it a stage. It is only a phase, but there are so many diagnostic things that go along with it. But because it is a season of our life, not unlike puberty, nobody cares about the perimenopause.

Martha, My Aloof Vagina:

Yeah. Yeah. Well, and I think, and you hear the nail on the head, our health system is not structured to be able to handle something that would require Yeah. And

Dr. Wendy Chorny:

about prevention.

Martha, My Aloof Vagina:

They don't care about prevention and they don't care about anything that might require some intervention or treatment or awareness or education that isn't also a pathology, right? If it can't be a disease state, they can't code it. They can't charge for it. Insurance doesn't know how to cover it, and so, so to call it natural stage, they can just kind of put their hands, take their hands off and say, well, thi this is what happens.

Dr. Wendy Chorny:

but see, here's where I'm going back and forth, because honestly, when you look at research journals in the ob gyn world, they are touted as the people that should be able to take care of us in the perimenopause. Once you're done catching the babies and once you have a baby. But having a baby is and isn't a disease process. Like it has its own like coding. Like we treat people that have babies well ish in the US ish. I mean, I don't know. I, I feel like it's very antiquated. Yeah, it's so, but no perimenopause. It's just

Martha, My Aloof Vagina:

Did they pathologize

Dr. Wendy Chorny:

I tell you.

Martha, My Aloof Vagina:

Like what if we treated pa, the perimenopause, which is what I'm gonna call it for the next week or so,

Dr. Wendy Chorny:

It cracks me

Martha, My Aloof Vagina:

what if we treated the perimenopause the way we treat pregnancy?

Dr. Wendy Chorny:

Well then I will tell you, there will be a lot of happier people in this world. So people want to make fun of menopausal and perimenopausal women. And I will say there was a tone in the research I was reading that. I think healthcare providers were like looking at us like toddlers throwing a tantrum in Home Depot, and what do we do with them? Do we just subtly drag them off to a side aisle so the tantrum isn't in public? What do we do with these people? Which I've done that with my son while he was throwing a tantrum at Home Depot and I did drag him to a side aisle. It's just like they're trying to pacify us. They're like, what do we do with them?

Martha, My Aloof Vagina:

Yeah. How do we

Dr. Wendy Chorny:

And

Martha, My Aloof Vagina:

them? Because they're gonna come on our office and they're gonna make demands. Here's the positive thing. They're gonna come on our office and they're at that stage in their life where they're not gonna be silent at this. In

Dr. Wendy Chorny:

And they used to call us that they used to call us whiny women. Whiny women. Oh, there's a. WW Whitey woman. But now that we are realizing that this hormone sh shift affects every facet of our tissues and our body, that we do have to start carrying and supplementing, but people are afraid. Uh, to talk about it because there's shame, women's self-esteem. 44% of women that are in peri Panama have perimenopause, have a decreased self-esteem. And I get why? Because you are told beauty looks this way, and now you are beginning to look this way and your hormones are shifting and your hair is dry in, your skin is dry and your belly gets bigger. And it's just all these things. It, it's a, it's, it's a bit disheartening and infuriating.

Martha, My Aloof Vagina:

Well, and it's such a holistic thing, and I think that's the other reason our health system's not great with it because. They don't do well with holistic. They just, like you said, they don't do well with preventative. They don't do well with something that they don't have an explicit treatment for. Right. So if they don't have a pill or a course of treatment to provide, that's easy to take and do Then. Then they don't know what to do with us,

Dr. Wendy Chorny:

Correct. So in emergency medicine, right, so what you're saying is there are no, to my know, And if somebody finds this And I am wrong, I would love them to comment. You know? So if some menopause guru hears me say this, and I'm wrong, please correct me. But in emergency medicine, so if you go to the er, they have to make quick decisions based on what is happening to you to save your life, your quality of care, decrease pain. They do this with something called clinical prediction. And in women's health, it is quite rare that we even have clinical prediction rules, let alone for menopause. So a standard of care doesn't exactly exist. Now if you look at the research, you do know that hormone replacement therapy has to be. Has to be, we need those hormones. Even if you don't wanna take a systemic hormone, you don't wanna take a pill, you don't wanna ingest it. A P size amount of estrogen, if you applied it, To your vaginal tissues and that little bit, the inner third, the lower third, could change your life. You know, we're so afraid because we had bad research and then there was this misinformation, and now women are terrified of hormone replacement because they think it's all gonna give them cancer. Hey there, this feels like a good time to pop in and remind you about the vFit Gold. And that you can get 10% off with my code, MAV10 or by using the link in the show notes. During my panicked research, when I first became concerned about my vagina. All signs pointed to the vFit. And here's the deal. Red light. Gentle heat. And Sonic technology encourage blood flow, which aids natural hydration. And helps you improve sensation, pleasure, and intimacy all from the privacy of your home. As you may recall, or you may have heard. I use mine scrolling Instagram. And nobody's the wiser. It also specifically helps promote a stronger pelvic floor and a bunch of other things that you can confirm on their website or with your own research. Just go to joylux.com and use code MAV10 as in My Aloof Vagina 10. Or use the link in the show notes and the discount will be automatically applied. You your vaginal health. And comfort and pleasure. Can thank me later.

Martha, My Aloof Vagina:

Can we talk briefly about that article? It isn't behind a paywall, so I can put a link in the show notes. Um, what alarmed me the most, so this is a, this was an article in New York Times magazine. And it kind of blew for the public, blew the lid off this idea that the women health initiative had been the biggest disservice to healthcare in, you know, ever. Maybe they wanna say it in a hundred years. And so it's, it's kind of a long article. I found it fascinating. Um, but what, what alarmed me and, and shocked me cuz I had been, you know, I'm, I'm in the algorithm. I get a, I get all the Vagina. And all the perimenopause stuff served up to me, so I already had awareness of some of the things. But the thing in that article that. Upset me the most, is probably the right way to describe it, is that they knew it was shoddy at the time, and

Dr. Wendy Chorny:

Oh yeah.

Martha, My Aloof Vagina:

there were people saying, wait, wait, wait. No, no, no. But once it was picked up by like the Today Show, like with Ann Curry interviewing people, and once it was picked up and put into headlines and pre, pre-internet click bait, it became a belief. And so anyway, that's what upset me about that article because I grew up believing it. I happened to work at A A R P at the time, by the way, and so this was like doctrine, and I had believed it all these years. And a lot of my friends, they're moms that are of the age that they were going through menopause at the time, and so they have beaten into their daughter's heads. That you can't use hormones, don't use hormones, it'll cause cancer. And a lot of my friends are like using like yam progesterone creams instead of, or over the counter stuff because they've been so scared off of hormones based on what was basically a news cycle, a 1990s era news cycle.

Dr. Wendy Chorny:

Well, you know what's interesting is, is that there were that particular generation, so our mothers and their mothers, the news was fair, and I'm gonna say balanced because it was just different. Like there was no spin to it back in the day. And, and that was very, very true. But like time has changed and technology has changed. And so now we. Be our own investigative people and have a flexibility in our mind, but also as a scientist, and we had talked about this, that I constantly question why I believe what I believe because science changes. We find new information and we have to pivot. You know, we have to change, we have to pivot. But in that they did us st. They did. But who's surprised that in a man's world they did women dirty. No one. No one. But, but this is why you give two chicks a microphone and a podcast. And here we are disking this, this myth that has hurt women for decades.

Martha, My Aloof Vagina:

the Vagina.

Dr. Wendy Chorny:

And I have had to, yes, I am, uh, the Vagina Debunker. I'm Dr. Wendy Charney and I debunk bad science

Martha, My Aloof Vagina:

yeah.

