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www.atravelpath.com We were so glad to be able to chat with Kyle and Renee Hanks from Happily Ever Hanks! They shared their inspiring story of how they uprooted their lives to pursue full time travel in order to get the most fulfillment out of life. In this episode you'll learn all about:   Getting Out Of Debt Kyle and Renee attribute much of their Freedom to the habits they developed to getting out of debt and not having to constantly pay large bills and debts every month. We learn some actionable steps they took to get themselves out of $230k in debt!   How to Seek Fulfillment Tired of the mundane 9-5 work life with only two weeks off out of they year, they wanted to pursue something different. They discussed how the loneliness of the road can be nerve-wracking at times, but it's also proved to be a great source of fulfillment, knowing they are out on their own and getting through everything. They discuss chasing the addiction of finally getting one whole month off from work, and how they turned it into a game so that they could find ways to take even more time off.   When Things Go Wrong Kyle and Renee shared a few things that cause them frustrations while they are on the road, and how they have learned to just laugh at times. They make a really good point about how when things go wrong, they have two choices: They can either get upset about it, or stay positive, share a laugh, and get through it.   Learn all this and much, much more during this inspiration-filled chat with Happily Ever Hanks!   Chapters ·        00:00 Introduction ·        04:30 What was some of the skepticism you faced when you started out in your RV? ·        06:15 How did you balance work and travel when you were travel nursing? ·        07:45 How long have you been out of travel nursing for? ·        09:30 How were you able to get out of $230k of debt? ·        11:45 When did travel become a priority for you? ·        12:45 What are the biggest frustrations you face currently while traveling? ·        15:45 Saying goodbye to family for the first time. ·        16:45 Any mistakes or embarrassing stories you'd like to share? ·        21:00 How do you handle it when things go wrong? ·        21:30 What do you love most about your RV lifestyle? ·        22:45 RV Techs ·        23:30 Do you have any advice for someone looking to buy an RV for the first time? ·        25:45 How do you get internet while traveling? ·        29:15 What does your budget look like while traveling? ·        32:30 What is it like traveling with a cat in your RV? ·        34:00 What has been your coolest travel experience? ·        36:15 What is one thing you need & don't need while traveling? ·        38:30 What tools should every RVer have? ·        41:00 Using the trucker lanes. ·        43:00 Who influenced you to travel?   Happily Ever Hanks on Social ·        Website: https://www.happilyeverhanks.com/ ·        YouTube: https://www.youtube.com/@HappilyEverHanks ·        Instagram: https://www.instagram.com/happilyeverhanks/ ·        Facebook: https://www.facebook.com/happilyeverhanks ·        TikTok: https://www.tiktok.com/@happilyeverhanks   Videos from Happily Ever Hanks ·        Financial Independence: https://www.youtube.com/watch?v=ZlIOjC7eyl0&t=182s ·        Avoid These Mistakes When Buying an RV: https://www.youtube.com/watch?v=VolVHbO1_L0   Past Episodes ·        Travel Nursing with Dakota and Courtney: https://atravelpath.com/travel-nursing/ ·        Part 1 with Laura and Jason: https://atravelpath.com/road-trip-with-kids/ ·        Part 2 with Laura and Jason: https://atravelpath.com/florid-keys/   Resources ·        Dave Ramsey Books: https://store.ramseysolutions.com/books/all-books/ ·        RV Dealer Mentioned: https://www.tomschaeffers.com/   Camping ·        Bahia Honda Campground: https://www.floridastateparks.org/BahiaHonda   Budgeting Tools ·        Tiller: https://www.tillerhq.com/ ·        Microsoft Excel/Google Sheets   RV Tools ·        VIAIR Air Compressor: https://amzn.to/3TBoIrn ·        Pole Buddy: https://amzn.to/3xjiRQ4 ·        (Commissions may be earned from purchases made on this page)   YouTube Channels Reference ·        Long Long Honeymoon: https://www.youtube.com/@LongLongHoneymoon ·        Keep Your Daydream: https://www.youtube.com/@KeepYourDaydream ·        Kara and Nate: https://www.youtube.com/@KaraandNate   Most Popular Blogs: • Most Popular Travel Hacks: https://atravelpath.com/money-saving-travel-tips/ • Travel Gear: https://atravelpath.com/travel-gear/ • How to Budget For Gas on a Road Trip: https://atravelpath.com/how-to-budget-for-gas-for-a-road-trip/ • Our Favorite RV Upgrades: https://atravelpath.com/rv-upgrades/ • How Much We Made Renting Our RV: https://atravelpath.com/renting-camper-van/ • Never Run Out of Gas on a Road Trip: https://atravelpath.com/road-trip-tip/     Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/abbynoise/rocky-mountains   *All content from atravelpath.com, including but not limited to The Travel Path Podcast and social media platforms, is designed to share general information. We are not experts and the information is not designed to serve as legal, financial, or tax advice. Always do your own research and due diligence before making a decision.       Transcript Host: Kyle and Renee, welcome to the Travel Path podcast.     Guest: Thank you for having us.     Host: So we know you on YouTube as Happily Ever Hanks. You built a very large community with your mission of both educating people in the RV life and inspiring your audience to break free from their comfort zone. Before we start, I do want to give a shout out to Laura, Jason, and Alexis. One episode of our podcast mentioned that they had watched so much of your content that their younger daughter, Alexis, has been inspired to become a travel nurse herself when she grows up. So here we are talking now full circle. But why don't we start by having you guys share a little about yourselves and then letting our audience know what your current travel lifestyle looks like?     Guest: Sure. Well, first of all, that's really inspiring to hear. Yeah, that's really cool. That's neat that we're bringing up the younger generation and inspiring them. That's like kind of why we started all this. We first started as your nurses back in Pennsylvania in around 2015. We just got tired of the mundane lifestyle and wanted to explore life on the road a little bit. So we started looking at travel nursing and in 2016, we started applying for our licenses. Actually, in late 2016, we started applying for a California license for our nursing. And from there, we just kind of hit the road. And then we had no really idea where we were going. We went to San Francisco for our first travel assignment and then thereafter is kind of up in the air. But basically, over the time being, I'm sure we'll get more into this later on in the podcast, but around 2019, something there, you'd say we were kind of hit a hiccup with nursing itself and we laid off for a little bit. And then that's what inspired us to start documenting our adventures and the RV lifestyle, sharing all the things. When we worked in the ER, man, how many times we were asked by our coworkers and other patients, they were so fascinated with us living in an RV or like, how does that work? It doesn't make sense. You're not living in a house. You're living in an RV. And yeah, we were just educating. We had people gathered around and we were talking about how they can get into like RVing with travel nursing.     Host: So I feel like that's probably maybe we've got the ball rolling for you guys starting your YouTube. Was it everyone asking you questions in your career as travel nurses that kind of got your head scratching? Well, maybe there's a void here we can make start a channel and actually inform a larger audience.     Guest: Yeah, pretty much. We just we learned that there's people who are RV and there's travel nursing. And, you know, when you think of an RV or you tend to focus more on people who are retired, so to have these travel nurses who were younger, just so interested, they're like, I've never even heard of this. I never even thought to get an RV. It's just it's like we were teaching others. But, you know, we didn't know it was a thing either until we found it on the Internet. We were just going to do housing, like apartment housing that the travel nurse company gives you until we stumbled upon some article that talked about, hey, you can live in an RV and do this. And we were like, no. And then here we are.     Host: Now, the purpose of the podcast is to help people, you know, get started traveling and ultimately reach their travel goals. So I do want to dial it back a little bit on your website. You had mentioned that when you made this transition, you fought some skepticism and then also you were, quote unquote, bucking the trend when you sold your house and went to travel full time. What was some of that skepticism and how are you able to overcome that?     Guest: Well, I guess the skepticism was jumping into a different way of life. See, when we were working as nurses back in Pennsylvania before we even started living in an RV, we were kind of just doing the mundane nine to five. And it just like one week flowed into another. And we were having to wait for those two week vacations. You know, you work all year to get those two weeks off. And it's like once you get those two weeks, it's just like, where do we go? What do we do? It seems so condensed into one time frame where we just didn't know we were kind of fumbling around. We're like, why don't we just kind of make a lifestyle out of this? And then through working in the ER, you know, we met a lot of other travelers there and it just blew my mind immediately that nurses could bounce around the country and live this different lifestyle filling in the gaps within schedules across the country, you know, other hospitals. So, you know, I think that's a really good question. So that's kind of like what inspired us, you know, to kind of get there. Is there anything I'm missing?   Guest: No, I pretty much we just also the trend of like you buy a house, you get married, you have kids, it's like life teaches you to follow these certain rules. We were like, what if we sell the house now and just kind of do whatever, travel around the country. So yeah, yeah, get out of debt, lose the mortgage and travel the country.     Host: You mentioned that mundane, like the two week vacation, right? That's kind of the ritual, the path that most people follow. And on our last episode with Wanda with Katie, she had mentioned that she had many nurses or many friends in the travel nurse field where what they kind of do is they'll get to a destination, an assignment. They'll be working like crazy hours for however many weeks. And then they'll take like an extended break, whether it's a couple of weeks or a month in that destination where they are and just explore it. Is that how you pretty much lived it when you were travel nursing?     Guest: That's exactly how we lived it. Yes. So we got a little taste of that. A typical travel nurse contract lasts about 13 weeks. And from that point, when you complete it, you can either ask to resign at the hospital if they still need you or you can move along to a different state, different hospital. It's also flexible. So we got a little taste of that when we finished our contract. We're like, well, now what? We have this money. We saved up a little money on the side and, you know, we could go work another job immediately and start making more money. Take a little time off, go explore some surrounding areas. And that's kind of what led us into becoming debt free. But yeah, just so much like just work your boat off for 13 weeks and then take like a month or two off and actually travel.   Guest: It was such a liberating feeling to be debt-free and have the flexibility to choose how we wanted to spend our time and money.     Host: Do you find it easier or harder, the fact that both of you are travel nurses?     Guest: Oh, easier, much easier. Yeah. Yeah. When we went to San Francisco, oh, my goodness. We were just... I'm not a city person. So I was kind of thrown in the middle of everything. It was very busy, very hectic, and just fast-paced. So having each other to rely on in the new location was kind of nice to kind of get through some of those hiccups.     Host: How long have you been out of the travel nurse space for?     Guest: Oh, man, it's... we took an assignment in 2019, and then that's when they were saying they couldn't resign us. So it's been... it's been a minute for sure. And then, you know, when we got laid off, you know, at that temporary time, we had tried to resign with the hospital, like, you know, we can't afford to rehire you guys. This is right during all the pandemic just to be completely transparent. You know, the hospital took such a hit with the money, you know, depleted and they kind of afford travel nurses. So they really had to hunker down with the budgeting and everything. So luckily we had set up enough of a almost like a safety net for ourselves to take some time off. And, you know, we were always wondering, well, this may be the opportunity to share and document all of our experiences with others. Yeah. And we didn't expect that it was going to replace travel nursing.     