Family in Focus- Re-centering our conversations about weight
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[00:00:00] Kara Wada, MD: Welcome back everyone to this week's episode of the Becoming Immune Confident Podcast. As you know, I love to welcome colleagues and guests on the show where we can have awesome conversations. And this week I have none other than Dr. Wendy Schofer. She is a pediatrician, a mom and founder of Family and Focus, where she specializes in helping parents who are worried about their children's weight creating healthier relationships with food, body, and family and Wendy and I got to connect last fall at the Physician Coach Summit in 2022. Had so much fun and then participated in a class together the beginning of the year. So I am really excited to bring her expertise and let you all get to meet her and her work. Wendy, thank you for joining me today.
[00:00:57] Wendy Schofer, MD: Oh my gosh. Thank you so much, Kara. It's funny because as you're like putting up the expertise stuff, oh my gosh, here comes the imposter syndrome. I just wanna connect and hang out with you because it's so much fun. We keep on crossing paths and just. So many beautiful ways that we're connecting, including right now. So this is fun.
[00:01:17] Kara Wada, MD: Yeah. Before we hit record, I hope it's okay if I share that, like learning that you share birthday with my daughter was just like the icing on the cake or the sprinkles on the donut, like it was just delightful.
[00:01:29] Wendy Schofer, MD: The sprinkles. I love it.
Introduction to Dr. Wendy Schofer and her Family and Focus coaching program
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[00:01:31] Kara Wada, MD: Can you share a little bit about how you got into this work and what exactly the work is that you're doing?
[00:01:38] Wendy Schofer, MD: Yeah. Oh my goodness. It's always like one of those things that I'm trying to figure out, okay, where do I wanna pick up the thread? Where do I wanna start with all of this?
And I think it, it's really. I've been a pediatrician now for 22 years, and the bumps in the road all along the way, the things that I was learning, the things that worked, things that didn't work for me. And as I think about with family and focus, where that really came from, I loved working with families in the office around growth and nutrition and mental health.
It was like, all the things that I love to do, the continuity of care, and I just felt like I reached a point where I wasn't really helping families and in particular it was, as we were seeing increasing concerns about weight. About overweight and obesity, and I was like, ah, I got this. I got the answers.
And write out all the prescriptions. We're gonna, this is how much I'm gonna advise that you move, how much to eat the portions, all these things, and write it all out. Have the families come back three to six months later and they're like, "Yeah, no, that didn't work. That is too much. I don't have time for that. My kid doesn't like that. He doesn't wanna do that".
All these things. I was like, Man. I'm not helping anyone here. And at the same time I was having my own concerns, like keeping an eye on how my own kids are growing, trying to get them out and be more active, look at the way that they're eating.
And all I was doing was creating food fights and headbutting at home and I know.
[00:03:23] Kara Wada, MD: That sounds familiar.
[00:03:25] Wendy Schofer, MD: Yeah. And this is so real and when I was first thinking about like this, kinda like where I came from, I didn't realize like this is the shared experience we're all going through right now.
And when I would describe to people as I was evolving with this and learning the approaches of coaching and finding what is working in our families where we wanna build from, as opposed to the traditional medical approach of this is what's broken, this is what you need to fix. It's completely flipped that.
But the thing is that I realized that it's not about the weight. So many people were like, "So does that mean that you're working with overweight kids? Are you working with kids that have a diagnosis of obesity?"
I said, "Actually I'm working with parents. I'm working with parents that are having concerns about their kids' weight, and it's not because of the actual like meeting a threshold or a diagnosis".
We as parents are all worried about our kids' weight. But that's the thing that we're concerned about weight. 'Cause we keep on being told we need to focus and keep an eye on and manage.
And it's doing one heck of a number on the relationships that we have at home.
[00:04:40] Kara Wada, MD: In what ways do you see that, hear that showing up?
[00:04:45] Wendy Schofer, MD: Yeah. So a lot of it is the searching, like the scrolling that we're doing as parents online. We're looking for the help, for the resources, for the answers.
Lot of it is also the frustration about not being heard with physicians with community members and oh my gosh, I take that so very personally in the sense of I get that. Because we're looking for something and others aren't necessarily able to meet our needs. And I think that's because we need to understand our own needs first. As parents, for me it was a need to stop looking at my family for what's broken. For how things were going sideways, which, you know that so much of preventative medicine is about watching out for these things.
