1 00:00:02,120 --> 00:00:03,720 Speaker 1: I don't think that there are many people in the 2 00:00:03,720 --> 00:00:06,000 Speaker 1: world who can claim that life isn't at least a 3 00:00:06,040 --> 00:00:10,680 Speaker 1: little stressful sometimes, and that stress manifests itself in unexpected ways, 4 00:00:11,039 --> 00:00:13,760 Speaker 1: like on our skin. But when it comes to alleviating 5 00:00:13,760 --> 00:00:17,840 Speaker 1: our struggles, the relief of feeling seen and acknowledged is immense. 6 00:00:18,320 --> 00:00:21,000 Speaker 2: He literally looks at me and goes, your poor poor guy, 7 00:00:21,320 --> 00:00:23,520 Speaker 2: is like, I am so sorry that you have to 8 00:00:23,520 --> 00:00:25,760 Speaker 2: go through this, and I literally almost cried. I mean, 9 00:00:26,160 --> 00:00:30,040 Speaker 2: he just really felt and could see the pain and 10 00:00:30,280 --> 00:00:31,720 Speaker 2: discomfort that I was going through. 11 00:00:36,159 --> 00:00:38,600 Speaker 3: Hi, guys, and welcome. I'm so glad you're here. 12 00:00:38,880 --> 00:00:42,040 Speaker 1: I'm Nicole Berry and this is Skin Queries, a show 13 00:00:42,080 --> 00:00:44,840 Speaker 1: all about our skin and its health as we grow 14 00:00:44,880 --> 00:00:47,040 Speaker 1: in age. Our skin is really a record of a 15 00:00:47,080 --> 00:00:49,760 Speaker 1: life well lived, because there isn't one body part that 16 00:00:49,800 --> 00:00:52,159 Speaker 1: I can think of that reflects our well being as 17 00:00:52,280 --> 00:00:54,760 Speaker 1: clearly as our skin. So let's go on this journey 18 00:00:54,800 --> 00:00:57,840 Speaker 1: together to really understand what's going on with our skin. 19 00:00:58,160 --> 00:01:03,360 Speaker 1: Let's unravel the mysteries happening inside and out. Today we're 20 00:01:03,400 --> 00:01:06,080 Speaker 1: going to talk about stress and its effect on our skin. 21 00:01:13,240 --> 00:01:15,080 Speaker 1: I know, for me, when things get to be too 22 00:01:15,160 --> 00:01:17,760 Speaker 1: much whether it's a stressful day at work or there's 23 00:01:17,800 --> 00:01:19,760 Speaker 1: a lot going on at home. I can see it 24 00:01:19,800 --> 00:01:22,520 Speaker 1: on my body. I can wake up feeling inflamed, I 25 00:01:22,600 --> 00:01:25,679 Speaker 1: break out, and my skin can seem dull and lifeless, 26 00:01:25,959 --> 00:01:28,160 Speaker 1: and then you know how it goes. Seeing a physical 27 00:01:28,200 --> 00:01:31,240 Speaker 1: response to stress just causes more stress than it ends 28 00:01:31,280 --> 00:01:34,320 Speaker 1: up feeling like a vicious cycle. This episode is going 29 00:01:34,360 --> 00:01:36,680 Speaker 1: to be very personal because I will be bringing in 30 00:01:36,720 --> 00:01:40,360 Speaker 1: my husband, Nick Moskovich, to share his journey with plaxoriasis. 31 00:01:40,600 --> 00:01:42,480 Speaker 1: If you don't know what that is, it's a chronic 32 00:01:42,520 --> 00:01:46,440 Speaker 1: disease that can affect the skin. Your immune system becomes overactive, 33 00:01:46,600 --> 00:01:50,280 Speaker 1: which causes skin cells to multiply quickly, and that can show. 34 00:01:50,200 --> 00:01:51,400 Speaker 3: Up all over your body. 35 00:01:51,520 --> 00:01:54,800 Speaker 1: There can be patches of skin that becomes scay and inflamed, 36 00:01:55,000 --> 00:01:57,800 Speaker 1: and it's often seen on the scalp, elbows, and knees. 37 00:01:58,160 --> 00:01:59,520 Speaker 3: Stress is such a big. 38 00:01:59,320 --> 00:02:02,160 Speaker 1: Factor when it comes to siiasis, so much so that 39 00:02:02,200 --> 00:02:06,240 Speaker 1: the National Psoriasis Foundation recommends managing stress must be part 40 00:02:06,280 --> 00:02:09,640 Speaker 1: of your treatment plan. We'll also be talking to Nick's dermatologists, 41 00:02:09,680 --> 00:02:12,920 Speaker 1: who's going to explain why stress manifests physically on our 42 00:02:12,919 --> 00:02:17,320 Speaker 1: skin and how to manage it. So let's get into it. 43 00:02:19,040 --> 00:02:22,920 Speaker 1: So we are back here with the one and only Nick, 44 00:02:23,160 --> 00:02:23,840 Speaker 1: my husband. 45 00:02:24,120 --> 00:02:24,960 Speaker 4: A lot of pressure here. 46 00:02:25,040 --> 00:02:30,200 Speaker 1: Yes, Nick and I have been married for almost ten years. 47 00:02:30,240 --> 00:02:34,320 Speaker 1: Next year will be our tenth anniversary time. Yes, and 48 00:02:34,360 --> 00:02:37,840 Speaker 1: we have two little ones. And I remember when right 49 00:02:37,880 --> 00:02:41,040 Speaker 1: after we had Jude, we were living in New Jersey 50 00:02:41,120 --> 00:02:44,520 Speaker 1: with my mom and things were just really stressful, and 51 00:02:45,200 --> 00:02:49,000 Speaker 1: you started to notice something happening with your hands, right, 52 00:02:49,080 --> 00:02:51,920 Speaker 1: they got really dry and cracked, and we were figuring out, like, 53 00:02:52,000 --> 00:02:55,840 Speaker 1: what is this, which eventually we came to discover that 54 00:02:55,919 --> 00:02:58,040 Speaker 1: it was psoriasis, but that took a long time for 55 00:02:58,120 --> 00:03:00,680 Speaker 1: us to figure out. So do you remember when you 56 00:03:00,720 --> 00:03:03,640 Speaker 1: first started noticing something going on with your hands? 