Host: I'm sure the travel nurse space has changed a little bit since you guys exited that area. And I'm just realizing now this is like the purpose. This is like a perfect follow up from our previous episode with Courtney and Dakota, who are actually just getting into the travel nurse space. So the episode that came out actually hasn't been released yet, but it's going to get released before this one. So if you listen to this now and you're looking to get into it, they provide details on actually like modern-day, currently what it's like transitioning into that. So that's perfect. Transitioning a little bit, I want to talk a little bit about how you went out of debt, because that's a... I forget the statistic I read, but I know there's a lot of consumer debt in this country. And you had a video a while back on how you went from two hundred and thirty thousand dollars in debt to financial independence. I want to know what your definition of F.I. is because I know that's been thrown around a lot with financial freedom. But how are you able to get or to get out of debt, essentially?     Guest: Well, getting out of debt was just mostly, I would say... I don't know what would what would the term be that I'm looking for? It's kind of just mostly discipline and just having a goal and following through with it. So we broke it down in as simple pieces as we could. We usually referred to Dave Ramsey at the time. We had utilized a lot of his teachings. I don't know how familiar most people are with Dave Ramsey out there. But it's a really simple way of just setting aside like baby steps of like setting some money over here for an emergency fund and then tackling all your lowest debt and then going forward from there to your bigger, bigger debts. So financial independence was a huge thing because, as I said before, once we got that taste of finishing a contract and then having that time off, well, we kind of became addicted to having more of that time off. Freedom. That freedom was like, oh, my gosh, I want more of that. A month was like only a month now that we get to travel. We want two months, three months. And so it became a game to us, to be honest. It turned into a game. We just went all in over time. All of our pennies and dollars went to paying off every single piece of debt that we had. So that to actually qualify, what would the financial independence? It was like the freedom side of it. That's what it meant to us is like not being tied to a loan or like having to work because you have to pay all these bills. It was like, what if we didn't have to pay all these bills and we can kind of just... you can live frugally if you want to not have to work as much or you can work your butt off and save. It's just like you had freedom to do whatever you want with your money.     Host: Yes, it's like once you learn it's that delayed gratification. Yeah, it's a sacrifice. You're giving up certain things now. But once you realize what you're able to do with that extra money and that extra time in the future, that's when it becomes, like you said, like a game and it gets addicting. And then you just try and find every nook and cranny you can start saving and and growing from there.     Guest: Absolutely. Yeah.     Host: Twenty seventeen is when we started travel nursing, right? And twenty nineteen is when we decided to start going full time. At what point did travel become the driving factor in that?     Guest: So, not the answer for Renee, but for most of my growing up, we traveled around as a family, maybe a couple of hours away here and there. We had done some flights across the country to go see some places, but nothing crazy. So jumping into the lifestyle was very new for us because we knew we would have to drive all the way from Pennsylvania to California for our first travel nursing assignment. And there is a lot of land in between to sightsee and just explore and take it all in. So as we proceeded from there, I think it just became a little bit of an addiction over time of like, wow, you know, we only do have one life to live. We live it responsibly. You know, we're not out here discriminating YOLO and blowing money like crazy and doing whatever. We're actually trying to be really responsible people, but get the most fulfillment out of this life as we can. So to kind of answer your question, I just say it gradually increased over time to where we are now of, you know, eventually one day, hopefully we can do some international travel. Yeah, it's a lot to see out there. Lots to see.     Host: Fast forward to where you are on the road now currently. What are some of the biggest frustrations you currently face traveling?     Guest: Probably the lack of consistency. You know, you might be in one area and the cell service is great and the resources are close by. But the campground is iffy or I don't know the weather is not good. So it's like and then you go to another place and the Internet's bad and then you go to this place. And the grocery store is like 20 miles away. So it's like you can never have consistency, but that's OK, because the best part is that you could just pick up and move and go somewhere new all the time.   Guest: Yeah, and it may seem just to piggyback on that, it may sound kind of like... I don't know where we're coming from. You know, if you're living at home, you're like, that doesn't really make sense. But try to uproot your life and all the routines that you have, the typical grocery store, you know, where everything's laid out all the time. You know, your favorite gas station that has all the best prices, friends, your family, everything you can rely on for. You know, you're kind of out here by yourself and it's a little nerve-racking. But in that, you kind of find some fulfillment within your life that you're pushing yourself, you're exploring new places, and it's just fun to be immersed in that kind of lifestyle.   Guest: Going to a grocery store and everything's backwards. Yeah. Walmart. Hey, got to learn it. We'll tackle it together. It's like every time stop and shop, they rearrange everything, except for you guys. It's every time you go to a grocery store. Yeah, it's like there's no learning the grocery store. Like you're just you're always walking around like you're clueless everywhere you go. And that's just the way it is. Roll with it.     Host: Do you guys ask for help in the grocery store? It's the first thing I do. Hope will never.     Guest: Yeah, I don't know. I thought she would be more, but I'm just like you, Tyler. I ask for a couple of times. She's like, where is this? And I immediately just find somebody. I'm like, listen, we don't want to. What's... I don't want to be defeated. It's like if I can't find the eggs, like what she likes, you know, can I even get by in life? It's like a personal scavenger hunt every time.     Host: Yeah, yeah, exactly. I wonder if that's like a man and a woman like personality thing, because it's the first thing I do when I go to a store, even if I know where it is, I'm still asking. But I know with you, like I just ask somebody, no. OK, fine. OK.     Guest: That's because we want to still look at everything. We want to meander around the store. We don't just want to get that one item. I do want to say that the thing I always forget about. I don't want to knock our friends and family like that. That's a big part of travel. That's hard is, you know, he has family in California. I have family in Pennsylvania. So they're spread out and they're all up north. So it doesn't make it like a snowbird situation where we could be in the south and visiting one of them. So that's another inconsistency or an issue with traveling that we don't like. Yeah. Yeah.     Host: So yeah, family. So that's one thing you probably expected, right? Obviously, if you're traveling full time, you're going to be saying goodbye to your family. Was that harder or easier than you expected it to be?     Guest: The first time, the very first time we said bye. Guest: Yeah. Yeah. That was hard. That was hard. It was difficult. I mean, like Renee said, you know, with us having family on the other side of the country, it was like saying bye to them and then being like, oh, I'm excited to see the other side of the family. But it's still kind of it hurts like that, that first time, because it's like, you know, your your mind is telling you, oh, my gosh, this is forever. But in reality, it's it's not it's just it's just a new step in life. That's what it is. Still hurts because we'll go back and visit for a month or two and then you say goodbye again. So it's like you're constantly reliving the like, well, you know, I'll see you next time. And it's always you're always trying to delay it because you don't want to say goodbye. But you think we'll be back.     Host: Like I said, you're mobile, so you can always pick up and go whenever you want to. Do you have any — and I know you guys do because I've watched your videos — but do you have any embarrassing stories or mistakes you want to share that could potentially save a future listener some trouble?     Guest: To keep it as short as possible, we were in Mississippi driving and we need to pull over for some fuel at a Flying J at the time. Now, Flying J is a truck stop out on the road that we had used quite frequently. And why we liked it so much is they also had these RV fuel lanes there. So if you can imagine where normal cars would fuel up, then there's RV fuel lanes. And then on top of that, they have the other section for all the truck drivers and 18-wheelers, so we pulled into the RV fuel lane. But we have been so used to filling up in the trucker lanes where everything was diesel over there. If you don't know where I'm going with this, eventually I got out of the truck, started pumping fuel, but quickly realized I pumped about a gallon, maybe two, two gallons of diesel and two or, excuse me, of gas into my diesel truck. So I stopped, panicked, received his panic. We likely didn't do anything. Didn't start the truck, but I I had no idea what to do. I didn't know what happened if I would fill it up with diesel and start running it. I just said, let's not do anything. We'll call for a tow truck and see what happens. So we end up calling for a tow truck, having to get the truck towed all the way to like a body shop or somewhere that can deal with dropping the tank, cleaning out the fuel injectors, everything. Meanwhile, our RV, our travel trailer sat there blocking the entire fuel lanes for three hours straight.   Guest: Yeah, I think Flying J didn't care. Yeah, they're like, I just let it sit there.   Guest: So we forgot we lock it up or anything.   Guest: I forgot.   Guest: So at the time we traveled with two vehicles.   Guest: Yeah. So I stayed back and just parked the car.   Guest: Oh, that's right. In front of it and just blocked it.   Guest: We need to see the trailer.     Host: Yeah, on guard.     Guest: So just be careful. The reason, just one last thing I want to add to that story, the black handles is what got me. So when you're over on the 18-wheeler side, it could be green handles for diesel or it could be black handles for diesel. But unfortunately, in the RV fuel lanes, it was only green for diesel. And I had picked up a black handle.     Host: Well, fortunately, you caught it and then you didn't end up starting it. Do you know what would have happened if I know it's only a gallon or so you said, but I can't imagine that being good.     Guest: My buddy said something with the combustion of like gasoline. They are nerding out on this stuff, but they said somehow the combustion rate of gasoline basically could really like do some internal damage on a diesel truck engine so that he made the best. A lot of people out there had commented on the video to like, hey, I've done that before, filled it up the rest of the way with diesel. I was fine, but I like to look at it with it being a truck that was at the time paid off. It was under warranty. I'm not sure. We just didn't want a chance that, you know, no dad. I called dad. I called my buddy. They're like, I'm not sure what what to do. So we just called again.     Host: Yeah, when in doubt, you're better off just calling someone. At least you're you're safe that way. Plus, when you're on the road, I mean, you couldn't go on to you. There's a good chance you're going to be in the middle of nowhere at some point. You know, that thing breaking down. There's no service. There's no one, nobody to help you.     Guest: Yeah, yeah. On that same trip, we did almost break down a mile in nowhere, Texas, with my car. Then it needed a new alternator. I don't know where. So we were just like, OK, this lifestyle is great. Yeah, you know, everything's breaking.   Host: You mentioned your previous video every time like you guys just you laugh when there's problems, you said something about that. We just can't get any worse. And is that is that a coping mechanism?     