Dr. Shaher Khan is double board certified in Plastic and Reconstructive Surgery as well as General Surgery. He is a Breast Explant Specialist and Implant Illness Advocate who has spent his fellowship training for Plastics and Reconstructive Surgery at the renowned Detroit Medical Center. He has received many honors and awards and is a published surgeon. Currently, he is owner and Founder of Executive Plastic Surgery in Novi, Michigan. In addition, Dr. Khan uses his Youtube Channel, Khan Plastic Surgery Academy to educate patients and fellow physicians alike on the large and growing group of women who have experienced adverse health effects termed “breast implant illness” attributed to the implants in their chest.
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Hello, everyone. Welcome to Our Podcast. I'm Alicia Swamy and I'm here with Erik Johnson and we are Exposing mold. Today we have Dr. Shaher Khan with us. Dr. Shaher Khan is double board certified in plastic and reconstructive surgery, as well as general surgery. He is a breast explant specialist and implant illness advocate who has spent his fellowship training for plastic and reconstructive surgery at the renowned Detroit Medical Center. He has received many honors and awards and is a published surgeon. Currently he is owner and founder of Executive Plastic Surgery in Novi, Michigan. In addition, Dr. Khan uses his YouTube channel Conplastic Surgery Academy to educate patients and fellow physicians alike. Thank you for joining us. Dr. KhanDr. Khan:
You're welcome. Thank you very much for having me. And it's a pleasure to talk to you in regards to what is a very important topic, breast implant illness and as you will see, when you look deep into this topic, it is very real, it is the real problem. And as you will see a problem that has been identified by the FDA, and also now by the many rheumatologists, and family medicine doctors, and the patients themselves who have taken ownership of their own health and sought solution to this very serious problem.Alicia Swamy:
Awesome, thank you for that, I just want to tell you a little story before we get started. So, you know, I have been obsessively looking for a surgeon to talk about breast implant illness and explants. And honestly, I've had zero luck with anyone being interested in coming on our podcast to discuss the subject. So I took to Facebook groups, and I found that you run a support group on Facebook about this subject. So um, do you think the reason why people don't want to talk about this is because it's such a new thing that people are seeing in this industry? Or what do you think is going on?Dr. Khan:
So the vast majority of the plastic surgeon so if there's 8000, of us board certified by the American Society of Plastic Surgeons, majority of us do not want to believe in breast implant illness, the belief or the general notion is that these are the cohesive, safer, newer generation, what they call the gummy bear implants. And that these are certainly safer, better, ever since the ban in 1992. And when they were reintroduced in 2007, the convention or the general notion is that these are safe devices. And that basically they are not associated with what is the breast implant illness. Now, what I direct my patients and anyone who is listening is to let's look at the facts, what we know of what the manufacturers themselves put forth. And they're basically studies and you will see very clearly that this is a real problem. And as I mentioned earlier, this is a real problem with the real solution. So the many plastic surgeons do not want to believe in it, unfortunately, simply because they feel within their mind from what the research has shown. Now there is again, ample evidence that proves otherwise. Obviously there is Yeah, and I will say this very boldly. There's obviously a financial interest as well. Right. This is the most common plastic surgery procedure that was done by the plastic surgeons. Not anymore. It used to be the number one breast augmentation with silicone and or saline implants used to be the number one operation that the plastic surgeons used to do now ever since COVID. And then obviously more and more of an awareness, less and less of the augmentations are being done. Now it is if you look at the FDA warning from a couple years ago, in October, where they clearly the FDA said this, if you're a plastic surgeon who is talking to a patient, and who is interested in augmenting be it for cancer oncologic reasons or cosmetic reasons, the plastic surgeon must sit down and discuss with the prospective patient these three facts Fact number one, that the implants are not meant to be in the body forever. Number two, that they're associated with breast implant illness, which is the many signs symptoms constellation of signs symptoms of what is brain fog fatigue, joint pain, dermatological problems. And third, that the breast implants are associated with breast implant associated anaplastic large cell lymphoma. And these are the three things that the surgeon has to discuss. Now. If you can imagine if you're a prospective patient who's interested in getting implants if I Just tell you this alone, you should easily be able to make a decision and say, Well, I don't want something in me that is not lifelong. So if you see this is the mentor ad, right, and I can give you a copy so you can put it. Now half of the ad itself, talks about natural feel, and I put down danger on top. Now, I'm going to read right now, this is the number one journal that the American Society of Plastic Surgeons puts forth. Look at the warning, if you will, warning, and I'm going to read it out to your word for word coat warning, breast implants are not considered lifetime devices period. The longer people have them, the greater the chances are that they will develop complications, some of which will require more surgery. So 10 to 15 years is what they say I see seven to 10 years. The second thing that I mentioned and remember this is the manufacturer, the mentor ad in the journal itself. Number two, quote, breast implants have been associated with the development of a cancer of the immune system called breast implant associated anaplastic large cell lymphoma. Big LCL period. This cancer occurs more commonly in patients with textured implants, then smooth implants, although rates are not well defined period, some patients have died from BIA LCL. And point number three patients receiving breast implants have reported a variety of symptoms, such as joint pain, muscle aches, confusion, chronic fatigue, autoimmune diseases, and others period individual patient's risk for developing these symptoms has not been well established period. Some patients report complete resolution of the symptoms when implants are removed without replacement. Now imagine, these are the points that the plastic surgeon has to discuss. Now this is a warning that's required, so that they have to be able to advertise this in any journal. Now, guess what, it doesn't stop there. It tells you breast implant surgery should not be performed and women with active infection number two with existing cancer or pre cancer of their breast who have not received adequate treatment for those conditions, how many breast cancer patients do not know if they have, you know, lymph nodes that are positive or negative? If they're going to get radiation or not? Right, you don't want to get radiation on a chest that has received implants. Correct. And then the court says over here, breast implant surgery should not be performed in women who are currently pregnant or nursing. So are you saying how many women who get implants and then eventually get pregnant because according to this, this is a red flag. Then they mentioned again, this is all in the ad, you can see this on my Facebook page that I've posted. Patients with a diagnosis of depression or other mental health disorders should wait until resolution or stabilization of these conditions prior to undergoing breast implant surgery. And then not only that, it says over here, the health consequences of a ruptured silicone gel breast implant have not been fully established period. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect for silent rupture. Now I will tell you this, this is in the advertisement. And I can send it to you so you have it, you can post it. Now, I'm not trying to scare you, I did not make this up. This is the manufacturer itself. Now not only that, look at the trail, this is the front cover, the same morning is on the inside. Now, I just read to you, if you have a person with an open mind, who says I want to get breast implants, be it after breast cancer or cosmetically, I will tell you any person with any reasonable mind. And I use the word very bluntly, if you tell now let you live in the Motor City here in Michigan, right? If I tell you I have a car that might break down in seven to 10 years, might literally just stop running in the middle of the road ie get cancer. Or it basically will be associated with transmission axle problems, ie the big symptoms, or you have to get a check every so often I will tell you, you're not going to even look at the car, right? And the point I'm trying to make here is breast implants are not safe devices, even the newer generation ones. If, let's say there was even a suggestion about a pacemaker, right, or a hip implant that was going to be related to all these problems, I assure you no one's gonna get the hip implant, right. Same thing implants are dangerous, be it saline or silicone and the rate of rupture is there last week I did a case this lady had implants that were ruptured at the seven year mark when She came to me where I removed the implant, and who knows could have been ruptured for a year or two, maybe six months. And this is the problem that we're dealing with implants. The newer generation, the cohesive are not safe. They're replete with problems. Eventually, all I use the word 100% of the patients are going to get breast implant illness because remember, it is a matter of time before the implant ruptures and when the silicone toxicity occurs. This is the breast implant illness where the silicone leeches out usually from day one at times. And now the patient has all these autoimmune rheumatological problems, fatigue, brain fog, and you know from the hair follicles for hair falling off to the dryness of the eyes, migraine site problems including emotional instability, depression, anxiety, neck, back pain, clearing of the throat, sinus problems, a neck and back pain, chest pain, irregularity, container contracture infections, not being able to help pay on a self monthly breast exam for what is breast cancer, right? Remember, one out of eight or nine women are going to get breast cancer now because of the big implant, they're not going to be able to palpate their breast, and now breast cancer is gonna get missed, or they may be reluctant to get a mammogram, cardiac issues, arrhythmias, palpitations, you have patients with blood pressure problems, GI issues, rheumatological problems, like I mentioned, gi disturbances, and again, the fibromyalgia type symptoms, endocrine problems, and almost all organ systems of the body, not all the time, but in majority of the cases, it will come and go, or it may touch on an organ system. And this is where the problem is real. And this is a real problem.Alicia Swamy:
So why are you so passionate about this? Like what? Because it sounds like a lot of surgeons are just turning a blind eye and they don't want to admit that this is an issue, what has been driving you and your passion within this and becoming an advocate for women who are falling ill from breast implants.Dr. Khan:
So number one, when I saw this very early on, when I was a medical student, and I saw the many patients I said do no harm. That's the oath I took. I know myself, when I finished, I could have easily augmented I chose not to augment this is when I first got out of medical school. And then my finished my 10 years of residency training, which is five years of general surgery, two years of burns, and then three years of plastics, that's almost 100 hours a week. And you know, you're in so much debt for example, the easiest answer is let's go ahead and get started the augmentation because that is where I said to myself, I'm not going to do something that I do not believe in and I saw patient after patient with ruptured implants, and I said I was not going to feed my family & I was not going to do something that I truly did not believe in to the point where I was working primarily out of the emergency room, I used to sleep at three, four in the morning, I used to be going from one dog bite in the emergency room to doing and I was very busy from week one. But I said to myself, I'm not going to do this elective procedure where it is the quickest. But for the time that you spent in an hour, this is how long it takes to augment. And for me, I did only one case in order to get board certified. And now for someone where I choose not to touch the even the breast implants. Now my whole practice exclusively 99% or more is devoted exclusively to exploitation and in a manner that I do such that the patient can remove the entirety of the implant plus the capsule that's around the implant plus any inflamed tissue so that that there is no inflammatory burden left behind and that most importantly, the patient has the capsule analyzed to make sure it's not lymphoma or the squamous cell cancer that the FDA just like 10 weeks ago mentioned in October in September that there is a new type of squamous cell cancer and that we rule out bacterial infection or fungal infections. They send cultures offer aerobic, anaerobic and fungal and I always return the implants to the patient. And whenever I'm caught cleaning out the chest if you will, which means removing all inflamed tissue, even the slightest doubt if it is inflamed or not, I will remove it because I do not want that inflammatory burden to live to be left behind such that the patient gets the best chance to bounce back to a normal state of good health and you will see patient after patient well over 90% of them. Look at this. I'm going to read this again this is very important. Some patients report complete resolution of symptoms when the implants are removed without replacement. And the answer here is you have to remove the capsule now tell you more than 90% of the patients will seek relief from their many sign symptoms. Breast Implant illness found out one thing I want. Yeah. And I want to mention, when I started, you know, it was very easy for me to do. So I talked to some of my friends, they're like, how come you're augmenting when you know the detrimental effects because you seen so many patients with ruptured implants and the many problems that they came in with forget that just look at the 1992 band, we have the same set of problems, the silicone toxicity, the same set of problems that the current patients are presenting with. And some of us surgeons, especially the senior ones, have already gone through this phase where they were banned, ie the silicone implants. And now we're going back into what is history repeating itself. And I just want to emphasize, the ceiling implants are as bad as the silicone and certainly as bad as the ruptured silicone. So all of these implants EBO, saline and silicone are bad, they are associated with the same set of problems. I cannot look at a patient and state or because of her symptoms, she's got saline or because of her symptoms, she's got silicone, they could indeed be both interchange, and you would not know which one has which. What's amusing to me is the fact that I'm not that old, but I'm not young. And in my short career. Now, let's go back into a little bit more detail. When I was doing my plastic surgery training, you know, we have the Allegan rep that comes and says, Okay, you sign up, we'll give you enough Botox sets kind of get you started. And then my friends were like, how come you're not signing up? I said, I'm not going to put Botox, I'm not going to put fillers, I'm going to be the real reconstructive surgeon and a burn surgeon, and I'm not going to get any implants. And they're like, What are you going to do? They're like, what a waste of plastic surgery fellowship, you know, and I say, you know, there's so many other things, plastic surgery is 3000 procedures. Now, in my short career, right before my eyes, I could never imagine my wildest dreams, that this is going to be my practice, I was doing skin cancer, leg reconstruction using artificial skin Integra, for example. Hands, burns, I was doing everything. And now all of a sudden, this is all what my practice has become. And it was a very interesting practice in the sense that I did everything except for breast. And now all what I'm doing is explantation, which is very, what's the word