57 00:03:03,919 --> 00:03:04,320 Speaker 4: Yeah. 58 00:03:04,360 --> 00:03:07,720 Speaker 2: So, by the way, you look beautiful, very nice. Nice 59 00:03:07,720 --> 00:03:08,840 Speaker 2: to see you from this cell. 60 00:03:11,040 --> 00:03:11,359 Speaker 4: Yeah. 61 00:03:11,400 --> 00:03:14,200 Speaker 2: We were in New Jersey living with the in laws, 62 00:03:14,360 --> 00:03:17,800 Speaker 2: and I was helping out actually with relocating some items 63 00:03:18,000 --> 00:03:21,040 Speaker 2: for your mom from the storage and then working on 64 00:03:21,120 --> 00:03:24,280 Speaker 2: the house here. And it was a really stressful time 65 00:03:24,320 --> 00:03:27,000 Speaker 2: because we were dealing with so many different factors of 66 00:03:27,080 --> 00:03:29,480 Speaker 2: the house not being done, our son being born. 67 00:03:29,800 --> 00:03:31,320 Speaker 3: Jude was like six months old. 68 00:03:31,639 --> 00:03:34,519 Speaker 2: Yeah, so all of that started to snowball on me, 69 00:03:34,560 --> 00:03:36,080 Speaker 2: and I could just tell that it was more and 70 00:03:36,120 --> 00:03:38,640 Speaker 2: more stressful, and I thought it was just me using 71 00:03:38,640 --> 00:03:40,840 Speaker 2: my hands a little bit too much, and you know, 72 00:03:41,000 --> 00:03:42,640 Speaker 2: it was like, oh, I'll just put some lotion on it, 73 00:03:42,760 --> 00:03:43,400 Speaker 2: just a guy thing. 74 00:03:43,640 --> 00:03:45,600 Speaker 4: Maybe the soapa musing is not good or something. 75 00:03:45,720 --> 00:03:48,000 Speaker 2: My hands are just kind of can't keep up with 76 00:03:47,640 --> 00:03:50,600 Speaker 2: my mind and everything else is going in my life. 77 00:03:51,160 --> 00:03:53,480 Speaker 2: And yeah, they started to get kind of chapped a 78 00:03:53,520 --> 00:03:57,480 Speaker 2: little worn in, like almost like a callus's situation. And 79 00:03:57,520 --> 00:04:00,200 Speaker 2: then the more work I was doing, the more it 80 00:04:00,240 --> 00:04:03,920 Speaker 2: would just kind of spread and continue to evolve and 81 00:04:04,240 --> 00:04:05,560 Speaker 2: never really healing fully. 82 00:04:05,760 --> 00:04:08,120 Speaker 1: I do remember you were complaining about your callous hands, 83 00:04:08,120 --> 00:04:09,600 Speaker 1: and I noticed that's what I thought it was. It 84 00:04:09,600 --> 00:04:11,600 Speaker 1: looked like callous dry hands. 85 00:04:11,960 --> 00:04:13,960 Speaker 3: Were they itchy? Was it painful? 86 00:04:14,360 --> 00:04:18,240 Speaker 2: So it started with just just kind of annoying. Honestly, 87 00:04:18,279 --> 00:04:21,480 Speaker 2: it wasn't even like that discomforting. It was just I 88 00:04:21,520 --> 00:04:23,320 Speaker 2: was like, oh, maybe they'll get better, you know, I'll 89 00:04:23,320 --> 00:04:25,600 Speaker 2: just keep putting lotion on. I found a couple of 90 00:04:25,600 --> 00:04:28,320 Speaker 2: brands that seemed to help, but in the end they 91 00:04:28,320 --> 00:04:31,479 Speaker 2: were doing anything. They were just kind of moisturizing it 92 00:04:31,560 --> 00:04:35,120 Speaker 2: for that moment, but not continually doing anything for that condition. 93 00:04:35,320 --> 00:04:37,200 Speaker 2: And that's when I realized it was something more serious 94 00:04:37,240 --> 00:04:40,240 Speaker 2: because it kind of went from my thumb to my 95 00:04:40,560 --> 00:04:43,200 Speaker 2: pointing finger, to the finger to the left of it, 96 00:04:43,279 --> 00:04:45,480 Speaker 2: and then it started to go on the other hand, 97 00:04:45,880 --> 00:04:48,200 Speaker 2: and it just kept going and going. There was just 98 00:04:48,279 --> 00:04:51,720 Speaker 2: no kind of relief of any kind. And that's when 99 00:04:51,720 --> 00:04:56,360 Speaker 2: I started to get kind of start to panic. Is panic, Yeah, yeah, 100 00:04:56,360 --> 00:04:58,920 Speaker 2: it really. It was really stressful because I was like, 101 00:04:59,160 --> 00:05:02,159 Speaker 2: I've never experience this. I would literally squeeze my hands 102 00:05:02,400 --> 00:05:04,880 Speaker 2: just like make a fist, and I could feel those 103 00:05:05,320 --> 00:05:08,480 Speaker 2: callouses kind of breaking, and it would just become really 104 00:05:08,480 --> 00:05:12,640 Speaker 2: difficult to grip anything to lift the kids up to walk, 105 00:05:12,760 --> 00:05:15,960 Speaker 2: and then after that it has to continue. 106 00:05:15,640 --> 00:05:17,839 Speaker 4: To get worse and flare up more and more. 107 00:05:18,160 --> 00:05:20,920 Speaker 2: Is it went to my feet on my heel, it 108 00:05:20,960 --> 00:05:23,520 Speaker 2: was almost felt like somebody just stabbing. 109 00:05:23,000 --> 00:05:26,200 Speaker 4: My heel all the time. It was really really painful. 110 00:05:25,880 --> 00:05:28,599 Speaker 2: So uncomfortable, that's awful. It would peel, it would just 111 00:05:29,040 --> 00:05:30,520 Speaker 2: it was absolute worst. 112 00:05:31,720 --> 00:05:34,480 Speaker 1: I think when someone is going through something, even if 113 00:05:34,480 --> 00:05:36,800 Speaker 1: you live with them, even if you are incredibly close, 114 00:05:37,080 --> 00:05:39,880 Speaker 1: you don't truly understand the struggle that they're going through 115 00:05:40,000 --> 00:05:43,040 Speaker 1: until it starts to affect your relationship with them. And 116 00:05:43,080 --> 00:05:44,400 Speaker 1: that's what happened with me and Nick. 117 00:05:45,040 --> 00:05:47,200 Speaker 2: I'm out and I see a lot of people, and 118 00:05:47,360 --> 00:05:51,000 Speaker 2: I meet people, and it became pretty uncomfortable for me, 119 00:05:51,400 --> 00:05:53,080 Speaker 2: just of like somebody wanted to shake my hand or 120 00:05:53,080 --> 00:05:55,400 Speaker 2: if I, like, you know, wanted to greet somebody, it 121 00:05:55,480 --> 00:05:56,479 Speaker 2: just didn't feel right. 