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 Den.

Speaker 2: 0:19

Hey everybody and welcome to episode 12 of the podcast. I am your host, Dr. David Hilden , and I want to thank my colleague Megan McCoy for being a guest host on the last episode on topics around our children. Today we are gonna talk about bipolar disorder with psychiatrist Dr. Vanessa Stump. She treats this condition here at Hennepin Healthcare in downtown Minneapolis. With me, we're gonna dive into this topic that's kind of misunderstood, but it affects millions of people worldwide. Vanessa, welcome to the show.

Speaker 3: 0:48

Thank you. Happy to be here.

Speaker 2: 0:50

So break it down for us. Start with the basics. What is bipolar disorder?

Speaker 3: 0:55

Absolutely. Well, I agree with your introduction that I do think this disorder tends to be misunderstood for various reasons. I think unfortunately in the media there's still a lot of stigma around this and I also think it doesn't get represented very accurately. So I think it's really good for us to sit down and talk about what this really looks like. So bipolar disorder is classified as a mood disorder. People do have contrasting mood episodes. So people for two weeks to months at a time can feel very depressed. Have an episode of what we call major depressive disorders. So they might not wanna get outta bed, they don't enjoy things like they usually do. They might feel really tired, not be eating as much, and then they can have periods of time for weeks to months on end where their , their mood is okay, they feel fine, they're kind of living their day-to-day life. And then they can have periods of time for usually at least a week or longer where their mood can get really elevated. And this can look different. So sometimes people can be really happy, really over the top , or they can even get kind of irritable and they're not sleeping. Sometimes people start talking really fast, they're just on the go doing all sorts of things they wouldn't normally do. And so people can have these fluctuations in their mood. It's not necessarily day to day . I think that's how some people think of it. It's generally sort of weeks to months on end and blocks. Exactly, exactly. So

Speaker 2: 2:28

Is is the elevated move , is that sort of the opposite of depression? It

Speaker 3: 2:32

Is, yeah .

Speaker 2: 2:32

And that's why bipolar to polls .

Speaker 3: 2:34

Exactly.

Speaker 2: 2:35

So I do sort of know the answer to this, but I want you to help our listeners even a little bit more about why is that bad? Mm-hmm <affirmative> . To be exceptionally happy. Mm-hmm <affirmative> . Or have what they might think of as the opposite of depression. Mm-hmm <affirmative> . Why isn't that a good thing? Well, it

Speaker 3: 2:48

Can feel good. So certainly sometimes for a period of time people feel good when they're, we call it manic or, or hypomanic is kind of the less severe version of that. The problem is, is it can become very disruptive for people's lives because for one thing, it can be hard for people to understand what they're saying 'cause they can be talking so fast, have all these ideas that some of it just starts to not even make sense. Sometimes people start to do really impulsive behaviors that they wouldn't normally do. So I have people who have spent their life savings in, you know, a short amount of time they think that they're gonna start a new business. So they might quit the job that they're working. Sometimes people do things totally outta character, like they use drugs or they have sex with people that they normally wouldn't. And when it gets really severe, sometimes people can even get what we call psychotic. And that means that they aren't really connected with reality anymore. So sometimes they might believe that they're a superhero or the president and you know, sometimes people do dangerous things because of that. So it , it can feel good but it can become incredibly disruptive to their life.

Speaker 2: 3:57

Why do you think it's important that we are even talking about this? Why, you know, why should the public know about bipolar disorder?

Speaker 3: 4:04

Well, it doesn't impact a small number of people. So the prevalence is anywhere between about one to 3%, which in the United States, they think is about 6 million people. 6 million people. Yeah. And so that's a lot of people. Mm-hmm <affirmative> . And individuals with bipolar disorder are higher risk for certain, like cardiac illnesses for being a victim of crime. There's sometimes higher risk for being incarcerated. Their lifespan can be shorter. So we have a lot of room, both as a society and in healthcare to kind of make interventions and try to improve these people's lives.

