Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Breastfeeding Nutrition Essentials and Guidelines
Join Dr. Holly Thacker on the Speaking of Women's Health podcast as she marks Breastfeeding Awareness Month by sharing the health benefits that breastfeeding brings to both mother and child. This episode also contains helpful tips on bottle feeding, how to increase milk supply and how to store breast milk.
Join us for a rich, empowering discussion aimed at supporting all mothers on their breastfeeding journey.
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to the Speaking of Women's Health podcast. I'm your host, dr Holly Packer, the Executive Director of Speaking of Women's Health, and I'm back in this August hot sunflower house for a new episode on breastfeeding, because August is Breastfeeding Awareness Month and there is a statement that breast is best. Now, it's not for all women, but it's really an important topic. And you might think, oh, I'm not breastfeeding, I'm past the childbearing age. But maybe you have a daughter or a niece or a neighbor or a coworker. Maybe you have a daughter or a niece or a neighbor or a co-worker.
Speaker 1:One of our fellows just gave birth to a beautiful little boy a little bit earlier than expected. So babies are just so important and so exciting. And I was just holding one of my neighbor's cute little babies, luciana. Oh, they're just intoxicating to hold such a little precious human. And she was there with her older sister with a play date with my granddaughter Artemis, and the mom was just getting off of work and the nanny grandmother, my friend, said well, we have to get the baby to the mom for breastfeeding. And so being a working mom and breastfeeding is really a big, big commitment and I was a marathon working, breastfeeding mom. I had three sons and I did tandem nursing through pregnancy because my first two are only 18 months apart. My sister breastfed all four of her children well into toddlerhood. Certainly, medically, we recommend hopefully six months and really ideally a year for nursing.
Speaker 1:But a lot of things play a role into whether a woman decides to breastfeed. Culture, family work status, health status, you know, affect a mom or a family's decision and there are some babies that are born with rare inborn errors of metabolism that actually can't be breastfed and some moms have medical conditions or medications that preclude it. Moms that need uninterrupted sleep, like, say, women with bipolar illness, many times will choose to take care of their health, their psychological and physical health, and not breastfeed and rely on other family members. Dads and other family members can be big time helpers if a baby's bottle fed to be fed at night, or they can still do bottle feeding with pumped expressed milk as well, pumped expressed milk as well. My son Stetson, the PhD in molecular medicine and cancer genetics, who has been on our podcast and provides a lot of content, is very interested in fathering and the role biologically, of fathers nurturing children and he's about ready to launch a podcast soon on thoughts from fathers, paternal musings and I think I'll have him back on the in the Sunflower House. His podcast that I did with him on genetics was actually in the top 10 of all of our 115 plus published podcasts, so it'll be interesting to hear his thoughts on a number of health topics. And I want to delve into anti-aging and one of the reasons why breastfeeding is so important is study after study has shown better health outcomes and lower burdens of disease.
Speaker 1:Now, that's not to say that moms or families that choose strict bottle feeding for various reasons can't nurture their babies and provide really nutritious benefits. I can tell you just from a personal, selfish reason. One of the reasons why I loved breastfeeding was it was the only time I could eat whatever I wanted. I remember our live-in nanny looked at me and said you're having two dinners almost every night. You eat more than you did when you were pregnant and truly it was the only time that I didn't have to really pay attention to what I was eating.
Speaker 1:Trying to do intermittent fasting and weight is really the biggest, biggest concern for women in general usually. I mean there's a small subset of women who are always naturally slender and they don't have any problems. But in this situation of bounty of food for most people, although there certainly is food insecurity. That is a problem. The other reason why I liked breastfeeding is not that I was a lazy mom, but it was just so convenient. You didn't have to clean bottles, you didn't have to worry about whether your baby was getting enough.
Speaker 1:And certainly most but not all, breastfeeding moms do seem to snap back into physical shape faster. My granddaughter, the mother of Beatrice and Artemis, who's a nurse practitioner with long shifts you know, 12 hour shifts so it was really quite a commitment to pump and transport and store all that milk for so many months. She actually got down so thin, even below her pre-pregnancy weight, that she was a little bit worried. Artemis was quite the good breastfeeding baby and was really plump, so she just sucked those calories and nutrition right out of her mom. And certainly breastfeeding moms need more calcium. They have to get enough omega-3s, enough protein. I ended up having a slew of dental issues that I think in part was nutritional. You know breastfeeding babies so long and right in a row and through pregnancy. So it is really important to bone up on nutrition at all ages, but particularly for for breastfeeding moms.