122 00:05:56,720 --> 00:05:59,120 Speaker 3: It's self consciousness. 123 00:05:58,440 --> 00:06:00,280 Speaker 4: Self conscious about the whole essageituation. 124 00:06:00,480 --> 00:06:03,360 Speaker 2: So in insecurity, that's when I was like, I need 125 00:06:03,360 --> 00:06:05,880 Speaker 2: to really take care of this and address what's going 126 00:06:05,920 --> 00:06:06,320 Speaker 2: on here. 127 00:06:06,720 --> 00:06:09,920 Speaker 1: Honestly, neither of us really knew what exactly was going on, 128 00:06:10,120 --> 00:06:13,440 Speaker 1: but we knew something had to change. 129 00:06:13,720 --> 00:06:16,359 Speaker 4: I don't have like the most fantastic diet like you do. 130 00:06:16,560 --> 00:06:17,479 Speaker 4: You're very good at it. 131 00:06:17,560 --> 00:06:19,200 Speaker 3: We're working on it. We're working on it. 132 00:06:19,279 --> 00:06:24,000 Speaker 2: I am, yeah, I'm your lifelong project. But I was 133 00:06:24,080 --> 00:06:26,720 Speaker 2: drinking like these juices and I thought I found something 134 00:06:27,120 --> 00:06:29,839 Speaker 2: and had a cleaner sugar in it, but my body 135 00:06:29,880 --> 00:06:31,040 Speaker 2: was not reacting well to it. 136 00:06:31,120 --> 00:06:32,520 Speaker 4: I remember I went on like. 137 00:06:32,440 --> 00:06:36,640 Speaker 2: A two three week like absolutely no sugar thing during 138 00:06:36,640 --> 00:06:37,480 Speaker 2: that time as well. 139 00:06:37,720 --> 00:06:39,520 Speaker 4: Might have helped. It might have been too late at 140 00:06:39,520 --> 00:06:42,000 Speaker 4: that point too, but it didn't hurt, I'll say that. 141 00:06:42,360 --> 00:06:45,400 Speaker 1: So when you finally decided that you've had enough with 142 00:06:45,520 --> 00:06:48,919 Speaker 1: you know, home treatment and trying to like use lotions 143 00:06:48,960 --> 00:06:52,880 Speaker 1: and potions, what was your journey in finding the right doctor? 144 00:06:53,080 --> 00:06:54,279 Speaker 1: Did you find it right away? 145 00:06:54,800 --> 00:06:58,039 Speaker 2: I spoke to a few specialists quote unquote, like you say, 146 00:06:58,320 --> 00:07:00,640 Speaker 2: I could take on just about anything, like I can. 147 00:07:00,680 --> 00:07:03,520 Speaker 4: Work through most things in my time. 148 00:07:03,640 --> 00:07:05,600 Speaker 2: Talking to those doctors, I'll be like, oh, it's you know, 149 00:07:05,720 --> 00:07:07,599 Speaker 2: it's just kind of annoying. It's this and that, but 150 00:07:07,640 --> 00:07:10,600 Speaker 2: it's really inside, I'm just like screaming about man, this 151 00:07:10,760 --> 00:07:12,280 Speaker 2: is driving me crazy. 152 00:07:13,000 --> 00:07:15,280 Speaker 1: After a long time of searching and coming up with 153 00:07:15,320 --> 00:07:17,960 Speaker 1: a lot of dead ends, a friend recommended we go 154 00:07:18,080 --> 00:07:21,360 Speaker 1: to doctor Mitchell Klein, a dermatologist based in New York. 155 00:07:21,560 --> 00:07:24,080 Speaker 1: You'll be hearing from him later. But when Nick walked 156 00:07:24,120 --> 00:07:25,640 Speaker 1: into his office. 157 00:07:25,400 --> 00:07:28,080 Speaker 4: He literally looks at me and goes, you're poor, poor guy. 158 00:07:28,240 --> 00:07:30,560 Speaker 2: He's like, I am so sorry that you have to 159 00:07:30,600 --> 00:07:33,000 Speaker 2: go through this, and I literally almost cried. I mean, 160 00:07:33,240 --> 00:07:37,400 Speaker 2: he just really felt and could see the pain and 161 00:07:37,680 --> 00:07:40,280 Speaker 2: discomfort that I was going through. And I've never had 162 00:07:40,280 --> 00:07:43,360 Speaker 2: anybody react that way in terms of not only did 163 00:07:43,400 --> 00:07:46,200 Speaker 2: he care but he understood. We talked, and we talked 164 00:07:46,240 --> 00:07:48,760 Speaker 2: actually for at length, and he said, you know, I 165 00:07:48,760 --> 00:07:50,720 Speaker 2: have other clients who have this condition. 166 00:07:50,880 --> 00:07:52,280 Speaker 4: There's different things we can do. 167 00:07:52,480 --> 00:07:55,040 Speaker 2: And and you write away that it was ciriasis, what 168 00:07:55,240 --> 00:07:58,360 Speaker 2: version of csoriasis it was? And he said that, you know, 169 00:07:58,520 --> 00:08:01,240 Speaker 2: you're obviously in a very strong whole situation. He's like, 170 00:08:01,320 --> 00:08:03,760 Speaker 2: this does not typically happen with just like a healthy 171 00:08:03,760 --> 00:08:06,120 Speaker 2: thirty year old. So I told him I have a 172 00:08:06,160 --> 00:08:08,480 Speaker 2: stressful job, I have two kids, we have run a 173 00:08:08,480 --> 00:08:10,520 Speaker 2: business together. There was a lot of things going on 174 00:08:10,560 --> 00:08:12,120 Speaker 2: at the same time, and he said, listen, you got 175 00:08:12,120 --> 00:08:14,520 Speaker 2: to find time for yourself to let go of some 176 00:08:14,560 --> 00:08:16,800 Speaker 2: of those things, you know, take some deep breaths and 177 00:08:16,840 --> 00:08:19,440 Speaker 2: like go for a walk and whatever time you can find. 178 00:08:19,520 --> 00:08:21,120 Speaker 2: You have to like let go of some of the 179 00:08:21,160 --> 00:08:23,880 Speaker 2: things that you're doing, that you're carrying, and that will 180 00:08:23,920 --> 00:08:25,760 Speaker 2: help with your medical issue. 181 00:08:25,880 --> 00:08:29,560 Speaker 3: Doctor Klein prescribed a treatment for Nick's blacksriasis. 