Speaker 2: 4:43

When, when they're in the various swings of mood, you say they kind of come in blocks, is the depression part more common or is the mania part more common? Mm-hmm <affirmative>

Speaker 3: 4:53

Most people spend more time of their life in the depression part, which that can actually be the more challenging part of the illness to treat. And that also can be part of why it doesn't always get identified right away. Because sometimes when people are having that elevated mood, that mania, well they don't really seek out help at that time 'cause they're feeling great. They're like, I don't need to go to the doctor. When they come and seek out help, it's when they're feeling depressed. And then it can be hard to kind of parse out what's really going on.

Speaker 2: 5:23

Do we know what causes it?

Speaker 3: 5:25

Like most things in psychiatry, it's a mixture in comparison to some of the other disorders we treat. It is thought to have more hereditary components. And unfortunately we haven't really been able to nail that down to, oh, here's one gene. But if somebody has a first degree relative with bipolar disorder, so that would be a parent sibling, they're actually about five times more likely to develop bipolar disorder than someone in the general population. So the risk is still, you know, it's about 5%. So it's not a guarantee, but still much higher risk. People who have what we call like adverse childhood experiences seem to be higher risk for developing this. So if people unfortunately experience trauma, they experience abuse. There also does seem to be some correlation to that. If people are using substances, especially cannabis, that that might kind of exacerbate the illness or they might develop the illness earlier than they might normally have. So it's kind of a mixture. There's not really kinda one thing that we can pin it down on.

Speaker 2: 6:36

I like what you said, like a lot of things in psychiatry.

Speaker 3: 6:39

Yes. We, we

Speaker 2: 6:39

Live in the , the human brain is complicated.

Speaker 3: 6:42

We live in the gray area. There's not a lot of things that are black and white in psychiatry. <laugh> .

Speaker 2: 6:47

What are the first signs of it? In other words, how, what are the symptoms that people should look for or that you look for? Especially early,

Speaker 3: 6:54

Most people at first they'll present with depression. And so that's why it's hard because when you meet with a patient, we'll always ask them if they've had a history of kind of a manic or hypomanic episode. And usually what I do with that is I kind of describe what that might look like. It can be helpful too, to talk to people's family or friends. 'cause sometimes they might have observed a change in someone's behavior that maybe they don't remember or didn't notice.

Speaker 2: 7:22

And you said they're not usually seeing you for the first time during a manic

Speaker 3: 7:25

Episode? Not usually, although unfortunately, especially if the mania becomes severe, sometimes the first presentation people have is actually in the hospital. 'cause they might be doing something kind of disruptive in the community. They, you know, maybe were trying to jump over the airport security or something that totally kind of out of their character. And so then their first encounter with us is actually in the hospital setting.

Speaker 2: 7:50

Is it possible that someone could have this for a long time and not know it?

Speaker 3: 7:54

You could. I mean there's definitely patients who, especially individuals if their symptoms are more mild and if they're still able to maintain their work or their relationships, there's probably individuals who can go a lifetime without really interacting with a healthcare provider. Probably that's the minority of people though,

Speaker 2: 8:14

Right? Right. Most people come to the attention of, of the healthcare system or their family. Mm-hmm <affirmative> or psychiatrists. Mm-hmm <affirmative> in , in the mental health professionals, are there different types or is it all bipolar? You have depression, you have mania, that's the type,

Speaker 3: 8:27

There are different types. So bipolar one disorder is kind of what we think of as classic bipolar disorder. So that's where people have episodes of depression and those episodes of mania that we talked about. And the episodes of mania are quite pronounced for those individuals. So it is a noticeable difference. They're behaving in a way that is noticeable to other people. They're talking really fast. They might be psychotic, they might get hospitalized. There's also a disorder called bipolar two disorder. The main difference with that is that, so they also experience episodes of depression. They have what we call hypomania, which is really just a fancy term for, they have periods when their mood gets elevated. They might be a little more irritable, they might not sleep as well, but it's not as disruptive or as noticeable. And they don't generally lose touch with reality like someone can during a full blown manic episode. There is kind of this subset, there's this disorder if people really dig or read into things, there's something called psychia , which is sort of this interesting disorder where people don't really quite meet criteria for manic episodes and maybe they don't even have full-blown depression. But they sort of have this, I guess, mood lability or some changes in their mood. But it's kind of more of a rare disorder and it's not something that we necessarily see as often.