Speaker 1:It's nice that there is more increasing social support for breastfeeding and work support and private breastfeeding areas. But that's not available to everyone and there certainly has been some improvements in pumping. Some women can pump while they're working with contraptions connected to them. There are pumps that have softer cups and that aren't so uncomfortable. One of our former Center for Specialized Women's Health nurses, samantha Graham, who I adore, who has two cute boys, was quite a great breastfeeder and very supportive to other moms in the center and other friends and family for breastfeeding had to really seek out a lactation consultant because her first, you know, son had an issue with latching on. And now I witnessed it right after the birth of my grandson, lincoln. They actually graded and checked and asked um right after birth if the mom and dad wanted the tongue clipped for just better latch on, and now we have more availability. Of course it probably depends on your area, but at the Cleveland Clinic, uh, we really have some terrific lactation consultants.
Speaker 1:And it's exciting to celebrate National Breastfeeding Month and this year's theme is Nourish, sustain and Thrive. I love that Nourish, sustain and thrive because our mission statement at Speaking on Women's Health is be strong, be healthy and be in charge, and so to me that nourish, sustain and thrive really seems to go right along with our theme, and this 2024 National Breastfeeding Month theme will shine a light on why. Protecting Breastfeeding Month theme will shine a light on why protecting, promoting and supporting lactation is really very important for the human life cycle. And we really honor the incredible work that organizations are doing to make the world just a more friendly place for new parents and families and highlight how individuals, funders and policymakers can contribute to strong and sustainable lactation. And at the Cleveland Clinic we're blessed to have a lot of really good breastfeeding resources to meet diverse family populations and their needs. So our OBGYN assistant nurse manager, marla Nichols, who helped author the column that we have on speakingofwomenshealthcom with links to a lot of these resources, she is a practicing international board certified lactation consultant and she supports Cleveland Clinic Lactation Department through work with the Melanin Rich Breastfeeding Support Group for Women of Color and we have those attachments on our website.
Speaker 1:And you know we have to focus on all people's needs and thankfully, in 2024, dying in childbirth is very rare. But not too long ago in human history one in 50 women died in childbirth. So obviously that's an issue and, um, you know there are, you know, wet nurses and there's some ability to get breast milk from milk banks, but there's also a wide variety of bottle feeding choices that can be obtained. That being said, in recent years there's been product callbacks on contaminated bottle milk. So anytime you put anything into your body or a baby's body, we want to be as sure as possible that it's healthy and it's not contaminated. In terms of dealing with breast milk, you may be your Mimi or grandmother, like I am, and you might be helping to watch a baby that needs breastfeeding milk and the mom's at work.
Speaker 1:Freshly expressed pumped milk can stay at room temperature for four hours. My daughter-in-law, the mother of Lincoln, was a really great producer of milk. She would just pull like a pitcher of pumped breast milk out. I had only just enough to fill the little packets for bottles, never that much and she just preferred not to breastfeed around people or public. She just wanted to put the breast milk in the bottle. Moms that have preterm babies many times will pump to gastrically feed the baby. So you know, kudos to all those moms who nurture their babies in whatever way that they're able to do that.
Speaker 1:Now. Fresh pumped milk can stay at room temperature for four hours. It can stay in the refrigerator in little packets or a pitcher, like Lincoln had for four days In the deep freezer. I would freshly pump milk and usually leave it for the next day and then sometimes I would try to build up a little bit of a supply mark it, do it as aseptically as possible and put it in a deep freezer for six to 12 months. And I was very specific about how to handle the breast milk. I didn't want anything wasted because to me it was like liquid gold. I wasn't able to pump just so much or extra, only just enough, and so I was very specific about that because I just didn't want a supplement. I never had a supplement. Some moms just don't want the stress of that and they do breastfeeding and they supplement. Certainly, once you start to introduce foods, your milk supply goes down. If you don't have enough time, hydration and physical contact with that baby, breast milk production will go down. Now, if you've already taken thawed milk out of the freezer, you can keep it for one to two hours in the refrigerator, but never refreeze it, just like food that you've had frozen, that you unfreeze. You don't then refreeze it generally at all because that's not recommended. If you've got leftover milk, like the baby just doesn't take all four ounces or six ounces of the bottle. You have to pitch it after two hours. So those are some just really good tips because you want to keep the baby healthy.
