Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , 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 our host, Dr. David Hilden .

Speaker 2: 0:19

Hey everybody, and welcome to episode 16 of the Healthy Matters podcast. I am your host, David Hilden , and today we are gonna talk about community violence prevention. In my job as a doctor, I see individuals, many of whom have been the victims of violence , uh, whether that be from gunfire or other types of violence in the community. And I deal on a one-to-one basis with the victims of violence. But it's so much more than an individual health problem. Our community's health is affected by violence. And so there are programs and I'm very proud to say that one of those programs is, is right here out of Hennepin Healthcare in Minneapolis, the next step program that are attempting to address that and they're doing so effectively. To help me out, I have brought Ra Galloway, he is the director of the Next Step program, and I'm gonna let him tell us what that program is all about. So Ra , welcome to the program.

Speaker 3: 1:12

Thank you for having me.

Speaker 2: 1:13

It's great to have you here. Now , if you could briefly just tell us what the next step program is to get us started.

Speaker 3: 1:19

Yeah. The Next Step program is a hospital-based violence intervention and prevention program that helps people who are survivors of community violence that come through the emergency departments here at Hennepin Healthcare North Memorial Abbott , Northwestern, and Children's Minnesota. Um , we're there to break the cycle of violence that's happening within our communities and it's also what happening within the families to help people understand what happened to them and to help them to start their healing journey as they are reintegrated back into their communities. Or if they can't reintegrate back into their communities, find a safe landing spot so they can start the healing process.

Speaker 2: 1:52

Sounds like a wonderful program and I happen to know it's a wonderful program. You're based outta several hospitals in the Minneapolis St . Paul area. Could you help us with some basic definitions and lay the groundwork for community violence and the scope of the problem? Start us off by when you, we say community violence, what are the common forms that takes?

Speaker 3: 2:11

So I'll just give two definitions of community violence. One is from the CDC , it says, community violence happens between unrelated individuals who may or may not know each other generally outside of the home. Examples include assaults, fights among other groups, shootings in public places such as schools and on the streets. And the next definition is from John J College of Criminal Justice. Community Violence refers to the type of violence neighborhoods residents may experience while going about their daily activities. It does not include domestic violence, intimate partner violence or intrafamily violence. It also does not include all forms of gun violence. Mass shootings and suicides are usually not included in the definition of community violence.

Speaker 2: 2:51

In this case, in this podcast, we're not talking about domestic partner family violence, and we're not talking about the mass shootings that people hear about

Speaker 3: 2:58

Or, or the suicide ideations that happens.

Speaker 2: 3:00

Okay . Okay. So how big of a problem is this in our communities and is it equally distributed in big cities, little cities across the country? Could you just give us a little bit of a scope of the problem?

Speaker 3: 3:10

The problem is huge because it's generational. I'm sure my father and his father before that have been talking about the same issues that we're gonna talk about here today. The root causes , um, community violence, it does happen everywhere, but it is focused particularly a lot more of populations have been marginalized, particularly people of color because there's not a lot of investment in some of our communities.

Speaker 2: 3:30

Tell us about those root causes and why that might be.

Speaker 3: 3:34

Well, some of the root causes could be, you start with the red lining that happened before I was born, and you talk about all the social issues that happened before I was born. We still don't even , uh, address some of the issues regarding slavery that happened in this country that marginalized people of color. And then you talk about the investment in the neighborhoods, the lack of investment in schools, the lack of investment, well paying jobs, easy access to guns, to people who are frustrated and can go out and do something irrational, but usually would not do nothing irrational if they didn't have access to a weapon. Just those are some of the, the basic things.

Speaker 2: 4:06

You talked about redlining, and I know that we live in Minneapolis, Minnesota and which is one of the more segregated cities, frankly, about where people live. And there were literally laws on the books about where people could live and it was all very intentionally. Is that what you're getting at is sort of some of that historical I would say it was planned that way. It wasn't an accident. Yeah,

Speaker 3: 4:26

It absolutely was planned that way. And yes, those are the , the policies that I'm talking about, the racist policies that was put in place to make sure they kept marginalized communities from being integrated into our American society.

Speaker 2: 4:38

How does the availability of weapons affect community violence?