Speaker 2: 9:57

Yeah . A lot of our listeners like to learn new medical terms. Cyclo, thia . Yes . Cyclo sounds like cyclical. Yes. What's thia ?

Speaker 3: 10:04

Thia So is essentially someone's like temperament or mood. So in the old days and sometimes still we'll say someone can be dysthymic and that is kind of another in a bad mood. Yeah, yeah. They're kind of depressed or they're in a bad mood.

Speaker 2: 10:19

Okay. Um, you already told us that maybe one to 3% or 6 million people have it in the United States alone. Is it more common in certain subgroups of the population or is it equal across the country? Across age, across men, women,

Speaker 3: 10:34

It's equal amongst men and women. Um, so we don't really see any differences there. It does seem more common in higher income countries, which is interesting. I did some digging into this. I don't have a good answer for you why that is. It could be that we just detect it more. It could be something to do with life experiences, genetic factors. Typically the onset of the illness is in early adulthood, so 18 to 20, 20 to 30 kind of depending on the source you look at. And this is considered what we call a a chronic mental illness. So it is classified in a group that we call serious and persistent mental illnesses. So once somebody is diagnosed with this, it is something that they generally are coping with lifelong.

Speaker 2: 11:23

You talked about it as being a mood disorder, the other big one being major depression. How is that different from uh , schizophrenia? Mm-hmm <affirmative> and the , the more psychotic disorders, because you did say that sometimes people with bipolar disorder can also have some psychosis. Mm-hmm <affirmative>. Are they different? They

Speaker 3: 11:40

Are different. So individuals with bipolar disorder will only have a psychotic episode if they're also in like a mood episode. So during times when their mood is good, life is going well, they're feeling good, they will not have an episode of psychosis. The other difference is that individuals with the illness that you mentioned, schizophrenia, even outside of psychosis, they tend to struggle more kind of with their thinking. Sometimes they become kind of less motivated , uh, less interested in things they used to. They can have kind of what we call like a flatter affect . So they're just not really as responsive to the world. Whereas that's not really seen as commonly with bipolar disorder.

Speaker 2: 12:25

It's more about the mood. It is,

Speaker 3: 12:27

It

Speaker 2: 12:27

Is breast mood, elevated mood and the things that are associated with your

Speaker 3: 12:30

Mood. Exactly.

Speaker 2: 12:31

How do you diagnose it?

Speaker 3: 12:33

So unfortunately we don't have any magical tests yet. So sometimes I have patients who say, can you just scan my brain? Right , right. Can't you just look at it and tell me what's going

Speaker 2: 12:45

On ? Is there a blood test? Isn't there an x-ray? Isn't there an MRI scan? Not

Speaker 3: 12:48

Yet. But basically we just do what we call a really good clinical interview. So when we have initial visits with patients, they're generally at least an hour long and we're sitting down with them and we are going over all of their symptoms. We're asking a lot of questions like I mentioned, if we can, we often will try to talk with family or a friend or someone who can kind of give us their observations. There are some psychological tests or some kind of questionnaires that we can use to help us narrow things down. But ultimately it's just sitting down, talking with someone, getting their story and then trying to put it all together.

Speaker 2: 13:27

We're talking with Dr. Vanessa Stump. We're talking about bipolar disorder and we're gonna take a short break, but when we come back I'm gonna ask you Vanessa, to talk about how bipolar affects real people. We've talked a lot, some about the data, the prevalence, what might cause it. We're gonna talk about what it's like to live with bipolar and I'm gonna ask you to sort of reflect on what you've seen in your patients and listeners. We're gonna talk about how you can support either yourself or a loved one who might have bipolar disorder. Stick around, we'll be right back

Speaker 3: 13:58

When

Speaker 4: 13:59

Hennepin Healthcare says we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 14:36

Hey everybody, we are back talking with Dr. Vanessa Stump about bipolar disorder. Vanessa, let's talk about treatments. We've talked about what it is, how common is it? What do you do about it? Yeah,