Speaker 1:You have been listening to the Speaking of Women's Health podcast and I'm your host, dr Holly Thacker, in the Sunflower Hot House for August, talking about National Breastfeeding Month, and I'm really happy to go over some content that we have on our speakingofwomenshealthcom website, provided by graduates of the two-year Specialized Women's Health Fellows, breastfeeding moms themselves. The first one is by Dr Faluki Ali. She just had had her third baby when she came to do her fellowship and her husband, a physician, was in another location practicing, so she took care of all three of her children, including a newborn, did the fellowship, managed to make homemade food and express mail it to her husband, and so you know, it's really incredible how, when women become moms, many become so efficient and just do incredible things like a superhero. So Dr Alley is so smart and accomplished and she contributed a column that went over women's blood levels for lead, mercury and PCBs, because there was a study done by Brown University published in the Journal of Environmental Research that measured blood levels of lead, mercury and PCBs, which are polychlorinated biphenyl, pcps, and this study showed that one in four American women of childbearing age met or exceeded the average blood levels for all three of these chemical pollutants, which is really concerning. And we in the Sunflower House in Northeast Ohio are not very far from East Palestine, ohio, which over a year ago had a huge chemical disaster and chemical poisonings in that whole entire area, and that it even extended into Pennsylvania. So environmental pollutants are a big concern for all of us and in this Brown University study there were 3,000 women aged 16 to 48 that were found to be at or above the average blood level for one of these chemicals.
Speaker 1:And it can be passed on to the growing baby in utero, the fetus in pregnant women through the placenta and to babies through breast milk. So these three pollutants are of the most concern in general because they're pervasive and persistent in the environment and they can harm the baby, the infant brain development. So risk factors include age the older the woman, the higher the risk of exceeding the level in two or more of these pollutants. Women in their 40s had a 30 times higher risk than younger women ages 16 to 19. And peak fertility is at 24, ladies and women who have a baby under age 18, even though socially, financially, educationally, economically, I understand that's a concern, it's really good on the breast and helps to reduce breast cancer risk because it actually matures the breast. So the younger you have a baby, just generally, the better it is for the breast.
Speaker 1:Women who ate fish more than once a week had 4.5 times the risk exceeding the average in two or more of these pollutants. So pregnant women are definitely advised to avoid fish that has high mercury contamination and to limit the fish ingestion. Omega-3s are so important, though, for brain mood, for postpartum depression, so flaxseed walnuts, almonds, are very important for the diet, as well as choline egg consumption, because choline is very important for brain development. Now heavy alcohol consumption was also found to increase the risk of these toxins. Now we know that breastfeeding has been shown to reduce a woman's risk of having elevated levels, because they're getting rid of things by having things expressed from their blood, and women actually who breastfeed have lower risk of premenopausal breast cancer. Women actually who breastfeed have lower risk of premenopausal breast cancer and women who breastfeed at least one child for at least one month in their life um also reduce the risk of exceeding the average blood level for two or more of these pollutants. Um, this may be because the woman's passing it on through breast milk, which isn't so good, but it hasn't been proven. So if you have heavy metal toxicity, you might have skin rashes, fatigues, headaches, menstrual irregularities, poor immune responses, abdominal pain, nausea, vomiting, and so certainly many of our functional medicine colleagues and we do have a women's health functional medicine expert who also did our fellowship, dr Sobia Khan and these types of toxins can be certainly assessed. So if mothers have babies who are exposed to these pollutants, they can have low birth rate, developmental delays, neurologic problems.