[00:05:34] Kara Wada, MD: Yeah. Gosh, I'm thinking about this past weekend we had our own little food struggle over a Cheetos, so we tend not to buy like too much of that sort of thing, it's just easier if we don't have it in the house, but the hospital where my husband works has a very generous physician's lounge, and so occasionally he'll bring home a bag of Doritos or Cheetos or something. And so we got in this kind of standoff over Cheetos versus the egg salad sandwich that this seemed to be five-year-old requested.
I couldn't blame her. Like of course the Cheetos tasted better, like salad sandwich but I thinking back, a lot of it for me stems from my fear and fear that my kiddos are going to end up with this, same or similar health conditions that I've dealt with.
And one of the ways that I've been taught, like trying to eat a diverse diet, trying to avoid processed foods, these sorts of things, but trying to let go to some degree of that perfectionism that tries to creep back in from time to time.
[00:06:40] Wendy Schofer, MD: Yeah. All the time. I totally recognize that, because you know so much of what we've learned.
This is the healthy way. And to me, that just seeps in as far as this is the right way. This is what it needs to be, all that perfectionism. Let's just remove the perfectionism word from it.
It's just the way that we're trying to strive for this ideal that has been created in our minds. To what end do we go with that? That's more of a rhetorical question than anything, but how often I find myself going there. Ongoing. It's not something that, it's
"Okay, that's it. I don't do that anymore".
No, I just get to see it. I get to witness it because I keep on going back to it. It's what we've been socialized to do in our society in general. And then on top of it, we get a double heaping of it in medicine.
[00:07:38] Kara Wada, MD: Yeah. Can you talk a little bit about how Family and Focus and the program is? First of all, I should clarify. I know you're, the company, is that the name of the program too?
[00:07:51] Wendy Schofer, MD: That is the program.
Raising awareness about weight stigma and its impact on family health
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[00:07:52] Kara Wada, MD: Yeah. Cool. Cool. Thank you. Can you explain like how that looks, how that works and what you're doing with your clients?
[00:08:00] Wendy Schofer, MD: Yeah, so I have both individual and group programs that kind of fall under the Family and Focus umbrella.
The primary program that folks know about is a group coaching program for parents. And so acknowledging we have concerns about weight, our own struggles that we've had over time as well as, with our kids and where they're going with their weight, the struggles that they have right now.
I have parents all come in together in order for one thing, to see that we're having this shared experience because so much of it feels so isolating and alone and that this is all our job to do.
Our responsibility as parents and recognizing how much of that is a shared experience, but also learning from each other all along the way. And what we do is really understand, first of all, where is this worry coming from? Why is it that we're focusing so much on food and exercise and our kids' weight? And really unraveling that. There's a lot behind that. With the education that we've received around health, what it means to be healthy, what it means to raise in healthy children. There's a lot there. And so we actually spend a number of weeks exploring that.
To really be able to understand, we're really trying our hardest here as parents and we've just been taught to look for what's wrong.
The Doritos coming into the house, the Cheetos, all of this. Like, how, oh gosh, that's a problem. It's a problem.
And so how is it that we want to interact and be with our kids, how do we wanna support them? How do we wanna acknowledge the concerns that we have about our own diagnoses and our own struggles? And then how do we wanna support our children
So a lot of it looks like understanding kind of different forms of weight stigma. Looking at how can we start creating that confidence in the steps that we are taking in our own home. And then getting into things like intuitive eating and the division of responsibility.
'Cause we've been given a whole lot of information as parents about how it's all our responsibility about our kids' weight and eating habits and, whew, it feels heavy just to be able to say that out loud. But it all feels like it's coming to us and we really work on how that's not the case.
We get to give this responsibility to kids to be able to trust, to let them learn. And that's part of them being able to build their own relationships with their food, their body.
[00:10:54] Kara Wada, MD: Can you talk a little bit more about intuitive eating? Because I suspect that there are a good number of listeners who maybe aren't familiar with what that is.
[00:11:04] Wendy Schofer, MD: Yeah, There's a lot of different ways that you're gonna hear about intuitive eating. The way that I think of it more than anything else is listening to your body. Really understanding what is it that your body needs right now, which is something that it's not something you can just go in and just teach.
It's something that you get to learn. It's actually something that little kids are really good at. If I think of the classic intuitive eaters, those are the two and three year olds that are running around. They eat when they want. They eat as much as they want. And everybody's, " Here keep on eating". And they're like, "No, I'm good. Yeah, I'm good". And I think about that intuitive part of it. It's just listening to your body, and right now, this is what I want. This is how much I want, I'm good. I'm moving on. And there's a lot more that happens behind the scenes as we dive into it a little bit more.
But it's really just getting that opportunity to listen to your own body to give it what it needs and then to move on. Because you know, it's something that, eating is amazing.
Eating food, it is amazing. And thinking about that two and three-year-old, they're like, "Yep, okay, now I'm done. And now I'm moving on to something else"
[00:12:31] Kara Wada, MD: " Time to go play"
[00:12:32] Wendy Schofer, MD: Yeah. Oh gosh. Go play. Yes. My other favorite thing is play.
[00:12:37] Kara Wada, MD: Yeah. Which so often we neglect or forget about as adults,
[00:12:45] Wendy Schofer, MD: And all the different ways that we are taught to do something different. Yeah. Like the way that we're taught- to not listen to our bodies.
You need to eat now, you need to eat this much, you need to eat this proportion of everything. So it's that learning, that socialization and then also there's not time to play right now. This isn't the time. It's "Oh man, what if we could just go back and just be the two and three year old?"
We got to do things on their terms. Like, right now it's time to play. It's play time. I'm totally channeling that toddler so frequently because that's when I'm like, "Oh, I don't need to do all these other things. Play is actually where all the magic happens."
[00:13:37] Kara Wada, MD: and where we get to like tap into like our, I think of it as a form of rest and like rejuvenation and that whole rest and digest.
[00:13:46] Wendy Schofer, MD: Oh, I'm just gonna sit with that one. Oh, I feel that close to my heart right now.
[00:13:51] Kara Wada, MD: I know we've talked a little bit online, but your program recently got some funding maybe. Can you tell me a little bit about, I'm really excited, like the academic medicine person in me is like, Ooh, tell me more. I'm excited.
[00:14:05] Wendy Schofer, MD: Oh, I appreciate the opportunity with that. So here's the thing, like I have been working with families in family and focus now for three years, and I've been telling my colleagues like, "Hey, there's a different way to connect with parents to really address the concerns that we have about weight and nutrition and mental and emotional health".
And of course my physician friends are always asking me, "Okay, what's the effectiveness? What's the evidence that this works?"
And I'm like, I'm creating the evidence. I'm creating it. I am so excited because a year and change ago, our local medical school, hired a researcher and her background, she's a PhD nutritionist and her background is in weight stigma, and as soon as I heard that she was coming, I'm like, "oh, we need to work together".
She got hired and she said, "That's it. We're studying your program". And so it's in combination with researchers with two local universities that we're studying the effectiveness of my program. We're doing a randomized controlled trial welcoming 60 families to be able to participate in the full eight week program. Free of charge. Thanks to some very creative grant writing and funding.
[00:15:28] Kara Wada, MD: Amazing.
Expanding the conversation beyond traditional medical models
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[00:15:29] Wendy Schofer, MD: And then that way we can study the effectiveness and be able to really highlight the work that's being done and the impact that it's having on our families.
Ultimately, the coolest thing, I love pointing this out, I never ask anybody about the actual weight. I don't ever ask like, how much does your child weigh? Percentiles, any of that. And we actually got a lot of feedback along the way as we were submitting for the research study. They're like, "What about biometrics? How do you know? Are you gonna check the A1C?"
No, it's not about that. Those are not the only outcomes. So in fact, they're not the outcomes that we're measuring. That's what everybody else is measuring. We're looking at indices of weight stigma in our home. We're looking at parental confidence in raising a healthy family. There are all these different skills I didn't know existed, so there's so much more to the conversation than what we traditionally look at.
I say traditionally in our traditional medical model. There's so much more and it's really being able to collaborate with my brilliant colleagues that know so much more about that social science side of it and being able to really use that type of evaluation because honestly, that's where all the beans are.
For us as families and being able to raise our kids in a way that we really want to. To be able to feel like, you know what, I'm doing a good job by them and by me.
