Healthy Matters - with Dr. David Hilden

S01_E17 - Hilden's House Calls - An AMA with the MD MPH FACP

July 24, 2022 Hennepin Healthcare Season 1 Episode 17
Healthy Matters - with Dr. David Hilden
S01_E17 - Hilden's House Calls - An AMA with the MD MPH FACP
Show Notes Transcript

07/24/22

The Healthy Matters Podcast

Episode - 17 - Hilden's House Calls - An AMA with the MD MPH FACP

Ever wondered - Why does it hurt when I do this?  Is there a downside to eating all these pickled foods? Could doing the Wordle actually be good for you? And what’s the story on monkeypox?

We've all got questions for the doctor, and now you have a doctor for all of those questions!

Join us for Episode 17 as we take another deep dive into the wide world of healthcare.  Dr. Hilden fields questions from podcast listeners about a recent polio case in the U.S., the new 9-8-8 mental health hotline, Paxlovid’s effectiveness, shingles vaccines, and more!  

Got a question for the doc?  Or an idea for a show?  Contact us!

Email - healthymatters@hcmed.org

Call - 612-873-TALK (8255)

Twitter - @drdavidhilden

Find out more at www.healthymatters.org


Speaker 1:

Welcome to the healthy matters podcast with Dr . David Hilton , primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare , and what matters to you. And now here's your host, Dr . David Hilton.

Speaker 2:

Hey everybody. Welcome to episode 17 of the healthy matters podcast. I'm your host, Dr. David Hilton, and we've been getting lots of really great questions from listeners about timely healthcare topics. So we've decided to do another episode of Hilton's house calls, where we dedicate an entire show to your questions about anything that's on your mind on healthcare . So let's get right to it, John.

Speaker 1:

Okay, so let's get started. The first question we got was Marie from white bear lake. She writes, I heard there was a recent polio case just outside of New York city. And I was pretty much convinced that this was a thing of the past. I have two young kids, and I'm wondering if there's anything I need to be concerned about at this point, or if you could shed any light on the subject. Thanks.

Speaker 2:

That's right, Marie, just this past week, there was a case of polio found , uh, just outside, I believe of New York city , uh, in the suburbs and you're right. Polio was determined to be eradicated from the United States , um, way back in the late seventies, or maybe it was the early eighties. And that is exclusively because of the vaccines that people get in their childhood. So polio, for those of you of a certain age, no is a devastating disease that causes weakness. And in the worst situations, it causes paralysis. Its full name is poliomyelitis and lots and lots of people got it back in the forties and fifties, it was devastating. And our president of Roosevelt, he had it for instance. So it , it was really a big deal. Then Saban and salt came up with their vaccines and it went away, but polio still exists in the world, just in pockets. There are no known wild cases or native cases of polio in the United States since the late seventies, but in many parts of the world, they use the oral polio vaccine. You know, there's two vaccines, one's a shot and one's oral. Mm-hmm , <affirmative> a , a liquid that kids take and the oral one is not used in the United States anymore because it contains a , a live virus. And, but it's used in other parts of the world. So the case in New York is likely it's brand new, but it is likely that that person came from another country where they used the oral vaccine. And because the oral vaccine is a weakened, but is still a virus. It actually contains the virus. It has the small potential to replicate and somehow or other. It probably did that. Now this is a brand new case. So , uh, we we're gonna learn more about that, but it , it is likely imported from another country likely due to a vaccine that we do not use in this country. And so there is a very, very obvious and clear thing you should do to protect your children. Make sure make certain that your children are getting their childhood vaccines. Remember the polio vaccine in the United States does not include that oral version. So it is you cannot get polio from it. And in fact, you are preventing polio if you give your child , uh, vaccinations. And so not only the polio, but all childhood vaccines are highly, highly effective at what they're intended to do. So all parents make sure your child children are getting their polio vaccines, and then you frankly don't have to worry about it.

