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One of my favorite tests in assessing hormone status, is the DUTCH (Dried Urine Test for Comprehensive Hormones) test used for comprehensive hormone testing. Production of our hormones occurs from an elaborate process via cholesterol and enzyme conversions. Ultimately, hormones are detoxified and then need to be excreted via stool, urine and sweat. This pathway is vital in hormonal health. Let’s break this pathway down. See figure  Cholesterol can get a bad rap without deserving it, but thanks to “Big Pharma,” it has been vilified specifically the LDL-c (low dense lipoprotein-cholesterol). Hormone replacement therapy has been looped into the “bad” category as well and is also misunderstood. Let’s take a look at how cholesterol (LDL-c) converts to hormones. Within the liver, cholesterol will begin its part of the metabolism process to become hormones via enzymes breaking it from one hormone into another one. Enzymes are necessary as well as co-factors to start the process of this steroid-hormone pathway. It is a downstream process. As the diagram reflects, cholesterol’s first hormone conversion is pregnenolone (a hormone naturally produced in the body by the adrenal gland). On one side of that conversion, progesterone is made. Progesterone (a hormone released by the corpus luteum in the ovary) has enzymes that cleaves (adheres to or sticks to) it into metabolites which can then be detoxified and will then enter the bowels, bladder and sweat glands for excretion. The same process occurs for our androgens, testosterone, cortisol, and estrogens, and also neurotransmitters, caffeine, alcohol, etc. The DUTCH test will reflect how your body does this breakdown. When you lack an enzyme and/or cofactors (i.e., folate, B12, zinc, etc.), the hormone pathway can be shunted in another direction and create a burden elsewhere. And remember, there are many endocrine disruptors in our environment that enter these pathways to be metabolized and compete at hormone receptor sites and/or create a huge toxic burden within this pathway. Ultimately, these hormones become metabolites. Also, 2-hydroxy (2-OH-E1) is considered the protective pathway, while 4-OH-E1 and 16-OH-E1 are oxidative in nature and cause DNA damage. Think of the rusting process that could occur on a car-that’s oxidation. When I review your DUTCH test, we will make a treatment plan on how to help your detoxification pathway to better excrete toxic metabolites. Remember that your bowel habits, water intake and exercise inducing sweating, help these toxins leave the body and why they are pivotal to hormone health. When prescribing bio-identical hormone therapy (BHT), it is essential to have this testing done on a regular basis along with other laboratory testing.
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 Hormonal declines are inevitable and when it arrives at our doors, the symptoms can be mild to a staggering feeling of exhaustion, depression, and not belonging to one’s own skin any longer. Symptoms include weight gain, mood changes, hot flashes, insomnia, joint pain, no sex drive, brain fog, and low energy. The neurohormonal shifts begin a decline in bone loss (osteopenia/osteoporosis), cholesterol changes atherosclerosis (hardening of the arteries caused by buildup of plaque), cognitive decline (Alzheimer’s), collagen loss (skin elasticity, wrinkles), vaginal atrophy (painful sex), and cortisol/stress hormone fluctuations (weight gain especially around the waist).
Bioidentical Hormone Replacement Therapy (BHRT), which is FDA-approved (except when compounded — a custom formulation of medication to fit a unique need of a patient), has been shown in research to reduce rates of heart disease, osteoporosis, Alzheimer’s, and vaginal atrophy. On the other hand, risks may include blood clots, stroke, and Myocardial Infarction (heart attack). However, because there is no long-term data with bioidentical hormones, the risks are not known. The studies for these side effects come from Premarin® and Provera® (conjugated estrogens) which are not bioidentical and taken in oral form. When I prescribe BHRT, I have them compounded and have them in patch, trouche (lozenges that dissolve slowing in the mouth), suppository or liquid form; they do not pass through the liver on its first phase of metabolism and where oral estrogen pass through the liver which is the reason the rate of blood clots increases. The oral birth control pill has the same risk due to the first pass in the liver. When patients initially establish care with me, labs and DUTCH test are necessary to assess their baseline hormonal status. The timing for starting BHRT is paramount to make sure bone density is established as well as warding off other disease processes. Once BHRT are prescribed, I require a yearly DUTCH test and labs. To remain as an established patient, the minimum visits will be two times per year. Most patients on average see me three times per year. Appointments can be conveniently held via telemedicine. "It takes no time to fall in love, but it takes years to know what love is." - Singer-songwriter Jason Mraz Romance is a hot topic and the romance novel industry knows something about as it brings in a whopping 1 billion annually. We are interested in keeping romance alive, yet while time passes most relationship will be plagued with the romance blues. Researcher, Helen Fisher, details her findings in the Chemistry of Love. Fisher’s research explores the various neuro-hormonal pathways of love, the longevity of such chemicals, and theorizes the idea of a love map.