Speaker 1:Low levels of lead exposure have been associated with a higher risk of spontaneous abortion, so-called miscarriage, as well as impaired cognitive development in children that have had prenatal lead exposure. Development in children that have had prenatal lead exposure. Lead the majority of adult elevated lead levels. Lead levels come from workplace exposures such as lead, battery manufacturing, recycling plants, ceramic wear with lead glazes you know there's. I get ceramic gifts from friends and patients and you don't want to cook or eat food. I mean they're great for decoration or for other things, but that lead can leak out of some of ceramic wear Tin cans, lead paints? The introduction of lead-free gasoline in the 1980s definitely contributed to a decrease in air lead levels in the United States and subsequently lower lead levels, but leaded gasoline is used in other parts of the world. Lead can also enter the environment and increase soil lead levels where natural disasters destroy homes, just like in the case of Hurricane Katrina, hurricane Sandy.
Speaker 1:Illegally distilled alcohol, so-called moonshine, is also an important avoidable source of lead exposure. Women who report using lots of herbal supplements have blood lead levels 10% higher than non-users. So you really need to check with your physician or clinician nurse practitioner about the use of herbal supplements and non-prescribed medicines during pregnancy and breastfeeding at any time. I mean, my patients know that I'm very specific about bring in your bag of what you're taking. Well, some people can't even tell me what they're taking, but I want to look at the bottle, look at the expiration date, look at the content, find out if they're on biotin, which interferes with all sorts of blood tests.
Speaker 1:Another heavy metal mercury. Women can be exposed to mercury by breathing mercury vapors, as seen in people who use exterior lead paints containing mercury in unventilated places, drinking or eating contaminated water or fish. Methyl mercury found in contaminated fish is toxic to fetal brain development. Pregnant and breastfeeding women should avoid eating fish more than once a week and get those other rich omega-3 foods like almonds and flaxseed, and chia seeds and walnuts. The Department of Natural Resource regulates the amount of mercury that can be released by industries and sets the standard for the amount of mercury in drinking water.
Speaker 1:So let's talk about PCBs. Pcbs are heat-resistant and non-conductive liquids and resins. They came into the use in the 1930s as coolants and lubricants for various electrical equipment, including transformers, capacitors, surface coverings, copy paper. Studies in the 1970s linked PCPs to cancer and other health problems. The United States companies stopped manufacturing PCBs in 1977 and the EPA Environmental Protection Agency banned most uses in 1979. But they still are very persistent in our environment. An improper disposal of old PCB laden equipment and industrial items continues to leak into soil and water, where they can persist and contaminate our marine fish food chain.
Speaker 1:So what about screening for chemicals in pregnant women? In general, this is not done. Widespread Children, certainly age one to two, are usually screened for lead poisoning. Pollutants are everywhere in the atmosphere, to the food supply or the walls of old houses. So what are our recommendations to reduce your risk, whether you're pregnant or not, and certainly if you're pregnant and breastfeeding. Well, avoid consumption of the high mercury fish like king mackerel, shark, swordfish, tilefish, ahi and some albacore tunas. Avoid exposure to lead fumes and lead paint if you're remodeling old homes. Decrease your alcohol consumption and no moonshine ever.
Speaker 1:Since PCBs can concentrate in fat. You know you want to avoid excessive fat ingestion, weight gain. Generally speaking, we recommend low-fat dairy options for for you or your child over age two. Under age two, babies need fat for brain development. One of my podcasts was on cheese and healthy cheese, so that's a fun one to go back to. I don't know why low-fat dairy and cheese gets demonized. We osteoporosis doctors love it. We osteoporosis doctors love it. Breastfeeding, despite environmental pollutants which can also affect bottle formula, is still strongly recommended because of the benefits to both mom and baby.
Speaker 1:The next column I'm going to go over is by Dr Christy Tufte-Sapri, an esteemed graduate of our fellowship, and she's been on our podcast to talk about osteoporosis. She's an osteoporosis expert and she went on and had three sons, being a boy mom like me, right after her fellowship when developing her practice in Chicago. She's got a great Instagram page and website, dr Christy DeSapri, and it's on bone and body health, and she's written several columns for our website, including a fun one on new moms' food fight breast milk or formula, and she wrote that in 2014 and updated it in 2020. So she talks about feeding your newborn baby. The planning, the cleaning, the storage of either breast milk or formula is a daily issue for new moms and obviously breastfeeding is in the news. It's breastfeeding awareness month right now.
Speaker 1:She talks about the mom and super model, giselle Bunchen, who posted a photograph of herself breastfeeding her daughter while her beauty team made her camera ready for a glam shot, and the photo caused a little controversy. But the international group La Leche praised her as a working mom making solid nutritional choices for her baby. Some people took offense, criticizing for her exposing her baby for a private event, but Dr DiSapri and I applaud Giselle for showing that women should have flexibility to nurse in public and multitask. We women are great at multitasking. We have a bigger corpus callosum than our male counterparts. But for many women, nursing's not all glamour that Giselle portrayed.
Speaker 1:Nursing often takes place in pajamas, without makeup or hairstylist, and breast pumping is even less glamorous, in fact. Oh, when I hear the breast pumping in my office because we have a private, you know area for our nurses and our co-workers who are breastfeeding to pump and I hear that sound. I almost get like post-traumatic stress disorder because I remember how you have to stay hydrated. You have to have a letdown. I always put a sign outside my office breastfeeding in progress. I told my team, unless it was a medical emergency, it had to wait until I was done pumping, because you want to look at a picture of your baby or think of something relaxing to let that let down and you want to express all the milk to keep it going and then get back to work. So I mean I returned after I had my son Stetson within five weeks. I returned after I had my son Stetson within five weeks and it's really nice that with later pregnancies I had more time. The 12 weeks that's a lot but not all women get. Some of my physician friends in private practice had to go back within a week or two. So we really have to be supportive of moms in whatever situation they find themselves in.
Speaker 1:Breast pumps can be covered by standard health insurance. Dr Desapri and I recommend a hand-free electrical pump with the soft cups that you can tote to and from work or social events. I've had fellows like Dr Heather Hirsch, who also is on Instagram and social media and completed our fellowship and has three children. She would pump in national meetings. I always took my babies with me everywhere I went. I just anytime I had the choice not to pump. That's what I personally chose. But women can pump in transit, at airports, at national medical meetings, in public. There's lots of nice clothes that make it easier to try to more discreetly breastfeed, but there's no law against breastfeeding in public. So in terms of this breast milk versus formula, there's a lot of debates.
Speaker 1:The American Academy of Pediatrics recommends it exclusively for six months, then introducing food but still breastfeeding for 12 months. This affords the newborn natural immunity, reduced respiratory infections, less ear infections. Breast milk and its antibodies may help reduce allergies, asthma and even type 1 diabetes. Breastfeeding allows for a quiet, rewarding bonding time. It does require an increased metabolic demand and modest weight loss, and there are some studies showing slightly higher IQ levels. I was a preemie baby and bottle fed, so it's fine and you can still have decent educational attainment. The most important thing is to nourish and protect your baby. Breastfeeding may also, as I mentioned, reduce breast cancer risk for the mom, cardiovascular risk and, potentially, breast postpartum depression. Although, if a woman does not have support and she's low in omega-3s or has other underlying neuropsychiatric problems, all women really should be checked for postpartum depression.
Speaker 1:Calcium and vitamin D are so important and a lot of times it's hard to get enough in the diet and breastfeeding babies don't get vitamin D. So, generally speaking, it is supplemented, recommended, supplemented by the pediatrician. And for babies and toddlers who are being protected from the sun for their skin, put sunscreen on them assiduously, like I picked up Artemis the other day and her dad put all the sunscreen on her face. She looked like a ghost. It was all so white, the zinc oxide. It's important to not necessarily rely on the sun for the vitamin D intake.
Speaker 1:Now, breastfeeding is a struggle for some and for others it's just completely naturally so if you have any issues, women should immediately reach out to a lactation consultant and or get advice from other seasoned mamas. There might be lactation groups in your region as nursing progresses and the baby is interested in the outside world and starts to get teeth. Watch out, because that can be a little bit of a surprise if the baby does bite your nipples and women can even bleed. That happened to me once with each one and I said a strong no and that was it. Never had any other issues. There's a great reference that Dr Desapri recommends the Nursing Mother's Companion, which is on our website and will be on our column. That's linked. It's by Katherine Huggins and RN.
Speaker 1:Supplements such as fenugreek have been anecdotally noted to increase mother's milk, but no scientific evidence to validate this claim and unfortunately herbal supplements are not well regulated by our FDA. Dr Tuftisapri found that adding a pumping session at night before bed, staying hydrated, keeping stress to a minimum, allowed her to keep her supply up. I used a lot of my vacation days so that I didn't have five days or seven days when I was on hospital service straight in a row. Sometimes I had to work seven days in a row after, like my third son, but I already had been a pretty successful breastfeeding mom, so was able to do that, but especially the first time around. If you can be with your baby every couple of days and not work long hours straight, it seems to make it a little easier.
Speaker 1:But if you don't nurse or can't nurse or don't want to, there is formula and formula can be an excellent option. Certainly, I think that in the past the hospitals used to push formula on the baby. When I went to go get my son after a long delivery Stetson, my prenatal Lamaze nurse was actually working that night shift and she had a bottle of formula stuck in his milk and I immediately ran to take it out because I had only ever had one breastfeeding session. So the you get free formula Anytime. You get free anything, it's usually trying to get you, you know, um, stuck on something.
Speaker 1:So Dr DeSapri writes that, um, she knows that, um, lots of women can't or don't breastfeed. Uh, she had a mom friend who had the BRCA mutation for hereditary breast cancer and had bilateral mastectomies at age 28 for stage 1 breast cancer. Some moms can't meet the weight goals or the baby may have lactose allergy or some other inborn error. I have a friend who had breast cancer diagnosed during her pregnancy and she had to undergo therapy and then afterwards have surgery and she only had one breast but she successfully breast fed for a year, still had to use some supplementation and then after that year had to then complete her treatment for breast cancer. So the strength of women and moms and how they choose to do things and care for their babies. It's certainly not one size fits all and it can be very inspiring and remarkable. Some moms have to get uninterrupted sleep and someone else has to do the nighttime formula and if that's what it takes to keep their physical and mental health going, that's what it takes.
Speaker 1:So we don't want to criticize ourselves or our patients or our family members. We just want to focus on growing and bonding and it's ideal to get the 12 months in Kudos to those who do that and beyond, but we really want to know that there's all sorts of options. So, as Dr Desapri said in her last column post on speaking on women's health as a new mom, you make the rules for your family, whether you breastfeed or formula feed or do the both, and just congratulate yourself on making the best nutritional choice for your baby. But make sure that you have that skin-to-skin contact and snuggle. And certainly having a baby next to your skin does increase that oxytocin feel-good neurotransmitter and I think that's why I just loved holding that little baby, luciana the other day for our play date with Artemis and her best friend Josie and Hope, and they were so entranced in seeing this little baby who was just gazing up, just looking like she was in love with all of us.
Speaker 1:So, dr Desapri, she's a board certified internist. She specializes in women's health and she's worked in private and academic practice and has expertise in osteoporosis and sexual medicine. And she has her own concierge bone and body women's health practice in Winnetka, illinois, and she focuses on perimenopause, menopause and osteoporosis and sexual health, and you can follow her at bone and body WH. So we also have a lot of good tips on breastfeeding your baby, in terms of positioning and burping, whether you're breastfeeding or bottle feeding. We have information on, speaking of women's health, about when to give a baby solid food, how much food you should be giving your baby. In general, we avoid honey under age one for sure for potential botulism risk, one for sure for potential botulism risk. And nuts and plain cow's milk usually aren't done until 12 months of age with adequate fat content. Chocable foods, seeds, um, now all have to be, you know, potentially avoided or at least closely watched.
Speaker 1:The podcast that I did with um, the pediatric dentist, um, who is so excellent, who also has a great um right, oral, muscular, uh, control. That's why we don't. We do want the baby to not just get the right nutrition but the whole mouth and oral facial um. You know, uh issues are very important to not be picky eaters. I had no idea until I did that podcast interview that picky eaters could be just because they didn't have the oral control Um, so I will have to get Dr Rachel Rosen um back on our podcast, uh, so if you didn't listen to that one, please, please do, because that's just some fascinating interest and I think a lot of our dentists are getting increasing training and interest in the airway, in breathing, in lactation, in just the muscular movements of the mouth and the tongue.
Speaker 1:And I also did a great podcast last June of 2023 with an adult dentist, dr Margaret Frankel, and so I refer a lot of my patients to listen to that podcast. So so many of these topics all interweave of my patients to listen to that podcast. So so many of these topics all interweave. You may not be a breastfeeding mom, but I hope this information is helpful to you and thank you so much for joining us in the Sunflower House and tuning into another episode. So thanks for listening and we'll see you again next time in the Sunflower House.