Speaker 3: 14:46

So fortunately we have a lot of treatment options now and in psychiatry I always tell people we kind of have three buckets of things that we're working on. So there's the biological stuff, so that's things like medications, interventional treatments, there's the psychological stuff. So that's things like therapy changing kind of how you think about yourself, how you think about the world. And then there's the social kind of bucket and that's things like, can we help you get back into employment? Can we support you with school? Can we help you form healthy friendships? All of those things. So bipolar disorder is best managed if people are on some kind of medication. And usually this looks like a class of medicines that we call mood stabilizers. And then there's also a lot of medicines called antipsychotics, which I think is kind of a misnomer 'cause we honestly use them for a lot of different things. And a lot of those medicines can be really helpful for individuals with bipolar disorder as well. So typically they're gonna be working with a psychiatric provider who's gonna be helping to manage these medicines. And we do know that for individuals who are on medication, that it does reduce the number of episodes they have of both mania and depression. It can reduce the severity of the episodes if they do happen. And it also seems to prolong people's lifespan. So it , some of the other things that people with bipolar disorder can struggle with, like their physical health, heart disease, these other things. It actually seems to be better when people are taking medication. What

Speaker 2: 16:22

Do you say to people who are maybe understandably nervous about taking medications for something they can't see And you know there's, you know, it's not like an antibiotic. I got this bug, you're treating it , the bug goes away. Mm-hmm <affirmative> uh , it's even been in our national discourse a little bit in the country. You know, sometimes people say, yeah , I'll use psychiatrists. You just want to give a pill to everything. How do you respond to that?

Speaker 3: 16:44

Well I always frame medications as you know, it's kind of one tool in your toolbox. So I certainly don't sell to people that medicines are the be all end all for treatment. There are other things that are important to do, but the way that I look at it is it's , it's kind of like if someone has diabetes and if you ask someone with diabetes who needs insulin not to use insulin, well that's just not gonna work. Or sometimes I think of it as, I'll tell people it's like running a marathon and you break your leg but you don't get to have a cast so everybody else gets a cast but you don't, so your leg is just gonna heal at all these weird angles,

Speaker 2: 17:21

You know ? I like that. Yeah, I like that. Yeah. Both the diabetes and the running thing, you know, there are some basic things that are part of the treatment that you need.

Speaker 3: 17:28

Absolutely. And you know, I tell people that you know, these medicines are working on biological things in our brain that we might not be able to see. But we know from science that they do work. And I also normalize for people that, you know, I understand that taking medication might not be what you were hoping for or envisioning for your life. And I say, let's find something that's a good fit for you. Let's work together to find a medicine that agrees with your body that you feel okay taking and then we can just have it there. We won't have to worry about it anymore. And then let's focus on your goals and the things that you wanna do and how being on that medicine and feeling well can help you with the goals that you wanna accomplish.

Speaker 2: 18:11

Makes complete sense. That's a great, that's a great response I think. Okay, so it's not just medications, there's two other buckets you said?

Speaker 3: 18:17

Yeah, so the psychology bucket is, and this can be a variety of things, but this kind of goes with what we call therapy or psychotherapy. And this is how people can learn stress management skills. 'cause we know that if someone gets really stressed, that can be, you know, it can impact your sleep, it can impact your mood. And that's when kind of a mood episode can start to unravel. So learning stress management and also just learning about the illness, getting education about it and kind of learning how people think about themselves. 'cause there can be a lot of shame that comes from bipolar disorder when people are in the midst of these mood episodes. And so it can be helpful to sit down with someone professionally who can really help kind of tease that apart and really look at it and kind of change how we think about it. And then the social piece is , well I mean some of this can kind of go in the other buckets too, but especially for bipolar disorder, exercise, sleep, eating, well obviously those are important for everyone. But for bipolar disorder it's like medicine. It's very important to help educate individuals on how to kind of live a healthy lifestyle and get good sleep. And then also just learning, yeah. How to go back out into the world. You know, how do you form friendships now? How do you have relationships? What do you want that to look like? You know, maybe when you were in the midst of a mood episode, that was something that you were struggling with. So how can we work on maybe evolving or repairing some of that? Um, or maybe you lost your job when you had a manic episode. Well let's help you get back in, let's help you find a job. So it

Speaker 2: 19:53

Sounds like a holistic approach. There's medications, there's therapy, there's social supports. Does it always get worse? Does sometimes it get better? Um, uh, and, and this is a hard question, but is it life threatening?