182 00:08:29,400 --> 00:08:31,880 Speaker 2: And within forty eight hours, I mean, it was it 183 00:08:31,960 --> 00:08:34,120 Speaker 2: was magic. He said it was going to be like magic, 184 00:08:34,160 --> 00:08:35,719 Speaker 2: and it was just that what was. 185 00:08:35,679 --> 00:08:38,520 Speaker 1: The feeling that you had when he said I know 186 00:08:38,600 --> 00:08:40,079 Speaker 1: what this is and I know how are we going. 187 00:08:40,040 --> 00:08:40,520 Speaker 4: To fix it? 188 00:08:40,800 --> 00:08:45,960 Speaker 2: Disbelieve I could not believe him, just because of you know, 189 00:08:46,040 --> 00:08:50,520 Speaker 2: dealing with the condition for two years plus minus. You 190 00:08:50,600 --> 00:08:52,680 Speaker 2: just kind of think that there's just that this is it. 191 00:08:52,720 --> 00:08:53,920 Speaker 2: I'm going to live with this for the rest of 192 00:08:53,920 --> 00:08:56,840 Speaker 2: my life. And that was really scary to me because 193 00:08:56,880 --> 00:08:59,480 Speaker 2: I was really uncomfortable and really I'm not happy with 194 00:08:59,520 --> 00:09:02,160 Speaker 2: what I was faced with. And the more he talked, 195 00:09:02,160 --> 00:09:04,560 Speaker 2: the more I was like, I'm on board, let's try 196 00:09:04,640 --> 00:09:07,439 Speaker 2: I'm willing to try anything at this point. And when 197 00:09:07,520 --> 00:09:09,439 Speaker 2: he told me about some of the options and how 198 00:09:09,440 --> 00:09:11,880 Speaker 2: he's treated patients before, the more it began to like 199 00:09:12,040 --> 00:09:16,280 Speaker 2: kind of feel relief and comfort and everything that he 200 00:09:16,360 --> 00:09:18,840 Speaker 2: was saying. And that was, honestly the first time I 201 00:09:18,840 --> 00:09:21,040 Speaker 2: had somebody who was like, I got the answer for it. 202 00:09:21,080 --> 00:09:22,720 Speaker 4: We just got to figure out how do we get. 203 00:09:22,600 --> 00:09:25,600 Speaker 2: You to continue to improve once I set you on 204 00:09:25,600 --> 00:09:26,800 Speaker 2: this path of treatments. 205 00:09:27,920 --> 00:09:31,720 Speaker 1: It's interesting, I've always perceived Nick as our rock. He 206 00:09:31,880 --> 00:09:35,080 Speaker 1: is the foundation when it comes to our family, our friends, 207 00:09:35,360 --> 00:09:38,240 Speaker 1: and also at work. So seeing how much he was 208 00:09:38,240 --> 00:09:42,559 Speaker 1: suffering physically and mentally was extremely painful for us to see. 209 00:09:42,840 --> 00:09:46,040 Speaker 1: At the time, I really was not realizing how much 210 00:09:46,040 --> 00:09:49,200 Speaker 1: stress was playing a huge factor in Nick's flare ups, 211 00:09:49,520 --> 00:09:51,760 Speaker 1: and once I found out that stress can be a 212 00:09:51,760 --> 00:09:55,640 Speaker 1: major trigger for psoriasis, I actually felt a lot of guilt. 213 00:09:56,080 --> 00:09:57,520 Speaker 3: I started to think of all. 214 00:09:57,360 --> 00:10:00,480 Speaker 1: The ways that I personally was adding to the stresses 215 00:10:00,480 --> 00:10:03,680 Speaker 1: of his life and kind of felt a little shameful 216 00:10:03,840 --> 00:10:04,520 Speaker 1: and hopeless. 217 00:10:04,880 --> 00:10:06,679 Speaker 3: Obviously, the feeling of shame. 218 00:10:06,480 --> 00:10:10,320 Speaker 1: And guilt around Nick's diagnosis were irrational. Of course, it 219 00:10:10,400 --> 00:10:14,080 Speaker 1: wasn't my fault, and thankfully we found doctor Klein, who 220 00:10:14,160 --> 00:10:17,480 Speaker 1: was a lifesaver for Nick and myself, not only because 221 00:10:17,480 --> 00:10:19,720 Speaker 1: we could get to the root of the physical problem, 222 00:10:19,880 --> 00:10:22,840 Speaker 1: but the compassion and the understanding he met us with 223 00:10:23,200 --> 00:10:27,360 Speaker 1: was such overlaf and also very essential. After doctor Klein 224 00:10:27,520 --> 00:10:30,800 Speaker 1: helped Nick reset his system, they worked together to develop 225 00:10:30,880 --> 00:10:33,360 Speaker 1: better ways for him to manage his stress and his 226 00:10:33,360 --> 00:10:37,080 Speaker 1: flare ups. We'll get into that later. First, let's talk 227 00:10:37,120 --> 00:10:39,959 Speaker 1: to the one and only doctor Klin about the relationship 228 00:10:40,000 --> 00:10:43,160 Speaker 1: between stress and skin and how you can protect yourself 229 00:10:43,160 --> 00:10:46,080 Speaker 1: from the effects of stressors in your life. Right after 230 00:10:46,120 --> 00:10:59,120 Speaker 1: this break, welcome back to skin Queries. Let's unravel how 231 00:10:59,160 --> 00:11:01,439 Speaker 1: stress shows up about our skin and what you can 232 00:11:01,480 --> 00:11:04,720 Speaker 1: do to manage it. I'd like to introduce doctor Mitchell Klein, 233 00:11:04,920 --> 00:11:08,840 Speaker 1: Nick's personal dermatologists and an academic with a private practice 234 00:11:08,880 --> 00:11:09,720 Speaker 1: in New York City. 235 00:11:09,960 --> 00:11:11,760 Speaker 3: Hi, doctor Klein, how are you hi? 236 00:11:11,840 --> 00:11:12,200 Speaker 4: Nicole? 237 00:11:12,360 --> 00:11:13,520 Speaker 5: How's everything great? 