Guest: I think so by now. I got to laugh or cry. So we just figured, let's just laugh about it. We make it a duty to like pick up the camera to show it. So the camera is in your face. You know, you kind of pep up a little bit. You're not. Yeah. There are so many kinds of words around. So yeah, like when things go wrong at first, it's like you used to get so angry. Like, why me? You know, why is this happening to me? Everyone's out at home and joined in or we're all stuck on the side of the road dealing with this, but we quickly realize that's just the way life goes. You know, either live at home. You deal with life or you live in an RV and you deal with life still. So yeah, you can laugh or you cry, but you can't change it.     Host: Yeah, exactly. You got to get it done. On a more positive note, what's the thing you love most about this lifestyle?     Guest: Probably just being able to go somewhere new all the time. You know, we'll be we'll be in one area and we'll love that area. But after a month, we're like, all right, it's time to go see something new. So the flexibility, you just go anywhere. You know, if you want to spend a summer up north, sure. Or if you want to be in the south, we're chasing all the warm weather. It's like, yeah, we're meeting some new people. Yeah, like our faith in humanity was restored. You know, once again, it was like turn off the TV and just get out there and have some conversations with people. And you'll realize that like people are awesome out there. There's a lot of great people to meet. We've met some amazing, amazing people during our travels. And still to this day.     Host: No, that's 100 percent sure. I do want to comment to you on your latest video when you had your leaf spring repaired, you talked about how you had called the RV techs and you weren't sure how they were going to be. But in our experience and at the end of your video, too, you mentioned it. They've been phenomenal. I have not met. We've worked with plenty of them so far. We've only been, you know, about four months. But everyone we've worked with has been great. And we've only heard good things like secondhand about them. I don't know what it is about our RV techs, but they're important to be aware of.     Guest: Absolutely. Yeah, we kind of agree more with that because a lot of people are sitting out there looking on the dealers to fix their problems and they're just not getting any answers. They're waiting. They're saying, hey, you got to wait six months before we can squeeze you into the schedule. And, you know, the RV technicians have been come such a great intermediate between the dealership and the consumer who had bought the RV and is looking for some help. So they're kind of just like that guiding light that could get some of those quick fixes done. Some of them are just beyond what we could ever ask for and repairs and done so much. It'll be to not have to pack up your whole home to take it to a dealership and sit and wait. It's just like they'll come to you and you just hang out. It's so it's so nice. Very convenient.     Host: Yeah. Do you have any advice for someone looking to buy an RV for the first time?     Guest: Oh, we did a video on this recently. Kind of where we talked about making sure you're doing your price checking and comparing. And I would say in today's world, like have an RV inspection, have like a certified RV tech that can do inspections. Come and look at your RV, whether it's used or buying it new off the lot. And if the salespeople or the dealership won't allow external inspectors to come in like a third-party inspector, I would probably not. I would. That's a big red flag. Yeah. Yeah. Sometimes it's not going to be well received, but you always got to be your own advocate with these things and have as many, I don't know, people on your side looking out for your best interests because the dealership certainly isn't going to be that person for you. Unfortunately. Yeah. Yeah, we, the reason we bought at the dealer and the reason we bought new is because it was our first time ever buying an RV and we had no clue what to look for. And I didn't want to buy something new or something from a private person or a private dealer just because I had no idea what to look for. Yeah. Had I known I could have had the RV tech inspector available, I think we would have jumped on that and done that instead of buying new and going through all the loops and hurdles and the pain points of going through a dealer and warranties that aren't really warranties and all that fun stuff. For sure. For sure. We were through that too when we bought our first one. We didn't even know anything about tow ratings. I mean, we just showed up with our half-ton truck. And luckily, they were really good about not looking at any RVs. He said, well, before we look at any RVs, I need to know what your truck can tow. We were like, what do you mean? Like, so, yeah, we rolled the dice on a good one. Yeah. A lot of people out there said, well, we never got that. They just, they'll show us that, you know, yeah. I'll show you the rakes and that's that. So that was good.     Host: So there are good ones out there, but just are good.     Guest: Absolutely. Yes. Yes. Tom Shafers in Pennsylvania. That's where that was. Yeah. So, OK, we'll link down the show notes.     Host: Obviously, you guys need Internet when you're traveling, you're full-time content creators. How are you getting Internet?     Guest: Our main form of Internet is Starlink right now. Yeah. Do you guys have Starlink at all?     Host: We're getting it.     Host: Yeah, we've asked this question almost every episode. And so far, the consensus has been T-Mobile, the T-Mobile home Internet plan with this. So the Starlink has been the most popular, but more often than not. What they're saying is they're using it as backup. And then they're using T-Mobile for the most part for their Internet. And then if they're in an area where there's no service there, it's Starlink. That's really nice. Starlink, that's your go-to.     Guest: That's our go-to. Yeah, we always have that up and running. And it's been working out good. You know, it was a little touch and go when we first purchased it. It was very somewhat newish and not as many satellites up in the sky. But yeah, well, we are also in the eastern US. So like so much more heavily populated, more like we were in Florida during snowboard season, so everyone had Starlink. We were all fighting for the satellites. But last year, it is perfect. I mean, it's beautiful. And then when we go east, we're going to be complaining about it. But it's good to hear about the T-Mobile because we do have we have a basic cell phone plan with AT&T and we use the hotspot if we need Internet, if the Starlink is not doing well. So it's good to know about that T-Mobile because we'll have to look into this if we need to. Absolutely. Yes, Ben. So far, so good.     Host: And we have our phone plans with T-Mobile and then we have like a third when we transfer over, we got a third like bonus phone. So we have 150 gigs of hotspot before we ever have to do anything. And then we're using the T-Mobile for Internet. So we're kind of rolling the dice with T-Mobile, kind of putting all of our eggs in one basket. But we'll get Starlink too just to have that as a backup. Is that set up process? The reason people have mentioned they don't use it primarily is because of the set-up process. How long does it take to set that up?     Guest: We're less than five minutes. Yeah.   Guest: Less than. Yeah. It's just we've integrated it with our typical setting up routine. It's mostly just sneaking a wire through the side, through one of the slide-outs, and then connecting it to the modem, and then getting the actual Starlink mounted onto a pole.   Guest: A pole. We call it a pole, buddy. You can buy it off Amazon and it just gets it up above your roof of your RV to have better signal, better access to the sky.     Host: Does the boot-up time take a long time? Is that what it is or?     Guest: That is probably what it is, that they're mostly, you know, it's not as soon as you plug it in, it's up and going. It does take about three to five minutes, I would say. Yeah. But like you could like get that set up. And then while you're doing the outside, I'll plug in the router and then just finish setting up the inside. And by the time I even have a second to like go on the internet it's already running.   Guest: So yeah, I guess if you need it in a quick pinch, if you pull over on the side of the road, take a break, it probably would be a little inconvenient because you'd have to set it up and wait a few minutes. So something like that.   Guest: But I will say, like, I think boondocking is becoming a lot more popular because of Starlink. Before, when you were off-grid, you were truly off-grid. There was like no cell service in a lot of these cool places you see on Instagram, you know, like Utah, Arizona boondocking. Yeah. Now, everyone's out there streaming and gaming. It's like a whole new, no longer off-grid. So it's really nice to have that.     Host: So you guys have been traveling for part-time, full-time. And I know you're pretty tight with your budget. You post videos on your YouTube channel. Have you ever been able to break down what a monthly or weekly budget looks like? I know it probably fluctuates quite a bit.     Guest: It varies. It just depends. Like we just had a very expensive month in San Diego, and our budget looked way different when we were trying to get out of debt. We still budget and track every penny, but we're a little bit more lenient. And then Alaska was kind of like a moment where we were strict. Yeah, I guess the best way to think about it was when we were getting out of debt. What was our budget? Did we go out to eat at all? Like, do you remember? Did we go out to restaurants and treat ourselves to something?   Guest: Yeah, we would give ourselves like two hundred dollars a month. Wasn't it like to go out to try new restaurants or go out to eat? And that included if you wanted to get drinks somewhere. So that ended up really quickly. So that wasn't even nowadays, like nowadays, I would get you a couple of drinks, two hundred bucks. Yeah, like a drink. Here's a cup of water. Yeah, like, wow, great. Yeah. And then groceries were kind of like, I mean, that's hard to control. Groceries are our biggest downfall just as a married couple. I don't know. You know, you get old, you get happy and you just like, oh, let's, you know, have some good dinner tonight and have some snacks. So that's one we got to like always keep coming back to. Yeah. The grocery bill. But to give you the other numbers, I can't really remember what it's been strict in the past. When we were really strict with our budget, we would just look at what we were already spending and then we would just try to cut that like a quarter of that and just try to chop that out and be better about spending.     Host: Do you have any budget apps or tools that make keeping track of that easier?     Gues: Now we use a program called Tiller, but we used to just do pen and paper and Microsoft Excel. And that was to kind of keep track of everything. Watch a quick YouTube video on how to line up with your expenses, highlight it all, and make a running total. And then it was really cool because as you paid off your credit cards or whatever debt you had, you subtracted that and then it would take away from the bottom big number. That was nice to see that. It's kind of like a little encouragement to keep going. So that was fun. Yeah.     Host: The visual is important. I'm glad you mentioned you had that starting out small, but bucks a month. You have to celebrate the small victories. Otherwise, you're going to burnt out. So being able to set money aside to celebrate, you pay something off. You're paying things down slowly. You know, those mini victories.     Guest: No, no. Yeah, it's crazy how when you don't track how much it slips away, because when we first started travel nursing, we weren't budgeting and we weren't being strict about our budget. It wasn't until we decided to see what our three to six months of expenses were. So we kind of got into it by accident because I was like, well, let's see what we are currently spending on every month. And then I saw how much we spent in restaurants because we were travel nursing. We wanted to go eat all the good food. We want to enjoy ourselves. And there was one month that it was close to a thousand dollars and just going out to eat. And I was like, oh, my gosh, like there's that there's a problem. I never guessed. So we saw that and we were like, OK, no more. And that's how like the whole budgeting happens.     Host: You guys are traveling with your cat, Dexter. And I don't believe we've had a guest who's traveled with a cat so far on the show. I would assume most people would assume that there's not much involved in taking care of a cat. But anyone to add to that?     