Speaker 1:

Excellent. Thanks for that. And moving on here now, this is a question from John in Minneapolis, which just so happens to be me. Uh, I love pickled foods, right? I am my father's son. I love all things pickled, whether that be herring or pickles or pickled onions, pickled mushrooms, pickled beets. What have you, is there a downside to eating that all the time? I can't believe that there would be , uh, cuz a lot of the planet does that, but uh , whether it be kimchi or anything like that, I hear there's some upside to it for sure. But what do you know about any downsides? If any,

Speaker 2:

John , you might be the first person I've met with that kind of passion for pickled foods. Yeah . I was in Finland once and everything was pickled. It was pickled this, that, and the other thing I, I asked one finished woman . One time I was in the line at a buffet and I said, what's that? She goes, it's fish . And I said, what's that over there? She goes, that's fish too. And I said, what's over that ? And she it's fish, but it was all pickled it's

Speaker 1:

It's a thing.

Speaker 2:

So pickling, no matter what you're pickling is a relatively healthy , uh, food preparation , uh, method. Oh, thank God. As far as I know a little caveat, I'm not a nutritionist, I'm not an expert on that. But what pickling does is it takes whatever your food it is and it marinates it basically and usually vinegar and some salt. Uh , basically Arine , mm-hmm <affirmative> there are some good things to that. Kimchi, for instance, probably has loads of, of probiotics in there because as things ferment and that's really what's happening in pickling you're fermenting foods, they develop , uh, beneficial bacteria and organisms in it. So that part is good kimchi for instance, or anything that you're pickling probably has some probiotics in it.

Speaker 1:

Good for your gut, then it

Speaker 2:

Is good for your gut. And secondly, it might contain other nutrients, various vitamins. Now I won't get into details in that, cuz I'm not an expert, but you know, vitamin a or vitamin C, that kind of thing is probably also in pickled foods. There's one downside that I'm aware of salt. That's the other thing that's in pickled foods , uh, it's usually vinegar and salt and, and some kind of brain . And so if you are someone with heart failure or you are someone with high blood pressure, you should make sure that you monitor your salt intake, wherever that salt came from. And so some pickled foods, or maybe lots of pickled foods, maybe all of them have a great deal of salt. So be careful if you , uh, if you are salt sensitive , particularly if you have heart disease, for all other reasons I say, go for

Speaker 1:

It. All right . I like this answer. I , you know, with low about pressure, just eat away.

Speaker 2:

Huh? That's right. Although , um, I also recommend a , an after dinner mint.

Speaker 1:

Yeah. Well, you know, if there's that <laugh> so there's always a downside to it, but uh , but Hey, all right . Good to know. So we actually did get another related question from Steve Kansas city on our phone lines. Here it is .

Speaker 3:

This is Steve from Kansas city. I have a question about grilled foods find from cholesterol or high fatty foods like red meat or pork. Is it bad to eat grilled foods all the time?

Speaker 1:

How about that one? I'm kind of setting you up here, but uh, is there such a thing is too much barbecue

Speaker 2:

In general, if you Charbroil your food, I mean, you're cooking it over a flame that makes it black and chars it. One that kind of tastes good for many of us, but that is the problem of grilling foods. If you don't blacken your food beyond recognition, it's not all that unsafe. In fact, it can be quite healthy because you are simply heating food through without having to use lots of oils or creams or things. So I say, go for it on barbecue. Just like I said on the previous question about pickling foods, it's a tasty and good way to eat many foods, but you should know that when you char food, when it becomes blackened, that is , uh, introducing carcinogens or cancer causing agents. Um , and so ingesting tons of that is probably not healthy. On the other hand, the I'm not sure what the science would say about how much charbroiled food do you have to eat. I mean, if you're doing this three times a day and you're having blackened this and, and you know, blackened fish one day and then you've got charbroiled steak, the next, if you're doing it, every single meal, that's not gonna be good for you. But I think the occasional grilled food that is charred would be okay and much more often I think grilling food is just fine if you're not Charing it. But you know , there is some evidence that there's a cancer causing agent in when food gets blackened.

Speaker 1:

Okay. But there's typically nothing, no such thing as too much barbecue, as long as you're . I mean, I suppose everything in moderation, right?

Speaker 2:

I think everything in moderation, but you know, I'm thinking, you know , this collar's from a place where barbecue is like, oh, it's a thing it's practically a religion down there and far be it for me to say that , that someone from the state of Missouri shouldn't be barbecuing, their food, that would be almost like a heresy. Yeah . Um , and frankly, it's getting me a little bit hungry.