238 00:11:14,080 --> 00:11:16,280 Speaker 1: Thank you for joining us. I kind of feel a 239 00:11:16,320 --> 00:11:19,920 Speaker 1: little guilty because the person that we met through is 240 00:11:19,960 --> 00:11:22,920 Speaker 1: my husband, Nick, who's not here to defend himself, but 241 00:11:23,600 --> 00:11:26,760 Speaker 1: you're Nick's doctor and dermatologist. And then he also recommended 242 00:11:26,800 --> 00:11:30,600 Speaker 1: our daughter, See who's now five years old. And you know, 243 00:11:30,640 --> 00:11:34,520 Speaker 1: you really had a profound impact on Nick's life and 244 00:11:34,559 --> 00:11:37,719 Speaker 1: his quality of skin, as well as our daughter. So 245 00:11:37,920 --> 00:11:39,840 Speaker 1: I'm so excited for you to join us today. 246 00:11:39,960 --> 00:11:42,080 Speaker 5: Oh well, thanks, it's my pleasure, my pleasure to be 247 00:11:42,160 --> 00:11:42,880 Speaker 5: here for all of you. 248 00:11:43,200 --> 00:11:45,560 Speaker 3: Do you mind telling us a little bit about yourself 249 00:11:45,559 --> 00:11:46,480 Speaker 3: and your practice? 250 00:11:46,640 --> 00:11:50,080 Speaker 5: Sure. I'm a clinical assistant professor in dermatology at while 251 00:11:50,120 --> 00:11:52,960 Speaker 5: in New York Presbyterian. I trained an internal medicine at 252 00:11:53,000 --> 00:11:56,240 Speaker 5: the University of Pennsylvania after medical school there, and then 253 00:11:56,559 --> 00:12:01,079 Speaker 5: switched to dermatology at Cornell Memorials On Kettering and Rockfeller 254 00:12:01,520 --> 00:12:04,680 Speaker 5: started private practice immediately after. And I've been in practice 255 00:12:04,720 --> 00:12:06,640 Speaker 5: for a long enough time that I don't want to 256 00:12:06,679 --> 00:12:10,200 Speaker 5: say how long. And I like all aspects of it. 257 00:12:10,240 --> 00:12:15,960 Speaker 5: Dermatology has general cosmetic medical and so I enjoy engaging people. 258 00:12:16,120 --> 00:12:17,760 Speaker 5: I do it for the people that I treat. 259 00:12:18,040 --> 00:12:20,520 Speaker 1: I love that and that really comes through as a 260 00:12:20,559 --> 00:12:24,080 Speaker 1: patient in your practice. And I'm so interested to hear 261 00:12:24,520 --> 00:12:27,560 Speaker 1: your take on how things like stress and this is 262 00:12:27,600 --> 00:12:31,200 Speaker 1: something that I actually learned later in life, that stress 263 00:12:31,240 --> 00:12:35,280 Speaker 1: can really affect your physicality, specifically your skin. So can 264 00:12:35,320 --> 00:12:38,600 Speaker 1: you talk a little bit about the relationship between stress, 265 00:12:38,640 --> 00:12:42,120 Speaker 1: which essentially is a mental thing and it manifesting as 266 00:12:42,120 --> 00:12:43,000 Speaker 1: a physical thing. 267 00:12:43,360 --> 00:12:47,160 Speaker 5: Sure, so let's start with a mind body connection. It's 268 00:12:47,240 --> 00:12:50,520 Speaker 5: the same, right, The brain is an organ, the skin 269 00:12:50,600 --> 00:12:53,160 Speaker 5: is an organ. It's connected through all of the body. 270 00:12:53,240 --> 00:12:56,320 Speaker 5: Chemistries that all the other organs are connected with so 271 00:12:56,600 --> 00:13:00,160 Speaker 5: I don't really distinguish. And I think that you under 272 00:13:00,160 --> 00:13:02,679 Speaker 5: stand that just as the brain and stress affect the 273 00:13:02,720 --> 00:13:05,240 Speaker 5: heart and people know that well, it affects the skin. 274 00:13:05,320 --> 00:13:09,439 Speaker 5: And in so many ways, there's well known science behind 275 00:13:09,480 --> 00:13:11,200 Speaker 5: all of it. And I think that you know, it 276 00:13:11,240 --> 00:13:13,480 Speaker 5: was a lack of understanding in the medical community for 277 00:13:13,520 --> 00:13:16,240 Speaker 5: a long time that there was a brain out there 278 00:13:16,360 --> 00:13:19,480 Speaker 5: and that there was this body and this skin, and 279 00:13:19,520 --> 00:13:22,160 Speaker 5: that these two things were not connected, and how could 280 00:13:22,160 --> 00:13:23,640 Speaker 5: that not be r right. 281 00:13:23,760 --> 00:13:26,160 Speaker 1: It's so refreshing to hear you say that. As far 282 00:13:26,200 --> 00:13:30,000 Speaker 1: as dress manifesting itself in the body and on the body, 283 00:13:30,240 --> 00:13:32,320 Speaker 1: what can that look like? What have you seen in 284 00:13:32,360 --> 00:13:33,040 Speaker 1: your practice? 285 00:13:33,120 --> 00:13:36,600 Speaker 5: Well, if you think about the conventional problems that people 286 00:13:36,640 --> 00:13:39,719 Speaker 5: talk about, like exema, psoriasis, which we'll talk about a 287 00:13:39,760 --> 00:13:43,280 Speaker 5: little bit today, and all of the dermatosis, all of 288 00:13:43,320 --> 00:13:47,559 Speaker 5: those things get worse or flair when you're stressed. And 289 00:13:48,000 --> 00:13:50,640 Speaker 5: that's because people think of the immune system as being 290 00:13:50,679 --> 00:13:53,640 Speaker 5: strong or weak, but it's very complex, and it's that 291 00:13:53,679 --> 00:13:57,320 Speaker 5: the immune system changes and it activates all kinds of 292 00:13:57,320 --> 00:14:00,440 Speaker 5: proteins and chemicals in the body, sometimes through nerves and 293 00:14:00,520 --> 00:14:05,480 Speaker 5: sometimes actually through circulating chemicals. It can be hormones, cytokindes, interferons, 294 00:14:05,760 --> 00:14:08,599 Speaker 5: and all of those things have an effect on the 295 00:14:08,640 --> 00:14:11,600 Speaker 5: immunity of the skin, which causes blood vessels to dilate. 