Guest: Oh, yeah. There's, I say, oh, go ahead. I was just going to say that he we had no idea when we got in this lifestyle if he would take well to actually living in an RV. That was kind of what pushes into RV life, to be honest, is having a consistent home for him. So we always joke that we buy these RVs for him, you know. And because the other option was when we were travel nursing is to bounce between apartments and, you know, there's all sorts of smells and you don't know what the rules are with pets and especially cats. So I don't like not having a consistent home. Yeah. So we did it. Exactly. So, you know, I would just say if you do own a cat and you're a little nervous about taking him or her out on the road, you know, just take some car rides, maybe just put them in a kennel and start off small. There's no need to bite off a huge chunk and travel across, you know, halfway across the United States to get an idea of how will they travel? Yeah. He did pretty well right away. We knew he didn't get nauseated or have anxiety or anything like that. He mostly just slept. So it was a good fit for him. I mean, if it's getting close to his dinner time, he'll speak up and he will not be quiet. So like it's yeah, he knows to tell us like, OK, I've been good this whole time, but it's time to pull over.   Host: Don't we all?     Guest: Yeah, don't we? Exactly. Well said.     Host: All right, guys, what has been the coolest experience you've had while traveling?     Guest: Oh, yeah. This question is great because there's, there's just been so many. Like sometimes we would be like, remember that time we just got first, the first time we ran the AC in Iowa, but we were so happy that the thing worked. Yeah, small things. I think there was one of our coolest times was when we were in the Florida Keys, we were at a state park Bahia Honda, and we managed to get a site that was right on the water. So we could literally snorkel like right off where our view was part every day. And that was just like such a cool thing to do. That was nice.     Host: Yeah, we have not been there, but we've seen videos and pictures of actually Alexis and Lauren Jason, the podcast I mentioned you guys, their part to travel tips was all about the Florida Keys, so very detailed on that. And they were sending us pictures. And yeah, that campsite, no joke, it's right on the water.     Guest: And you can snorkel, sit and pull up a long chair. And yeah, so cool. It's like being in the Caribbean, but you're in the States. So that's like what's so cool about it.     Host: And same thing for you, Kyle, Bahia Honda?.     Guest: Yeah, I really enjoyed that. And I guess this to kind of cover your story that you brought up at the AC. It was funny when I said we hit the road at the first time when we left for travel nursing, we left at two o'clock in the morning, left her parents' house, and just drove to WalMart, stayed the night in a random WalMart. And then we kept driving and it was about to where did you say it was Iowa? I remember we made it to Iowa. We made it to Iowa. It was just it was so hot and humid for whatever reason. It was right around four o'clock. We finally pulled in an RV park. But then we turn on the AC for the first time in the RV. I know crazy, right? We tried this out when we got the dealership before we drove off. Now we waited till we got to Iowa before we ran the AC. But I kid you not, it was just like when that cold air was blowing on you and then you could turn around and look out and it's just something completely new. It is just like, wow, we are doing it and we're actually we're going to live like this. And yeah, that was really cool. That was a neat moment.     Host: After spending just about seven years traveling now, has there been anything you've learned that you cannot live without outside of the internet?     Guest: I would have to say, I mean, this is going to sound like something a young person would say, but my smartphone. Think about when you're out to get anything or figure out anything directions. Where's the nearest grocery store? Like, what's the Google reviews on this restaurant? It's like you gotta have your cell phone, like that little mini computer, to tell you so much.     Host: On the contrary, has there been anything that you've learned that you don't need while traveling?     Guest: Yeah, I think living in the RV when we started watching YouTube videos way back when we were first getting into it, there was a lot of unrealistic expectations of like, do I need all that before I hit the road and, you know, something like a ten thousand dollar solar set up or the same thing like crazy like that. You don't really need it to get it out, include knocking and blowing time off grid. You know, you can survive a night or two. Yeah, kind of what what what comes with your RV, just a battery, a water tank, water heater, you have everything you need. So I guess I just would say don't keep up with the Joneses all that much. You know, try to keep it realistic for the lifestyle you're looking for. Yeah, there's a lot of pressure online, social media with all these products. You gotta have this before you own this. And it's like just take your RV. Like, don't buy anything and just go like buy your basic stuff, your hoses and all the stuff to get by. But you don't need all the fancy digits and gadgets. Like, we still don't have a backup camera. And that was on our list when we first hit the road. We were like, look at one eventually. And now it's seven years and we're like, we don't really need it. You don't have to have it like you'll get by.     Host: If you wait and wait and wait until you have everything you need, you'll never hit the road. Exactly. A good point is kind of air on the side, especially with those expensive things. Air on the side of don't buy it. And then once you hit the road and you're traveling, you'll either learn that you need it and then you can buy it then or you're going to learn you don't need it and save ten thousand bucks on a solar panel set.     Guest: Well said. Well said.   Guest: Yeah, that's exactly how we feel, too. You can always get one battery and then add batteries from there. Any tools that RVers should have on them? Why don't you tell them about your favorite one?   Guest: Oh, yeah. We have a thing called a VIAIR and we just love it. It's amazing. Basically, it's an on demand air compressor that you can hook up to your truck battery and then it just creates on demand compressed air. They can fill up your tires if they're running a little bit low. Man, that was a huge concern for us because we were thinking when we get out there, how are we going to be able to fit into gas stations to fill up the tires if they're running low? This just eliminates all those stressors and you just have that whenever you need it most. And we had this huge normal air compressor like I think it's still in a storage unit.   Guest: Oh, yeah, that thing is huge. Really? Do we bring that? How do we fill up our tires? But I think we use that almost every time. This thing is lightweight. It's small. It doesn't take up a lot of space and it can pump up tires to like 120 PSI. So our trailer tires are 100 PSI maximum at cold pressures. So it does more than enough to handle those loads. So if you're thinking, oh, I drive a big class, say that's not going to help me. Actually, probably will. Yeah. And we just told people you don't need to buy stuff, but you do need to buy that.     Host: That's a good point. That's actually something we have not heard in the podcast yet. That's not one of those. I know you said it's smaller, but it's not one of those 20 volt compress bigger than that for your rig, right? Or is that something you can actually use? I guess you can charge it. I guess.     Guest: Well, I'm thinking of one. I've seen like people have like handheld ones. I don't know if those that's what you're thinking of. But this one is probably. Yeah, it's all it runs off the volt battery. So, you know, and you don't really charge it. It just literally plugs into the positive and negative terminal on a truck battery.     Host: And I think it's something else. And because it's the point I want to make was you really can't rely on gas stations. Like you said, you can't you might not be able to fit your RV, but also the air doesn't always work. We've had tire issues where we've pulled in. I've gone back and forth. I went to one gas station. The air didn't work. The next gas station. The air worked, but it didn't have the pressure gauge. So I go back to the first one and it was just the crapshoot going back and forth. But yeah, one person in the gas station had one of those. I think it was VIAIR, but it was smaller. It was like a DeWalt size volt compressor. And we just pumped it up right there. So, yeah, that's a good thing to have for sure.     Guest: Absolutely.     Host: If you could listen to this podcast when you were first starting out, is there a question I did not ask tonight that you wished I would have? And how would you answer that now?     Guest: Oh, you know what? There's, going back to the trucker lanes. I remember when we first hit the road, we had the diesel truck, but we were towing a smaller RV, and we kept squeezing into small, normal-sized gas stations because we didn't know that we could use the trucker lanes. We were like, "We're not allowed in there for the truckers." But if you're starting out, and I mean, basically, you're allowed to use the truck lanes. You're allowed to park in rest areas where trucks park. Like, basically, there were a lot of moments where we felt very timid. And then, just as you go along, you start to be more like, "Yeah, we own this road," you know? Like, you start to be a little bit more like, "Come on in and move over." So, and the reason we say that is because, you know, these RVs, especially the one we're living in, it's the same kind of tractor-trailer. So we measure 13 foot six inches at our first AC over our bedroom. So you've got to be really considerate of where is able to accommodate you. You can't just pull into any random gas station because you can get into a pickle pretty quickly. So, after some time of traveling and sweating it out, those trucker lanes look real nice at the end of the day. And you're like, "No, partaking that. Yeah, go in there, stretch out."     Host: That's a good point. I could definitely see myself being more hesitant like you guys. And once you start seeing, "Oh, there's an RV over there. Okay, we can go over there." And then once you start seeing that, "Okay, we can do that too." But I would be a little more reluctant to get over there.     Guest: Exactly, yeah.     Host: I know, you guys. It seems like you were kind of trailblazers in the digital creation space with travel nursing and traveling full time. But were there other influences or YouTube channels that influenced you or books maybe to do this travel full-time life?     Guest: What got us into travel nursing was just meeting other travel nurses at work. You met actually a couple that would travel together. That's how you found out they do it together. Yeah. But then when we started looking into RV travel, you know, we got on YouTube like a lot of people do. And I remember watching a lot of Long Long Honeymoon and Keep Your Daydream as a lot of them just to help get us, you know, give you, like, not you're not just learning, but you're gaining that confidence to, like, travel on the road. Yeah. And Kara and Nate is another one that's really fun. If people like fast-paced adventures that are like across the world, they're some of our favorite, or my favorites. Yeah, because they do. Yeah, they're really good with their storytelling, things like that. And so they inspire us to be better storytellers too.     Host: Yeah, I feel like if we were starting out, we didn't discover your channel. We were starting out because we were in the van life space. We were watching a lot of Adventures of A and K and Kara and Nate. But if we were looking for fifth wheels or camp trailers, we would have been all over your channel. I feel like we were like relate a lot to you guys and you're very entertaining. But also you provide a lot of useful information. So, yeah, I'll link your channel as well as the other channels you mentioned in the show notes. One last question for audiences in a ton of suspense before the next episode. Where are we talking about for travel tips?     Guest: So our destination we want to talk about is San Diego. San Diego. Yeah, we got a lot to say about that.     Host: All right. San Diego. Tune in in two days, everybody. Kyle and Renee, thanks again.     Guest: Thank you so much.    

Are we all burnt out?The term became so ubiquitous during the pandemic it came close to losing its meaning. However for many people struggling to managing the stresses of lockdown, childcare, demanding jobs and economic uncertainty, it became a way to communicate something quickly and with limited vulnerability. "I'm burned out" became a way to say many other things. Burnout does have a clear definition though. This week on the podcast, occupational health psychologist and researcher Professor Gail Kinman guides us through what we mean we we say burnout. Host Does using it as a catch-all phrase make is meaningless? What is emotional labour? And very importantly - what's going on when we cry at work?You can follow Prof Kinman on Twitter hereFor more episodes of Storyteller or to drop us message, go to https://www.welcometostoryteller.uk/ See acast.com/privacy for privacy and opt-out information.

