As we blow out the candles, I am so incredibly proud of the way Houston Female Urology has grown over the last year. With God’s grace and guidance, we helped more women than ever get their lives back to normal so they can continue to do the things they love to do.
We are still the only practice in Texas dedicated entirely to Female Urology and Pelvic Restoration.
In case you’re wondering what we have been up to this year, here are some of the great ways we have grown:
1,000 new patients
That’s a lot of women! We are honored to have such a huge increase in the number of women who place their trust in our staff. From the bottom of our hearts…thank you.
Exceptional new staff
We are beyond fortunate to have added Rosemary Pinkard as our nurse practitioner. Patients continue to tell us how comfortable they feel in Rosemary’s care. She is one of a kind.
Another amazing addition is Stephanie, our LVN. Stephanie is a dream-come-true for surgery scheduling and triage.
We also added more front desk specialists to make sure your phone calls are answered quickly and your check-in process runs smoothly. And in just a few weeks, online patient registration will be available.
New clinic for Female Sexual Dysfunction (FSD)
It’s the problem many women don’t want to talk about, but it is real and it happens to more women than you think. Click here to find out how we can help.
New technology: ThermiVa
Women can’t say enough great things about their results from this painless treatment for vaginal restoration and urine leakage.
“I was tired of worrying about peeing in my pants every time I go running, but I really didn’t want surgery. Dr. Pramudji told me about ThermiVa and it has made a world of difference. I had no idea it was such a simple fix.” -35 year old woman
“Intercourse was so painful that I completely avoided it. Now the problems with pain and dryness are gone and I feel great!” -45 year old woman
Click here to learn about this amazing nonsurgical procedure.
As we look toward our fourth year, our birthday wish is to continue providing the very best in pelvic care. There’s truly nothing better than watching women’s lives change for the better, and we are so grateful to be able help.
Our wonderful patients and referring physicians are the best gifts we could ever receive. Thank you for trusting us. We can’t wait to see what the next year holds!
Cheers to a healthy you!
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I want to introduce my team in this blog. I can’t believe how incredibly blessed I am to have been able to find such wonderful people to work for/with me and help me take care of my patients. I am nothing without my staff. These women bring so much life, excitement and knowledge to my team, and each individual is vital to the success of Houston Female Urology.
Each team member has been hand-selected by me, so that I can ensure that they encompass my vision for providing exceptional medical care to every patient on every visit. Patients always comment that they can really see a difference in my office, and I attribute it to a staff that goes above and beyond the call.
Houston Female Urology truly is a staff of excellence. My team rolls out the red carpet for each and every patient. Here, patients are given the attention they deserve on every appointment, and we take time to listen to patients and understand their needs. Every day, we strive to be knowledgeable, gentle and kind. Throughout 2016, it is our promise to continue to excel in quality medical care.
Now, I want to introduce you to each member of my team so you can get to know us a little better and feel right at home on your next visit!
Kim Brey, Physician Assistant, is an astute clinician who takes time to listen to patients intently and is excellent at trouble-shooting. Sometimes I think we share a brain since we think so much alike! Kim studied psychology prior to medicine and is the proud mother of an energetic, handsome boy. She has worked with me for the last three years and has 10 years of urology experience. Learn more about Kim, here.
Carrie Hiatt, Medical Assistant, is intuitive, very intelligent and gentle on procedures. She is full of ideas. She does an excellent job with Urodynamics, Pelvic Floor Muscle Training and surgery scheduling. We started working together four years ago. Carrie is a proud “cat-mother” of two felines and loves to cook vegetarian meals and baked goods.
Marissa Mattyre, LVN, is on the phone most of the day but also does several procedures. She is a very patient nurse and quick to respond to patient phone calls and needs. She is able to determine what the patient needs and efficiently help them. Marissa is married and has three beautiful girls. She was a massage therapist prior to attending nursing school. She is the newest member of our team and has been with me for six months.
Patty Ramos, Medical Assistant, is my sidekick day-to-day in the office. She is a dynamo and is full of energy and initiative. She warmly greets each patient and helps get them set up for me to come in to see them. She clearly explains the next steps and also does a great job with Pelvic Floor Muscle Training. Patty is married with two beautiful daughters and has worked with me on-and-off for 13 years.