296 00:14:11,920 --> 00:14:15,040 Speaker 5: It causes the skin to get thicker or thinner. It 297 00:14:15,080 --> 00:14:17,559 Speaker 5: causes the skin to maybe get spots, to be more 298 00:14:17,600 --> 00:14:22,560 Speaker 5: susceptible to spots and wrinkles, and also rashes. It changes 299 00:14:22,640 --> 00:14:26,440 Speaker 5: those rashes very often much, much worse. So we always 300 00:14:26,480 --> 00:14:29,400 Speaker 5: see this dramatic effect when we see somebody coming from 301 00:14:29,520 --> 00:14:32,920 Speaker 5: a place of great stress, emotional or physical or both, 302 00:14:33,400 --> 00:14:36,920 Speaker 5: because physical causes emotional stress, but emotional stress as well. 303 00:14:37,120 --> 00:14:40,560 Speaker 5: And you see all of these things occur in the skin, 304 00:14:40,800 --> 00:14:44,080 Speaker 5: and you see these breakouts of all sorts, and then 305 00:14:44,360 --> 00:14:46,840 Speaker 5: you know it's apparent, and you know somehow that it 306 00:14:46,960 --> 00:14:47,960 Speaker 5: just doesn't look right. 307 00:14:51,760 --> 00:14:53,960 Speaker 1: Do you think that there or have you been able 308 00:14:54,000 --> 00:14:57,360 Speaker 1: to identify certain triggers when it comes to a flare up, 309 00:14:57,400 --> 00:15:00,560 Speaker 1: whether that is exima or psoriasis or other kind of 310 00:15:00,560 --> 00:15:01,520 Speaker 1: skin inflammation. 311 00:15:02,240 --> 00:15:06,160 Speaker 5: So the story usually goes that I didn't have anything, 312 00:15:06,360 --> 00:15:09,800 Speaker 5: and now I suddenly have spots. That's called guttap'soriasis, and 313 00:15:09,840 --> 00:15:12,920 Speaker 5: it's often from a strep throat. It can be stress, 314 00:15:13,080 --> 00:15:15,880 Speaker 5: but also strap and so usually you ask questions about 315 00:15:15,880 --> 00:15:20,520 Speaker 5: a sore throat because infections, infections that run through the body, viral, bacterial, 316 00:15:20,880 --> 00:15:24,600 Speaker 5: cause stress and they also can cause a flare of psoriasis. Okay, 317 00:15:24,720 --> 00:15:27,680 Speaker 5: so that's guttaped psoriasis, and you can go to other 318 00:15:27,800 --> 00:15:30,440 Speaker 5: forms of psoriasis that affect other parts of the body. 319 00:15:30,640 --> 00:15:34,280 Speaker 5: And again you see this and you hear from the patient, Well, 320 00:15:34,320 --> 00:15:37,080 Speaker 5: I've had this chronic condition of my scalp, or I've 321 00:15:37,080 --> 00:15:39,680 Speaker 5: had this rash on my elbows, or maybe my hands 322 00:15:39,680 --> 00:15:44,120 Speaker 5: have been uncomfortable, but suddenly it's so much worse. I'm uncomfortable, 323 00:15:44,560 --> 00:15:47,480 Speaker 5: And that immediately begs the question, well, what have you 324 00:15:47,560 --> 00:15:50,320 Speaker 5: been through as they've been through a life stress? Has 325 00:15:50,320 --> 00:15:54,440 Speaker 5: somebody been ill, somebody passed away? Are their family stresses? 326 00:15:54,720 --> 00:15:57,680 Speaker 5: Do you have job stress or personal stress? And once 327 00:15:57,720 --> 00:16:01,280 Speaker 5: you sort of elicit that history, it helps you because 328 00:16:01,600 --> 00:16:04,440 Speaker 5: you're giving somebody insight into the fact that what they're 329 00:16:04,480 --> 00:16:07,440 Speaker 5: going through is causing some of the problem. And we 330 00:16:07,480 --> 00:16:09,440 Speaker 5: all know that we don't go through what we go 331 00:16:09,560 --> 00:16:12,920 Speaker 5: through forever and that you know eventually as the stress 332 00:16:13,360 --> 00:16:17,000 Speaker 5: kind of settles down, the skin will settle down, and 333 00:16:17,360 --> 00:16:20,240 Speaker 5: you see this, you know, everything's worse. The skin's redder, 334 00:16:20,480 --> 00:16:23,960 Speaker 5: the spots are scalier, they're more numerous, they're covering new 335 00:16:24,040 --> 00:16:26,360 Speaker 5: areas of the body. Sometimes you feel like it's taking 336 00:16:26,400 --> 00:16:28,960 Speaker 5: over your body because previously it was maybe one or 337 00:16:29,000 --> 00:16:32,200 Speaker 5: two patches and now it's widespread or on your scalp, 338 00:16:32,200 --> 00:16:36,120 Speaker 5: which can happen with people with psoriasis, and so you know, 339 00:16:36,240 --> 00:16:40,160 Speaker 5: all important questions and always important to reassure someone again 340 00:16:40,320 --> 00:16:42,920 Speaker 5: that you know, this is not going to remain this way, 341 00:16:43,000 --> 00:16:45,600 Speaker 5: not with the medications and not with the treatments we 342 00:16:45,680 --> 00:16:47,640 Speaker 5: have these days, and not with the fact that the 343 00:16:47,680 --> 00:16:49,040 Speaker 5: stress is going to go away. 344 00:16:49,360 --> 00:16:53,479 Speaker 3: You mentioned treatments, So what are the types of treatments 345 00:16:53,560 --> 00:16:55,640 Speaker 3: that you treat psoriasis with? 346 00:16:56,120 --> 00:17:01,239 Speaker 5: So there really are a thousand and so and foremost 347 00:17:01,360 --> 00:17:05,000 Speaker 5: reassurance and then you move to well, what's easy. Well, 348 00:17:05,000 --> 00:17:09,560 Speaker 5: they're topical creams. Sometimes they're steroid creams. People are terrified 349 00:17:09,600 --> 00:17:11,679 Speaker 5: of that, no reason to be. We know how to 350 00:17:11,760 --> 00:17:14,760 Speaker 5: control how much stereoid goes into your body with the cream, 351 00:17:15,080 --> 00:17:18,560 Speaker 5: and sometimes we move after that into light therapy, but 352 00:17:18,640 --> 00:17:21,760 Speaker 5: that's a little more evolved, but it also covers more 353 00:17:21,760 --> 00:17:25,680 Speaker 5: of the body surface area before we get into systemic drugs, 354 00:17:25,840 --> 00:17:29,080 Speaker 5: oral drugs or injectable drugs. In each one affects a 355 00:17:29,080 --> 00:17:32,240 Speaker 5: different arm of the immune system, and all of them 356 00:17:32,280 --> 00:17:35,960 Speaker 5: work to sort of slow or diminish the inflammation in 357 00:17:36,040 --> 00:17:40,080 Speaker 5: the body, not just psoriasis, but psoriasis comes with arthritis, 358 00:17:40,359 --> 00:17:43,600 Speaker 5: ziausis believe or not, comes with heart disease and stroke 359 00:17:43,720 --> 00:17:46,320 Speaker 5: and all of these things which are risks if you 360 00:17:46,359 --> 00:17:51,400 Speaker 5: have severe versions are managed and controlled with these biologics, 361 00:17:51,440 --> 00:17:52,800 Speaker 5: which is why they're so popular. 