to use, defined, but at the same time, I feel this will be bring up the biggest impact. Now one thing I want to mention here is, and I say this humbly, one of my patients from Texas said, You're the only plastic surgeon in the US who's board certified, and this is the logo. This logo, if you have this, this is like the seal of approval, who has not put in any implants deliberately, purposefully, because they hurt. And I said, You bet. And I'm very lucky and fortunate to say that, you know, I did that. Now, I was not vocal around it initially. But in 2018, I gave my lecture and I've been giving lectures, and I've been exclusively talking about this, I've never said no to a podcast, ever that I've received. You know, I could be home right now. But I say you know what, you're gonna help me take this to the many other 1000s and 10s of 1000s and hundreds of 1000s. And hopefully they'll benefit from your work and from your colleague, such that, you know, they will enhance the quality of life. And this is why I became a doc. And I will tell you this, I feel richer than Elon Musk times 100 You know, in my mind and heart and soul, when I put my head on the pillow, because you know what, when a patient comes to so two nights ago, a patient from Hawaii signed up with me. And she had not even talked to me, she had not even had a phone consult no virtual consultation, she paid for her surgery without even talking to me, I have a patient next week coming from the Netherlands. I have patients come from Japan, Egypt, Germany. And this is just from word of mouth from my Facebook. And this is where I can say humbly I have nothing but my patients 100% best interest sets that she's able to get back with her life. So that and this is I will tell you, the world to me, this is where I can say I've worked on my heart and as hard as I have to help each one of these where the rest of the world is saying that whatever I was doing initially was crazy. Right? And now if anything has been proven to be right, and that is humbly I'm able to say I have had any physiologist and other plastic surgeon and internal medicine doctors poke fun of me and say what do you try to do change the world? Call me Mother Teresa, things like that. And I said listen, I'm trying to better the system. Don't listen to me Listen to the patient'sAlicia Swamy:
Wow. Wow, that's incredible. Thank you. And you know, I'm afraid for you because I feel like you're you're on a big mission and you're on a big mission against the FDA. adds, I don't know, Have you received any threats? And he death threatDr. Khan:
No, no, see, the FDA overall is a is a bureaucratic institution. You know, I told the doc, Dr. Cornelissen, just get on a plane, come spend the day with me. So you can see now she's a nice lady. I talked to her, I finished the conversation with her, she wanted to talk about it, you know, and I said, You know what, this is enough. I got the point across. I really sincerely believe, you know, sometimes when in the world of the government, DC, it's just too much paperwork, too much red tape too much. It's too slow, too passive of a process. I really feel and believe that they want to bring about the change. And if I did not believe that, I would say otherwise, you know, and so I feel now, I said to them, you have 350 1000 complaints. I just read this out to you. Are you not aware of that now, they said they kept it secret away from the public. Now that is someone has to account for this. You know, we're not in a regime where, you know, we hide stuff. There's disclosure, and there's open discussion. And there's checks and balances right? Now, there is apparently no check and balance in this right. Now, another thing here is Joe cigarettes are still smoked by a lot of teenagers, unfortunately, despite pulmonary fibrosis, that needs to stop look at the world of narcotics, right? Billions of dollars exchanged with the companies and even the medical community, right? All at the expense of the patients, how many patients look at the drug world. And as a way again, I see this you see, the inherent problem here is this. Medicine is a business, the world of medicine is a business, you go to the emergency room, they're gonna bill you for stuff, you know, that is five times 10 times 20 times exaggerated. They're going to put stents in the heart of patients, and they did not need stents. And I know this, we all know this, just ask any cardiologist, you go to the emergency room, break your hand, the next day, you go to your doc, they're gonna get another x ray, Hey, Doc, we got an x ray and all we need to do the X ray, we're gonna sell you this point, we're gonna do this every time you come, we're going to have our own therapist, what I can do to maximize from your injury that unfortunately, now in the world of medicine, dermatology, and plastic surgery is the most business aspect of medicine, right? Because you're coming here you have extra money, and you want to look good, and that comes at an expense. Sometimes laser sometimes fillers sometimes this surgery sometimes is not uncommon. 8, 10, 12, $20,000 easy rhinoplasty for example, or even augmentation for good. The point I'm trying to make here is this boron between the doc and the patients should be only to help the patient where patients come in, I see you don't need this, stay away. DNT DO NOT TOUCH stay away from the just today I told someone stay away from the plastic surgeon you do not need to do plastic surgery just because you happen to be working in a plastic surgeons office, right? Because she can get access to free Botox free laser free everything is the ultimate you you're gonna hurt yourself. And this is the point, do no harm. If you need it, then get it and you know, and I'll end with this on my end and plastic surgery. Let's see if I have melanoma on the finger. The textbook answer is amputated the joint before right. I will tell them if you have to amputate before, even just so that I don't get this recurrence or there's any satellite lesions I want to live to 120 just like you and just like everyone else. one patient, one of the doctors asked me so what are you supposed to do if you get breast cancer? flat chested? I said this and you can do other flaps, but don't do augmentation because the silicone and all these other problems ruptured and whatnot. Just last week, I did a surgery case with the patient has breast cancer. In the nipple sparing mastectomy, there was more focus on the aesthetics than removing all of the breast tissue behind. Right and this is a problem right? The focus is so much on the aesthetics at the expense of the health. No we want to do without compromise of the the patient's health and that is the full goal do no harm. Absolutely.Alicia Swamy:
We'd like to take a moment to thank our sponsors. Home cleanse, formerly known as all American restoration is a company that specializes in improving indoor air quality through proper mold remediation. offering services nationwide, you can visit them at home cleanse.com. To learn more. The mold guy performs mold sampling and testing for homeowners, renters and businesses. Please visit the mold guy inc.com To learn more BlackDiamond services provide solutions to the unforeseen challenges that can affect homes and families with no out of pocket costs. Services include temporary housing relocation and Mold Test referrals for homelessness, visit BlackDiamond services.com To learn more, Great Plains laboratory provides toxic exposure testing to those living in compromised environments. tests include the mycotoxin panel that tests for mycotoxins in urine samples in the environment tox panels, tests for environmental chemicals in the urine, and provides an overall metabolic snapshot of a patient's health visit GP dash labs.com To learn more, thank you again for your sponsorships. It is integral to our ability to serve our community and to improve the quality of life for all.Erik Johnson:
Do you see thickening of the capsule that correlates to the strength of the immunological response?Dr. Khan:
So that's a very good question. I see patients with a capsular contracture, which is thickening of the capsule in patients who have saline implants maybe just from six months ago. And so these patients react, one may have great for contracture with a capsular contracture and thickening of the capsule, and the other side is normal with the good aesthetic result. And majority of the times we do not know why thickening occurs on one side versus the other. Now we know that if there is a biofilm, or if there is maybe a bacterial contamination during surgery, or maybe majority of the times we do not know why a capsular contracture would occur on one side versus the other. So there is no true correlation. I have seen patients with thin what I would say very average benign looking capsules, once the implant has been removed along with the capsule, they have complete resolution of their symptoms. And so there is no true correlation between the thickness of the capsule and their immune response and the relief of the the the presentation of the breast implant illness symptoms.Erik Johnson:
Do you see a consistent fungal or bacterial colonization that associated success? Yes,Dr. Khan:
Yes, So I would say so every single patient I have had I have sent maybe except for three patients. These were Canadians or patients with no insurance and they chose not to proceed with pathology. So almost every single patient is sent to pathology. And then I sent to microbiology for Aerobic fungus. So today, I have had three patients with active mold infection, two of these patients. I always whenever I see any mold, I always send these patients, along with microbiology report to the infectious disease doctor so that they can officially see and treat the patient because this can sometimes be very comprehensive and very detailed. And I'm not infectious disease doc so that they can tailor the treatment accordingly. So two out of the three patients who had mold, the infectious disease doctor said, well, the foreign body is out. Your exam is unremarkable. They did blood cultures and their routine. And their exam was essentially not suggestive of an active infection. One out of the three patients. She actually had an active infection and she needed to be treated for eight months with antifungals and she was actively followed by the infectious infectious disease doctor. Now this is fungus, the bacterial colonization and cultures have come back positive almost on 15% of my patients where you have Qt bacteria McKinney's, that being the most common and there are other groups other plastic surgeons who have reported this likewise, where Qt bacterium that Curie means skin bacterium Akina, meaning acne for example, that may have seen it that implant and remember anything foreign body, it is very quick to pick up on what may be in the bloodstream or in the proximity of the implant any bacterial via the whole the hair folliclitis, for example, seating the implant for example, or skin flora, or maybe it was supposed to be a no touch technique when the plastic surgeon introduced the implant into the chest through the color funnel, but somehow there was contamination. So 10 to 15% of the time and I've seen this in literature. There is similar findings by other surgeons who take cultures that indeed this is what I would say is a benign finding. I use the word benign, meaning non surgical management now in my practice, I'm happy to state that I've had zero cellulitis infections, I give my patients a dose of antibiotics through their IV a one hour prior to prior to the surgery, which is according to the criteria any surgical standard of care across the US just like after any breast surgery, and then I give them antibiotics preferably Keflex for the skin FLORA, 500 milligrams, one tablet of Six or eight hours depending on their profile for seven days. And this I have seen in my practice has certainly led to what would be a zero post operative cellulitis. And so these are the the this is the breakdown of the microbiological findings and my patients,Erik Johnson:
how often do people have problems because of ruptures compared to just strictly becoming ill from the presence of the implants?Dr. Khan:
Very good question. There are patients that I have seen in my practice, who have had implants. For let me give you the example. I have a 22 year old lady, two and a half weeks into her augmentation, she started developing GI issues Fibromyalgia tingling numbness in the arms and legs, and I actually did a Facebook live with her. I saw her emergency in my clinic, and the very next week, I put her on the course schedule at day 29. I operated on her and she had not developed the capsules that day 29. And she had what was almost complete resolution of her signs and symptoms of breast implant unless this early on, just within the 29 days that she had the implants. There are patients that now fact, if you look at any study, the rate of rupture, now look at this mentor, ad, it tells you right there, the manufacturer is telling you, if you have an M augmentation, gel implants, silicone and that time zero years three, you need to have your first MRI, and then every two years there onward, you need to have an MRI to look for a silent rupture, meaning the patient's sitting around like talking, walking and routine, day to day activities. And she could have a silent rupture, meaning she is sitting on what is a ruptured, you would think the body in itself would form a thicker capsule or would be in pain, or would alert the patient that something is wrong. No, these are silent ruptures. And that's why MRI screenings are being recommended by not only mentor but FDA. Now, in fact, number two, the if you look at the studies of the silicone implants, you will see clearly they look at the number of years that the implant is in the body. And you will see after 10-12 years that rupture starts to go up significantly high and sometimes exponentially high such that if I have a patient who calls me and says I have breast implants, silicone from 1990, I will say 95% chance to 99% chance that you're likely ruptured, because they're not meant to be in the body forever, right. And so going back to there are patients were 1979 saline implants intact both, to my surprise, you would think they will be ruptured. But these are the outliers. If you go back and look at the literature that the manufacturers themselves have put forth and studies have been done, it clearly shows at the 10-12 year mark, the rate of rupture starts to go up significantly high. And the reason behind that is this silicone is sitting in the chest with a lot of repeated trauma and being incubated at 98.5 degrees plus minus temperature. And all these reactionary forces were primarily the implant is sitting below the muscle. And now it's subject to all these movements and where the implant it starts disintegrating, it starts breaking down. And now what happens is it literally disintegrates and ruptures as you see the many that occur especially after the 10 12, 15 year mark. Every side being different and every patient being different.Erik Johnson:
We've seen a lot of people developing multiple chemical sensitivity or mold hypersensitivity. How many people do you see and does the explantation address this?Dr. Khan:
So when you see mold hypersensitivity, it's hard to gauge that I have talked to a lot of patients, they say, Well, I have an active mold infection and I say to them, Well, what proof do you have? Have you had blood cultures? What is this hypersensitivity? Now, other than these three patients, I don't know, if you look at the chest itself. Now anytime you have a foreign body, be it like a hip implant or a pacemaker, for example. There's susceptibility to infection or to fungal infection. Now, if you look at the chest itself, where the implant is sitting, the chest is not the area where a fungus fungal infection is going to likely occur in the proximity of the silicon. This is not where fungus likes to grow. For example, if you have the nails, a lot of water, or let's say from the gym, you're able to easily pick up on the ball In itself has a very well equipped immune system. Fungus will not grow inside the chest in the proximity of the implant on a very common occurrence. It's a very rare a rare phenomenon. And that's why we do not I have not seen and my mentor has been practicing for 42 years, for example, he said, I've not seen mold visually, in my practice. Now, the question becomes, has he checked for mold. These three patients when I was operating, had I not sent the swabs off of the chest. Now remember, I take cultures, not from within the capsule around the implant, I take it from the chest, because ultimately I want to be if they're positive, treat the patient because the patient has to be showing the signs symptoms. Remember, if someone has a