Mary Yanez, Medical Assistant, helps Kim with her clinic and occasionally helps me as well. She is soft-spoken and gentle. Mary is wonderful at the initial patient intake and teaching patients what they need to know. She is married with a beautiful teenage girl and a handsome toddler boy. We have worked together periodically over the last six years.
Yoisel Betancourt, Front Desk Specialist, warmly greets patients on the phone and at the reception window. She’s a great first impression for my office. She is very organized and very knowledgeable about insurance. Yoisel also comes up with great decorative signs to celebrate office events. She has a beautiful young daughter and is a make-up artist on the weekends.
Ria Avelar, Front Desk Specialist, is very helpful with phone calls about insurance. She takes a lot of time to help out the patients with questions. Ria is also well-versed in the various plans. She also is very warm with patients and makes them feel comfortable. Ria is married and has two beautiful baby sons 18 months apart!
Marlene Magness, Practice Administrator, has been wonderful for my practice. Having worked in hospitals in the past, she was not unfamiliar with medicine, but managing a private practice required learning a lot of new things. She has tackled numerous challenges with gusto and has been such a great leader for my team. She runs things with a steady hand and helps me and the patients in countless ways. Marlene’s true love, however, is antiquing and you can find her at Round Top during the festival season.
As you can see, I am one lucky and blessed girl to have such a great team. I hope that knowing about my staff will help you feel even more comfortable when you come visit us.
To schedule your appointment with my team, visit us online to review next steps!
As 2015 draws to a close, I can’t help but look back on this year and think about how far Houston Female Urology has come since we first opened in July 2014. This year we celebrated our one-year anniversary. That’s one year in the books as the only urology practice in Texas that exclusively serves women. This is something that makes my team so proud. It’s an honor to help our patients get their lives back and say goodbye to urological issues every day.
This year we also added the MonaLisa Touch laser – a leading edge treatment that resolves gynecologic health issues often caused by menopause. I offer this as an in-office procedure that is virtually painless and requires no anesthesia. I am excited to be one of the first physicians in Houston to offering this treatment to help postmenopausal women and breast cancer survivors. (We are also thrilled that the Houston Chronicle covered our story!)
I love interacting with my patients. One way I did this in 2015 was through free seminars. My team organized two amazing events where our patients (and their friends!) were able to gather and learn more about urological issues and treatment options. We had drinks, snacks, door prizes – the events were so successful that I’m already planning more free events for 2016!
Giving back is something that is really important to my practice. This year we gave new athletic clothing wear and monetary donations to Houston Area Women’s Center. We prayed that these donations would bless the women who receive them as they break free from domestic abuse and start a new life.
So as the year winds down and Christmas approaches, I pray for real joy and peace for the whole world. So much heartache has happened in 2015, and it reminds me of the poignant lyrics of the Christmas song, Oh Holy Night – “A thrill of hope, the weary world rejoices.” Take time to rest and not get caught up in the hustle and bustle of the season. This is a time for joy – God reached down to touch mankind.
Enjoy your fresh start to a new year, and come see me in 2016! I can’t wait to continue providing the same great care to my patients.
Before I became a PA, I used my Master’s degree in Psychology to work with the severely mentally ill. During this time, I learned that everyone has a story to tell.
While training in PA school at Saint Louis University, one of my instructors told our class that the most crucial part of an appointment is taking an accurate history and knowing what questions to ask. After this, you need to allow the patient to talk, because they will often give you the diagnosis.
Throughout my 10 years as a PA, I have used the skills I acquired in these two learning environments to encourage my patients to tell their story and chronicle the events that led up up their appointment.
During their story, I only interrupt at a minimum to verify my understanding while collecting pertinent details. When the story concludes, I typically only ask a few additional questions to fine tune an accurate history.
If I don’t have a diagnosis by this point, I’ve at least narrowed down to a handful of possibilities before conducting the physical exam and ordering labs, imaging and office procedures.
Make no mistake, I realize that listening is a skill that takes time, patience and practice to hone. As the provider, you must train yourself to quiet your thoughts and remain in the moment with the patient. Remember those seemingly insignificant details, because you often must make inferences and deductions. Lastly, you need to listen to what they are not saying.
This process takes a little longer than other methods. However, the clear benefit is that fewer delays are encountered while developing an accurate diagnosis. The end result is that the provider initiates an effective and appropriate treatment more quickly, which leads to better outcomes for the patient.
– KIM BREY, PA-C
“Tomorrow morning at 8:00 we will have the ribbon-cutting and then start the actual business of seeing patients, ready or not! At this point, I can only pray that God will bless this practice, as I use the gifts, talents and passion that He has given me to bless the people that walk through our door. Tomorrow starts the next chapter of my life!”
This excerpt is from my first blog entry. I wrote this the day before I prepared to open the doors and welcome patients into my brand new practice. I was feeling so many emotions! Excitement, stress, peace, fatigue, joy.
I took a big leap of faith, and looking back on the past year in private practice, I see God’s blessings in every area of my personal and professional life.
This month marks a huge milestone for me. I’ve successfully made it through one year in this new chapter of my life. It is important for me to stop and reflect on my influencers and supporters and share my thankfulness to so many people who have made this year possible:
I’ve built such a wonderful, thoughtful and knowledgeable team of women around me! They have supported me every step of the way and have truly caught the vision for what we are doing here. Patients truly see a difference when they come to the office. I get comments from patients almost daily that they have never been to such a great doctor’s office where everyone is helpful and cares about them. I’m so proud of each one of them.
MY REFERRING DOCTORS
I am so thankful every day for the valuable relationships I’ve fostered throughout the years with Houston-area doctors. These colleagues have supported my practice and believed in my team to provide quality urological care as they refer their own patients for us to take care of. We do not take it for granted and strive to provide great service at all times.
I have learned so much from other physicians who are further down the path than I am. They have been so generous to share their wisdom and insight. There are many pieces that have to fit together when you start a new practice, and my mentors have been great to help me put it all together.
I owe so much to my loyal patients. These women have trusted me and my team to provide solutions for their urological needs, and I am always blessed by their kind words, success stories and commitment to Houston Female Urology. You are the reason I am here, and I hope to continue to earn your trust and loyalty for many more years to come.
Most importantly, my family has stood beside me through thick and thin. They have shared in my successes and encouraged my spirit. None of this would be possible without my amazing husband and two children! They have been great cheerleaders while I have embarked on this endeavor.
This journey is only beginning…I have so much to look forward to throughout the coming years! I can’t wait to continue to develop and grow Houston Female Urology as we seek to provide expert medical advice, life-changing procedures and uncompromised personal care to every woman who walks through my door.
From the bottom of my heart – thank you.
It has been a long time since I wrote in my blog. The holiday season is very busy for surgeons (having met their deductible, many people try to have surgery before the end of the year), and then the time just got away from me. I started this entry right before Thanksgiving.
As a Christian, my life is dedicated to trying to bring glory to God in any little way that I can. Now, I often fail, but it’s a striving and a focus that informs my day to day living. I don’t think that we have a “spiritual life” and a separate “secular life”. I think it is all integrated. As such, when I come into an exam room or the operating room, I am thinking “What is God doing here? How can I join in with His work?” Sometimes it is as simple as giving her an antibiotic, other times it is praying about a struggle in her life, or praying that the surgery and recovery go well, and using my surgical skills to help her.
I used to pray with every patient before surgery and take a spiritual history on every patient, but that began to seem a little too rote and forced. Now I follow the leading of the Spirit. When I feel that I need to pray or ask probing questions, I do it. It is amazing how God answers, often in ways I didn’t expect. Just the other day, I prayed with a patient who had just found out she had rectal cancer. I could see that she needed the comfort of knowing that God will be with her in her fight.
Patients are often surprised to have their doctor pray with and for them. Sometimes I feel a little silly praying for a what is for me a simple routine bladder lift; I mean, it’s not brain surgery or heart surgery. But then again, for the patient, there is nothing simple or routine about it. I typically pray for the surgery to go well, for the entire OR team, for the patient to be healed and to recover well, and for her to have peace as she goes into surgery. Most patients are very grateful for the prayer. Occasionally I can see that someone feels uncomfortable, so I try to be sensitive to that before I pray.