Many factors are contributory toward the decline and the rate at which couples may experience the diminishing romantic feelings, such as each partner’s sexual constitution, lifestyle, health, finances, work schedule, children, living situation, religion, etc. Also, one’s expression of romance is important to understand to ensure that their love language is conveyed in a way that is received. Bottom line is we are wired to connect. Within a very complex neural network, we have a reward motivational system that is activated when we encounter a potential mate. This juices up the system with dopamine and norepinephrine. This system gives us the craving for that person leading to focused attention, obsessive thinking, and euphoria. We may relate to this as “the fall.” Serotonin which helps regulate moods, emotions, sleep and appetite drops during this phase, which causes the lack of appetite, reduced sleep and emotions and moods that feel uncontrollable. Our bonding hormone, Oxytocin ensures the attachment and provides the peace and calm we feel when in their presence. Of course, testosterone needs mentioning as this propels us into the pursuit and desire for sex. Once sexual activity takes place, these hormones and neurotransmitters go into overdrive to essentially ensure procreation and pair bonding. However, there is the caveat. It’s a short-lived experience. It’s essentially not sustainable. The question becomes how to create sustainability and satisfaction for both partners. First and foremost, hormones levels are important to know as hormone replacement may be all it takes to ignite the desire and pursuit of romance. Of course, communicating wants and needs is fundamental to a healthy bonded relationship. Stella Resnick, PhD., a leading researcher in keeping the spark alive in long-term relationships, says there are three distinct behaviors these couples exhibit with each other. First, they eye gaze and attune to their partner. Secondly, they touch each other and hold hands often. Lastly, they have continued kissing one another throughout their relationship. As a sexuality counselor, these behavior are usually absent from couples I see. Training in these behaviors alone, gives the kick start. From there, scheduling dates, doing activities together that arouse a sense of excitement and fun together, and mostly, it’s the true desire to want to engage with each other with an authentic and connecting approach. Cheers! Over the past 25 years, Neuroscience is exponentially growing elucidating the positive influence meditation has on our health. Cultivating constructive qualities of mind such as lovingkindness, compassion, gratitude, and empathy, continue to provide very rich data of the neuro-hormonal activations that occur essentially priming our systems with good health. Multiple brain regions are involved in the generating the embodied process of these mental states. Studies are often cross-linking, reporting many of the same brain area activations that stimulate the nervous system, giving us the elixir of well-being.
Last year, the University of Southern California’s Brain and Creativity Research Institute released a research paper, Neural Correlates of Gratitude. Eminent Neuroscientist Dr. Antonio Demasio was one of the researchers, which brought my attention to this article. The study hypothesized that brain regions associated with moral cognition, value judgment, and theory of mind would be activated. These areas are seen to be activated in the above mentioned mind states as well. In eliciting the quality of gratitude, various scenarios drawn from the Holocaust were told to the participants. Stories ranged from being given food, a place to sleep, and someone saving their life. Participates were asked to put themselves into that experience (which is an empathic experience) and rate their level of gratitude, 1-rating lower level of gratitude and 4-rating high. There were 26 participants, none of which had any connection to the Holocaust. The overall rating was 2.6. The participants stated they felt as if they could live in the experience that the Holocaust survivor had lived and the gratitude that must have been felt. As researchers hypothesized, the area of the Prefrontal Cortex, the seat of moral cognition, was activated, as well as, regions associated with prosocial behavior, interpersonal relationships, and social support. Gratitude considered a virtue in all religions, does appear to have a place in the brain. With the stimulus of imagining a scenario to elicit gratitude, we can activate the center of moral cognition affiliated with positive emotion and mental well-being. While many of us know the felt sense of practicing gratitude, this study, demonstrates the neurological correlates. Also remembering, our brains are neuroplastic, therefore, what we fixate on wires neurons, for better or worse. We are wired to experience gratitude as this study suggests. Our brain circuitry has gifted us with a byproduct of gratitude when we have benefited from the goodwill of another, imagined or real. Not only that, but he next byproduct of this experience is resiliency, emotional stability, and well-being. Amazing, how we are gifted again. With gratitude and may all being know gratitude. " She’s crazy. Just when you think you’ve reached the bottom of her craziness, there’s a crazy underground garage." - Anonymous Many of us have had that brush with the type of boyfriend or husband that is like riding Full Throttle at Magic Mountain. Even you guys out there know what I’m talking about. I’m sure you’ve been dazzled in the elixir of the love-hate relationship just the same. These theme park-like relationships seem to be very common experiences in partnering. Even the fad diets and exercise programs offer this yo-yo style relationship with ourselves, yet 95% of the time, they fail to yield any lasting happiness.