fungal infection likely will have fungimea or redness, erythema tenderness, and remember, so this is very important, we want to confirm, justify with full confidence that this is a fungal infection. Now I tell my patients, there's three checks technically that I have for patients, they have a fungal infection. Number one, I take the cultures from the fungus. If the culture comeback, they grow on a petri dish, the swab and four to six weeks later they send me a report on each and every single patient that if this is fungus, yes or not. Number two, remember the capsule in itself is removed 100% of the time, all of it and sent to the pathologist and now the pathologist, the MD doctor is looking at it under the microscope. And now looking at figuring out if there is cancer histiocytes cells multinucleated itself and I will tell you, if this doctor sees hyphae or these branch like structures underneath the microscope, which we all have seen when we were in grade six right, he will alert and say I see fungus and to date he has not reported that yet. And number three grossly if there is an active fungus I will see the black around. Now I have seen gray, dark gray or dusky appearing matter that is suggestive of fungus. And when the pathologist is looking at the capsule, he or she will be able to definitively rule out fungus because he will alert me because that's another check where he's looking for fungus on stains. For example,Erik Johnson:
While I'm thinking about Crystal Hefner, Hugh Hefner's wife who developed the case of sick building syndrome as a reaction to the Playboy Mansion, which she blamed on toxic mold, but also on her breast implants and had to go through the surgery and seems to have responded to this very well.Dr. Khan:
Sure, sure. No, absolutely. Don't get me wrong. This is very, very, I use the word it is important to rule out but at least in my practice, a direct association of fungus and implants. I don't see that every other month for example, it is a relatively rare rare. Now I will tell you I once went to and took care of a patient. He actually moved into a house there was mold inside and this gentleman he actually was living in a house and he did not know that in this new house that he had bought there was actually an active mold, a fungus infection, a fungal colonization and then he was breathing the air. And the next thing you know he ended up getting a lung infection now he has no implants. But now all of a sudden, he gets the fungal infection and it is in his blood. That's how you get the fungemia right. Now you can only imagine wherever there is foreign body, be it a hip pacemaker lat port or in this case, a silicone implant, it does not take much for the fungus to deposit around a foreign body just like a patient with a prosthetic tricuspid valve. You before any dental procedure, you have to take prophylactic antibiotics, right. So in a similar situation, if someone gets fungemia, it may seed the silicon now that has to be worked out by an infectious disease where blood cultures and other physical exam along with other blood work needs to be done to actively prove that this infection indeed did or does exist, like a blanket alveolar LandWatch, for example. And this patient was conclusive where he was literally putting out fungal mucus discharge.Erik Johnson:
The most prolific fungal infection is Candida albicans. A lot of people develop oral candidiasis when their immune system is suppressed. Do you routinely see this as people start to descend into implant illness?Dr. Khan:
Yes, yes. So very good point. I have had a patient you know Again, the someone diabetic will certainly be susceptible. So just this week alone, a patient said I have oral thrush, another patient of mine 895 cc implant I removed from this nice patient, she ended up getting a fungal infection right at the crease at the incisional crease. Now, this is where this is approximately seven weeks after the fact. Now this might be just because of she's wearing the bra, the binder for hygiene. But remember, if you look at our culture results, and the capsules, there is no mention of any fungus there. And on my physical visual exam, the patient did extremely well. Now it certainly can happen. Just like after a pinnacle it is someone gets a superficial, topical candida infection. And you treat this with the Nystatin powder, for example. And that usually takes care of the problem. So it does indeed occur in patients postoperatively who are immunocompromised or who are set up because they may be diabetics or because of their their predisposition to forming these infections.Alicia Swamy:
Thank you for that we're, you know, we were talking earlier. Erik, and I'm you know, we're trying to think about like, when When did all this start? You know, when did breast implants? When did it become popular? And so we were talking about Carol Dota in San Francisco in the 1960s. And that's kind of the person who made it just trendy. And, you know, whatever. I guess people were loving it at that point in time. And we're just curious like, because from that timeline, for so many years, there were no issues with these implants. And I don't know if the materials are still the same, or if they changed or whatever formulation, depending on what decade it was. But all of a sudden, it seemed like in the 90s people were having problems with these with these implants and getting sick from it. And I just would I wanted to gauge your history and your knowledge in this in this arena.Dr. Khan:
Sure. Good question. Now, I will tell you that the problem with implants, be it saline. Now let's talk about saline implants. Saline implants, the vast majority, if you hold a saline implant in your hand, the vast majority of what you see on the inside is saline you can give to a newborn, the outer shell is silicone, right? You would imagine look at the 99 ban. Right. And this is the irony of the whole situation. And very intriguing part, they banned silicone implant. So 1992 Onward. If anyone says I have had an augmentation, I always tell them you have saline it's like how did you know I said because the silicone was banned under experimental reasons that allowed for silicone. Now, the look at the symptoms. Look what I mentioned that 15 minutes ago, patients with saline implants, they have the same set of problems that silicone implants, patients do suicidal ideation, fibromyalgia, all these other symptoms of breast implant illness. Now, what was unique about this time is now in the 60s and 70s 80s, this was no social media. No one was doing it at the 60s and 70s. At the rate that they were doing it in the 80s. The augmentation. Now all of this mountain of evidence from the 80s that occurred and the rate of rupture, led to what was a ban of silicone in 1992. Right. What you're seeing again, is this, in 2007 they reintroduced what was silicone implants again, "safe, good," gummy bear, excuse me. So in 2000, and sorry, these were the sensor lights. So in 2007, they introduced what were the silicone gummy bear safe. Now, as you will see, they have had them in for a period of time. And now you see a surge of these patients who are now starting to get rupture and the breast implant illness. And now this is purely what is purely a social media phenomenon, where now they're talking in 1970, 80. They were not truly talking was more the heumatologists and the other doctors that basically said, "Whoa, this is real. Let's go ahead and put a band there are a lot of complaints. People are really hurting." So now the patients interestingly, are the ones who are driving this if we ask any plastic surgeon in general, and this is the point I made very early on, you asked a very good question. The average plastic surgeon will tell you this is a myth, "breast implant illness is a myth, it doesn't exist." It's true. Maybe 2% vast majority of the patients actually are very happy with their decision. absolutely not true because remember I said eventually all of them will succumb to breast implant illness because their implant will rupture, or will give out the silicone toxicity and it's only a matter of time. Now, what happened in the 70s and 80s. It truly did translate to a 1992 as a ban. Now, what's interesting is right now you're seeing, look at your four groups of people. You have the manufacturers, they're actually advertising and saying they're safe. Right? You have the plastic surgeons, they're still saying, you cannot