Speaker 3: 4:41

Well, because when people are having an argument and then they do, people are not being rational. They're not in their rational mind frame . So again, things would get heated. And then to have access to a weapon to go out and do something irrational that you normally wouldn't do, really then that's how the community violence gets spread because then say I go get into an argument with someone and then I go get a gun and I start shooting at them. I might not hit that target. I might hit someone else again and then I'm affecting someone else. But if I didn't have access to that weapon, then that wouldn't necessarily be able to take place.

Speaker 2: 5:13

What do you say to people who might say that? Well, people have the rights to weapons and they have the right to protect themselves. Yeah,

Speaker 3: 5:20

I would agree. People have a right to weapons, but people need to be responsible with their weapons. And I, and one doesn't, don't understand why we don't have to sometimes register our weapons to make sure people are following the law.

Speaker 2: 5:32

Yeah, I I see that frankly all the time in my individual practice. And we're talking about violence in the communities, but access to weapons, easy access to weapons is one of the primary drivers of individual use of firearms. It just is, it is in other areas like suicide , um, for people who die by that cause is less likely if the access isn't as easily available if you had to think about it or if he had to go get the weapon or if it , if it wasn't so readily accessible to everybody. So you're seeing that in the community. What are the effects on the rest of the community of community violence? I don't mean an individual who's maybe been the victim of violence, but how does it affect the whole psychological wellbeing of communities?

Speaker 3: 6:16

Well, people don't feel safe, and if you don't feel safe in certain spots of your community, you tend to do more irrational things. And then there's that loss of hope that percolates because people don't feel safe. And when people don't feel safe, people tend to act out a little more than they normally would. And then it's that cycle of trauma that's passed on from generational to generational because folks have never felt safe. And once you don't feel safe, you , your , your behavior changes and your pattern changes. So it is like Maslow's hierarchy of need. You have to have basic safety first if you want people to be productive.

Speaker 2: 6:49

Exactly. And if you don't have that, it's very difficult to go to the next level of community building and personal growth. Um, if you just simply don't feel safe. And if you have whole communities that don't feel safe, we're talking about the health of communities is not stable. Let's talk about prevention strategies. We're gonna later, after we take a break, we're gonna talk about some of the interventions that you're doing in your program and in other similar programs. But let's talk about what works for prevention.

Speaker 3: 7:16

Again, I believe investment in communities, you know, most marginalized communities , investment is usually grant funded or some type of special funding from the government instead of having a , a stable streamline of investment into communities. And , and I mean like housing education, well-paid jobs. So folks don't even gotta work three or four jobs to support their families instead of having their kids watch the young ones while they're at work. Because right now we have folks out there who are on the opposite side of the law , are able to make a full investment into some of our folks to cause 'em to do some of the risky behaviors that's happening out there. And to combat that, we have to be able to put an investment in them to show 'em that there's a different way that they can be successful and that they can be safe. But again, it's, it's that investment we have to put in their people because once somebody feels invested in something, they're able to do things that they normally wouldn't do, either good or bad.

Speaker 2: 8:07

So I wanna delve into that a little bit more because you said people on the other side of the law, these are folks that are, are influencing young people and influencing communities and they're, they must have something to offer.

Speaker 3: 8:19

Well , they're offering them what we just talked about. Safety. They're giving them a , a purpose. And even though those folks who are, are on the opposite of the law, they're doing things that they're taught to do 'cause that's the way they're taught to survive. Again, we talk about investment. So that's the investment they feel like they have to do to survive. So we have to change that, that outlook and give them a different way. Say, Hey, that investment that you're doing is harming your community. Let's give you a different way to invest in a community that's uplifting your community instead of harming your community. And sometimes folks have to do what they have to do to survive. And, and again, sometimes it goes against the law, but that's the way they're surviving.

Speaker 2: 8:54

In your programs of prevention, what avenues do you use? Um , you know , do you just walk down the streets and offer a different way? Or is it more through school programs or community programs, church programs, at what ways , um, are used?