Speaker 1:

I hear that. All right . Okay, cool. Okay. And then we got this one also on an email and this one came from Claire in St . Cloud. She writes, I'm curious about monkeypox, we've been seeing a lot of it in the news lately. Curious about not only just the name, but are there cases in Minnesota and are there many cases in the us and is it something to be concerned about?

Speaker 2:

You know, it , it , it almost just seems like , uh, what we all come to expect. There's gonna be some new horrific plague that hits the planet earth. And now it's, monkeypox in reality, monkeypox is not new. It's been around for decades. It's just not very common. It is caused by the same viruses that cause the other pox P O X disease , um, uh, and, and things like smallpox or chicken PS . Okay. These are caused by viruses and the monkeypox originated in some other , um, um, portion of the , of the globe. I'm I'm frankly not aware exactly where, where that started, but it is not just this thing you get from monkeys. It is probably in other mammals and rodents and , and things like that. I'm gonna liken it to chickenpox, but it's not the same, but you get these little vesicles or these little fluid filled things on your skin. They can get itchy. They last a couple weeks, and then they go away in the majority of cases, even of monkey pox , it's, it's mild and people, they just goes away in three, four, 5% of people, whoever it can be very, very serious and it can infect your whole body. So it's potentially quite dangerous. The good news about monkeypox is that it's not common. There have been a couple thousand cases in the us so far. And you know, that sounds like a lot, but as in with a country, the size, it's not that many, there have been a handful in the state of Minnesota, but I frankly don't even know if they were confirmed. There were a handful of suspicious. Um , people came in with a thing and I don't even know if they were confirmed. Okay. So it's relatively small. There is a vaccine that is effective against it. It is not widely available because we haven't needed it. So I, I, I imagine, I don't know, but I imagine that there are some smart people trying to figure out a way to get vaccines out to people. It is known how you get it, you get monkeypox through skin, to skin , transmission that we know, okay. That is not , uh, any great mystery. And so any kind of skin to skin transmission, so that can be sexual transmission, but it doesn't have to be , it can be just touching skin , shaking hands with somebody . Yeah . With somebody who has kissing things like that. It is not a disease of any particular group of people. It is a disease that anybody can get with , uh, skin to skin contact. So if you are , um, in large gatherings of people that you're, that you're not that that familiar with or people who've come from a variety of places, big parties or something. And, and , uh, that's where I think some of the outbreaks have been seen, but , uh, you are not at risk of getting it without skin to skin contact. And the good news is it's rare and it's mild. In most cases, it's mild

Speaker 1:

As far as where we are right now, though. Not much to be concerned about at this point. Yeah.

Speaker 2:

I'm not telling people to be , uh, too concerned about monkeypox. This is not the great plague. The next one, although, you know, it's a , it is spreading. It's weird because we, you know, it's been around for decades. Why now? Why are we getting 2000 cases? We didn't have that a few years ago. So it is spreading. So people should be cognizant of their behaviors. If you are in close contact with lots of people with whom you're not particularly familiar , uh, that that's how it's, it's probably spreading. So just be careful with your behaviors.

Speaker 1:

Gotcha . Okay, cool. We're gonna take a quick break and then we're gonna get back to a couple more of these questions. Hang tight. You're listening to the healthy matters podcast with Dr . David Hilton , have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org . Or give us a call at six one two eight seven three talk that's 6 1 2 8 7 3 8 2 5 5 . And now let's get back to more healthy conversation.

Speaker 2:

And we're back with more healthcare questions on this episode of Hilton's house calls. John , what else do you have?

Speaker 1:

Okay, so this one seems to be kind of related to what we were just talking about as far as skin conditions and maybe vaccines. Uh , this one came in from Diane, from Lin . She writes I'm 45 and I've got some friends who recently got the shingles vaccine. Wondering if it's a good idea, if I'm a candidate and if so, when and where should I look to get one?