Celebrating parenting wins and the power of positive outlooks
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[00:17:17] Kara Wada, MD: Yeah. I think there's something to be said too. I am thinking back to a conversation I had with my mom earlier this week where I was just reflecting on a rough dinner the other night.
Same kiddo. She was not thrilled with the meatballs and pasta option of dinner, which I was actually surprised about 'cause we tend to be big noodle fans in our family. And so lots of tears and I was like, "Hey, let's just step away from the table. Let's go calm our bodies down". And I like my cup was not fully full at the end of the day. And so I really easily could have seen me losing my, you know what too, and just know reenacting scenes that would've come from the table that I grew up around. And it was one of those moments, like afterwards of reflection of, "Damn. I did pretty good right there", and I mentioned that not as like a humble brag, but I think there is something to be said about, celebrating those wins when you do have them versus seeing the fall that you were mentioning about, and a lot of times these behaviors that we fall into are default from what we were taught.
[00:18:28] Wendy Schofer, MD: If that's humble, bragging, go for it.
[00:18:32] Kara Wada, MD: Maybe not so humble. I don't know, whatever
[00:18:34] Wendy Schofer, MD: I don't really know what that means anymore, but it's just one of those things that it's let's celebrate those moments, of " Oh damn. Yeah. You know what? We just slowed it down". We changed the temperature.
[00:18:46] Kara Wada, MD: Yeah. And then we went back to the fridge. Like I do have a bit of a rule and you can call me out on this if it's not appropriate or not. 'cause I don't wanna be cooking like another meal for the family. So instead we went back to the fridge and we looked to see, okay, what was in there like from leftovers or whatever. And I was like, let's find something that's gonna help you stay full. Ideally something with protein or fiber, and then maybe something else. And I actually got her to eat a few chickpeas that I had roasted with some like some spice mix on them. Kind of surprised. Pleasantly surprised. And then she had leftover corn on the cob from the night before and I was like, "We'll count that as a win". It's like a veggie, protein slash fiber, we're good. And I didn't have to cook anything else.
[00:19:31] Wendy Schofer, MD: Hey, there's wins all around here, so yes celebrate it.
[00:19:36] Kara Wada, MD: Yeah, it's rare, but it happens occasionally.
[00:19:40] Wendy Schofer, MD: That's why I love taking those moments to just slow down and yeah, let's celebrate that. Because you know the whole thing about what we train our minds for what it is that we're focused on. So often we're focusing on the problem. So often we're focusing on, "Yep, that's another rough dinner."
It was another rough night. And we just, our brains work. We're like collecting evidence all the time. "Oh, look at that. There's another one". It's an active process of actually just trying to shift that focus to, "Hold on a minute. This is a little gem here". Yeah, this really worked. Let me just, first of all, take a moment to actually enjoy this and then we can keep on coming back to that, like how can I reprogram my brain to start looking for more and more of this, because they do exist.
[00:20:32] Kara Wada, MD: Yeah. And if I remember you need about three positives to counteract every negative.
[00:20:40] Wendy Schofer, MD: According to somebody somewhere.
[00:20:41] Kara Wada, MD: But just to know that we are programmed at baseline to have a more negative outlook because that's what kept us alive for a long time. Now it's a little less helpful.
[00:20:51] Wendy Schofer, MD: And just thinking about the amount of practice that we've had with these current habits that we have. And I think of that focus on, the things to fix, the things that are broken, the problems. That's just another habit that we have.
It's one that you are really good and practiced at. And taking that information well, if I wanna switch that, thinking about maybe it'll take three times of practicing in another way to start unraveling that it's not gonna make it perfect, it's not gonna undo it.
It's just okay, maybe there's a little bit more that I can start shining a light to what's actually working here. And that's so much of what we do, within family focus, it's like, all right, let's start digging. What is working? The smallest bit, what is working for you? What is working for your family right now?
And a lot of times parents come in and they're like, absolutely stone cold nothing. Like, all right, we're gonna dig because there is something. And it's just like where you start finding it like that little hint. There's something there. Let me keep focusing on it and teasing a little bit more and a little bit more and it grows.
That's where I think of the foundation building. We're looking for the foundation. It's kinda like we're digging. I'm totally in a mental image right now of a pit. We're excavating trying to find where is the foundation and then once we find that we build upon it.