One of the main concerns for surgical patients is how much pain they will experience after their procedure.  Dr. Kenneth Fan discusses the Enhanced Recovery After Surgery (ERAS) protocol, which not only reduces pain after surgery, but also decreases the use of opioids.    TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: We’re speaking with Dr. Ken Fan, a plastic surgeon at MedStar Washington Hospital Center. Thank you for joining us, Dr. Fan. Dr. Fan: My pleasure. Thanks for having me. Host: Today we’re discussing ways to reduce pain after various types of plastic surgery. Dr. Fan, pain has to be one of the most common fears patients have prior to plastic surgery. Can you explain how much pain patients can expect from surgery? Dr. Fan: Yes. With the enhanced recovery after surgery, multimodality, multidisciplinary protocol, the most important thing is to set the expectation of pain. So, the first part of the series of treatments is the pre-operative assessment of the patient. So, we go through a detailed discussion with how the patient has recovered in previous surgeries and how they tolerate pain. I discuss with them how they can see themselves recover from this particular surgery. This discussion is very important because not all patients perceive pain the same way and not all surgeries have the same amount of pain. Host: How long does recovery normally take after plastic surgery? Dr. Fan: Recovery varies, based on the type of procedure. Some procedures are out-patient, meaning that patients are discharged and go home. Some procedures require a 3 to 4-day in-patient stay. The benefit of using this ERAS multimodal analgesia protocol is that no matter how long the recovery, it’s shortened - patients return back to base-line functioning sooner and have decreased narcotic usage. Host: What kind of treatments do you provide patients to help them deal with pain or discomfort after plastic surgery? Dr. Fan: So, we use a combination of pre-operative non-narcotic medication that decreases the way the nerves fire. So, they don’t fire strongly, and they don’t fire as hard. Intraoperatively we work with our anesthesia colleagues and they provide a lot of medications that decrease nausea and vomiting after surgery and decrease the amount of pain. We also use wide-spread local blocks, meaning we use local anesthesia that also targets the nerves and prevents them from firing. This also decreases pain. After surgery, we usually provide a cocktail of medications that are also non-opioid anesthesia. They also target the way the nerves fire and they subdue everything and decrease the pain levels for patients. And we found with this ERAS protocol after major surgery, patients are only taking 1 to 2 narcotic tabs after surgery. And, this is research that is being published soon. Host: Is this one way that MedStar Washington Hospital Center is trying to decrease narcotic usage in light of the current opioid epidemic? Dr. Fan: Absolutely and thank you for asking. Yes, opioid use across America has reached a tipping point to where it’s been declared a health emergency. And this protocol especially addresses narcotic use across the board. With our research we’ve been able to demonstrate that application of this protocol has reduced opioid use significantly. And this is great because patients are not reliant on narcotic usage. This takes them out of the cycle of pain and opioid dependence that we unfortunately have seen as health care providers. And this also has the additional benefit of just returning patients to baseline and making them feel a lot better. Host: Does pain tolerance vary from person to person? If so, to what extent? Dr. Fan: Absolutely. I think some patients have higher pain tolerances, some patients have lower pain tolerances. Some patients have had extensive history of opioid use. And therefore, it’s up to us, the provider of the patient, before surgery, to have a discussion and so we can better manage their pain after surgery. Host: Could you share a story in which a patient received optimal care for their plastic surgery with minimal pain at MedStar Washington Hospital Center? Dr. Fan: Yes. There’s one patient in particular that comes to mind. This is a patient who has given permission for me to share her story. She previously has had more than six hernia operations. Her most recent one required a prolonged hospital stay, over two weeks, part of which was in the ICU. As you can imagine, she was not excited to come to the hospital after her hernia came back. In fact, she was putting off her surgery since July of 2018 and her hernia, subsequently, got a lot more complicated. But, long story short, because of the collaborations between the general surgeons, the anesthesia providers, and us, the plastic surgeons, we were able to devise a plan that decreased the amount of pain and decreased the amount of surgery that we had to do. She ended up doing great after surgery. She was with this ERAS protocol, was walking postoperative day 1. She said that this was the best she’s ever felt in her 7 previous surgeries and that she was very excited to tell all her friends that MedStar Washington Hospital Center offers this service. Host: Thanks for joining us today, Dr. Fan. Dr. Fan: Thank you for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

From pelvic pain to fertility problems, endometriosis can affect women’s quality of life and relationships. Discover which treatment options Dr. Vadim Morozov says can reduce symptoms, and what to expect during recovery.   TRANSCRIPT Host: Thanks for joining us today. We’re speaking with Dr. Vadim Morozov, a gynecologic surgeon at MedStar Washington Hospital Center. Today we’re discussing endometriosis, a gynecologic condition that affects more than 11 percent of women between 15 and 44 in the U.S. Welcome, Dr. Morozov. Dr. Vadim Morozov: Thank you for having me. Host: Could you start by telling us what is endometriosis? Dr. Morozov: Endometriosis is a disease where endometrium, which is normally growing on the wall of the uterus and inside the uterus, starts growing outside of the uterus on the surface of your intestines and the surface of your bladder, all around the pelvic organs in the areas. And, as a result of that problematic growth, you start having pain and symptoms associated with it. Host: What are the most common symptoms of endometriosis? Dr. Morozov: Most common ones would be very difficult menstrual periods, cramping, severe pain with that. Pain with sexual intercourse. Pain when you go to the bathroom, having the bowel movements or when you’re urinating. Those are the top four that comes to mind when we’re talking about endometriosis. Pain perception is individualized, obviously, right? So, as you know, one person hits the finger and barely notices, and the other person hits the finger with the same strength and like, you know, ‘I’m dying, that’s it, call the ambulance.’ So, having said that, it obviously depends on the patient, her perception of the pain, support structure that she has, and her goals in life. Host: How is endometriosis diagnosed? Dr. Morozov: Unfortunately, the only way to diagnose endometriosis nowadays is by laparoscopy. We can make a presumptive diagnosis that the patient might have an endometriosis just by symptoms of what she’s describing and the physical examination. But to be 100 percent sure, usually we have to look and see the lesions of endometriosis and even better to biopsy those lesions and send them to pathology to tell us that, ‘yes, it is exactly endometriosis.’ Host: Are there any genetic or environmental components associated with the risk factors for endometriosis? Dr. Morozov: There are some. We know, for example, that if you have a mother or a sister or an aunt with endometriosis, you as a patient are at higher risk of developing endometriosis. There are some studies also saying that the environmental factors such as organic pollutants that we have in the atmosphere also affect the development of endometriosis. Um, but there are no conclusive results yet that can pinpoint us with 100 percent accuracy. Host: Can endometriosis go away on its own? Dr. Morozov: That’s a very interesting question. The short answer is probably no. Um, you might be asymptomatic, meaning you don’t as a patient don’t have much of the symptoms related to endometriosis. But if you have them, highly unlikely that the disease will resolve and go away on its own. Host: What are the treatments for endometriosis? Dr. Morozov: Normally if we diagnose somebody with endometriosis, it’s not unreasonable to start some sort of a medical treatment, such as non-steroidal anti-inflammatory, birth control pills. There are some other medications that are a little ‘heavy drugs’ as we call them - anything that controls hormonal fluctuations in your body - usually is the first line of treatment. In my experience, most patients don’t do too well on those, um, medications. And inevitably ends up with a surgery. Um, so the gold standard would be something like minimally invasive surgery by laparoscopy, with small, tiny, less than an inch incisions that made in the belly, and then the endometriosis diagnosed and removed at the same time.  Host: Are there any risks for a woman’s health long term if she doesn’t get her endometriosis treated? Dr. Morozov: There are. Endometriosis, to a certain extent, is almost like cancer. Obviously, it doesn’t kill you but it tends to spread in the abdomen and in the pelvis in a similar way. It can actually involve and invade your bowels, it can invade your bladder, it can invade other structures and organs that are in the pelvis. So, technically, if you leave severe endometriosis untreated, you are at risk of developing complications related to it. Host: Can endometriosis affect fertility? Dr. Morozov: Yes. Technically we’re saying that endometriosis does not cause infertility, but rather it causes what we call a subfertility, meaning if you’re a woman with endometriosis, for you it is going to be much harder to get pregnant than for a woman who doesn’t have it. The reason being is because endometriosis creates the inflammatory environment in the abdomen and pelvis. Your pelvic organ is constantly in the state on inflammation that lowers the chances of becoming pregnant.  Host: Does all of that inflammation and all of that scar tissue and so forth that happens with endometriosis increase cancer risk or anything like that for women? Dr. Morozov: There’s been some association between endometriosis and endometrioid type ovarian cancer. There is no direct correlation, but some researchers are looking that they, some particular endometriomas, which is a chocolate-filled cyst of the ovary, can lead potentially to endometrioid-type cancer.  Host: Have you seen any exciting research that has you excited for women’s health in the future? Dr. Morozov: There are a couple of good areas of research in endometriosis. One of them is to develop markers of endometriosis that allows us diagnosis without doing the surgery. So, the markers are done from drawing the blood from the patient or even the saliva test that goes to the laboratory and tells you as a patient and me as a physician that there’s a good chance that you might have a disease. It’s in the research phase right now but the results, at least preliminary results, are looking very promising. The other field of interesting research is to develop better laparoscopic visualization tools. Very often we go into laparoscopy with a small camera is placed in the abdomen and pelvis and we don’t see anything or maybe we miss a lesion because our eyes are not trained to recognize highly specific lesions in the pelvis. So, some companies are working on the, what’s called filters, that allow a better visualization of endometriotic implants during laparoscopic surgery. Host: Are there any questions that a woman should ask when she goes to her doctor? What does she need to know to take care of herself going forward after she’s received treatment? Dr. Morozov: Well, one thing is, what’s the long-term prognosis? What kind of endometriosis I have. Is it the mild disease that’s easily treated or versus a severe disease that involves surrounding organs such as rectum, bowel or bladder or anything else? The next question the woman should ask, depending on her fertility age, will it affect my fertility? Can I get pregnant? Can I get pregnant on my own or do I need to go to see an infertility specialist for this? The next question would be, in 10 or 15 years when I’m done with my childbearing, what are the options for me as far as having a definitive surgical management of this condition? So those are something that every woman diagnosed with endometriosis should keep in mind. Host: What is recovery like for women after undergoing surgery for endometriosis? Dr. Morozov: Usually it takes about 6 months to feel better. So, within the couple first months, you’re sore with the surgery itself. After that time the surgical pain starts going away and you’re feeling great. But it still lingers for some time. So, within the 6 months period we expect to see a result of the pain improvement and the symptoms related to endometriosis improvement. How long does it last as recovery depends. I’ve seen patients that are very good and for years don’t have any symptoms and then sort of slowly starts coming back. And I’ve seen the patients who recur within 3 to 6 months after surgery. Unfortunately, it’s unpredictable. Host: Can a woman expect to become pain-free eventually, after she has treatment for endometriosis? Dr. Morozov: Very tricky question. The answer is, depends on the conditions and the extent of the disease. Very often, by the time we see those women, the disease is severe enough that it’s near impossible to make them completely pain-free. And I try to have a very honest discussion with my patients in anticipation of whatever treatment options we choose, saying the goal of, whether we do surgery or anything else, the goal is not to make you 100 percent pain-free. The goal of everything we do is to bring it to the point where you can function normally every day. You’re probably going to have pain here and there, but that pain shouldn’t be debilitating. You shouldn’t be missing school or work because of the pain. In my experience, it’s near impossible to make a woman diagnosed with endometriosis 100 percent pain-free. Host: Why should a woman come to MedStar Washington Hospital Center for endometriosis care? Dr. Morozov: Well, we are the largest and probably the best equipped group on the east coast, mid-Atlantic. We have multiple fellowship trained specialists that deal with nothing else but endometriosis and pelvic pain. Our group at the National Center for Advanced Pelvic Surgery have multiple urogynecologists and the specifically trained female urologists that deal with the conditions of the pelvic pain and of the reproductive disorders.   Host: Thanks for joining us today, Dr. Morozov. Dr. Morozov: My pleasure. Thank you for having me.