I have some examples that show how God has answered prayers in my practice and in my life. One day the robot at the hospital broke down before my case. That was just one of many things that had happened that day. There were odd delays and unexpected events that occurred. Everyone did great and no one was harmed by any of the issues. But it was really stressful on me, because things weren’t going smoothly. I just continued to lean on the Lord and pray for my patients and for our whole surgical team. One of my patients told me that she was shocked when I prayed for her, but she told me that a sense of peace filled her heart and any nervousness that she had was gone. Her surgical procedure was changed at the last minute due to the equipment malfunction so there was a lot of anxiety for her. But the Lord gave her amazing peace. She is now several weeks postop and doing great.
Another example was a stone case. I had been covering this patient in prayer for a few days prior to the surgery date due to her underlying health issues and the size of her stone. This case went from a simple laser case to an open bladder case because the stone was bigger and harder than anticipated. I was also concerned because I thought the bladder had partially ruptured when I was using the laser. When I realized that I had to open her up, I called my office to let them know that I would be running late for my other patients due to the change in the plan. I didn’t know it at the time, but my staff then all took a moment to join hands and pray for our patient. Well, the open surgery went about 500% better than I had expected: there was no rupture, the bladder was not as malformed as I thought it might be given her underlying disease, and the stone popped right out (it was about a 4 inch stone). Another answered prayer! She recovered beautifully and is doing better than ever.
Not only do I pray for my patients, but my staff does, too. We all get to participate in what God is doing. He cares about every part of our lives, even our urological health!
I have always been so thankful for the privilege of being a doctor and specifically a female urologist. I hope that God is honored in my service to my patients. I am humbled for the opportunity.
It is 8/8/14. We opened our doors 7/7/14, so that means we have one month under our belt!! Woohoo! We did it/are doing it! Things are coming along very well. We have helped almost three hundred ladies with their urological issues so far and have registered almost 400 into our system for appointments. We’ve started doing surgery through the new practice: some bladder repairs and a few stones. And our pelvic floor program is in full swing. We have been busy!
I truly feel blessed. This is the realization of a dream that I have had for many years: to have a urology clinic for women and to have my own practice. It is so fulfilling. Everything is the way that I have envisioned it: a beautiful, calm, clean office where patients can feel assured that they will be treated gently and professionally. My staff is amazing. They have put their heart and soul into this start-up and they truly see this as a mission to help women and not just another job. I am so proud of them. And, we have a lot of fun together!
There are of course, moments of doubt. These are brief moments, but a frustration will occur and I will think, “what have I done?!?” Gulp. But in those times, I stop and think, “Christi, remember who is in ultimately in control here. Who has orchestrated everything to make this happen? Who has paved the way, given you the desire to be a doctor since you were three years old, opened up and closed the right doors along the way? God has got you, and He has your practice, too. The whole thing is squarely in His strong hands. Rest. Don’t worry. This is His practice.” He gives me a strong peace and courage to continue forward. It’s all going to be good.
So, I am incredibly blessed and thankful and peaceful about this adventure. Life is too short not to make big moves and walk by faith! If I weren’t a Christian, I would be a wreck, I think. But knowing that God has already paved the way and having His peace, I can relax. I can just lean on Him and go step by step. He has placed me here at this time, and my job is to trust Him and share the love of Christ through urology!
When I first signed up for a urology rotation in medical school, I thought I was going to spending the next 6 weeks seeing old men with prostate cancer. I really was not interested in urology at that time, but I needed something to fill my fourth year schedule. What I really wanted to do was anesthesiology: putting in IVs and breathing tubes, lots of fun procedures.
But, the anesthesia rotation was already spoken for. So, now what? Well, I was planning to be a gynecologist, so I thought, well, at least if I do urology, then I’ll get more exposure to the pelvic anatomy. Get a refresher course on all the blood vessels and structures. That will be helpful, right? Even if it is just old men and their prostates.
Well, I couldn’t have been more wrong. Even then I didn’t realize just how wrong I was. Now as I sit here practicing not just urology, but 100% female urology, it is ironic that I thought that it was only prostates!
Of course, urology does encompass prostates in men. It includes everything in the urinary tract from the kidneys through the bladder and out the urethra. Urologists have medical treatments and all kinds of surgeries to treat patients. We treat patients from birth through death, men and women, boys and girls for everything from bedwetting to terrible cancers. It is a great variety surrounding that one part of the body. That’s the reason I fell in love with urology and switched from my pursuit of gynecology.