In my health and sexuality practices, I’ve contemplated the dilemma of how the relationships with our bodies, genitalia, love relationships, exercise, food, etc. … resembles the love-hate dramas of relationships that exist. No offense guys, but I call these relationships “the bad-boyfriend syndrome.” While we know that half of marriages end in divorce, how many relationships have you encountered the wild ride of the love-hate game. Now here's some data about how we have a love-hate relationship with ourselves. Research suggests that 91% of women dislike their bodies. And currently, about 8 million people suffer from eating disorders, while the weight loss industry revenue tops $55 billion dollars annually. It gets better. The cosmetic industry revenue is $58 billion annually and the fashion industry, sit down for this one, is 1.2 trillion dollars annually. Somehow we spend a lot of money attempting to “love” ourselves/bodies, yet most women are still very unsatisfied with them, seems like some internal aggression toward ourselves. This roller coaster of fabricating a sense of love toward ourselves with a new outfit, more Botox, another boyfriend/girlfriend, a new diet plan, a new pair of underwear to entice but don’t get to cozy down there because you don’t like the way it looks, smells, taste, is the cycle of this syndrome. In John Mayer’s song, The Heart of Life, he sing’s “fear is a friend who is misunderstood.” As I coach clients about this dualistic framework on the love-hate dynamic at play, fear shows itself with a mighty presence. Fear reveals the secret to healing. It’s certainly a very edgy, scary, and less traveled involvement we have with this emotion, and, unfortunately, the data tells the story. Americans are billions and trillions of dollars away from their fears. The thing with our fear though, is we can’t break up with it and leave it at another house. It’s a shadow that follows us so closely and intimately. The mega bucks spent on avoidance will never produce the most reliable love of our life called facing our fears. The capitalistic monkey at play in this story is not interested in our befriending this energy, in fact, it would become crippled if we did actually engage with it in a meaningful and loving way. We each want that relationship with a partner that is loving, kind, compassionate, thoughtful, and delicious, but you know the story of this. We must first have it within to have it on the outside. There are transformative exercises and methods to transform these fearful emotions into a warm regard and love for ourselves. We can make friends with our fears. We can stop searching for something that a mega-wealthy industry distracts us from and begin to love ourselves anew. As Rumi says, "maybe you are searching among the branches, for what only appears in the roots." For coaching on your fears, contact Sherri through her website. “The true function of sex is to bring more love into the world.”