Panel: Aaron Frost Brian Love Special Guest: Amir Tugendhaft In this episode, Aaron and Brian talk with Amir Tugendhaft who is a web developer who is located in Israel. He finds much gratification developing and building things from scratch. Check out today’s episode where Aaron, Brian, and Amir talk about just that. Other topics include UI Design, Flexbox, UX design, PrimeNG, and ag-Grid. Show Topics: 0:00 – Advertisement: AngularBootCamp.Com 0:52 – Host: Welcome! Today’s panel is myself, Brian, and our guest is Amir Tugendhaft! 1:13 – Guest: I am a developer and experience with Angular and React. 1:56 – Host: You spend your days/nights there? 2:03 – Panel: He is committed. 2:08 – Host: I am going to back up a second, and Brian could you please introduce yourself, please? 2:26 – Brian: I am the CETO at an Angular consulting firm (Denver, CO). We have the pleasure with working with Aaron from time-to-time. My Twitter handle is @brian_love – check it out! 2:52 – Host: What is CETO stand for? 2:59 – Brian answers the question. Brian: I oversee the crew among other things. 3:31 – Host: What do you want to talk about today, Amir? You are the guest of honor today! 3:40 – Guest. 4:00 – Host: That is a lot of information – that might be more than 1 episode. We have to stay focused! 4:14 – Host: I read one of your recent blogs about Cross Filled Violators. I met you through your blog before we did the Host: Give us your own ideas about starting your own app. 4:50 – Guest answers the question. 6:17 – Host: I am biased. But here is a fact. I used to work on a large team (60 people) and everyone committing to the same page app. We were using Angular.js 1.5, which I think they are still using that. I know that it worked but it wasn’t the easiest or fastest one to maintain, but it worked. 7:05 – Brian. 7:10 – Host: What are you trying to do? React doesn’t fulfill that need. I think you are being hyperballic and using extreme cases as the norm. Let’s be honest: we do cool stuff with jQuery plugins when we didn’t have a framework. When they say that the framework is stopping them then I say: I agree to disagree. 8:00 – Host: What do you think, Amir? 8:04 – Guest: I don’t have preferences. I try to build applications through the technologies and create components and simple applications. 8:30 – Brian. 8:33 – Guest: You create the component, and then... 9:21 – Brian: You don’t have to have a template file and another file – right? 9:35 – Guest. 9:48 – Host: I do in-line styles and in-line templates. One thing I learned from React is that I like my HTML, style and code. I like it being the same file as my component. I like that about that: I like single file components. This promotes getting frustrated if it gets too big. Yeah if it’s more than 500 lines than you have to simplify. That’s one of the things that l like. 10:47 – Brian: Modules versus... 10:55 – Guest. 11:07 – Host: I think in React and Vue you have the word module but in JavaScript you have a file that exports... 11:26 – Host: I have my opinion here and talking with Joe. He made a good point: at a certain level the frontend frameworks are the same. You could be doing different things but they basically do the same thing. 13:57 – Guest: Basically what that means is that the technology used it will do the same thing. Your patterns and practices are huge. 14:17 – Brian: If you are talking about the 3 popular frameworks out there – they are basically doing the same thing. I like Angular a little big more, though. Like you said, Aaron, people tend to pick the same one. I like the opinionated things about Angular. You get properties, components or called props or inputs you are getting a lot of the same features. It comes down to your personal preference. 15:31 – Host: What else Amir? 15:35 – Guest: Let’s talk about the UI. 16:05 – Brian. 16:08 – Guest asks a question. 16:25 – Brian: How have you tackled this problem? 16:34 – Guest: I kind of ran with it. If there wasn’t something that I liked I started from scratch, because it really didn’t feel right. 16:51 – Brian: I am an enemy of starting over type of thing. You have a lot of engineers who START projects, and they can say that they start this piece, but the experts and choice team members have what it takes to ship a feature. I mean fully ship it, not just 80%, but also the final 20%. I think it takes a lot of pose decision making to say I want to rewrite it but not right now. I still need to ship this code. I have always been a bigger fan as not rewriting as much as possible; however, if you started with good patterns then that’s true, but if you are starting off with bad patterns then maybe yes. I like that opinion b/c you have to start right. Brian: How do you do your CSS? 19:05 – Guest. 19:52 – Advertisement: Get A Coder Job! 20:30 – Brian: How do you make those decisions, Amir? 20:39 – Guest: I see something that I like and ask myself how do I apply this to my design and I start scaling things. 21:50 – Host: Are you using a tool like Sketch for your initial UI design? 22:05 – Guest. 22:54 – Host: I worked on a project where the client had a designer (UX). 24:00 – Host and Guest go back-and-forth. 24:51 – Host: I am sure it’s all about the quality from your designer, too. Hopefully it works well for you and it’s quality. 25:18 – Host: There is a lot to building an app from scratch. I am not a good designer. I am not a designer – I mean straight-up. I got nothing. I appreciate team members that can do that. 26:06 – Guest: Do you write...? 26:35 – Host: Only on the most recent project. The designer didn’t own the HTML CSS but he initially wrote it and then gave it to me and now I own it, and it’s in components. If he wants updates then I have to go and make changes b/c he doesn’t know Angular. If it’s a sketch or a PNG you have to make it look like that. That’s what most of my career has been. Host: HTML and CSS got me 762x easier once Flexbox came around! I know there is a decimal there! 28:23 – Host talks about Flexbox some more. 28:42 – Guest asks a question. 28:50 – Host: I suppose if I really had heavy needs for a table then I would try CSS grid could solve some problems. I might just use a styled table. 29:12 – Brian: ag-Grid or something else. 29:21 – Host: On this recent project...I’ve used in-house design and other things. If I ever needed a table it was there. I don’t rebuild components b/c that can get expensive for me. 30:50 – Brian: Accessibility. 31:00 – Host: Your upgrade just got 10x harder b/c you own the component loop. I really don’t build tables or drop-downs. Only way is if I really need to build it for a specific request. 31:30 – Brian. 31:58 – Host: Let me give you an example. You can think I am crazy, but a designer gave me a drop-down but he told me to use PrimeNG. I had the chose of building my own drop-down or the designer has to accept whatever they gave him. I made the UI make what he wanted and I made the drop-down zero capacity and then... Host: When you click on what you see you are clicking on the... Host: Does that make sense? 33:35 – Guest. 33:50 – Host. 34:25 – Brian: That is interesting; remember when... 34:58 – Host: We will send this episode to Jeremy – come on Jeremy! Any last ideas? Let’s move onto picks! 35:20 – Advertisement – Fresh Books! 30-day free trial! END – Advertisement – Cache Fly! Links: Vue jQuery Angular React C# What is a UX Design? UI Design Flexbox Sketch ag-Grid PrimeNG Brian Love’s Twitter Aaron Frost’s Medium Amir’s Medium Amir’s Twitter Amir’s GitHub Amir’s LinkedIn Amir’s Facebook Sponsors: Angular Boot Camp Fresh Books Get a Coder Job Course Cache Fly Picks: Aaron Movie: “A Star Is Born” Concept - Model Driven Forms Amir Puppeteer Arrow Function Converter Brian TV Series: “The 100” Angular Schematics

Panel: Aaron Frost Brian Love Special Guest: Amir Tugendhaft In this episode, Aaron and Brian talk with Amir Tugendhaft who is a web developer who is located in Israel. He finds much gratification developing and building things from scratch. Check out today’s episode where Aaron, Brian, and Amir talk about just that. Other topics include UI Design, Flexbox, UX design, PrimeNG, and ag-Grid. Show Topics: 0:00 – Advertisement: AngularBootCamp.Com 0:52 – Host: Welcome! Today’s panel is myself, Brian, and our guest is Amir Tugendhaft! 1:13 – Guest: I am a developer and experience with Angular and React. 1:56 – Host: You spend your days/nights there? 2:03 – Panel: He is committed. 2:08 – Host: I am going to back up a second, and Brian could you please introduce yourself, please? 2:26 – Brian: I am the CETO at an Angular consulting firm (Denver, CO). We have the pleasure with working with Aaron from time-to-time. My Twitter handle is @brian_love – check it out! 2:52 – Host: What is CETO stand for? 2:59 – Brian answers the question. Brian: I oversee the crew among other things. 3:31 – Host: What do you want to talk about today, Amir? You are the guest of honor today! 3:40 – Guest. 4:00 – Host: That is a lot of information – that might be more than 1 episode. We have to stay focused! 4:14 – Host: I read one of your recent blogs about Cross Filled Violators. I met you through your blog before we did the Host: Give us your own ideas about starting your own app. 4:50 – Guest answers the question. 6:17 – Host: I am biased. But here is a fact. I used to work on a large team (60 people) and everyone committing to the same page app. We were using Angular.js 1.5, which I think they are still using that. I know that it worked but it wasn’t the easiest or fastest one to maintain, but it worked. 7:05 – Brian. 7:10 – Host: What are you trying to do? React doesn’t fulfill that need. I think you are being hyperballic and using extreme cases as the norm. Let’s be honest: we do cool stuff with jQuery plugins when we didn’t have a framework. When they say that the framework is stopping them then I say: I agree to disagree. 8:00 – Host: What do you think, Amir? 8:04 – Guest: I don’t have preferences. I try to build applications through the technologies and create components and simple applications. 8:30 – Brian. 8:33 – Guest: You create the component, and then... 9:21 – Brian: You don’t have to have a template file and another file – right? 9:35 – Guest. 9:48 – Host: I do in-line styles and in-line templates. One thing I learned from React is that I like my HTML, style and code. I like it being the same file as my component. I like that about that: I like single file components. This promotes getting frustrated if it gets too big. Yeah if it’s more than 500 lines than you have to simplify. That’s one of the things that l like. 10:47 – Brian: Modules versus... 10:55 – Guest. 11:07 – Host: I think in React and Vue you have the word module but in JavaScript you have a file that exports... 11:26 – Host: I have my opinion here and talking with Joe. He made a good point: at a certain level the frontend frameworks are the same. You could be doing different things but they basically do the same thing. 13:57 – Guest: Basically what that means is that the technology used it will do the same thing. Your patterns and practices are huge. 14:17 – Brian: If you are talking about the 3 popular frameworks out there – they are basically doing the same thing. I like Angular a little big more, though. Like you said, Aaron, people tend to pick the same one. I like the opinionated things about Angular. You get properties, components or called props or inputs you are getting a lot of the same features. It comes down to your personal preference. 