Speaker 3: 9:08

Uh, all encompass ? I think the best resource that we have is our relationship building that we have with folks, building that long lasting relationship so that they trust that we're there on their behalf to help them do better or to help them be more of a positive influence in their community and their families or with their kids or whatever it is. But whatever they feel like they need to do to do something positive, we are there to help them do that. And that could be, you know, helping somebody financially, helping somebody deal with the mental health issues that they're having, helping somebody find a different trait that they want to do, that they're invested in, something that they don't have to do for money, but something they love to do for money . It is a big difference right there. Um , and again, like I said, just building that bond. They know that somebody's putting that investment into 'em .

Speaker 2: 9:52

You talked a little bit earlier about policies and advocacy and I mentioned that a lot of our things we've done over the decades was intentional. Those were a actual intentional policies to make sure that certain people were congregated in certain communities. What policies, if you could advocate for today , what policies would you advocate for today?

Speaker 3: 10:13

Ah , that's a , that's a great question. Uh , you , you have to do equal housing, affordable housing, figuring out affordable food for, for folks. People know if they have a secure place to stay and a secure line of where they're gonna get their next meal. You know, we see community violence decreases in those areas. That's, that is a proven fact. So I would advocate for policies that's going to affect those two changes right there. And then again, an investment in our educational systems, especially our public schools. Um, we want kids to , to behave, but we have to give them something to do to replace that behavior that they're doing. So if they're doing something that's wrong, we have to give them a behavior. That's right. So you can't tell someone to stop doing something without giving them an alternative option. I

Speaker 2: 10:57

Wish we would shout that from the mountaintops, what you're talking about. It makes such perfect sense. It is housing that people can actually access. You don't have a place to stay. That's like job one. And then you said something as simple as food, nutrition and then you said education, public education. These are things that our communities ought to be doing.

Speaker 3: 11:16

Absolutely. Again, I go back to that investment, like we have to have an investment. It's not my motto 'cause it's been around, but people have been saying for decades, hurt people, hurt people. We all know that. Right?

Speaker 2: 11:27

Hurt people, hurt people.

Speaker 3: 11:28

But we need to change it to heal people. Heal people. And how do we figure out how to heal people? And people have given us solutions that policy makers have not listened to or only listened to when it's in election year, or listen to when it's in their best interest instead of doing what we know is right. Yeah.

Speaker 2: 11:45

Amen to that Ra . I think that was well said . So I think we should take a pause here. I'm talking to RA Galloway. He is the director of the next step program, which is a community violence prevention and intervention program that is based outta hospitals here in the Twin Cities area of Minnesota. When we come back after a short break, we're gonna talk about interventions in the communities and some of the downstream effects when people seek healthcare , when they've been the victims of violence. Stay with us. We'll be right back

Speaker 4: 12:15

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Speaker 2: 12:52

And we're back talking to Rael Galloway about community violence prevention and interventions. And I wanna shift to the second half of that right now. Ra if we could, interventions, what do you and your team do to intervene in community violence situations?

Speaker 3: 13:06

So I'll just go , um, when a patient comes into the hospital, I'll just describe what we do. So we get an alert that someone's been shot. Uh , my team will then respond directly into the stab room,

Speaker 2: 13:18

Stabilization room, the emergency department where all the sickest folks go. Correct.

Speaker 3: 13:22

When we get into the stay room, there's a good chance that my staff, 'cause most of my staff live in the community, knows that person. When we go in there, sometimes patients are, you know, a little hesitant to let the emergency team work on them because they don't know who they are. They're surrounded by a bunch of strangers, some of 'em don't even look like them. And they're expecting that those folks to save their lives. And they're hesitant because of all the history that we've had with hospitals.

Speaker 2: 13:46

So that's understandable. Just to start out right there, they're coming from a place of decades, hundreds of years of mistrust.