- Diana Richardson As I reflect upon the years as a Sex Counselor and consider the root of the problems couples have with their sexuality, it seems to boil down to passionless sex. While that seems like an obvious statement, I’d like to share the depth of what I mean by that statement. While there are many causes and conditions that merge together creating sexual dissatisfaction from couple to couple, what I have witnessed over the years may be distilled down to that simple statement, passion burnout. We can turn to the current state of affairs in the typical American bedroom. The average time a couple spends on foreplay is 10-19 minutes and intercourse is about 7 minutes. Yet for woman, igniting the female arousal system takes about 40 minutes to fully engage. While some woman may have an orgasm quickly, this does not indicate full arousal. If the goal is to have an orgasm, the genitals are wired to get you there. If the goal is deeper intimacy, meaning more intentional heart-centered approach, then having an orgasm is only an aspect of the encounter, but not the goal. When we first encounter a love relationship, that passionate spark makes us feel alive and that we’ve met the one and only (rationalizing all the other one’s that seem to have fit the bill). Our neurobiological system in on full throttle giving us the primal body sensations to have sex. These physical sensations are quite intense and have a sense of urgency to them for after all it’s “the one.” At some point, maybe even the first date, we have sex and then we just don’t seem to stop. But eventually, the pleasure center tops off and the descent begins. The descent begins with seeing the shadow of the other and who they are with their annoyances, idiosyncrasies, personality quirks, immaturity, emotional unavailability, anger, shutting down, etc. As this emerges, sexual encounters begin to wane and lack that initial charge and power. And another power rears up: the power struggles. One wants it more, the other less. It becomes a chore, either to pursue or oppose the pursuit. Lovemaking went from playful fun and excitement with orgasm being the norm, to a bantering about “doing it” or not “doing it.” And commonly, the woman begins to not have interest in her own orgasm and he stops attempting to please. The passion seems to have run dry and lovers soon become roommates, housemates, and business partners of their household. The question becomes how might we come together to shift these dynamics to re-ignite the passion and create sustainable passion. It is suggested in wisdom traditions through transformation (hence, inner work to do!) of passionlessness, we step into the arms of a sustainable passion. Cultivating a passion that can withstand the ups and downs of the myriad aspects of modernity, requires a process that we each commit to by arousing our heart-centered compassionate nature. The genital-centricity with which is often the primary focus in romantic relationships burns us out. A heart-centered awareness brings the sexual energy up, allowing for connection of the minds. The genitals are quiet proficient at their function so put your focus in a higher realm. To begin, consider not treating your sex life like a McDonald’s drive thru. Begin to slow down the process. If your average time with a sexual encounter is 15 minutes, double the time and don’t rush the process. Engage all the senses, but keep it simple. Turn off all the distractions, phones, computers, TV, chores, etc., and turn toward each other as if that person really matters to you. As Nelson Mandela says, “there is no passion to be found playing small.” When we rush through the most intimate human connection available in our lives, we play small, which suggests that love hasn’t fully emerged. When we take our time and take our sexual encounters slowly, we will begin to notice all the nuances being offered in each moment. As we allow the sensations to be felt slowly and not rushing or forcing it’s intensity, our minds come to the process. When the mind finally settles in this sweet space, love shows itself. So slow down, pay attention as if it your life depends upon it. “Only the united beat of sex and heart together can create ecstasy.”
- Anais Nin, Delta of Venus Breath. Sex. Connection. Fear. Arousal. Confusion. Love. Fantasy. Argument. Love. Rejection. Pursuit. Object. Closed. Joy. Repression. Fight. Kissing. Anger. Touch. No desire. Orgasm. The many faces of the sexual experience, possibly an infinite list. While at UCLA, one of the mantra’s that we used and has stuck with me is “It all Belongs.” And really, until we meet this way of life straight on, we will experience suffering. Sex and all it offers, is opening Pandora’s box. And we can think of Pandora’s box as offering it all and therefore it all belongs. The question about our sexual life to ask is how might I embrace all the aspects with kindness, resiliency, generosity, curiosity, and warm-regard, when the confusion, anger, rejection, lack of desire, no orgasm, affairs, etc., enter on the stage of sexuality. Might we find a way to have all the suffering sit before us and open up to it? Sex in its most raw form is like fire, wind, motion, water, harshness, multi-dimensional, and transcendent. Yet we want to harness it, capture it, tame it, and somehow fit it into our conditioning so we remain comfortable, untroubled, invulnerable. If the absolute