15:31 – Host: What else Amir? 15:35 – Guest: Let’s talk about the UI. 16:05 – Brian. 16:08 – Guest asks a question. 16:25 – Brian: How have you tackled this problem? 16:34 – Guest: I kind of ran with it. If there wasn’t something that I liked I started from scratch, because it really didn’t feel right. 16:51 – Brian: I am an enemy of starting over type of thing. You have a lot of engineers who START projects, and they can say that they start this piece, but the experts and choice team members have what it takes to ship a feature. I mean fully ship it, not just 80%, but also the final 20%. I think it takes a lot of pose decision making to say I want to rewrite it but not right now. I still need to ship this code. I have always been a bigger fan as not rewriting as much as possible; however, if you started with good patterns then that’s true, but if you are starting off with bad patterns then maybe yes. I like that opinion b/c you have to start right. Brian: How do you do your CSS? 19:05 – Guest. 19:52 – Advertisement: Get A Coder Job! 20:30 – Brian: How do you make those decisions, Amir? 20:39 – Guest: I see something that I like and ask myself how do I apply this to my design and I start scaling things. 21:50 – Host: Are you using a tool like Sketch for your initial UI design? 22:05 – Guest. 22:54 – Host: I worked on a project where the client had a designer (UX). 24:00 – Host and Guest go back-and-forth. 24:51 – Host: I am sure it’s all about the quality from your designer, too. Hopefully it works well for you and it’s quality. 25:18 – Host: There is a lot to building an app from scratch. I am not a good designer. I am not a designer – I mean straight-up. I got nothing. I appreciate team members that can do that. 26:06 – Guest: Do you write...? 26:35 – Host: Only on the most recent project. The designer didn’t own the HTML CSS but he initially wrote it and then gave it to me and now I own it, and it’s in components. If he wants updates then I have to go and make changes b/c he doesn’t know Angular. If it’s a sketch or a PNG you have to make it look like that. That’s what most of my career has been. Host: HTML and CSS got me 762x easier once Flexbox came around! I know there is a decimal there! 28:23 – Host talks about Flexbox some more. 28:42 – Guest asks a question. 28:50 – Host: I suppose if I really had heavy needs for a table then I would try CSS grid could solve some problems. I might just use a styled table. 29:12 – Brian: ag-Grid or something else. 29:21 – Host: On this recent project...I’ve used in-house design and other things. If I ever needed a table it was there. I don’t rebuild components b/c that can get expensive for me. 30:50 – Brian: Accessibility. 31:00 – Host: Your upgrade just got 10x harder b/c you own the component loop. I really don’t build tables or drop-downs. Only way is if I really need to build it for a specific request. 31:30 – Brian. 31:58 – Host: Let me give you an example. You can think I am crazy, but a designer gave me a drop-down but he told me to use PrimeNG. I had the chose of building my own drop-down or the designer has to accept whatever they gave him. I made the UI make what he wanted and I made the drop-down zero capacity and then... Host: When you click on what you see you are clicking on the... Host: Does that make sense? 33:35 – Guest. 33:50 – Host. 34:25 – Brian: That is interesting; remember when... 34:58 – Host: We will send this episode to Jeremy – come on Jeremy! Any last ideas? Let’s move onto picks! 35:20 – Advertisement – Fresh Books! 30-day free trial! END – Advertisement – Cache Fly! Links: Vue jQuery Angular React C# What is a UX Design? UI Design Flexbox Sketch ag-Grid PrimeNG Brian Love’s Twitter Aaron Frost’s Medium Amir’s Medium Amir’s Twitter Amir’s GitHub Amir’s LinkedIn Amir’s Facebook Sponsors: Angular Boot Camp Fresh Books Get a Coder Job Course Cache Fly Picks: Aaron Movie: “A Star Is Born” Concept - Model Driven Forms Amir Puppeteer Arrow Function Converter Brian TV Series: “The 100” Angular Schematics

Panel: Aaron Frost Brian Love Special Guest: Amir Tugendhaft In this episode, Aaron and Brian talk with Amir Tugendhaft who is a web developer who is located in Israel. He finds much gratification developing and building things from scratch. Check out today’s episode where Aaron, Brian, and Amir talk about just that. Other topics include UI Design, Flexbox, UX design, PrimeNG, and ag-Grid. Show Topics: 0:00 – Advertisement: AngularBootCamp.Com 0:52 – Host: Welcome! Today’s panel is myself, Brian, and our guest is Amir Tugendhaft! 1:13 – Guest: I am a developer and experience with Angular and React. 1:56 – Host: You spend your days/nights there? 2:03 – Panel: He is committed. 2:08 – Host: I am going to back up a second, and Brian could you please introduce yourself, please? 2:26 – Brian: I am the CETO at an Angular consulting firm (Denver, CO). We have the pleasure with working with Aaron from time-to-time. My Twitter handle is @brian_love – check it out! 2:52 – Host: What is CETO stand for? 2:59 – Brian answers the question. Brian: I oversee the crew among other things. 3:31 – Host: What do you want to talk about today, Amir? You are the guest of honor today! 3:40 – Guest. 4:00 – Host: That is a lot of information – that might be more than 1 episode. We have to stay focused! 4:14 – Host: I read one of your recent blogs about Cross Filled Violators. I met you through your blog before we did the Host: Give us your own ideas about starting your own app. 4:50 – Guest answers the question. 6:17 – Host: I am biased. But here is a fact. I used to work on a large team (60 people) and everyone committing to the same page app. We were using Angular.js 1.5, which I think they are still using that. I know that it worked but it wasn’t the easiest or fastest one to maintain, but it worked. 7:05 – Brian. 7:10 – Host: What are you trying to do? React doesn’t fulfill that need. I think you are being hyperballic and using extreme cases as the norm. Let’s be honest: we do cool stuff with jQuery plugins when we didn’t have a framework. When they say that the framework is stopping them then I say: I agree to disagree. 8:00 – Host: What do you think, Amir? 8:04 – Guest: I don’t have preferences. I try to build applications through the technologies and create components and simple applications. 8:30 – Brian. 8:33 – Guest: You create the component, and then... 9:21 – Brian: You don’t have to have a template file and another file – right? 9:35 – Guest. 9:48 – Host: I do in-line styles and in-line templates. One thing I learned from React is that I like my HTML, style and code. I like it being the same file as my component. I like that about that: I like single file components. This promotes getting frustrated if it gets too big. Yeah if it’s more than 500 lines than you have to simplify. That’s one of the things that l like. 10:47 – Brian: Modules versus... 10:55 – Guest. 11:07 – Host: I think in React and Vue you have the word module but in JavaScript you have a file that exports... 11:26 – Host: I have my opinion here and talking with Joe. He made a good point: at a certain level the frontend frameworks are the same. You could be doing different things but they basically do the same thing. 13:57 – Guest: Basically what that means is that the technology used it will do the same thing. Your patterns and practices are huge. 14:17 – Brian: If you are talking about the 3 popular frameworks out there – they are basically doing the same thing. I like Angular a little big more, though. Like you said, Aaron, people tend to pick the same one. I like the opinionated things about Angular. You get properties, components or called props or inputs you are getting a lot of the same features. It comes down to your personal preference. 15:31 – Host: What else Amir? 15:35 – Guest: Let’s talk about the UI. 16:05 – Brian. 16:08 – Guest asks a question. 16:25 – Brian: How have you tackled this problem? 16:34 – Guest: I kind of ran with it. If there wasn’t something that I liked I started from scratch, because it really didn’t feel right. 16:51 – Brian: I am an enemy of starting over type of thing. You have a lot of engineers who START projects, and they can say that they start this piece, but the experts and choice team members have what it takes to ship a feature. I mean fully ship it, not just 80%, but also the final 20%. I think it takes a lot of pose decision making to say I want to rewrite it but not right now. I still need to ship this code. I have always been a bigger fan as not rewriting as much as possible; however, if you started with good patterns then that’s true, but if you are starting off with bad patterns then maybe yes. I like that opinion b/c you have to start right. Brian: How do you do your CSS? 19:05 – Guest. 19:52 – Advertisement: Get A Coder Job! 20:30 – Brian: How do you make those decisions, Amir? 20:39 – Guest: I see something that I like and ask myself how do I apply this to my design and I start scaling things. 21:50 – Host: Are you using a tool like Sketch for your initial UI design? 22:05 – Guest. 22:54 – Host: I worked on a project where the client had a designer (UX). 24:00 – Host and Guest go back-and-forth. 24:51 – Host: I am sure it’s all about the quality from your designer, too. Hopefully it works well for you and it’s quality. 25:18 – Host: There is a lot to building an app from scratch. I am not a good designer. I am not a designer – I mean straight-up. I got nothing. I appreciate team members that can do that. 26:06 – Guest: Do you write...? 26:35 – Host: Only on the most recent project. The designer didn’t own the HTML CSS but he initially wrote it and then gave it to me and now I own it, and it’s in components. If he wants updates then I have to go and make changes b/c he doesn’t know Angular. If it’s a sketch or a PNG you have to make it look like that. That’s what most of my career has been. Host: HTML and CSS got me 762x easier once Flexbox came around! I know there is a decimal there! 28:23 – Host talks about Flexbox some more. 28:42 – Guest asks a question. 28:50 – Host: I suppose if I really had heavy needs for a table then I would try CSS grid could solve some problems. I might just use a styled table. 29:12 – Brian: ag-Grid or something else. 29:21 – Host: On this recent project...I’ve used in-house design and other things. If I ever needed a table it was there. I don’t rebuild components b/c that can get expensive for me. 30:50 – Brian: Accessibility. 31:00 – Host: Your upgrade just got 10x harder b/c you own the component loop. I really don’t build tables or drop-downs. Only way is if I really need to build it for a specific request. 31:30 – Brian. 31:58 – Host: Let me give you an example. You can think I am crazy, but a designer gave me a drop-down but he told me to use PrimeNG. I had the chose of building my own drop-down or the designer has to accept whatever they gave him. I made the UI make what he wanted and I made the drop-down zero capacity and then... Host: When you click on what you see you are clicking on the... Host: Does that make sense? 33:35 – Guest. 33:50 – Host. 34:25 – Brian: That is interesting; remember when... 34:58 – Host: We will send this episode to Jeremy – come on Jeremy! Any last ideas? Let’s move onto picks! 35:20 – Advertisement – Fresh Books! 30-day free trial! END – Advertisement – Cache Fly! Links: Vue jQuery Angular React C# What is a UX Design? UI Design Flexbox Sketch ag-Grid PrimeNG Brian Love’s Twitter Aaron Frost’s Medium Amir’s Medium Amir’s Twitter Amir’s GitHub Amir’s LinkedIn Amir’s Facebook Sponsors: Angular Boot Camp Fresh Books Get a Coder Job Course Cache Fly Picks: Aaron Movie: “A Star Is Born” Concept - Model Driven Forms Amir Puppeteer Arrow Function Converter Brian TV Series: “The 100” Angular Schematics