[00:22:19] Kara Wada, MD: My mental image. We just watched, I think it's a relatively newer Netflix documentary on the lost pyramid that they're trying to dig out and find in Egypt. So I think we were on probably similar-ish mental pictures.
[00:22:36] Wendy Schofer, MD: Love it.
[00:22:37] Kara Wada, MD: My kids actually like, were pretty glued to that. I was surprised for something that was not a cartoon.
How to participate in the ongoing study
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[00:22:43] Kara Wada, MD: Are you still looking for participants in the study?
[00:22:47] Wendy Schofer, MD: Actually, yeah. So we are trying to finish up with our last phase. So we are enrolling for the last group that's gonna be going through this year. And so we are looking to close that enrollment in August. Yeah, it's something that it is still open and folks can get more information about joining.
[00:23:07] Kara Wada, MD: Awesome. How would they do that?
[00:23:10] Wendy Schofer, MD: I would love to be able to get you some links, if that's okay to put in the show.
[00:23:14] Kara Wada, MD: Yeah, absolutely.
[00:23:16] Wendy Schofer, MD: I don't quote, I don't quote numbers. You saw me like defer on the three times. Yeah. I don't quote numbers and I don't quote, I. Internet addresses.
[00:23:25] Kara Wada, MD: Wow.
[00:23:25] Wendy Schofer, MD: I always gotta be able to look up my references, but what I will do is get you information about how folks can look up the information about the study and connect with my assistant who does all of the eligibility checks, and then give so much more information.
The importance of continuous experimentation and adaptation in family health
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[00:23:40] Kara Wada, MD: Amazing. I just, I think, this opens up the potential for coaching and coaching interventions and helping a lot of folks that maybe finances might be a barrier or just gives that little extra push to be like, Oh, yeah.
I have to say too, having been a participant in research and several different capacities over the years, there's something cool too to feel like you have contributed to body of science.
And maybe it's because obviously I'm in the community. But even a couple weekends ago I was at a conference and there was a startup company that needed some biometric data, like for their device. And I was like, sure, I can lay down and stand up for five minutes and but it was really cool then to see, to have that involvement and participation and now I'm gonna be looking forward to seeing like what they do and having some I don't know, some stake in the game.
[00:24:43] Wendy Schofer, MD: Love that. Yeah, it's something that I really value the input that everyone provides along the way with the program because I completely acknowledge this is something that hasn't been done before.
It's really creating something new and saying what aspects, which aspects work for you, which aspects are you like, "Yeah, no, this doesn't work". Or other recommendations because, I think it's something that I'm really incorporating so much of the experimentation along the way.
Like everything is an experiment. Everything that we're doing, we're just gonna keep on trying, seeing what it is that we're gonna take from this particular iteration and go into the next one. And what is it that we wanna scrap? It's all experimentation.
[00:25:33] Kara Wada, MD: Yeah. I think of it like in quality work. You just, you go through these cycles of, "Okay, let's tweak this. Let's assess. Let's think about how we might like tweak and then let's do it again and again and again for the rest of time."
[00:25:50] Wendy Schofer, MD: Exactly. It's funny 'cause everybody wants like the solid answer. I said I'm just PDSA and the snot out of this. So I just keep on doing it and that's the cool thing because I get to decide.
It's let's stay as nimble as possible and just keep on doing this in the fastest cycles we can think of.
Considering the generational aspects of parenting and healthcare
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[00:26:10] Kara Wada, MD: And I would expect too, as you think about maybe as over the decades that you will continue this work, you are gonna have parents of different generations too that probably have different needs or I read an article that was just linked off Yahoo this morning, and I don't remember what it was originally published on, if you want to understand a millennial, go back and look at some of the movies that we were immersed in. They were talking about Bridget Jones, that some of these others where weight stigma was such a key part when she was like a thinnish human like on the screen and yet was portrayed as like having this big weight problem. And it's yeah, now you know, where like the millennial parents may be are coming from as opposed to maybe a Gen Z or a Gen X, and how those those will adapt and change over time.
[00:27:04] Wendy Schofer, MD: There is so much more that we're gonna be just learning as we continue to evolve and yeah, see what the different generations, I haven't even gotten to that place yet. Because I think it's really just meeting each individual where they are. And I work with parents.