Speaker 3: 20:06

So your first question, you know, does it, does it get worse? Does it get better if people do not treat it? People can start to have more episodes or more severe episodes over time. So typically we expect it to be sort of chronic or even kind of get better with time. But if someone's not treating it, we can kind of see an increase in that frequency or the severity of episodes. It can be life threatening. And so this is something where when we're working with patients, there can be a lot of joy in the work we do together. And you know, we can have a lot of humorous moments. And also kind of like I mentioned earlier, this is classified as something that we call a serious and persistent mental illness. When people are diagnosed with this, unfortunately we don't have a cure. We have ways of managing it, but we don't have a cure. And there are a subset of patients, I mean up to a fifth of patients with bipolar disorder may attempt suicide in their lifetime. Which is, that's a serious statistic. That's something we really have to take seriously.

Speaker 2: 21:09

That is a serious statistic. It is . You are so right.

Speaker 3: 21:12

Yeah . Yeah . So there can be complications and you know, like any serious illness, when we're sitting down with people we say, you know, these could be complications and at the same time, look at all these strategies we have for managing this . Let's focus on kind of the pieces that we can control and taking charge over it and taking control of the disorder.

Speaker 2: 21:33

Let's talk in our last segment about impact on people's lives. Can people live like a normal life or what are your reflections from your own practice about of the impact of bipolar disorder on real people? Mm-hmm <affirmative>.

Speaker 3: 21:46

Individuals with bipolar disorder absolutely can live a, a quote unquote normal life. I don't really know exactly what a normal life means. Yeah , it

Speaker 2: 21:54

Was a normal life. I'm not exactly sure what that , I dunno what a normal life is . You live a normal life. I don't think either one .

Speaker 3: 21:57

I'm sure I do, but certainly they can. I always say if you've met one individual with bipolar disorder, you've met one person with bipolar disorder, the illness is incredibly different in different people and comes in varying degrees of severity. So yes, for some people, you know, it can become hard for them to return to school or it can be hard for them to work or they might work part-time or do a different job because they just do have challenges with functioning at the same level as they used to. But I have a lot of individuals that essentially resume their regular life. And the only difference is that now they take some medicine once a day or twice a day and maybe they check in with a therapist once a week or every other week. Definitely it can be helpful if people have supportive family or supportive friends who are willing to kind of go on their journey with 'em and learn about the illness. We know that people who have supportive family and friends really have a much better outcome with this illness. So that's something early on. If we can get people's family or friends kind of engaged and educated, that can be really helpful.

Speaker 2: 23:08

Talk to us if you could, about your own practice. Yeah.

Speaker 3: 23:11

So I treat many, many patients with bipolar disorder. Like I said, variety of kind of severity that I see. But , um, many of them, like I said, really have been able to kind of resume their quote unquote normal life. Um, and some of them actually have kind of shared with me some sort of pieces of advice or kind of experiences that have been helpful for them. Are

Speaker 2: 23:36

You able to share those with us?

Speaker 3: 23:37

Absolutely. Yep . So this is, this is straight from the experts. 'cause I always say the the true experts on bipolar disorder are the people who are living with it. Some of the biggest things, so one is like education, education, education. So podcasts like this are fantastic. Like I was saying earlier, it's so misunderstood and so much of the information that people see really doesn't explain what this illness is. And unlike something like high blood pressure or a heart attack, not a lot of people really know what bipolar disorder is. Yeah .

Speaker 2: 24:09

I think most people don't really know.

Speaker 3: 24:10

No, they don't really know. So I think finding whether it's podcasts like this from medical professionals , uh, if you can even attend a visit with a loved one and getting education straight from their psychiatric provider. One of the organizations that is fantastic is the National Alliance for Mental Illness or NAMI Minnesota has an incredibly strong active NAMI organization in our state. They have support groups, they have education groups for both family and individuals living with a disorder. They have really good information online that you can read. They are just like a gold mine of sources

Speaker 2: 24:51

Listeners. I would concur with that and we'll put a link to that in the show notes.