Dr. Wendy Chorny:

and. I I tell I have had to beg people. Okay, so we had talked about vaginal tissue and keeping it plump, and I talked about the mucosa and keeping the vaginal area pink and red and having good blood flow. Sometimes on a vaginal exam, the first time I meet someone, if I'm gonna look at their pelvic floor, if that's what I need to do on that day. And I see their vaginal area and it is so, so B blanched and white. Now I'm talking about like white

Martha, My Aloof Vagina:

Like

Dr. Wendy Chorny:

the vaginal.

Martha, My Aloof Vagina:

Likea and the vegetables.

Dr. Wendy Chorny:

We want things to be plump and pink and they did not have enough blood flow. And then that is telling me and my brain as a scientist, okay, so this means that they're probably at least two to three years postmenopausal when the vaginal atrophy hits it. Hard, and then you are at risk for this really painful condition called lichen sclerosis, which is like little lesions on your vulva because you have this tissue crying out for estrogen. Crying out for estrogen and steroid cream is not going to fix a tissue that is crying out for estrogen. It actually will only make it thinner and. And in these women, I beg them to go see a specialty ob gyn, a specialty gynecologist that specializes in dermatology because there is nothing other than estrogen that can save that vaginal tissue that is painful. And they get infections because they get those little cracks because it is dry. Like the Sahara Desert, there is nothing else that can save that.

Martha, My Aloof Vagina:

So, um, before we, I know that we had things we wanted to cover, I'm gonna have to bring you back. I hope that works for you. But before we

Dr. Wendy Chorny:

That is acceptable. I, I do accept

Martha, My Aloof Vagina:

Thank you. Thank you. We need, there's more Vagina debunking that needs to be done, so you'll

Dr. Wendy Chorny:

Yes. We are the, uh, investigators of the Vagina debunking.

Martha, My Aloof Vagina:

Yes. Um, what you and I had spoken briefly, and I just wanted to make sure I had you talk about it, um, about the idea that when we talk to women in their thirties or even their forties and say, Oh and they have all these symptoms, all these traits of perimenopause, and we say, Oh oh gosh, that sounds like you're in perimenopause. and they freak out and they're in denial. can we can we talk about

Dr. Wendy Chorny:

Oh Yes. because it's bad information. So perimenopause. Can start as early at as 35 to 45, and when all these symptoms, these phantom crazy symptoms that seem to not match and it's not your thyroid. I'm gonna tell you it's perimenopause because education is power and they get all frustrated at me, and it's not unlike when I have a person who is in their thirties or even like twenties, who has an exceptionally painful and arthritic joint. Because arthritis is just wear and tear. Osteoarthritis is just wear and tear. If you had a car wreck, if you were a collegiate athlete, you are gonna have degenerative changes because of wear and tear. If you have a Vagina, you will have a hormone shift and it can shift If you've had surgery, it can shift based on your socioeconomic, if you drink, if you have alcohol like in your life. And you know, there's all these reasons. People think perimenopause isn't really a thing. They think of menopause, which is just really one day it's, you know, a year after your last period. So there's really perimenopause and postmenopause, but there's this bad information. And then when you tell them, Hey, listen, this is happening to you and I want you to know that the suffering you're experiencing, you're not crazy. And they're like, I, I get a regular period. I my period, I have my period every. And so yesterday in my research, uh, there are stages of perimenopause. And in the early beginning and mid stages of perimenopause, there won't be a change in your period. Ladies, it's gonna look like, uh, irritability anxiety two days before your period. A high L D L. Blood pressure, PVCs, where your heart races. And so these women are having cardiac issues and dental issues and we're not telling them that, Hey, it's your hormones, you, we have to support your hormones. Also, widespread joint pain. Brain fog walking to the basement and you don't even remember why you're there. Walk back upstairs. Oh, now I remember. Walk back down. You forgot. Oh my gosh. Am I crazy? You know, so I feel that along with hormone replacement therapy, we need to tell people it isn't the devil. We need to tell people. Perimenopause exists and it comes earlier than you realized, and we can help you if you acknowledge what it is. And we have real convers.

Martha, My Aloof Vagina:

Yay.

Dr. Wendy Chorny:

by the way, how do you find a person to help you?

Martha, My Aloof Vagina:

How do

Dr. Wendy Chorny:

If you want, it would have to be, if you go to the North American Menopause Society, you can click your zip code into the the box, so dropdown box and find a healthcare provider in your area. Because only people truly trained in taking care of menopausal, perimenopausal women will get it and understand you. Because if not gaslighting could exist. And the sad part is women wanna go to their OB gyn because we do think that, but like, no offense, they're phenomenal surgeons. They're great at catching babies, but they are not trained in perimenopause. Menopause,

Martha, My Aloof Vagina:

So that message alone is the reason, one of the reasons that you and I are just like simpatico, because as soon as I found that out, I started screaming it from the rooftops because of course we thought it, was our gynecologist. That's our lady doctor. That's who you think you're gonna go to. And it's not.

Dr. Wendy Chorny:

you're lucky, maybe they know it, but they might not.

Martha, My Aloof Vagina:

Even if they know it. I mean, if you're lucky, they might be certified. If you're lucky, they're paying attention and they're keeping up on it. If you're lucky, they believe in interventions they're gonna are gonna support you. But why not go to an endocrinologist or a specialist for what is a hormone issue? Someone who that is their focus. Right? Or other health, women's healthcare.

Dr. Wendy Chorny:

Absolutely. So there, it's, it's multifactorial, but you know, the reason I feel strongly, and we're sharing this, is we want to keep our tissues healthy to prevent the future damage that is happening to so many women because they didn't know they were behind. They didn't even know it was an option.

Martha, My Aloof Vagina:

This is why this

Dr. Wendy Chorny:

tissue acts younger.

Martha, My Aloof Vagina:

Yeah.

Dr. Wendy Chorny:

When you have hydration in your tissues, a hydrated tissue looks younger. Acts younger. Things younger is younger. And without having the proper estrogen and water metabolism, your tissues are going to act pathologically crazy, and you're gonna have frozen shoulder and tendonitis and joint pain, brain fog. I mean, it just goes on bladder infections.

Martha, My Aloof Vagina:

Yeah,

Dr. Wendy Chorny:

So plump and hydrated is the the message plump and hydrated.

Martha, My Aloof Vagina:

our plumpness in our bodies. Our

Dr. Wendy Chorny:

our, it's a water loving molecule, you know,

Martha, My Aloof Vagina:

Oh, I'm so

Dr. Wendy Chorny:

so that's, that's, that's the fun. Well, thank you for having me on, uh, the Vagina monologue that could go on for days.

Martha, My Aloof Vagina:

Well, just in little 29 minute. Segments. Right. And then we'll just do that. We'll just keep telling the story.

Dr. Wendy Chorny:

we want people to have the digestible bits about their bits.

Martha, My Aloof Vagina:

yes. Right. And women listen. Uh, it's a, it. It's not that I don't listen to two hour long podcasts or 90 minute long podcasts, or even one hour long podcasts, I do, but I cannot listen to them typically in one session. And so I wanted these shows to be something a woman could listen to on the way to wherever she's going, while she's cleaning the house, while she's working out, and get the whole story at once.

Dr. Wendy Chorny:

Digestible bits in a takeaway that they can have to help change who they are today. It doesn't need to be overwhelming or complex.

Martha, My Aloof Vagina:

No,

Dr. Wendy Chorny:

No, it has to be real.

Martha, My Aloof Vagina:

thank you. Dr. Wendy. I

Dr. Wendy Chorny:

Well, thank you. It was a lovely date. I had a really nice date.

Martha, My Aloof Vagina:

I like your dress.

Dr. Wendy Chorny:

Oh, thank you. It's Amazon.

Martha, My Aloof Vagina:

That's perfect.

Dr. Wendy Chorny:

Of course it's

Martha:

Thank you for listening until next time. Take care of yourself and take care of your vagina. If you enjoyed this episode, please share it with a friend. You think would enjoy it too.