The definition is very variable, as far as biologic parents and children. If we're talking about foster parents, we're talking about kinship care. There's so many different forms. I've got a bunch of grandparents taking care of grandkids, and so when I'm talking about parents, I'm using a very general term to be able to talk about those that are taking care of children and recognizing that they do come from so many different backgrounds and like you're saying, generations and I haven't really thought about it so much from the perspective of which generation, I think about what is it that you're experiencing right now?
[00:28:03] Kara Wada, MD: Yeah. That cuts through all of that.
[00:28:05] Wendy Schofer, MD: Anyways, Yeah, I guess I don't know that, that would be interesting though. Now you're making me think about other things. That'll be more fun to think about the generational aspects.
[00:28:16] Kara Wada, MD: Yeah it comes up in medical education too, right? As you see how the learning styles and things change over time.
And I was joking with a colleague that like, the years add up so quickly. And so we're about 10 plus year, 10 ish years out from residency training. And those who are residents now, they really are from a different generation primarily than what we're from. And you do see some of those differences in values and priorities and things, and some of those things that you used to laugh at about with your attendings or whatever, like now you're the attending that's getting, and it's just, it's a funny evolution.
[00:29:00] Wendy Schofer, MD: Keep on evolving, all the time. So much more to look at there.
[00:29:06] Kara Wada, MD: Thank you so much for spending time with me on your birthday of all days. Happy birthday.
[00:29:12] Wendy Schofer, MD: Thank you so much.
[00:29:12] Kara Wada, MD: I hope you have a wonderful rest of the day and I can't wait to share the links are already available on the show notes by the time you're listening to this. So make sure to click on there so that you can connect with Wendy and her assistant, see if you qualify and maybe start exploring some of these issues while also maybe contributing to science too.
[00:29:38] Wendy Schofer, MD: Hey, there you go. I would love to have you. So thank you so much. I appreciate the opportunity to share.
[00:29:43] Kara Wada, MD: Oh, I'm just so excited about the work you're doing and I think, if we can, it's one piece of the puzzle of can we actually get other folks to help pay for this too, right?
That's where so we think about really holistically taking care of our health.
Future plans: Bridging medical practice and coaching for accessible care
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[00:29:58] Wendy Schofer, MD: Goodness gracious. And I will just add on a side note, this is something that I'm also looking at integrating in a medical practice as well. And so Family and Focus is, it's not medical practice, it is coaching. But I also use those coaching tools in the medical office, and I'm actually in discussion with leadership to be able to create and what I call a "bridge clinic" where it's not primary care and it's not the behavioral health, it's really in between. Because so often we have identified concerns in the primary care office, whether it is mental health, whether it is nutrition, behavioral health, and then it's now I'm gonna refer you.
We gotta hit like the exit button here, and then families go out into the unknown where there's long wait lists, long waiting times, but actually, I can do these things.
This is actually using many tools that I'm already using. We just need to create the structure that we have, the time and the support to have these types of conversations. And oh, by the way, making it something that's accessible to folks who do wanna use insurance. Absolutely, yes. And so there's gonna be so much more coming there.
But it's about thinking I always joke about thinking outside of the box, and usually when I said the box, I mean outside the medical office, I'm actually going inside the box here. I'm trying to see how I can bring what I'm learning in the community and ultimately there are significant needs that our families have and I'm saying, "Hey, I wanna help. I've got the tools, I have the interest, I have that passion. Let's make this work for everybody".
[00:31:56] Kara Wada, MD: That's so exciting.
[00:31:57] Wendy Schofer, MD: Oh, I cannot wait. There's more to come on that.
[00:32:00] Kara Wada, MD: Cool. We'll just, schedule another time, like a year from now or whatever, and we'll be talking about it then.
[00:32:06] Wendy Schofer, MD: That would be perfect timing. I love it.
[00:32:09] Kara Wada, MD: Next year's birthday. Hey, there you go.
[00:32:12] Wendy Schofer, MD: We have a Good what do you call it? Put a pin in it there.
[00:32:15] Kara Wada, MD: Aw, thank you so much, Wendy, and I wanna hear more about that offline.
[00:32:19] Wendy Schofer, MD: Awesome. Thank you so much, Kara.
[00:32:20] Kara Wada, MD: Take care. Bye.
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