nature of sexual energy with all it’s qualities is beyond such constrains, then our suffering is more about our methods of tramping this very powerful energy. Passion is defined as a powerful, strong emotion that is filled with love, desire, and even hatred and anger depending on the motive behind it. Emotions are physiological impulses that provide feedback on stimulus, either internal, external or both and have a half-life of about 90 seconds. Narrative feeds the emotion for better or for worse. If raw sexual passion arises then, what are we feeding into this powerful impulse? Is it more frustration, anger, edginess, if so, we begin a cycle of supplying our sex life with kindling of dislike, contempt, resentment, hatred, for ourselves and our partner. Another story we have the potential to cultivate is just staying present to how it arises and stay with the felt sensations and ride these sensations like a surfer rides a wave. We may choose to imbue those sensations with some space and freedom and warmth. How we unite our mind to our body during sexual impulses/experiences, is how we will ultimately experience our sex life. The mind interrupts sex through the body’s impulses. How do you interrupt yours? If the mind is embracing the quality of love, then sex will be experienced in the body as love. If the mind is objectifying, judging, and conquering, then sex will be an experience of selfishness and dehumanization, disconnecting the mind and body from the raw form of sexual energy. Alas, suffering. Applying mindfulness into the sexual experience of our lives goes without saying, it is essential, necessary and fundamental to a deeply satisfying sex life. To the degree that we become mindful of our sexual impulses and allow it’s form to arise and welcome it all, is the degree to which our sexual experiences will transform our lives into authentic intimacy. In allowing our mind to remain present, open, loving, accepting, and empathic to what arise, we come home to life and our bodies. "When love expresses through you it first expresses as the body. It becomes sex. If it expresses through the mind, which is higher, deeper, subtler, then it is called love. If it expresses through the spirit, it becomes prayer.” - Osho “The cultivation of compassion is no longer a luxury, but a necessity, if our species is to survive.” - Dalai Lama The Center for Compassion and Altruism Research and Education, or CCARE, was founded by Neuroscientist Dr. James Doty and after meeting His Holiness the Dalai Lama and his prompting to explore the relationship of science and compassion, CCARE emerged. With good fortune, I attended the program that was developed at Stanford on Compassion Cultivation Training (CCT). This training took place at Vajrapani Institute in Boulder Creek over the course of a four-day emersion.
The program includes science, psychology and contemplative practices that support the process of living a more compassionate life. One of the highlights that seemed to emerge over and over throughout the course was Self-Compassion and how often we turn to provide compassion for others and forget about ourselves. The risk to such forgetting may lead to empathic burnout and the subsequent physical and mental health issues that result from this burnout has some fairly significant consequences. When the tank of empathy begins to show it’s initial signs we may find ourselves fatigued, to frequent colds/flu’s, to complete despair and hopelessness. The remedy while seeming very simple at first blush, is often more challenging for us than we may think, but self-compassion is the antidote. Kristin Neff, a Professor at University of Texas, Austin, is the leading researcher in Self-Compassion. Her work on self compassion, explores how being kind to ourselves is what is necessary to most effectively provide the framework for giving compassion to others. While this seems obvious, I think many of us still find it easier to help others first before ourselves. My intention for taking this course was to understand the more current research on compassion cultivation and how I might integrate this new material into my mindfulness curriculum that I’m currently utilizing with law enforcement. I discovered the more important aspiration was self-compassion. So with a filled empathic tank and ready to spread compassion, I might suggest a very valuable book from Kristin Neff, "Self-Compassion: The Proven Power of Being Kind to Yourself." "I can't say I have control over my emotions; I don't know my mind. I'm lost like everyone else." - Richard Gere If you haven’t watched "Inside Out" (see sneak-peak clip on YouTube) a Pixar movie, it’s worth viewing, not only for the pure entertainment value, but also the educational aspect. Imminent emotion Researcher, Paul Ekman, who also helped develop the Cultivating Emotional Balance Teacher’s Training (CEBTT) with B. Alan Wallace, was beckoned to Hollywood to give guidance on the facial movements for the characters in the movie. The movie illustrates only five of the universal seven. Regardless of gender, culture, ethnicity, age, we each will exhibit the same macro and micro facial movements for these seven emotions. They are sadness, anger, fear, disgust, contempt, surprise, and joy (or called enjoyable emotions in CEBTT). Of course, there are many other emotions, more nuanced, that do have cultural, gender, and ethnic differences.