362 00:17:52,960 --> 00:17:55,399 Speaker 1: When you do talk to your patients, do you recommend 363 00:17:55,760 --> 00:17:58,120 Speaker 1: or ask them questions about how to treat their stress 364 00:17:58,400 --> 00:17:59,680 Speaker 1: in a non medical way. 365 00:18:00,160 --> 00:18:02,560 Speaker 5: To get into that, because when you have something that's 366 00:18:02,600 --> 00:18:07,040 Speaker 5: really profound and you're dealing with something that needs something 367 00:18:07,080 --> 00:18:11,320 Speaker 5: that goes beyond the medicines you're applying, leaving that out 368 00:18:11,440 --> 00:18:14,800 Speaker 5: of the concoction is a mistake. You know, if you're 369 00:18:14,800 --> 00:18:18,760 Speaker 5: not talking about addressing depression, which can be addressed with 370 00:18:18,960 --> 00:18:22,960 Speaker 5: you know, therapy and help and sometimes medication, you're talking about, 371 00:18:23,160 --> 00:18:25,480 Speaker 5: you know, what are the social circumstances that you're in 372 00:18:25,560 --> 00:18:27,880 Speaker 5: that are problematic that you might be able to do 373 00:18:27,920 --> 00:18:33,240 Speaker 5: something about. And then also again very broadly, thinking about 374 00:18:33,640 --> 00:18:36,280 Speaker 5: how do you get to those blue zones? You know, 375 00:18:36,400 --> 00:18:39,480 Speaker 5: how do you get a piece of nature where I 376 00:18:39,560 --> 00:18:43,080 Speaker 5: love meditation and exercise, you know, as a way of 377 00:18:43,160 --> 00:18:45,400 Speaker 5: burning off that anxiety and stress. 378 00:18:45,320 --> 00:18:50,080 Speaker 1: Shifting back to specifically storisis or other skin inflammation. I 379 00:18:50,119 --> 00:18:52,639 Speaker 1: feel that at least for Nick, you know, he and 380 00:18:52,720 --> 00:18:55,640 Speaker 1: many other people, they're usually run to the drugstore and try, 381 00:18:55,680 --> 00:18:58,960 Speaker 1: you know, everything on the shelf and become their own 382 00:18:59,040 --> 00:19:02,560 Speaker 1: kind of treatment mint guru until it comes to a 383 00:19:02,560 --> 00:19:04,919 Speaker 1: point where he said, you know, I need to see someone. 384 00:19:05,200 --> 00:19:09,000 Speaker 1: And my perception was that natural is better, but in 385 00:19:09,040 --> 00:19:12,280 Speaker 1: certain cases it's not. So what would you say to 386 00:19:12,280 --> 00:19:14,200 Speaker 1: people who are kind of at a loss? 387 00:19:14,560 --> 00:19:17,080 Speaker 5: Right, So you try things, and I don't think there's 388 00:19:17,080 --> 00:19:19,879 Speaker 5: anything wrong with that. In general. For skin, things that 389 00:19:19,960 --> 00:19:23,919 Speaker 5: hydrate and moisturize are always going to help all aspects 390 00:19:23,920 --> 00:19:26,160 Speaker 5: of the skin. And then you know, if you think 391 00:19:26,160 --> 00:19:29,600 Speaker 5: about it, and just in a really basic common sense way, 392 00:19:30,160 --> 00:19:32,679 Speaker 5: it's when you say to yourself, you know, I'm not 393 00:19:32,720 --> 00:19:35,440 Speaker 5: getting any better, maybe worse, but not getting any better. 394 00:19:35,520 --> 00:19:39,199 Speaker 5: And who is it out there who has some expertise 395 00:19:39,280 --> 00:19:42,159 Speaker 5: or training. It might I even not Alie with my 396 00:19:42,240 --> 00:19:44,200 Speaker 5: way of thinking. You know, maybe I think of only 397 00:19:44,880 --> 00:19:48,720 Speaker 5: traditional Eastern methods and natural methods. But I need to 398 00:19:48,760 --> 00:19:50,880 Speaker 5: find somebody who's going to give me something that's going 399 00:19:50,960 --> 00:19:52,680 Speaker 5: to give me relief and put me in a different 400 00:19:52,680 --> 00:19:57,639 Speaker 5: direction because I'm uncomfortable, I hurt, I itch, or I 401 00:19:57,680 --> 00:19:59,640 Speaker 5: just don't feel good about the situation, or I don't 402 00:19:59,640 --> 00:20:01,480 Speaker 5: feel good about the fact that my child has a 403 00:20:01,560 --> 00:20:05,360 Speaker 5: rash over their body and it's just not coming under control, 404 00:20:05,520 --> 00:20:08,880 Speaker 5: and the child is itching and scratching, and all right, 405 00:20:09,040 --> 00:20:11,640 Speaker 5: it's time. Let's see if we can find somebody professionally 406 00:20:11,720 --> 00:20:15,119 Speaker 5: who will put us in the direction and not just 407 00:20:15,440 --> 00:20:19,080 Speaker 5: immediately give us something that conflicts with what we believe in. 408 00:20:19,600 --> 00:20:22,600 Speaker 5: How about maybe just doesn't dismiss us for how we 409 00:20:22,640 --> 00:20:23,479 Speaker 5: feel as people. 