Speaker 3: 13:52

Correct. So then my team will come in there and there's a good chance we know who they are, we'll help, we'll settle them down, allow the medical team to do the life saving work they need to do to save that person's life. And then once they're cleared and stable, we start talking to them about who's coming up here to support you, what family is coming up here, what happened to you? How can we be helpful? And then once we get those questions asked , if someone is coming up, then we'll go out again to meet the family. Because again, our hospital system sometimes will put up a wall and say, we don't want all those people coming up here. Or I'll say our people coming up here, but we want them to come up here because we want them to have a, a place where they can grieve, understand what's going on with their loved one within the hospital system. Because you know, sometimes we put up red tape where we can't tell them what's going on, which then causes people's anxiety to go through the roof and then they start doing irrational things at our, on our hospital space. And we are causing that. And we don't understand that we are causing that . And we are re re-traumatizing that family because they've already been traumatized when they get a phone call and say, such and such has been shot, come up to the hospital, hurry quick. Or sometimes they're even at the scene and they're talking with the EMS and the police and they say, Hey, go to Hennepin County Medical Center, or hey, go to North Memorial. And then they show up and because we've made them no information, our security team has to tell them they're not here. Like

Speaker 2: 15:13

Your loved one's not here.

Speaker 3: 15:15

Not here.

Speaker 2: 15:16

And they are

Speaker 3: 15:17

And they are. Yeah. Because the police and EMS have told them to come to our hospital, but be because our internal systems made them no info. Our team has to, and and I know they don't like doing it, but they have to say they're not here and we've lost

Speaker 2: 15:32

Trust. So, so the first point is when family members loved ones their community, they don't have all the information that is erodes trust. Correct.

Speaker 3: 15:41

And then we have the family, then you know, you're gonna act out because they wanna know what's going on. I would, so my team is there to, to bridge that, to say, Hey, we talk with the person who's in there, they give us some identification points, we go out there, we have a conversation with their family, they show us pictures, and then we bridge that like, yes, they are here and we will figure out how we can get the, the doctor or the nurse to come out and have a conversation with you. Yeah.

Speaker 2: 16:05

That's a complicated situation and I'm, I'm certainly not an expert in it, but it's this balancing act about an individual patient privacy versus the legal obligations of the hospital. But the end result is that family members and, and survivors and, and the healthcare team aren't always , um, communicating in the best way possible. But I know that's a , that's a hard one, so I appreciate you bringing that up. Yeah .

Speaker 3: 16:28

And even in the back end there , there's sometimes miscommunication between our own team . So again, we just have to figure out that's why our , our team was created in the first place to, to address them . Those biases that's happening to patients , especially patients of color that come into the hospital. And again, to stop people from going back out in , in the community and doing something irrational. Let's give them a place to grieve. Let's give them a place of , to get information about their loved ones. And then again, to start the re humanization process because when they come in, they've already been dehumanized. And sometimes our uh , staff will then keep that dehumanization process going. Not understanding that people are not coming outta the hospital because they want to, they're coming to the hospital in their worst moment of their lives looking for help, looking for hope. And sometimes we don't provide that . So that's why our team is there to make sure that that does get provided. And if it doesn't get provided, we call it out and we educate our, our team members and say, Hey, what you're doing or the way you're treating somebody, not that's racist.

Speaker 2: 17:28

So your job, you see it as an advocate at that moment.

Speaker 3: 17:31

We are absolutely advocates for that patient coming in. Uh , but we're also advocate for the staff too to , to help them understand what's happening so that they can still feel like their sense of safety is not being compromised. And, and then also building a relationship between them and the family. Because that's our goal too . We want our hospital staff to have a good relationship with the family and vice versa. 'cause we know better outcomes for our patient happens when there is trust between both parties.

Speaker 2: 17:57

I'm gonna come back to that at the end of the program. I'm gonna talk about the downstream effects and how it affects healthcare workers and community members. I'm gonna come back to that. So I'm gonna put a little , uh, pause in that. When that person then gets treated for whatever their acute consequences of whatever the violence was, what happens then? How do we support that person after they're out of that immediate danger?