Sociologists suggest the evolutionary function of emotion is to save our lives and to motivate us to engage in behaviors necessary to form relationships. Such facial cuing had to be the same in order for understanding to be passed along our makeup for these reasons and it all happens below the scene of conscious awareness. Even if we are trying to conceal an emotion and blunt the gross movements on our face, there are micro-facial movements that are out of our control. We are caught in the grips of evolution and those around us will catch on via their own attuning networks signaling them “something’s up.” Antonio Damasio, University of Southern California, has studied neural correlates of emotions and formulated a theory of Somatic Marker Hypothesis. Essentially, there are neural pathways that connect to the brain, going both directions to and away from brain (not a one way street), and it is this that allows us to have the embodied experience or maybe all to often, the un-embodied experience. Our meditation practice informs us very intimately about these neurological processes if we are mindful and attuning to our meditation experience. If we are having a difficult time with an emotion and not so sure what it is, Dr. Paul Ekman might just suggest to you, grab a mirror and check out your facial movements. Ahhh, maybe you’re not familiar with those facial movements, then watch Inside Out and you’ll very clearly see the common five emotions we display on our face. The two emotions cut from the film are contempt and surprise. I think we know what a face looks like when we are surprised. For contempt, not to get overly politically here, but just check out the majority of Donald Trump's photos and you’ll witness contempt at it’s best (universal gesture is lip corner tightened and slightly raised). Until next blog, enjoy the movie and may your practice be truly an embodied experience and your emotions held with compassion and loving kindness. "We cannot solve our problems with the same level of thinking we used when we created them." - Albert Einstein As we continue our investigation of the Four Balances (see link for previous blog explaining Four Balances), let’ examine how our cognition influences whether we are aligned with cultivating balance in thought or dropping into a dissonance and miserable mental state that arises with thought.
A slogan suggested from renown author and nun, Pema Chodron, is "don’t believe your thinking, don’t believe your thinking, don’t believe your thinking." If it’s true that we think about 50,000 thoughts daily and most of these thoughts are recapitulations from the past or futuristic thoughts, then we surely may want to adopt this slogan for the time being. As a sex counselor there are few topics (maybe money being the other hot topic) such as sex that ignites mental states that are riddled with much intensity and density. While understanding our stories about our sexuality is vital to undercover it’s nature, the negative thinking about our sexuality is what needs transformation. If we could download our daily thoughts about our stories around sex, what would they be? Write it out. What is the story line? What would the title be? This inquiry is important to know. Because once we peer into the thoughts produced, we can see how it leads to mental states that plague our sexuality. A recent exchange between a couple in my office, I’ll call them Jay and Karen, went like this. She shared what she thinks when he makes advances toward her. It goes something like, “I hate when he comes onto me like this. It’s always the same and he never asks me if I’m even interested. He just goes in for the ‘kill’ and I just give in because it’s too much of a headache to talk it out." Karen says this is at least 90% of the time what she is thinking. Jay shares his thoughts, “I know she doesn’t care about sex anymore and she always turns away from me if I try to kiss her. She seems like she’s just putting up with me. I’m usually thinking that she doesn’t really like me or sex, but because I want to have some closeness with Karen, I guess I look at this type of sex as something that may get us to be close.” Jay says this is what goes on for him in his mind almost 100% of the time. They both said they knew the other person had those thoughts as they had shared them with each other at various times, but could not get themselves out of the habit of recapitulating the same story. This is what I call a cognitive imbalance or cognitive dissonance. We often just let our thoughts run amuck and we don’t intervene on our own behalf to stop the storyline that we repeat over and over. I asked them what their deepest intention is for the relationship. They both agreed that they want connection, closeness, love, and to feel sexually satisfied. So how do we bring about a cognitive intelligence and resonance with our sexual partner? Check up on your thinking. Is it aligned with your intention or conative intelligence? If not, then we must change our level of thinking to a resonance with the Intention. Jay and Karen want to have connection. They’re ruminating thoughts are not in alignment so the first step is to create a new thought pattern that reflects connection. Instead of Karen assuming Jay is just wanting sex and pursues her to “get some,” she is practicing mindfulness of her thoughts and changing the story knowing that Jay wants connection and that he wants her to enjoy their sexual play together. Jay is doing the same thing. They are telling a new story that reflects connection and love and their sexuality is founded on these principles. Quoting from Gandhi, "watch your thoughts, they become your words; watch your words, they become your actions." To watch our thinking requires mindfulness. It requires us to remain on guard, to be a custodian of our thinking is such a way that when we sway from a balanced emotional state we reel in discursive mind of rumination and negativity bringing it back to rest in calm and peace that is held with kindness, love, and connection. To finish quoting Gandhi, “ watch your actions; they become your habits; watch your habits, they become your character; watch your character, your character becomes your destiny.” So begin to think kindly of your partner and watch how your destiny becomes that of kindness and connection. |
Sherri AikinSherri Aikin is a Fellow of Integrative Medicine, Nurse Practitioner, Sex Counselor, Mindfulness Facilitator, and Life Coach. Categories
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