Speaker 2:

So this one's near and dear to my heart, cuz I got shingles when I was roughly that age, you know , you know I did, I had on my forehead and um, and so I , I can relate to this question from Diane at age 45, you are not yet at the suggested guidelines. Okay ? The CDC guidelines say that all people and I mean all people over age, 50, 50 or older, you should consider getting the shingles shot . The , the story of shingles is this. It is , uh, the medical term is zoster, herpes, zoster . Um, herpes is a , uh, you know , everybody thinks they know what herpes is, you know, but you only know one little bit of it. What herpes viruses are, is a whole family of viruses of which Epstein VA is . One of them. Varicella is one of them and that's the virus that causes chickenpox and shingles. So when you get chickenpox, you get better. You get it as a child, you get better, but the virus goes and lives in your, in your nervous system. And, and frankly it lives in your spinal column and it just goes dormant and your body took care of it, but it's sitting there and it's dormant. Hmm . Sometime later, fast forward in your life, 30, 40, 50, 60 years, your immune system, isn't all it was cracked up to be. And that virus sort of wakes up. Okay. It , it was sleeping. It wakes up. But now because it's living in your nervous system, it only, it only becomes active in the distribution of a single nerve. That's called a dermatome. It was a , it's a cool thing in medical school that medical students are always trying to memorize. It's the human body, this stick figure, this outline of human body with all these lines across, it looks like, sort of like the weather map when they're doing all those lines, those isotope lines . Anyway, the chickenpox becomes active in one of those. And so you get what looks like a chicken pox outbreak, but only in one portion of your skin and it's never across the midline. So if it starts in your back, it goes left or right. It doesn't go both directions. Hmm . If it's in your , um, neck, it goes down your one arm, it doesn't go down the other arm because it's serviced by a single nerve and your nerves. Don't go out in two directions at once. So that's the , that's what shingles is for the vast majority of people who get shingles. It's a nothing burger. It is, you get it for a week or two or three. It's painful it itches. And then it goes away. Okay. And then it's over. But not everybody is at a nothing burger for many people, not, not the majority, but many people you get what's called postherpetic neuralgia. That is where the pain from shingles never goes away. You might, you might live your whole life with this nerve pain where you got shingles. That is why we give the shingles shot. We give the shingle shot, not to , not to spare you one week of discomfort with some scabs on your body. Mm-hmm <affirmative> it's to prevent that long term pain that can be debilitating for the rest of your life. So we do tell people it's not maybe on the, is high up on the, on the, your mind about why would I get this? You know, no big deal. I'm gonna get shingles, get it. I would get it because you don't wanna be one of those minority of people who get post neurologists . So at age 50 you get , um, you are eligible. It's a two shot series. You get it one time and then you get the second one, two to six months later.

Speaker 1:

Okay. And are there any side effects to the shingles vaccine? I , yep .

Speaker 2:

Yeah. Well , people tell me , uh, uh, I haven't had it yet, which is kind of ridiculous because I'm, I'm quite qualified. You know ? It's like doctors never do what we say .

Speaker 1:

Right?

Speaker 2:

Of course. Um, people do get a very sore arm. I , I , and I have , I have heard of people getting , um, feeling a little, quite fatigued and achy , um, for a day or two after the shingles vaccine. Okay. But that goes away

Speaker 1:

Fry.

Speaker 2:

That's small fry. It goes away. So I do strongly recommend the shingle shot . There was a previous version of it called Zastava with a Z. That was a decade ago. That was pretty good, but not all that great. The new one, the brand name is Shing . Rick's S H I N G R I X . And it is highly, highly effective. Okay . Two shot series. Go get it. If you're age 50 and you D they , we don't even ask anymore. Did you ever have chickenpox as a child? We don't even ask.

Speaker 1:

Just okay . Get it . Just assume it. Okay, cool. And then one other follow up . You said that you had shingles when you were 45, but don't have the vaccine. Can you get it twice?

Speaker 2:

Yes. Yes. Most definitely. So you should get the vaccine, even if you had had it, because I got it in my eye when I, not in my eye, but in my forehead, when I was training for a marathon sounds in pretty good shape. I'm literally running 25 miles at a crack. But what somebody told me is that that's also not that uncommon. My immune system was doing everything it possibly could to support me running 25 miles at a time. And what it wasn't doing was keeping track of that little virus in my , and so it , I think I was diverting all my body's energy stores and all my strength to running a marathon. And what happens is that I got it in my forehead. Well , as long as I'm on that, if you get shingles in your forehead, you must get an eye exam. Um , because it can go into your eye. That's the one time shingles is very bad.

Speaker 1:

Wow. I'll have the nothing burger. Thanks. Okay. All right . Moving on to our next one. We got this one from Sarah in Hudson. She, of course it wouldn't be a Hilton's house calls without a question about COVID . She is wondering about PAX livid , the antiviral pills she asks in her email , uh, are plod the antiviral pills effective on the most recent strains you're seeing in COVID .

Speaker 2:

That's a great question. And the short answer is yes, they are effective even against the newer strains. Okay. As always with COVID what we learn changes week to week , day to day sometimes, right ? It changes so fast. But what we are learning is that the viruses that is similar enough, and these are not, they're different than the vaccines. These are oral antiviral medications that , uh, uh, appear to be quite effective against all strains, including the current ones. Now, Paxil is the brand name for two medications that are in a single pill. They are antiviral pills . So they are taken by someone who has a tested positive for COVID. You had to have tested positive B are at high risk for having complications, because what they have shown is they reduce your, the seriousness of COVID just to put it, to put it, you know , succinctly it reduces the seriousness. It would reduces your chance of getting hospitalized or getting seriously ill. It can shorten the length of it. It does not just make it a magically go away today. You don't take this pill and feel better three hours later. So you take it. If you meet criteria for being at high risk. So a 24 year old who has got tested positive for COVID and doesn't really have any symptoms is not the person who should be taking these medications. You should take or ask your doctor or pharmacist. You should ask them about Paxil . If you are over age 65, you automatically qualify. If you're over age 65, or if you have other high risk conditions, you are a cancer patient. You have heart to failure. You have other kind of chronic conditions that might be affecting your body's ability to fight COVID . If you're in those groups, age 65, or you have other high risk conditions, and you were ahead of positive COVID test, then you are a candidate for these pills. You do need to take it within the first five days, the earlier the better, okay. After five days, it's not worth taking it. And it's better to take it on day one or two. So contact your healthcare provider or your pharmacist early, and then you take it for twice a day for five days,

Speaker 1:

Five days, and still , uh, proven effective.

Speaker 2:

It is proven effective. And, and, you know, people get a little side effects. You can get a little headache, you can get a little fatigue, a little bit of nausea, the things you can get from almost any other pill, nothing

Speaker 1:

Compared to

Speaker 2:

COVID, nothing compared to COVID . If you were gonna get serious, COVID anything's better than that.

Speaker 1:

Gotcha. Okay. Fantastic. Well, moving on, we got this one , uh, on our phone lines from Kathy in Koon rapids.

Speaker 4:

Hi, Dr . Hilden , this is Kathy calling from Koon rapids. I've heard about the new 9 88 number for mental health. Can you tell us a little bit more about that? Thank you.

Speaker 2:

This is brand new, hot off the presses just this month. Uh , when we're recording here in the summer of 2022, there is a new national hotline for people experiencing a mental health crisis. And the number is simply 9, 8, 8 . That's it? Everybody knows 9 1 1 for emergencies, but for now , uh, now we have another number 9, 8, 8. That's great. Now this is done by the same people who have brought you the national suicide hotline. And, but that was a regular 10 digit number that you had to remember, and it isn't on the tip of everybody's , um, the top of your mind, right? And so , um, this was a brilliant move by the nonprofit organizations in the federal government to come up with 9 88 . So what you will get when you call 9 88 is a live human trained counselor about mental health issues. So it's best used by people in a mental health crisis, specifically those who are at risk of hurting themselves or perhaps , uh, suicide. Okay. There are loads of people who are thinking about suicide, who are thinking about hurting themselves, and simply don't know where to turn. And if you can remember 9 88 , or if you have a loved one who is a maybe struggles with some thoughts like that, 9, 8, 8 is the number they can call and talk to a non-judgmental well trained person. The other thing that's kind of interesting to me, at least in our current climate is that often now we don't, our system doesn't really know how to always handle mental health crises, right? So often you get a police officer and maybe that's not always the best way to go. Police officers are highly trained to do a whole bunch of things, but they're not mental health counselors. They're not professionals at talking to someone in crisis. So if you call 9 1, 1, they have to deal with everything from car accidents to a crime in progress to, you know, your cats up a tree to mental health crisis is it's just too many things. So 9, 8, 8 , you will get a dedicated, not law enforcement officer. You will get a dedicated mental health counselor. I would encourage everybody to , uh, to know that number and use it. And, and I just applaud the , the people who put it

Speaker 1:

All together. Yeah. Yeah. That's really great that they got that set up. Mm-hmm

Speaker 2:

<affirmative>, it's just wonderful. Yep .