Speaker 3: 18:20

So once, if they get um, admitted , uh, we will have a conversation with them. Because our program is voluntary, it is not forced on anyone. It's voluntary for someone to say, yes, I'm interested in the service. We talk about how we can help them because their life is gonna be changed. It's different. I'll just give an extreme one. Somebody is 19 years old , been walking for the first 19 years of their life, get shot, come in, now they're wheelchair bound. That is a life changing event. So then we start talking about what life is gonna look like after discharge. What is it, what is it you feel like you are gonna need to start helping you on your journey of healing, rehabilitation and making sure you start to build your community safety net around again because it's been shattered. Like their sense of safety has been shattered. So how do we start building that back up and again, start the re humanization process. So that could either be a little bit of financial help. 'cause if you shot and you , you can't go to work. So we help out with , with bills, mortgage payment, whatever other cost that comes with that give be once they're discharged they're like, man, I'm , I really wanted to go back to school. How do I do that? We'll figure out how to help them go back to school. 'cause when we're talking with them in the hospital, we call it the golden moment. Especially for those who, you know are out there committing some of those risky behaviors. Like what were you, what did you grow up wanting to be? Nobody grows up saying, I want to start committing violent acts or be a , be a criminal or any of that. They have aspirations and we try to get them back to, hey, those aspirations are not gone. You can still do that. Take it as a second chance. You are given a second chance to do something special. How can we help you get there and do something special? Um , helping 'em find a mental health provider that looks like them to provide support. We have three community groups that happen without in the community. We have a women's group that takes place over in Shiloh Temple. Uh , we have a men's group that it goes to different places within the city so they can just all gather and just have a conversation and, and talk about how they're healing and what's going on in their lives and bring resources to that . And then we also have a trauma recovery group, which is the first in the country that deals with the anger management and the mental health aspect of being a survivor of community violence. And you will never hear me say victim because when we learned early on, when you start saying victim of people or calling them victims again, that's kind of re-traumatizing them and having 'em relive that trauma again. So you hear us use the word survivor. The trauma recovery group really gives our participants a a toolkit . A toolkit of how to have different resources in place when they are triggered or something happens or they have a step back, they know they have a plan in place that they can go to help recover themselves. And then also the the mental health piece. Giving them some mental health strategies , uh, when they're alone and they go in that dark place. Well , here are some strategies that you can use to help get yourself out of that place until you can go back to see your provider or when you're getting angry, here are some, here are some strategies that we can give you when you get angry. Or if you, you get angry and you should do this. How about we give you a different strategy to channel your anger somewhere else? Again, it's with that group mentality. Having folks who want to work on changing their, their behavior in that group saying, I'm not alone. I want to do something different. I

Speaker 2: 21:33

Really like what you said, I'm not alone is a great thing to remind people of and to show them this supportive environment. I really, really like that . These are success stories that next step is doing. You said it's the first in the country, the trauma informed

Speaker 3: 21:47

Group. Yep . It's first in the country that's combining anger management and mental health. It's the first in the country.

Speaker 2: 21:53

What a great program. What about the cycle of community violence and what are some of the ways you can break that, that need for revenge or getting back at somebody or retaliation?

Speaker 3: 22:05

That's a lot where the community groups help out with is is that retaliation piece of people wanting to go back out and do something to , to someone who did something to their loved one that keeps that, that keeps that circle of violence going. So we are in there and telling people, hey, let's let the legal process play out. You go out there and you hear someone's loved one and then they do the same thing and then it keeps going. Where does it stop? And that's why we want families to come up to the hospital so we can start intervening right there in the moment instead of waiting, you know, two or three days. Sometimes you just gotta give 'em a little space to vent and cry and be emotional. I know I would be emotional, I would be upset. I'll be ready to go back out there and do something. But if we give people the space to get all that out when they show up, they're not in their rational mind. So we have to give 'em a chance to get outta that irrationality out and then we can start having a rational conversation once they get information. Once they know what's going on, people tend to settle down and you're able to have a conversation with 'em .

Speaker 2: 23:04

Before I let you go, I wanna talk a little bit more about the effects on the healthcare system because you're a hospital-based program, you intervene the moment the survivor of violence shows up and their families. I'm well aware in our large hospital in downtown Minneapolis, and this is played out at hospitals across the country, it's not unique to us that healthcare workers and the care teams, the social workers, the violence prevention program, the doctors, the nurses, especially the nurses and the paramedics, it affects everybody. It really does. And I know that sometimes that can lead to biased care of people who are the victims of violence and it can lead to to differential treatments and it can read to racist acts. All of that is true. All of that is true. Could you comment on your , just your thoughts on that, on the effects of our healthcare systems and how should we respond to the community stressors of violence in our healthcare system ,