Can talcum powder cause ovarian cancer? Dr. Louis Dainty discusses why he recommends women not use the product on their genital area.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking to Dr. Louis Dainty, Regional Director of Gynecologic Oncology at MedStar Washington Hospital Center. Welcome, Dr. Dainty. Dr. Dainty: Thank you. It’s great to be here. Host: Why don’t we begin by telling us a little bit about yourself. Why did you go into medicine, and how did you come to be at MedStar Washington Hospital Center? Dr. Dainty: My interest in medicine began as a, as a kid. I knew I wanted to be a doctor and going the long way to get there, I went in the military, went to medical school after spending some time in infantry and just retired from the military a physician after 26 years just last year. Host: What led you into women’s health and women’s oncology? Dr. Dainty: I fell in love with women’s health as soon as I rotated on my OBGYN rotation as a medical student. Initially I thought I was going to be interested in orthopedics but then it was much easier working with women—they were a lot tougher than men. Host: Today we are talking about ovarian cancer and talcum powder, or baby powder. So, a jury in August 2017 awarded a woman $417 million in a case against Johnson and Johnson. The woman claimed that her terminal ovarian cancer was caused by the company’s baby powder, which she said she’d used for decades. And this isn’t the first time that talcum powder has been blamed for causing ovarian cancer. So, Dr. Dainty, what does science say about whether baby powder can cause ovarian cancer? Dr. Dainty: The first concern about the possible link between the use of talcum powder and ovarian cancer dates back to 1960s, and that sprung from the initial contamination of talcum powder with asbestos. For some time now, there hasn’t been any asbestos in talcum powder, but still the question remained whether or not there was an association between the use of talcum powder on a female perineum and risk of developing ovarian cancer. The data has been studied, mostly not in a prospective manner but in an observation manner, and the data is mixed—most studies showing that there is no association between the use of talcum powder and ovarian cancer, and others showing that there is a small increased risk of ovarian cancer with the use of talcum powder. When scientists have gone back and looked at the data in total, it seems that statistically there is a very small increased risk of ovarian cancer with the use of talcum powder on the perineum, with specifically a single type of ovarian cancer, and that’s the most common type which is papillary serous carcinoma of the ovary. Host: What do the studies suggest about a woman’s risk for developing ovarian cancer if she’s used talcum powder? Dr. Dainty: Your lifetime risk of developing ovarian cancer is about 1.6 percent of all women, so slightly less than two women out of 100 will get ovarian cancer during their life. And the majority of women die from that cancer because it usually doesn’t present until it’s very advanced. Some of the studies suggest slight increase of a risk of ovarian cancer where, if the baseline risk was 1.6 percent, some studies have shown that it might be as high as 1.8 percent. Now that doesn’t sound like it’s a lot, but instead of 14 women out of a thousand, 16 women out of a thousand would develop ovarian cancer. So those two additional women would certainly not feel that that’s not a significant increased risk from talcum powder. So, while statistically it seems like a very small increase, anything we can try to do to try to decrease your risk of developing ovarian cancer, especially something as simple as not applying talcum powder to your bottom, is worth the effort. Host: So, would it be fair to say that you do recommend that women who use talcum powder stop doing so, or use it less frequently? Dr. Dainty: Yeah, I would recommend that they don’t apply it directly to their perineum because the vagina is interesting in that there is a communication, obviously, physiologic communication, between the outside world and the inside of your body by means of the vagina and the cervix. And so, in theory, talcum powder could be transported from outside of your body into your vagina and up through your cervix because that’s where sperm travel. Talcum powder certainly also could be transported that way, physiologically. So, yes, I’m recommending that if you’re going to use talcum powder that you use it sparingly around your bottom and not apply it directly to your perineum or your vagina. Cornstarch, without any other additives, seems to do some of the same functions as talcum powder without, the, any obvious risks or any clear association between risk and, so if you have to use something, maybe a more natural subject like cornstarch would do. But again, so just avoid using talcum powder. Host: Why do women use talc in these areas, and are there certain groups of women who use it more often? Dr. Dainty: Historically, generations past, I think that a lot of women were taught to put a sanitary pad on, and prior to application of the sanitary pad on their vaginas, they would put talcum powder just to absorb moisture and to also combat bad smell. I think a lot of women, especially older women, grew up doing that. I think younger women, there’s very few women that do that anymore. And so, that’s why people started using talcum powder in the first place. Host: And when you say that it affects the perineum of the woman, could you explain what that body part is, for individuals who might not know. Dr. Dainty: So, the perineum is anything, the vagina, the labia, external genitalia basically, between your thighs, from your pubic bone down to your anus. Host: Are there other products a woman may use, internally or externally, such as petroleum jelly, that may raise her risk for ovarian cancer? Dr. Dainty: Yeah, that’s an interesting question and the bottom line is there is no evidence to date that there is any increased risk with those, at least not that I am aware of, but you bring up a good point—any petroleum-based product that’s applied to your perineum could have, theoretically have, a risk. The bottom line is what I tell most of my patients is when people ask me, you know, “should I use douching or anything like that,” I say “no” and basically that God designed the vagina just the way it’s supposed to be and you shouldn’t mess with that—mess with it as little as possible. So, I don’t recommend using any foreign products, that are artificial products, that you don’t have to. Obviously, people that need artificial lubricant in order have comfortable intercourse, the products with the least number of additives, either color or perfumes or anything like that, are, are, going to be the safest. Host: Is it safe to use baby powder on a baby’s bottom? Dr. Dainty: We don’t know what that risk is, but certainly the use of baby powder for babies is pretty common, and we don’t know whether or not that increases risk. It’d be hard—it’s hard to design a study where you take a hundred babies and expose half of them to talcum powder and the other half you hold back, so all you’re left with is recollection of whether or not a mother said that she used talcum powder on her baby’s bottom or not. So, it’s difficult to get at those kind of exposures through scientific investigation. If I had babies again, I would probably not use talcum powder on their bottoms. Host: If you have a woman who’s used talcum powder for years or for decades, should she be concerned, or should she see her doctor more frequently? Dr. Dainty: No. There is no—there’s no call for alarm and there’s no call for increased testing or surveillance. There is no current routine screening that is recommended for the prevention or diagnosis of ovarian cancer in people that are at baseline risk. That means a lifetime risk of 1.6 percent, perhaps, in the United States. So, no, I wouldn’t say that anybody who has used talcum powder in the past should do anything different except maybe stop using talcum powder. Host: When you’re talking about screening for ovarian cancer, there is really no great test, like mammography for breast cancer or pap smears for cervical cancer. What does screening look like, then, for ovarian cancer? Dr. Dainty: There is no routine screening. As you just said, there is no routine screening for baseline risk, women at baseline risk for ovarian cancer. There are some screenings that we recommend for women who fall into the category of familial or hereditary ovarian cancer, which is a different topic altogether. But for the baseline-risk, general population, there is no routine screening. The only thing that, as an individual and/or a provider, that you may ask a patient to look for are symptoms. So, early satiety, bloating, increased abdominal girth, abdominal pain that occur more days than not—if that’s a new finding, that’s something you need to bring up to your OB GYN. And so that’s really the only screening that I would recommend for all folks. Host: So, you alluded to this a little bit before. What are those main risk factors for ovarian cancer? Dr. Dainty: Probably the biggest is age. So, the average age for ovarian cancer is about 63. So, the older you get, the higher risk you are of developing ovarian cancer. Obesity is the number one modifiable risk factor. If you are 25 pounds overweight, which we all are, you are at 400 percent risk of having endometrial cancer. So, we talk about talcum powder because it increases your risk by 20 percent, and being overweight by 25 pounds, you increase your risk by 400 percent. If you are 50 pounds or more overweight, the risk goes up to 10 times the baseline risk. Certainly—and let’s not even talk about smoking, right? So, yes, talcum powder is real, but it’s not, the data is not so strong. Certainly, the most common talked about risk of ovarian cancer is familial risk. Now, right now, familial risk accounts for maybe 15 or 20 percent of all ovarian cancers. So, most are sporadic or just happen spontaneously. Family history is certainly, though, very important. So, if you have other family members who have breast or ovarian cancers, especially those that have had those cancers prior to age 50, those are folks that may need to be referred to a geneticist for testing. Host: Does that include both sides of your family—so my mother’s side of the family or my father’s—or does that run more prevalently in one or the other? Dr. Dainty: No, it includes both sides. That’s an excellent point. It’s all first-degree relatives. So, if your father’s sister had ovarian cancer early or your father had breast cancer, that would be something that would be very concerning and something that would possibly warrant referral to see a geneticist. Host: This has been very insightful and eye-opening so thank you again, Dr. Dainty, for joining us to discuss this very delicate but also very important women's health topic. Dr. Dainty: I appreciate the invitation. Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.