Speaker 1:

Yeah. Excellent. Cool. We got time for one more here. And I guess this is kind of a semi-related question about , uh, brain health and, and , uh, kind of mental wellness, Kevin and east grand forks wrote us and asked us this. I've heard about some connections between exercise and mental health. Is there any connection between exercise and cognitive decline in particular, such as Alzheimer's?

Speaker 2:

Yeah, that's a great question, Kevin, because right now there is , uh, millions of people who have cognitive problems. And by that we mean things like dementia , uh, of which Alzheimer's disease is the biggest one memory loss , uh, slowing down of how we're thinking. This is , um, not just a few people it's exceptionally common. And, and the other thing is that there's not a lot of great treatments there just aren't. And so that's why , um, what it would be great to know is, is there anything you can do to kind of help your cognition? When I say cognition, that is your thinking functions, it's your memory, it's your speed at which you can process information. Can you handle technology? Can you remember things that's cognition? It is the high level human brain functions. It's not emotion so much. It's more the thinking skills. And right now we don't have just a ton. We don't know how, why it develops in some people it's not purely genetic because loads of people have Alzheimer's disease , um, who did not have a genetic basis. So it's probably not that it's just not clear. Um, lots of research is being done, but it's just not clear, but what some things have been shown to help a bit exercise and I mean, exercise both physical and mental exercise. So it is especially , um, thought to be the case for believe it or not women. There was a recent study that showed that women who exercise moderately, or even not that much like 15 minutes a day, walking their speed of processing information was preserved better than those who didn't exercise. Wow. So it did not help memory itself. They , they were still forgetful, but the speed with which they processed information, which can make a huge difference. For instance, if you're trying to read a map to get to your next appointment, if it's taking you 10 minutes to , to figure it out. So that , um, that was with physical exercise seemed to help speed of, of thinking in women. It didn't work so well in men for , uh, which is unfortunate, but there's also all kinds of other information out there in the scientific , um, uh, research studies that show that mental exercises doing crossword puzzles, reading, word fines, watching jeopardy. I I'm just the

Speaker 1:

Wordle,

Speaker 2:

The Wordle , I'm just throwing things off the top of my head, exercise your mind. Excellent. That has that's helpful and exercising your body because it also helps your cardiovascular health . It keeps you, it keeps you physically fit. And it is thought that perhaps physical exercise might help a little bit, but that recent study was mostly in your speed of processing. It was really fascinating. And , uh, definitely in any case, there's very little downside. So as we get older, we should all exercise our brains and exercise our bodies as much as we

Speaker 1:

Can. That sounds like a plan. Well, that's it for today. Once again, Dr . Hilton , we got a lot of great information in a short amount of time. I wanna thank you for answering those questions.

Speaker 2:

It's been great to hear what's on listeners' mind, lots of really relevant stuff. I think in this episode, stuff that , uh, uh, is on people's minds. So thank you everybody for sending in your questions, keep those questions coming, regardless of what topic it is, whatever's on your mind, keep your questions coming to us and we'll get to them in a future episode of Hilton's house calls. So if you like the podcast, please tell your friends. And if you have the time that I'd appreciate it , if you'd leave us a review, thanks for joining us for this show. We're glad you've been with us. And I hope you'll join us for the next episode of the healthy matters podcast and in the meantime, be healthy and be well.

Speaker 1:

Thanks for listening to the healthy matters podcast with Dr . David Hilton, to keep up to date with the latest in healthcare and your health, subscribe to this podcast, wherever you get your podcasts for more information on healthy matters, or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us at healthy matters, HCM E d.org , or give us a call at six one two eight seven three . Talk to catch all the latest from Dr . Hilton and the healthy matters podcast. Follow us on Twitter at Dr. David Hilton . Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan kudo and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician. If you have more serious or pressing health concerns until next time, be healthy and be well.