Speaker 3: 24:00

Particularly with our , with our staff? Um, because a lot of us are desensitized to it. So when you're desensitized to it, you you tend to just look at it as a just another person coming in and not understand the human aspect about it. And I think as some folks are desensitized to it, then they start to question why is this happening? They were doing something they weren't supposed to be doing, not really knowing the whole story, putting their own narrative on the spin on what's happening to people out there instead of actually knowing factually what's taking place. Again, it's also hard, like I said, me myself, I can't go in the stabilization room when there's a young person in there, especially kids. 'cause I have kids. And that is a tough, tough thing to experience. And I think sometimes because our staff might be trained to block out what they're really feeling and then we don't come back and we don't talk about it. People take on that secondary trauma and don't realize sometimes they're taking on that secondary trauma and then push it off as something else. We don't want to talk about that . Come back and have a debrief about what really took place. How did that make us feel? And I always say, 'cause I know my team, we have a mental health professional who is part of our team, who is ingrained in our team. I think everyone who's doing this type of work should have a mental health professional ingrained in their team so people can go and take care of themselves. And sometimes we push that self-care off and then it starts to come out in other ways with our implicit bias, the way we are blaming and shaming people as they're coming into the hospital. Or sometimes it's just blatantly racist. And some of us know and some of us don't know. But then when we do educate folks and we tell 'em that it is racist , we're not attacking you. We're just saying what you're doing is hurting people. You are in the healthcare system to help folks and your behavior right now is not being helpful. It's really hurting our patients as they show up.

Speaker 2: 25:46

Are we making progress?

Speaker 3: 25:47

Yes, I think we are.

Speaker 2: 25:49

I was taught to put your emotions in compartments to separate it from the patient and to keep this professional distance. Now that was 25 years ago, it's gotten a little bit better so that we recognize the humanity in front of us. But when I say we making progress, you said yes. We have a lot of work to do though, don't we? We

Speaker 3: 26:05

Absolutely do. And I will say when I first started, I was hired by SIL Jones. Oh,

Speaker 2: 26:10

SIL Jones is a luminary of the Twin Cities community. If, if if PE for people who don't know 'em . And

Speaker 3: 26:16

SEAL created a narrative I think that most people should use. We call it narrative medicine. The way we speak to people is medicine, just as a provider providing pills and, and as a mental health professionals providing care around people's trauma, the way we talk to our patients when they come to hospital, we should say we're using narrative medicine. We're using our words to heal them as much as we're using medicine.

Speaker 2: 26:37

I just have to make a shout out to Seal Jones. He is a storyteller. He's a journalist, a playwright , um, just a really great man. Uh, and so I I I am glad you brought up Seal Jones in the concept of narrative medicine. Crell Galloway is the director of the next step program, a community violence prevention program here at Hennepin Healthcare and other hospitals in the state of Minnesota. If you could leave our listeners control with , uh, some words of hope for the future, what would that be?

Speaker 3: 27:08

I always say this, and I don't know if it's hope or not, but what , what I will say is being shot is not normal. Let's not make being shot a normal thing in our society and we have the solutions in front of us. We just have to be in a collective mind to get together, to get our policy makers and , and folks who decide what happens in our society to say, yes, we have had enough of this. I am hopeful. What I tell people is I'm hoping the conversation that we've had today that my grandchildren won't have to have the same conversation. So that's how hopeful I am.

Speaker 2: 27:39

I think that's a great way to end this podcast. Um , Kentrell , thank you so much for being here. This is an important topic. I have been talking with you about getting you on the podcast for a long time now and I'm glad we were finally able to do it 'cause it's a hard conversation. Talk about the trauma that people who are survivors of violence have experienced. And so I was really looking forward to having this conversation and I want to thank you so much for sharing your expertise and your perspective as with us.

Speaker 3: 28:04

Thank you for having me.

Speaker 2: 28:05

Listeners, I hope we've got you thinking about community violence and some of the root causes of it and what you might be able to do to contribute your energies towards a future where our children don't have to be having these conversations. This has been a great episode. I hope you'll join us for our next episode. And in the meantime, be healthy and be well.

Speaker 1: 28:24

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan , CTO 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 physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.