410 00:20:23,960 --> 00:20:27,080 Speaker 1: Doctor Klin, thank you so much. This was such an 411 00:20:27,160 --> 00:20:30,680 Speaker 1: enlightening and great conversation. I really appreciate you taking the time. 412 00:20:30,800 --> 00:20:33,080 Speaker 5: Oh thanks for bringing me in. And that's why we 413 00:20:33,160 --> 00:20:33,760 Speaker 5: do what we do. 414 00:20:34,040 --> 00:20:37,600 Speaker 1: It feels great, honestly having someone who hears you and 415 00:20:37,640 --> 00:20:40,439 Speaker 1: sees you can be life changing. It made such a 416 00:20:40,480 --> 00:20:44,040 Speaker 1: difference that doctor Klein was compassionate and present during his 417 00:20:44,080 --> 00:20:47,440 Speaker 1: appointment with Nick. I think that's essential, especially when you're 418 00:20:47,480 --> 00:20:51,240 Speaker 1: dealing with something that's not only physical but mental. Let's 419 00:20:51,240 --> 00:20:53,520 Speaker 1: bring back my husband now to talk about how he's 420 00:20:53,560 --> 00:20:55,800 Speaker 1: currently dealing with hysteriasis flare ups. 421 00:20:56,760 --> 00:21:00,280 Speaker 2: I'm still kind of discovering new things about what does 422 00:21:00,320 --> 00:21:02,679 Speaker 2: help me, what does trigger me, and what does not. 423 00:21:03,160 --> 00:21:05,680 Speaker 2: I try to space things out that I know will 424 00:21:05,680 --> 00:21:07,800 Speaker 2: stress me out, you know, and if I'm like, okay, 425 00:21:07,800 --> 00:21:10,119 Speaker 2: I got address these like three major things that I 426 00:21:10,640 --> 00:21:13,400 Speaker 2: just I hate working on or I hate facing I'll say, okay, 427 00:21:13,400 --> 00:21:15,320 Speaker 2: i'll do one today, I'll do one in two days, 428 00:21:15,600 --> 00:21:17,560 Speaker 2: I'll do another one later down the line. In the 429 00:21:17,560 --> 00:21:19,639 Speaker 2: past that would have done all of them at one time. Yeah, 430 00:21:19,800 --> 00:21:22,360 Speaker 2: one day, one hour. I also tried to make time 431 00:21:22,400 --> 00:21:26,280 Speaker 2: for myself with like grabbing a sandwich or a coffee 432 00:21:26,320 --> 00:21:28,080 Speaker 2: and just sitting in the park and just staring at 433 00:21:28,119 --> 00:21:31,440 Speaker 2: a tree. Just finding time to do that, continue to 434 00:21:31,480 --> 00:21:35,080 Speaker 2: take just those small moments for myself really made a 435 00:21:35,160 --> 00:21:37,320 Speaker 2: huge difference. And being able to do that and just 436 00:21:37,359 --> 00:21:40,280 Speaker 2: creating time for myself in that way has really helped out. 437 00:21:40,480 --> 00:21:42,840 Speaker 2: If you're dealing with this, you're not alone. There are 438 00:21:42,880 --> 00:21:46,240 Speaker 2: people out there that understand your condition and keep at it. 439 00:21:46,320 --> 00:21:48,840 Speaker 2: There's people that will help you and you'll get through it. 440 00:21:49,040 --> 00:21:52,200 Speaker 3: That's so important. Thanks, babe, I love you, Love you too. 441 00:21:55,280 --> 00:21:58,159 Speaker 1: For me, this is such a healing episode because we 442 00:21:58,280 --> 00:22:01,160 Speaker 1: really got to ask Nick about how he's feeling, which 443 00:22:01,200 --> 00:22:04,040 Speaker 1: is not something we often talk about. I think Nick 444 00:22:04,200 --> 00:22:07,000 Speaker 1: is actually really quiet when it comes to his own emotions. 445 00:22:07,240 --> 00:22:09,800 Speaker 1: He's really strong and really good at getting things done, 446 00:22:09,880 --> 00:22:12,439 Speaker 1: but here he was so honest and vulnerable and I 447 00:22:12,520 --> 00:22:14,960 Speaker 1: just want to honor him for that. It also really 448 00:22:15,000 --> 00:22:18,360 Speaker 1: helped having someone like doctor Klein who was very patient 449 00:22:18,560 --> 00:22:21,360 Speaker 1: and open minded when it came to my own approach 450 00:22:21,480 --> 00:22:24,600 Speaker 1: to alternative healing. When it comes to my own philosophy, 451 00:22:24,640 --> 00:22:28,000 Speaker 1: I don't discount mainstream medicine, but I also don't solely 452 00:22:28,040 --> 00:22:31,160 Speaker 1: rely on holistic medicine either. I really want to see 453 00:22:31,160 --> 00:22:34,119 Speaker 1: what's going to work for someone with a specific situation, 454 00:22:34,440 --> 00:22:36,800 Speaker 1: but I think it's really important to find a doctor 455 00:22:36,840 --> 00:22:40,600 Speaker 1: who understands you and sees you and has the compassion 456 00:22:40,680 --> 00:22:42,240 Speaker 1: in patience so that they. 457 00:22:42,080 --> 00:22:43,560 Speaker 3: Can meet you wherever you are. 458 00:22:45,320 --> 00:22:48,479 Speaker 1: Another big thank you to our guests Nick Moskovich and 459 00:22:48,560 --> 00:22:52,520 Speaker 1: doctor Mitchell Klein for sharing their experiences. Skin Queries is 460 00:22:52,560 --> 00:22:56,760 Speaker 1: hosted by myself Nicole Berry, an executive produced by Evon Sheehan. 461 00:22:57,080 --> 00:23:00,960 Speaker 1: Our senior producer is Tory Weldon. Our juniors are Reem 462 00:23:01,040 --> 00:23:04,000 Speaker 1: Alma Grabi and Jenny Cunningham. The show is mixed and 463 00:23:04,040 --> 00:23:07,560 Speaker 1: features original music by Sam Sagan. If you enjoy the show, 464 00:23:07,640 --> 00:23:09,960 Speaker 1: share it with your friends. You can also listen and 465 00:23:10,000 --> 00:23:13,679 Speaker 1: follow on the iHeartRadio app, Apple Podcasts, or wherever you 466 00:23:13,720 --> 00:23:16,040 Speaker 1: get your podcasts. We'd love to know what you think, 467 00:23:16,080 --> 00:23:18,680 Speaker 1: so make sure you leave a review until next time.