Speaker 3: 24:54

The other thing that people have shared is that it can be helpful if their friends or family are kind of educated on warning signs of when they're not doing well. One of the unique things about bipolar disorder is that there is this phenomenon that some individuals really don't have insight into when they are sick. And it's not that they're in denial, it's, it's different than that. It's truly part of the disorder that they do not realize when they are sick. And that can be challenging because of course when they get really sick, that's when they might need treatment or need medicine and they'll say, I , I don't need medicine. There's nothing wrong with me. I don't have an illness. But if somebody that they trust who knows them can say, I know that you don't think you're sick right now, but you're not the person I recognize, you know, you're not the loved one that I know. I think something's going on. Maybe can we get some help that can be incredibly valuable. Other things that they've shared with me, patients have shared is , uh, it's helpful if family members don't kind of think everything is part of the illness. So they're like, it's okay. Chalk every single, they're like, I'm allowed to have a bad day <laugh>. I'm allowed to be in a bad mood. And I, I think some of that just comes with time and , and living with an illness and learning things. And it's understandable that family can feel anxious when they've, when they're seeing these changes happen in their loved one. But just understanding that they can have bad days. And then the other thing I think is important to note is that people are not their illness. And as I mentioned earlier, sometimes in the bouts of severe depressive episodes or severe manic episodes, people will do things that are way out of their character that really aren't reflective of who they are as a person. And I think it's important to be able to differentiate that and really respect that. 'cause that's where a lot of the shame can come with living with this disorder is kind of having to live with the, the consequences of some of the bad things that can happen in the midst of a mood episode.

Speaker 2: 26:55

Yeah, I think what the , some of the misunderstanding around the dis the disorder that it leads to that stigmatization of people mm-hmm <affirmative> . Who are not, they're not acting as the person that you know them to be.

Speaker 3: 27:06

Exactly.

Speaker 2: 27:07

Are there emergency resources available?

Speaker 3: 27:09

There are. So most counties in Minnesota have some kind of crisis team or crisis line. Uh, in Hennepin County. We're lucky to have what we call Hennepin County cope, which is a fabulous organization. If you call 9 8 8, they will directly connect you to your county's local crisis intervention service. And that doesn't automatically mean that you're gonna go to the hospital. Sometimes that's just talking with someone. Sometimes they can get you connected with more resources. Sometimes they can meet with people kind of doing a little bit of like therapy or some interventions for a few weeks to help them through a tough time. And

Speaker 2: 27:48

Then , then that's important. If you're living in the United States, call 9 8 8, yes. Three digits. Yes. That's,

Speaker 3: 27:52

That's national. That's not just in Minnesota. Here at Hennepin Healthcare we're lucky enough to actually have a psychiatric emergency department. It's called acute psychiatric services. You know, certainly any emergency department, whatever's closest to you is good, but you know, if needed, that's also a service we have available as well. So

Speaker 2: 28:12

We're just about out of time. Vanessa, if you could leave our listeners with any parting thoughts, what would they

Speaker 3: 28:17

Be? Like I said earlier, get educated, find good resources, ask your healthcare provider. Ask your psychiatric provider. Find podcasts or, you know, reliable resources. You know, Reddit is great for getting tips on how to fix your sink, but not necessarily the best place to get information about your health. I glad

Speaker 2: 28:37

You said that. Yeah. Yeah.

Speaker 3: 28:38

I think be curious. I think anytime that you think that you might have this disorder or a loved one or someone you care about has this disorder seek out help. Um, I always tell people, you know, primary care is kind of our first line , so if you aren't able to get into a psychiatric provider immediately, primary care providers are a great place to start and get connected to someone who can help you with care. You know, even though we talked about that this can be a serious illness and can have complications, I don't want people to be scared of it. People with bipolar disorder are not scary. This illness is treatable. You know, this is something that every day it's part of my day-to-day life that I'm treating people with this and it can be very routine. Um, so I just don't want people to be afraid of it.

Speaker 2: 29:24

Great words to end on. Dr. Vanessa Stump . Thank you so much.

Speaker 3: 29:28

Thank you for having me.

Speaker 2: 29:29

Listeners, just a friendly reminder to please seek care from your primary care clinic, seek emergency care if you need it, 9 8 8 is available as well. And thank you for listening to this episode and I hope you'll join us in two weeks time for another show. And in the meantime, be healthy and be well.

Speaker 1: 29:48

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.