even published breast implant illness in the regular journal at a rate that they're published elsewhere, right? They're not actively, if you will, saying that implants are bad, right are highlighting many of them. Let's say for example, I have a, I'll go to 10 college students, and let's say they want to get implants, or 10 cancer patients, and all of us get on a plane and we go to the top 100 hospitals in the country, the top 100, all of them will be told you deserve implants. This is maybe this is a warning that you should be aware of. But here get him, you deserve the best. And this is good for you. No one's going to tell them don't put an implant these are dangerous. And look at all these warning signs. Have you read these? Are you really sure you want to do this, they will all 20 of them be getting implants in a heartbeat. And this is the problem and the disconnect. Going back to the four groups of people, the manufacturers are laughing themselves to the bank. The plastic surgeons likewise are being like passively accepting that these are still safe, which they're not. The FDA, unfortunately, is very passively, very softly, politically correct. Putting out these warnings that they did two years ago, right, that you saw that we talked about earlier. And then the squamous cell, do you think they're actively implementing? Look, the textured implants have been banned. They tell those patients who have textured implants to get them removed. Imagine you had textured implants, and they were they are banned right now in France and in the US. And all those ladies who have textured implants, I remove textured implants today, for example, did the FDA let them know or tell them you need to take them out? No, they told them live happily ever after there is no recall. You just be aware that textured implants are associated with BLCL. Again, this is what I read in this thing. So now what you have is a fourth group of people which are the patients, they themselves are taking the responsibility of saying oh, this is breast implant illness, I am going to go to a plastic surgeon who believes in removing the entire implant and capsule and all inflamed tissue and take the cultures and then send the capsules off and any inflamed tissue. And so I can get my health back. And it is these ladies who are talking to each other through the many Facebook's social media and now they're overriding their own plastic surgeons, their rheumatologist, their family medicine doctors, these are the doctors, the family medicine, doctors, dermatologists who have not even touched implants in their life, who are now making the decision: "Oh these are safe. This is what I read." And so the medical literature is not keeping up with it. And now you see this movement of patients who are now taking this medical decision and surgical decision in regards to explanting because they know their best friend explanted and they did well. You want to hear something unique? I had an 82 year old patient, 82 year old patient she came in she's a great great grandmother. And she's like, I have mental confusion. Now anyone who listens to the 80 year old, they're gonna say well guess what your 82.. No! she is as sound as sound can be. And unfortunately, the implants are causing her all this problems along with just the weight of the implants on her neck and back plus all the symptoms, right. And the point I'm trying to make here is there are patients from all walks of life, the young, and the cancer patients and the old and everyone in between, who unfortunately are hurting directly. Now, one thing I just want to mention here is this. What is the proof we're looking at? I want you to see on my Facebook whenever I removed for example a saline implant or a silicone implant, I touch it and there's some fluid around almost always. And if I go like this, you will see the gum sign where you see the silicone even though the implant is intact. And then what I did was I took one of my patients saline implants, she had intact saline, and I send them to Dr. Henry Dykeman. In the Netherlands, he took the saline out of these implants and he centrifuge the saline and collected what was a pellet and he showed under electron microscopy that these were indeed silicon small particles that was slowly leaching from the shell of that saline implant which was made up of silicone and this is what is going into the saline and certainly what's going in to the rest of the body. We know from Dr. Atul Mehta, who is Cleveland Clinic pulmonologist, if you go back and look again on my Facebook Live I did with him. That's another Facebook Live that you should see and everyone else, you will see a publication where he has a patient with intact saline implants. And she had a lung biopsy that showed silicone in her lungs. And clearly, Dr. Mehta proves in his paper. And it is a publication through a collaboration with Southwestern Medical Center and Dallas, two major hospital systems of the United States where the silicone under electron microscopy, and energy dispersive X ray is clearly showing that this silicone within the lung tissue itself has come from the saline implant, clearly proven and patient has resolution of the symptoms a year out, given the explantation she had. And again, consistent with that line that says patients have basically complete resolution quote, unquote, of symptoms when the implants are removed. And this is again. Now sometimes I look back at all what I just said, and I laugh and I say, are you serious? Do I have to prove? Do I have to show all of this to someone to say that breast implant illness exists? No, it is right there. It is right before us. And history is indeed repeating itself.Alicia Swamy:
I did have two more questions. It sounds like that insert that you had read to us that that's a new addition to the recommendations. Is that true? Or I'm just trying to makeDr. Khan:
that is that is more or less a translation of what the recommendations were. So yeah, so basically, if you look at, you know, if you go in, and I want my listeners and viewers to do this, go to Google, and type in FDA warning, recommendation, breast implant illness, and you will see clearly those three points and I'm gonna highlight them again, if you want, I can pull it up on my cell phone, but you can do it all yourself. Number one, it says FDA is clearly says implants are not lifelong devices the last 10 to 15 years in the body some sooner. Number two breast implants are associated with breast implant, breast implant associated anaplastic large cell lymphoma, people have died from it. And number three, that breast implant illness exists brain fog fatigue, dermatological problems, autoimmune issues, and that if you have these symptoms, seek consultation from a board certified plastic surgeon. These are the three points and I paraphrase them directly highlighted by the FDA and I want each and every single listener to fact check whatever I said you have these publications, these are hard copies. This is not opinions, these are facts, which remain undisputed. This is what has been reported by the FDA. So this is not this is very similar to what the FDA pointed out in October of 2020.Alicia Swamy:
Wow. So this this wasn't a standard since the beginning of the invention of breast implants. This is like a new new newDr. Khan:
absolutely, absolutely.Alicia Swamy:
So so I feel like they've they've been seeing this progress and not till this has become explosive and affecting so many people now they're saying, Okay, now there's a warning. Now this is causing these problems. Now, this is an issue. This is insane,Dr. Khan:
Right, absolutely. I will tell you, so I myself. So in September of this year to 2022, the FDA itself put forth another warning and said, medical community, please be aware that breast implants are associated with squamous cell cancer. Now, this is very interesting squamous cell cancer. I called the FDA myself, and I talked to them, Dr. Cornelissen. She is an MD PhD OBGYN doctor, because I asked her, you know, if you're a plastic surgeon or not, and then Dr. Bashar is the one who is the head Who's the one who published that, but as on behalf of the FDA, and there's a whole committee that sits together and puts forward these recommendations. And she's a general surgeon, not a plastic surgeon. And I asked him, it's amusing to me, and I exactly put it like that. It was a 26 minute conversation I had with Dr. Cornelissen. And I said here you're worried about these 16 patients. Now it's important to mention 16 patients with squamous cell cancer and they wanted to alert and say you know what, if they're 16 There's probably a whole lot more. And I said here you're worried about 16 Patients are you not aware that millions of these patients with breast implant illness, are hurting suffering, you know, with all these other problems, do you not want to put an end to the implants or put them on hold till you figure this out? And she said, Well, we have not received complaints. Now I want you to do this. If you want, I will show to you, the FDA has had 350,000 complaints. Now, I'm going to put you on hold here for a second. If you don't mind, please bear with me, because this is part of this. So this is, you know, I have my other phone. So I just want to show you this. So you basically can see this. And again, I want the patients to do their own look, and workup. And this is again, all present on my Facebook page that I recommend that each one of you. So this isAlicia Swamy:
see if we can see it. Yep. We really love your passion. Dr. Khan, I wish there were more doctors that were as ethical as you are.Dr. Khan:
Just one second as you bear with me. So since 2009, all right. So the US FDA administration has received more 000 complaints. So you can only imagine how many more there are than 350,000 incident reports involving breast implants, comma, according to a chart shared by the agency. And here I am, you're going to see this the title here is FDA kept hundreds of 1000s of breast implant incidents hidden from public, and how many are there 350,000 incident reports. I'm not making this up. Now, this is where you would use that is insane. And I say it's actually amusing that here your mountain of evidence, versus you have all these patients. And if you all one needs to do is just listen to the patients, and you will get all the answers because they're telling you, you just go to my Facebook page, or you just come to my clinic. And you will hear the patients that will speak to you in the masses. And they will tell you that they're hurting not only them, their significant others, their sons and daughters, their neighbors, their students, or whoever they might be. And I will say to you, and to everyone else who's listening, what is it going to take to put a ban on the implants? Right? I mean, what else are you looking for, and I use this example that I use previously, you know, I have a note nine, right here, I had a Note Seven, it would catch on fire, it would literally Samsung, it would blow up. And so you were not allowed on a plane with these, they would actually announce if you have a Samsung phone Note Seven you cannot take because it was a not only in the United States. But all over the world, you had risk. And there was only a few fires. And that was enough to put a ban on these cell phones, you have these millions of 1.8 million people on Earth in 2017, for example, that got patients. Now there's only 350, augmented, it's a lot of people and multiply those over the years you have so many people who are hurting, and all of Europe, all of South America, all of the North America is in denial, and including the Middle East, that breast implant illness exist. And we have all these patients literally hurting on a day to day basis. And you know, what's ironic is when I asked these patients, what percent chance do you think you have breast implant and unless you know how many times I hear the word 100%. So this is this is the disconnect. And this is what you know, I will tell you if you can reach another patient who is not going to get augmented because of this podcast, or the zoom call, or another patient who finds out and says oh, okay, this is the reason why you know what that is? What I would say is a successful podcast because we've prevented one more patient from being hurt. And it is a very interesting time of a hurt. There is no lab diagnosis. There is no imaging diagnosis. It is a diagnosis of exclusion, where if a patient comes to me, I tell them, Go to your doctor, get the rheumatological workup, get your basic blood workup. If all of that is negative, more and more fingers are going to be pointing towards what is breast implant illness. And implants only hurt the body no one comes to my clinic and says or the implants are making me more energetic or I can run farther I can concentrate better if anything, the opposite implants are only associated with badness and they have no place in our society. We have no role in a woman and they have no role in basically hurting the patient and causing harm. Now, let me just mention one other thing. Why are breast implants bad? Again, I will basically outline them number one, they're associated with breast implant illness, the many signs say Symptoms, they're associated with lymphoma squamous cell cancer, they're associated with infection, they're associated with capsular contracture they're associated with rupture, sign and rupture. They're associated with a lack of a good physical exam where you're not going to be able to palpate and feel a small mass because it was cancer was undiagnosed, which is the most common way of picking up on a breast cancer is by itself monthly breast exam, are these patients choosing not to get a mammogram because the last time they got a mammogram they had their implant caught crushed against the machine, for example, right. Number Number, the next thing you have patience with the asymmetry, how many patients do you have patients that have literally implants that need to be replaced every so often, where they have pain as a result of the implant and sitting next to the proximity of a nerve, and you have lots of sensation, change of sensation of the chest and the breast. And you have over time the implants only bottom out and cause what is skin rashes amongst others in the proximity of the nipple area complex with distortion of the chest wall, for example. And again, the other thing last but not least, if you can imagine the pectoralis muscles on the chest and insert into the upper arm, the humerus, now the implant is sitting below the muscle investment during the cases where the surgeon is put in. And now what is happening is the muscle is compromised. And so now the upper extremity pectoralis function is compromised. And now the patient is not able to weightlifter exercise, because every time she does the implant bounces up and down just like an a male bodybuilder, right. And so that's why the female bodybuilders they get the implants above. So you have a compromise a mechanical compromise of movement of the arm as a result, because every time the patient uses the upper arm, it's going to press against the implant and the patient feels awkward. So small activities like holding a grandchild, for example, is can be bothersome. Plus just the mechanical effect of having the implant on the chest heavy objects with the neck and back pain. So again, look that evidence is massive. There is anyone who's listened to this should not even think about augmentingAlicia Swamy:
thank you so much Dr. Kahn, I really appreciate your passion, your honesty, and really being an advocate for these people who are falling ill. And it's just astounding to me that you know, out of 8000 surgeons that you're kind of the only one really speaking out about this, like you're a lone warrior here. And I do appreciate that because, you know, so many doctors and so many levels, and I feel like breast implant illness is kind of parallel with what we deal with mold illness. You know, so many doctors just pretend like it's not a thing and oh, you know, nothing's going on CDC and everyone's like, oh just causes an allergy and this but we're seeing an explosion of issues. So we really do appreciate your presence on our show, and agreeing to come on and talk about this. Kealy Severson is passionate and committed to exposing the truth about toxic mold and its effects on the human body. Many mold injured people are often misdiagnosed with autoimmune conditions, nerve damage, mental illnesses and other chronic health conditions. Due to the lack of knowledge about water damage and toxic mold growing in their homes. The crippling effects of toxic mold on the body has destroyed many lives. Been there done that when she became a health care provider specializing in acupuncture and herbal medicine. It was only then that she truly began to understand