Female Urology, of course, focuses on the female urological tract. We don’t have prostates, so we don’t need to worry about that (thank God!), but we do have other issues. The most common issue that we have is overactive bladder and incontinence. God made us with short urethras (the pipe that the urine comes through) and a big opening in our pelvis muscles to allow us to have babies. If that opening gets stretched out, such as after having babies, then we start to have problems with organs dropping and having a difficult time controlling our urine. Sometimes it happens even if one has had only C-sections, or has no children.
Female urology is here to help with that! We have everything from physical therapy to medications to surgery to pacemakers, Botox and more. It is a very exciting time because we have some very effective treatments for this now, whereas ten years ago, the options were very limited. You don’t have to live with those pads your whole life!
That is not all that Female Urology entails. It also includes urinary tract infections, painful bladder conditions, kidney stones, evaluation of blood in the urine, slow urinary stream, bladder and kidney tumors, and more.
There is even now a subspecialty, in which I am certified, called Female Pelvic Medicine and Reconstructive Surgery, which focuses on certain conditions of the pelvic floor, especially prolapse (dropped organs) and incontinence. There are even more advanced surgeries that can be used to treat these conditions, including robotic surgery, which I have been doing for several years with beautiful results (beautiful from a pelvic surgeon’s perspective!).
Over the last twelve years, I have narrowed my urology practice down to females only. I couldn’t be more pleased with my choice. I get to treat some lovely women and see them get their life back: from a life of pads and worrying about where every bathroom is to urine control. And for others, it is helping them with infections, pain, stones, or reassuring them that the blood found in the urine isn’t serious for them. Female Urology is my complete career focus and my mission.
Well, we’ve almost completed our first week of the new practice! Oh, boy! I am pretty exhausted. And I feel like I have ADD. One minute I’m discussing surgery with a patient, the next fine-tuning the process of ordering tests, next hanging a scope sterilization caddy on the wall, next minute learning about Google Adwords.
It’s like when you are trying to clean your house and you move the blanket to your bedroom, only to see a cup that needs to go to the kitchen, and in the kitchen is your child’s backpack that needs to go to their room. Like that. But it’s every day, all day. 7a-7p. I am not really stopping for meals, just working and grazing.
It’s all-consuming. I can’t stop thinking about the new practice and trying to get every little thing just the way that I think it should be. I know that the day is coming when I will again mostly be spending my time practicing medicine, my first love, and spending less time on the business part, which I like, but it wears me out. It doesn’t feed my soul the same way.
I do love it, though. Building something. Creating a business and a place of healing. Helping people with their bladder problems. Yes, I’m a doctor who hasn’t lost the drive and satisfaction to help people. That is what keeps me from burn-out. Keeps me going no matter what frustration comes along. It is just the best feeling to have a patient smiling and hugging you, because she doesn’t need to wear pads anymore.
I love that I’m also able to employ some great women and (hopefully) help them realize the life that they dream of. And I couldn’t do any of this without their dedication. I truly get so much more from them than I give to them. We have a great team, and everyone has the vision to fulfill the mission of our practice. And we have a lot of silly fun as seen on the Facebook page.
Some of the challenges and frustrations that we’ve encountered: Well, day one, the Comcast internet wasn’t working. In fact it has gone down a couple more times since then. We have a new modem now, so hopefully that will help. And hey, Comcast sent me a $20 credit today! Internet is essential because our medical records are cloud-based. Thank goodness that Methodist has a free guest wifi. Otherwise, I’d have to pay for a backup internet service.
Challenge two: As much as we tried to learn the new Kareo electronic health records (EHR) ahead of time, there is just no way to know all the ins and outs until you go live. Day 4 now, it is getting much easier. We have figured out some good shortcuts.
Challenge three: Today we started using our Phreesia pads. I was hoping they would be ready Monday, but they weren’t. Another lesson in letting go of the desire for perfection! These are like ipads that patients use to check in and pay their co-pay. Very cool. At first, they didn’t work too well, but by the end of the day we were starting to see the light. Patients seem to like them. Decreasing paper waste!
We started out the week with one patient per hour so that we would have plenty of time to figure everything out and that was key. I’m still going to limit the number of patients for a while until we really start to feel like we are getting efficient. The patients have been so wonderful and patient with us. Sweet ladies.
I say we’re off to a good start! I think we are all tired and longing for the smooth-running machine that we all know we are capable of. It will take some time, but each day gets a little easier. It’s like the beginning of a run when you are sucking wind and just want to slow down or stop. BUT, if you can get past mile 3, the breathing gets easier, you reach your stride, and then you are cruising for the long run.
It is the eve of the opening of my solo private practice, Houston Female Urology! I cannot believe it is actually happening. I am sort of in a state of shock, actually.
This is a REALLY big deal. I think most people don’t appreciate what goes into opening a medical practice. It’s not only starting a business, but also a medical practice. Not only did I have to buy computers and printers and office supplies, but also exam beds, lights, cotton swabs, major equipment, etc etc. I have numerous government regulations on medicine to learn and to comply with. I had to sign up for Medicare and all the insurance companies, a job so big that I outsourced to a firm that does only that. I have spent a lot of savings to get this business going. It really is a big deal, and a risky proposition.
I have dreamt of having my own office for female urology for several years. I’ve been in a prestigious urology group in Houston for twelve years, since I finished my residency training in 2002. While I really enjoyed being in the group, I could see the need for an office where women could come in for urologic care and know that they are the full focus of the office, as most urology has traditionally been geared toward men. Women have sought me out as a urology doctor who is a woman, and my practice has naturally become more and more focused on female urology over the years. So, it just seemed like a very natural next step in my medical practice. And, most of all, I love female urology. I think it is fascinating.
Many of my colleagues think I am completely crazy to open a solo practice in the current state of medicine today. (Maybe I am crazy!) In the world of medicine today, the payments get smaller and smaller; the regulations increase; it takes so much time and effort to collect from the insurance companies. It is like a game that we have to play with them. The business side of medicine is very difficult. That is why most doctors just want to work for a hospital and not have to deal with it.
But the drive inside of me tells me that I have to take this risk. I only have one life to live, and I don’t want to have any regrets. Life is an adventure to be lived with passion. This drive that has not subsided for several years, and it is time now to jump in. I see many colleagues in solo practice who are doing well. I am confident that I have what it takes to succeed, with God’s help. And if it doesn’t work out, I’m OK with that!
Planning has been going on for a long, long time, but the last few months, and especially the past few weeks, have been incredibly intense. I have had to learn so much about business in general, the medical regulations, and all the various, endless choices that go into setting up a practice. I was prepared for it because I researched what I would need to do. Even so, it is a bit overwhelming: everything from phone system “trunks” to what kind of printer do I need (laser or inkjet?) to picking out exam lights and tables. It goes on and on! I can’t believe how many different types of betadine swab options there are!
It’s been a fun journey! My staff has really given their all, and we’ve enjoyed this time of setting up. (Free lunch every day from our great drug reps!) Sometimes things don’t go as planned…the electrical outlet doesn’t work where we set up the water cooler, the paper towel holders don’t fit now that we added upper cabinets, the computer system isn’t quite working. As much as I want everything to be perfect, I have to keep my eyes focused on what really matters, and let go of trying to be too much in control. It’s a good lesson for my soul. I’m so glad we planned a soft opening so that we have more time to work out the kinks and not be running ninety to nothing from the start. We’ll be super-busy before long!
None of this would have been possible without the great people who have helped me. My staff is incredible. Truly they are the greatest asset of my practice, and I can’t imagine doing this without them. But even more than my amazing staff, my family has been so ultra-supportive. My husband has not waivered one bit in helping me and boosting me, even when I faltered and had a brief moment of buyer’s remorse or when I get impatient when he is trying to advise me on something. He has brought his expertise as an entrepreneur to help me with my new venture. And my two children- wow. They are my biggest cheerleaders. I don’t want to forget my parents and sister and friends as well! They are pushing me along the way with encouraging words and prayers. I am so so blessed.
So…the chairs and signs arrived at the very last moment. We have all the essentials in place. Staff are ready. The electronic medical record has been painstakingly customized by my physician assistant. The billing systems are in place. We have a working water cooler! We borrowed speculums from our colleagues since ours didn’t come in (thank goodness for friends!). It’s all good.
Tomorrow morning at 8:00 we will have the ribbon-cutting and then start the actual business of seeing patients, ready or not! At this point, I can only pray that God will bless this practice, as I use the gifts, talents and passion that He has given me to bless the people that walk through our door. Tomorrow starts the next chapter of my life!