the connection between her health and the environment that she was living in. Three years after becoming a licensed care provider. She became incredibly ill. She was suffering from kidney failure, reoccurring UTIs and various negative mental health symptoms. When she learned that her family had been dwelling with mold trapped under her kitchen floor the relationship between the toxic mold factor and her health finally began to make sense. It became part of her life's mission to help educate society on the extreme effects that mold can have on the body. Her work is vital because there exists a lack of experience and acknowledgement from mainstream medical practitioners and even mold experts. She has firsthand experience dealing with mold exposure and she makes sure to address all the signs and symptoms during every environmental screen that she performs. She's developed a line of organic herbal tinctures and formulas to help most patients reduce symptoms commonly associated with toxic mold exposures. These symptoms vary and can manifest themselves very differently from person to person. Her herbal education and experience has helped her increase awareness and recognize signs in patients that may result from their toxic environments. Kaylee's dedication to learning and understanding the effects of Toxic mold and educating and bringing awareness to her patients and other providers keep her motivated. She knows just how devastating the untreated consequences can be on your health and the health of your families, relationships and life outcomes. If you or someone you know may be affected by toxic mold exposure, rest assured that you and Kealyy will work together to find a solution. By working together to treat the symptoms and stay educated on toxic mold exposures, we can reduce the impact of this devastating phenomenon to consult with Keeley please visit exposing mold.com/consultations That's exposing mold.com/c o n s u l t a t i o n s book your appointment today.Dr. Khan:
I just want to mention two things just to kind of complete and finalize. You know, they're all my patients have said two things after explantation. Number one, they wish they had never augmented number one, and I tell them it's not your fault, because the system told you that they're safe. And number two, they wish they had explanted it sooner, such that they would have gotten their life back and they would have had their meaningful lives return. I will tell you, and I say this very humbly, from a financial perspective, you know, whenever augmentation I said earlier takes one hour, on average. So it is not uncommon for plastic surgeons to do four to six, up to eight in a day that I've seen one of my friends that ate between two operating rooms. Now, it takes me four hours to explant. Let today I was supposed to do this interview with you at four o'clock with a two hour buffer, right. And I ran into my case, and I finished two cases alone at 4pm. And I was here at 615 in the morning. And the point I'm trying to make here is I had a 750 cc implant on the nice lady that came all the way from out of state and another patient with textured implants. And she was very, very much hurting. Now, the surgery is a very serious surgery, the surgeon has to be fixated that the entire implant capsule plus all inflamed tissue must be removed and the capsule must must must be sent. Because if you're not sending the capsule, you cannot look at the capsule and see if there is cancer or not. If there is mold or not, we have to rule it out such that we know with certainty that it was not this. It was not cancer, it was not mold, right. And so that is very, very, very important. And I wish hopefully with these talks, and hopefully, you know, ultimately it is my firm belief, no plastic surgeon or the plastic surgeon community is now going to say okay, we're going to stop augmenting, and we're going to only explant. And we're going to do this right? Look, they're already calling this a myth. There are surgeons and you know, I've gotten a lot of, quote, negative feedback from the community. And you know what, I will say this to them, and to anyone who's listening, you know, I say don't listen to me, listen to my patients. I'm helping them I'm benefiting them. One of my friends who's a very good friend, it was a well wisher, he called me up and he said can't what you're doing is pretty dangerous. I said, Tell me because what you're saying is very concerning to me. He said, you're talking about removal of implants, you have this following on Facebook and you know, on social media. And I said, all what I'm doing is removing the implant and removing the capsule. And I'm taking cultures. And I'm doing it in a very safe manner where 99% of my practices are removal of implants and I'm ensuring removal of complete capsule. If someone has BIA LCL what is the requirement, if it is not removed, it is malpractice. The requirement is to remove all of the capsule, you don't want to send off half of the capsule, there's actually I was reviewing a case where part of the capsule was sent and it came back as a BILCL. And now that patient has to go back and remove the rest of the capsule and remember this is where we know clearly those patients who have had just the implants removed, they have had to go back for a second surgery to remove the residual capsule because if that capsule is not removed, the patient is not getting better and healthy and freedom from the breast implant illness. And so that is the most important part of the surgeon has to believe that breast implant illness is real and the capsule and implant plus all inflamed tissue. And I will tell you if a surgeon is augmenting he cannot be believing in breast implant illness because why would you knowingly put it in implants and be also taking them out because you're only ultimately going to be hurting like that 22 year old patient who had age 29 had to get her explant. No, I thank you very much. I tell my patients do your homework Sometimes just talking to a surgeon listening to a podcast like this should give you enough mountain of evidence and I say to each one of my listeners and viewers, go to my Facebook page, look up Dr. Atul Mehta, MD HTA. From the Cleveland Clinic, his publication, Dr. Henry Dykeman. This in itself is the proof the manufacturer, this is the company that makes the implants that's telling you the bad detrimental effects of the implants, get into a discussion school on a listening tour, listen to the patients and when you listen to the patient, you will be convinced without a doubt, the implants are bad, and they need to be taken out in a very defined sophisticated way such that when the surgery is done, you have full confidence that your surgeon did the right surgery. And this is what I see that the patient should have the peace of mind that the surgery was done right. You don't want to be postoperatively thinking if something was left behind or not because you don't want to be second guessing your surgeon or yourself. So please go to executive plastic surgery. My name is Dr. Shara Khan, k h a n and you will only find me is far as explant surgeon and I recommend my patients to go seek other plastic surgeons sometimes when if the the irony of the situation is if you go to 10 Different Explant surgeons, you're gonna get 10 different answers. And sometimes within their own practices. Some surgeons choose to do the more sick patients in a different quick way, versus the young, healthier ones. So for example, nine days ago, I did a patient at the hospital, she had stents in her heart and open heart just validating how they feel and just letting them know this surgery in the same manner that I do my 25 year old patient. And so all patients deserve the best. So go to my YouTube channel, my Facebook, and my Facebook Lives that I have done such that you can be an informed patient and a better patient and your significant other and your family can certainly listen in as well so that they're well aware as to what you're going through because people say you're stressed out or crazy. Are you making this up? No. It is a real problem. Just like the is a real thing. And here's the proof. So thanks again, Dr. Kahn 82 year old lady came. She came in because she had a defined problem. and to all of our listeners. We appreciate you and we hope you have a wonderful day. Thank you very much. It was a pleasure to be on and thank you very much for yourUnknown: