Exploring the Intersection of Oral Health and Chronic Illness with Dr. Mark Su

Do you ever wonder why some people struggle to recover from chronic illnesses while others seem to bounce back quickly? In Dr. Carver's fascinating conversation with Dr. Mark Su, a board-certified family physician and founder of a functional medicine practice, we delve into the world of root cause medicine and the importance of teamwork in the healing process.

Together, we explore the complex root causes of fibromyalgia, chronic illness, and gastrointestinal issues, discussing the various lab tests available to help diagnose and treat these conditions.

Dr. Su shares his insights on how addressing the underlying causes of inflammation can help manage or even reverse high blood pressure and other common diseases. We also examine the critical role of oral health in diagnosing and treating certain conditions, revealing how it can be both a cause and a reflection of what’s going on in the body.

So, join Dr. Carver today as she uncovers the power of collaboration between physicians and patients and the need for patients to take personal responsibility in their own healing journey. Raising awareness and working with like-minded health professionals can help patients get better faster and improve their overall wellness.

Don't miss this groundbreaking episode with Dr. Mark Su!

To get more information about Dr. Su's virtual practice, go to:  www.functionalmedicineconsultinggroup.com

Or reach out to Dr. Su directly via email: drmarksu@gmail.com 

To learn more about holistic dentistry and find a biologic dentist located near you, check out Dr. Carver's patient education page:

http://carverfamilydentistry.com/patient-education-library/

To contact Dr. Carver directly, email her at drcarver@carverfamilydentistry.com

Want to talk with someone at Dr. Carver's office? Call her practice: 413-663-7372

Disclaimer: This podcast is for educational purposes only. Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. Before using any products mentioned or attempting methods discussed, please speak with a licensed healthcare provider. This podcast disclaims responsibility from any possible adverse reactions associated with products or methods discussed. Opinions from guests are their own, and this podcast does not condone or endorse opinions made by guests. We do not provide guarantees about the guests' qualifications or credibility. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Dr. Carver : 0:00

Hello everybody and welcome back to the podcast, The Root of the Matter, with me, Dr Rachel Carver, as your host. In this podcast, we like to highlight the connection between oral disease and diseases occurring in the rest of the body. I'm very excited today to have Dr Mark Sue with us to talk about well, I think, like the most common medical chronic diseases, maybe we see and really what's at the root cause of this, because both Dr Mark and I are really interested in bringing awareness to the public about root cause medicine so that we can actually get answers instead of just treating symptoms. So, as a way of introduction, Dr Mark Sue is a board certified family physician. He's been practicing for 20 years now same as me happy 20 years And also, like me, 2014,. He founded a personal care physicians as a functional medicine practice. So that's kind of when I started going to the more biologic side of dentistry and really again trying to get at that root cause of oral disease. His practice is located north of Boston And in 2021, he has created a virtual consulting practice We'll talk a little bit more about at the end so people know how to contact you. He is the president for the International Society for Environmental Acquired Illness and is a member of a bunch of other organizations as well, And Mark's mission is to increase root cause medicine to help more patients get better faster, and also by collaborating with like-minded health professionals, And I think this is really important.

Dr. Carver : 1:30

We talk about raising children and it takes a village. It's the same thing with your wellness. There are so many of us who are experienced and have expertise maybe in one area or another, but no one can know everything right As much as we try and I certainly have in my area because there aren't a lot of other functional practitioners in my area but that just gets exhausting and it's hard. And I think certainly what I've learned right is that even though we are the doctors per se and we may have all these letters after our name and experience, we aren't here to make people well. We are here, right, for support, but really the person is going to heal themselves And I think that's a really important If I have somebody coming to me and they expect me to make them better. I know it's going to be a challenging road, right, Because we all have to kind of take some personal responsibility, but we need support because we don't know everything that's helpful. So I like to consider that you really need to have a team. What would you say to that?

Dr. Su: 2:31

Yeah, a couple things. I mean yeah, thanks for, yeah, thanks for the opportunity to join you on this project and on this podcast. Yeah, i think back to, i mean concisely, when people, when I went, when I was, when people asked me, when did you decide you wanted to go into medicine? I was really pretty sheltering and not very life experience going into college. I just didn't know what I was, didn't have any directions, with a life kind of a life fork in the road moment.

Dr. Su: 2:56

Sophomore year of college, i realized, yeah, i need to do something that's people service oriented, not be stuck like in a lab. For example, my dad was actually, interestingly, a drug researcher for Eli Lilly And I just figured, i'll just do what he does, because I don't. I don't know what I'm going to do And but you know, since I was already in science and pre-med, whatever I had the option to thankfully got into medical school, et cetera. But when I went to medical school and it was about okay, well, what direction do you want to go in medicine? Quite honestly, i could have been a way better student. I could have paid attention to medical school much better than I did, because in the end, that was just a, it was just a road to an, it was just a means to an end for me. And the end was not about medicine, it wasn't about the specialty or the science. It was actually all about relationship. It was always it was very clear to me.

Dr. Su: 3:47

The purpose of going into medical school was to serve people in a professional relationship, and longitudinally. So the goal was like I don't want to be segmented to people by gender, age, health specialty, pulmonology or kidney disease or whatever the case may be. It was about the people. So of course it's going to be primary care And in the Midwest it's easy to be in family medicine, where it's pretty common. It would have been harder to, maybe it'd been harder to pick family medicine to the East Coast, but I don't know if it would change things for me.

Dr. Su: 4:19

But in any case, yeah, so I'm with you. It's about relationship and ultimately being somebody's professional guide, if you more or less. But the it's a guide, it's not. It's not a one way street and it's not that we're carrying the load that the it's a relationship The person on the other side of the equation has should have as much or more investment in the process and being equally engaged. So that matters, of course. And then you're right, we can't not only can we not be the one stop shopper carry the, carry the load. I mean, if we want to talk about burnout, that's, that's more than real, and during the pandemic I got statistics right next to me. It's daunting totally daunting.

Dr. Su: 4:57

What happened in last year year and a half Burnouts totally real. And I would say it's equally real in the non-conventional world the integrated medicine space, the functional foundational medicine space, just in a dip for different reasons. So yeah, the whole village team thing. Yeah, for real, legit.

Dr. Carver : 5:14

So when you 2014, so you had a few years of practice before that what, what tell us your story about how you got more into this root cause and kind of veered a little bit away from conventional practice?

Dr. Su: 5:26

Yeah, you know, i mean, I think it's a simple story of just, i take no credit for it, i'm just, i'm just wired to. I'm just wired to want to know why. I'm just, i'm just inquisitive. I don't think I recognize that about myself, but I'm just inquisitive. And so I was in my first practice from 2003, 2006,. I just always think back to.

Dr. Su: 5:42

There were folks who they usually had a diagnosis of fibromyalgia and recurrent. There were a number of times that they said to me so I know you're telling me that I have this, i have this virus infection, whatever, and it's mostly gone, et cetera. But I just got to tell you, like in the past, when I've had somebody give me antibiotics, all these aches and pains I had after my virus infection would feel better, but only if I took antibiotics. And I know it doesn't help with virus infection. But could you please give me antibiotics? And my thought was what? someone's trying to scam me of antibiotics Like that doesn't make any sense. This is am I not going to believe this person? Am I going to think that they're making it up, that it's all in the brain and the mind or whatever, i don't know. But if it feels better to that if they feel better I got at least consider it, and I don't see an ulterior motive here. They're not going to go and sell antibiotics on the street. They're not asking me for percocet. So this happened often enough, and a number of these people had some kind of either unofficial or official diagnosis of chronic Lyme which I'd never learned about. And so I was like what's that about? So 2006, i'm in another practice, and just by the name of that practice it just drew more people who were less conventional minded. I just gave me a chance to kind of explore and learn more about that stuff.

Dr. Su: 6:58

And then somewhere in 2000, maybe eight or nine, i attended some weekend conference in Boston from a lab a functional medicine lab at the time, it was Metametrics that eventually sold to Genova And it was just man, the speakers there, the presenters were just top notch. I was just, i was so in awe and respectful of them Todd Lapine, who's at Ultraman Center with Mark Hyman's office, karefus Gerald, who a lot of people know as a naturopath well, and then it was the daughter of the Metametrics founders and owners at the time, who's a PhD In any case, they were just so professional and respectful And I just was like, wow, this eye open, right. So anyway, i just, i just kept asking questions about why, why, why, what's behind it? It really is the equivalent of what's the root cause of whatever else And it just, it just led to the road of from that conference became Institute of Functional Medicine, went to their week long intro course and then did a few of their modules.

Dr. Su: 7:51

And then there was a nurse practitioner at our office who works in our office at this point. That previous office closed. She introduced me to iLADS for the Lyme disease story And that was another huge eye opener. And then it just, each door you open, it just opened four doors And all of a sudden you're down a road and you're like what happened? What did I? I can't believe all this I didn't know about. And then it just becomes, as I said a lot of colleagues, like now it's a hamster wheel, you just can't get off, but once you've cracked the screen there's no going back.

Dr. Carver : 8:20

That's very true. I remember I once had a friend who told me I'm done learning. I never, i don't want to learn anything new ever again. And I think my jaw was on the floor. So I was like what I'm like? I just live for learning more. I'm the same thing, you know, and most of us who are in this space are curious why, why, why? why I must read three, four books a week? I'm just so curious, and not only for my own healing, but I want to take what I've learned to be able to share, because I feel that purpose too, that I'm here for something bigger.

Dr. Carver : 8:48

I love what you said about your patients. I'm always telling mine this is a partnership. There are a lot of times somebody will come into me and their tooth is hurting and I can't find any clinical or radiographic evidence. So I often say to them what do you think as well? Right, because a person knows their body better than we do, and so you need to have that conversation. And, and it's important, how many times, right, have you had a patient come to you and say, well, i've been to a million doctors or nobody listens to me and they just, they just push you off. So I'm like you, always thinking, well, there's something, like I don't see something. But you know, i believe that they feel this pain And maybe it's emotional, maybe it's trauma related, but there's something And I think it's really important.

Dr. Carver : 9:28

I was telling my consult this morning never go against your intuition, right. If you feel like something's wrong, if something is not resonating with you, trust your instinct. So you talked about fibromyalgia, which is not something that I thought maybe we talked about, but I think it's so important because how many, like you said, so many people get this diagnosis And it's kind of the catch all, for we're not really sure what's wrong with you, right? So you just that chronic fatigue, very similar thing. So what we know as we've been studying all of this, this root core medicine, dr Mark and I met at Cell Core, right? Did we meet then?

Dr. Su: 10:05

Yeah.

Dr. Carver : 10:05

Yes. So, and those of you have been following that I love this this company, cell Core, and they're really based in teaching this functional type of medicine, which is really comes down to toxins and infections. Right, so you could be diagnosed. I mean, i don't really care anymore what people's diagnosis are. Let's try to figure out what these toxins and infections are that are creating this immune system dysfunction. So tell us a little bit more about fibromyalgia and what might be the root of that. I know it's a very long story We could talk for 10 hours about it but in general, yeah, not 10 hours, but I think I'm trying to.

Dr. Su: 10:44

I'm thinking like this could go down one of two roads, but well, i think, i think, maybe categorically I'll just yeah, i love, i love using fibromyalgia as an example because, as you said, it's a, it's a conventional diagnosis. At this point, right, i mean from from, and I remember in in residency at at Tufts in 2002, 2003,. If you use the term fibromyalgia then you're getting some crooked eyes from people or stink eyes from people who are more academic. That's not a real thing. But we know how it is in conventional medicine and it's not a, not a jab, It's just the nature of the beast that terms, thoughts, concepts, whatever. They take time to sort of gain enough credibility, traction and then acceptance and adoption of the terms or whatever. It is right. So no one really questions that at this point. It's got an ICD code attached to it for billing purposes and everything. But you're right, anything that's got a.

Dr. Su: 11:36

You know, i say to patients all the time, if you, if you have a, if you're reading about or you've been labeled with a term that has the words syndrome in it or, if you like, hypertension, if you look at officially in ICD coding, insurance submission coding. The word is essential hypertension. Okay, anything with the word essential idiopathic or syndrome. It just means we don't know what causes it. Right, it's a syndrome, is just a collection of symptoms, and so a lot of people might just say, oh, you got some weird auto immunity thing. We don't know what it is. It's an autoimmune.

Dr. Su: 12:08

I mean, we could put that in the bucket of fibromyalgia, more or less loosely. So I love using it because it's something a lot of people are familiar with by name. They know somebody. If they're not diagnosed with it think hopefully not They know somebody who's had it, they've heard of it somewhere, et cetera, et cetera. So when you ask, if we were to talk about, well, what's root cause of fibromyalgia there isn't, i would. I would submit that there's no singular answer It's a, it's a collection Different for everyone.

Dr. Su: 12:33

Right, yeah, yeah, absolutely. But I think that that's where it opens up for me into a bigger conversation, that we won't get trapped in that rabbit hole unnecessarily. You may not want to, so we can just talk about let's extend on your topic about bugs and toxins, right? So I've mentioned this a couple of times, at least within the cell core community that for me, professionally, when I go through conferences, the types that I go through, like at the end of a weekend, at least five or six out of the whatever 15 or so presenters or more are are trying to persuade me. I feel like that, hey, for your chronic complex patients or your sick patients, that mystery diagnosis patients, the reason they're sick is because you haven't looked at this condition that I'm presenting on today And that's the big magic one that you haven't yet, you haven't seen, and that's your, that's your new trick, right? But look, it's not the case with everybody. And all six of those presenters are right, and I'm not poking jabs, i'm just saying I don't know how to come out a weekend with some summary for myself to apply, coming into the office on day one on Monday, right? So somewhere along the way in my what I called my search for sanity, i'd come up, i'd come across a paper in multiple papers in research publications to do with cell aging. So it's like anti aging medicine but it's on a cellular level, and I just use that model and extrapolated that into more of a macro level, clinical, patient level, all right. So, and the idea was, hey, this term is inflaming, aging due to chronic inflammation. It's called inflaming and the definition more or less is chronic, low grade, sterile inflammation. And I just upgraded related to that to say chronic, high grade, active instead of sterile, like it's actually symptomatic inflammation. And they break that into three categories And they called itself non self and quasi self. And I just said, hey, well, let's keep those like self, non self And instead of quasi self, i just I call it the interfaces, the regulations between the self and non self, and largely we're talking about the gut, all right, so we can easily get into that topic, right? Yeah, so when you say bugs and toxins, that's the non self, all right. Self is like neurotransmitters, hormones, immune system, genetics, even auto immunity, because that's self attacking self not a good way but itself. And so anything I read about, hear about a conference test for it should fall into one of these three categories more or less.

Dr. Su: 15:00

The bugs and toxins is the non self, or in my wife's research world they call it the expose home. We don't use that as much in the clinical world, but we've heard that sometimes at Socor, the knowledge and study of everything that we're exposed to. Right, bugs and toxins, they don't come from us, they don't belong to us. And then the third category is we're always in constant exposure, whether internally in our gut or mouth right, big time mouth side scabies, all that stuff or externally to us, because everyone's thinking. I'm automatically thinking what am I eating, drinking, breathing, in touch with blah, blah, blah, et cetera? But hey, the average person's got more bacteria that don't belong to us in the colon alone, then all the stars in the Milky Way, so we have a galaxy gut. You better hope you can regulate that internally pretty well, right, and they're not all bad. A lot of them are friendlies. But there's these three categories. So when you say bugs and toxins, absolutely So.

Dr. Su: 15:55

If we go back to fibromyalgia, what's the root cause? Hey, everyone's different. What's that person's bug and toxin profile? How's their immune system? specifically under the self, the immune system to me is like the key to everything. In. So far we talk about the mitochondria. To me they're kind of synonymous. It's just cellular level mitochondria or more macro level immune system. But ultimately, can you regulate, can you well regulate the bug and toxin versus self? ultimately, how much stuff is taxing and attacking and burdening, or potentially burdening, your immune system? And if you do not have healthy toll boosts in the highway, you do not have a functioning bouncer at the club, you do not have a well-functioning TSA at the airport, you're not regulating that constant interaction, well, we're in trouble, right? so that's, that's how I think through, not just for our knowledge about anything. What's it? the root cause? Well, it's a matter of how. How expansive of a look am I going to go with these three categories?

Dr. Carver : 16:55

Right, and so obviously you take a very detailed history for a person comes in. Would you say there's in general, obviously every person is individualized, but are there certain tests that you like to run to try to look for these external factors that may be impacting the immune system that you commonly would get?

Dr. Su: 17:14

Yeah, sure. So, yeah, you probably don't know it, but you're touching on one of our three principles in, especially in the virtual practice but we've adopted in our office practice. Well, it's a little different because our office practice is part primary care, part consulting, etc. But one of the practices is look, you've seen these stories too. We haven't. I don't know if we've talked about this that much, but the sicker the person is, the more likely they've had this story or, unfortunately, will have the story where they see one practitioner there who, look, we're all human right.

Dr. Su: 17:46

So, practitioners, it's hard to juggle a lot of topics. It's hard to be like, we just said, the jack-of-all-trades, the one-stop shop. Is that even possible? So it's not uncommon that as practitioners we kind of funnel into one, two, maybe three topics that are kind of more our wheelhouses, right, and the likelihood is you come across enough of these similar kind of sick people with a variety of symptoms but who are chronically ill. You're gonna find those problems in the far majority, if not maybe all these patients, right, adrenal fatigue, gut health issues, nutrition issues, like we're gonna find that in most everybody. But the key question is in my mind, how big of a top dog problem are those issues that that practitioner or I am honing in on. Okay, and so the sicker the patient, the more likely they're gonna have an experience past, present or future of they see one practitioner, they're identifying two or three topics, let's say maybe even just one, but one to three topics. They're working on those things for a number of months, maybe a year, year and a half, whatever. Then they're better, but not better enough. They move on to another practitioner. They go through the same thing, maybe it's a different set of one, two, three topics, and then the cycle repeats over and over. And some of us as practitioners, we see these patients who they come to us with a stack, boatload of labs and all that right, but it's compiled over years with multiple practitioners.

Dr. Su: 19:09

So one of our, one of our premises and this is not this isn't meant to be like a self-emotional thing, but it's just is one of our principles is let's not draw this out and waste your missed opportunities, quality of life. For the next number of months or years, we're gonna take as wide of an expansive look as you're willing to allow us to help you do right now. It's gonna take more effort to get that testing done. You're gonna wonder how the heck you drew that many tubes of blood at one time. It's gonna take a little effort and it might even be a little more cost, but we're gonna put together what we call your, your personal health map now instead of piecing it together in the next three or four years over labs drawn out over three or four years, plus all the extra costs of all those visits and the wasted quality of life, right?

Dr. Su: 19:58

So when you say, what kind of labs do you look at? So again we straddle the conventional and less conventional world. So we do a lot of testing through conventional labs, lab core, quest, etc. A big topic for me is the immune system so we can look at antibody levels, the lymphocytes, both the T and the B lymphocytes, the natural killer cells, all that stuff. That's all available lab core and lab core and quest. There's a lot of stuff. We very regularly look at mass cell topics. That's a really high yield topic to address and I haven't mind that. We should be sure we chat about that a little bit more with the cell core.

Dr. Carver : 20:30

We'll have to have a part too.

Dr. Su: 20:31

The whole thing is a thing that we can bring to cell core a little bit more. That's a three or four labs. Again, lab core quest Yeah, we can do all that right. A lot of false negatives, but nonetheless we should at least look The other conventional labs I won't go into right Whether it's auto-immunity screen, adrenal hormones, thyroid, all that stuff. We can do all that stuff conventionally, non-conventionally, quote-unquote, common sort of template default labs for us tick-borne illness for sure, mycotoxin testing for sure, and some kind of gut health testing. We tend to use GIFX. I know a lot of people use GIMAP, biome FX by microbiome labs out there. I haven't heard a lot of practitioners using that yet, but there's options out there. Then we often will do a SIBO breath test as well, which is usually insurance covered as well. That's the large basis. I love a lot of Cyrix labs as well. It depends on how far the patient's willing to go.

Dr. Carver : 21:26

Right, maybe what they're learning. Yeah, i mean my big ones that I often help when my patients with their or even my own family, like once a year, i'm always running a talk screen. I've got teenage daughters now who are into the perfume and the makeup and all the body care products now, so I'll run that, or an organic acid test. I kind of like to see the metabolites because and so those are kind of the two that I like to do, but I'm not an MD. Right Again, those are some of the things I do for my family.

Dr. Su: 21:55

I'll validate that. We've done a lot of them. Oats, the organic acid testing We've done a lot of that. Some of these decisions I won't for the sake of just objectivity here I won't name like which labs per se The gut one I just did because there's only a few that do it. But a lot of labs are organic acid testing. And which line tests are we doing?

Dr. Su: 22:10

I purposely am not naming labs here, just to be effective, because it's quite honestly our goal is to favor the patient. Case in point most practitioners. They don't like Medicare because it doesn't reimburse. Right. I love Medicare man. Oh my god, let's go to town with a Medicare patient with testing because we can get $3,500 of the gold.

Dr. Su: 22:32

What clinicians consider gold standard lab lime testing through that particular lab. $3,500 worth of Medicare patient pays zero. We can do the SIBO testing definitely for free. We can do the gut health testing for free through at least one lab I know about, if not maybe more than one. We used to be able to do this organic acid test through one particular lab but they kind of put the kibosh on that year and a half ago, unfortunately. So very familiar with organic acid tests, lots of information through there, awesome stuff. The tox testing similarly, really really like that. I haven't used that as much historically, but really it's more again like if we're being cost-conscious for patients. For me, i need to know about the mole toxin, i need to know about the lime test, the tick-borne lime topic and I need to know about gut health. So that's where the breath and stool test comes in.

Dr. Carver : 23:15

Yeah, but I love that part of it. Again, one of the reasons I'm doing this part is creating this awareness, because I feel like the way things change is when it's like a grassroots effort, right, the patients start demanding these. The demand for I don't like the term alternative, but other options, functional type medicine, is increasing every year, right, i mean so, again, by creating this awareness. The more we talk about, the more patients are asking for this. The insurance companies, just they have to start going in that direction and start needing to cover it. Because imagine if I think insurance companies would save themselves billions of dollars if they allowed for some of this testing, because it would be so much more easily able to identify a cause and to treat it versus having Venicos with the whole drug companies who won't get into that conversation.

Dr. Carver : 24:03

Sometimes we like to keep people sick so we're making a profit, but again, that's a side note. But the more people demand this, the more it can become conventional, right, that's the idea is that we're looking more at this, the root cause. So let's talk a little bit about some of the other more common diseases. As you mentioned before, like hypertension, i see a lot of patients in my clinic with reflux. Can you give an MDs perspective on what might be some root cause? So many people believe reflux is from too much acid and that's really not what's happening, but I'd love to hear your take on it.

Dr. Su: 24:41

Yeah, i mean there's a lot more potentials, right? I think a term I use a lot I'm not alone in this referencing what you just mentioned about, like what I call alternative or functional foundational root cause medicine, whatever it is. It's just, ultimately the thing is there's so many more tools in the toolbox than what conventional medicine offers. And that's again, it's not a jab, it's just having gone through that system, having been cut my teeth and raising that system, trained through that system, i only know what I know because that's what I was taught. I just don't know those things, right. So until I somehow, fortuitously, was led down some road or whatever, right? So in a lot of us we're led down that road because we personally or our family members are sick enough that we learn that. Okay, the conventional system is not getting us answers. We need to look elsewhere. I don't know what it was with me because that wasn't my story. It's just like I said, i don't take any credit. It was just born that way, with an inquisitive mind, i don't know.

Dr. Su: 25:37

So, going to the reflux topic, same thing. There's so much more to the story than just too much acid. Hey, even if we talked about too much acid, the question is okay, well, why does that person have too much acid? Right, And the conventional story is probably oh, stress, okay, fine, but I mean, there's a ton of people who have tons of stress, tons of trauma in their life and they don't have reflux. So it's not just a simple one size fits all answer. So, yeah, we could easily start with just okay, there's a lot of people who a lot of people do have too much acid. Let's just say that there are some people who have too little acid, as we both know, and a lot of people do know they've read about that.

Dr. Su: 26:12

Unfortunately, as a more analytical minded person myself, the problem is I don't think there's any way to test for the acid story. I have a couple of GI friends, not just colleagues, but even like social friends, and I've really burrowed in on this And in fact, i thought one my favorite person in town. She was. She had a couple of patients who are furls to her from us, who she was doing some kind of a test on them that wasn't familiar with And I was sure it was testing for acid. And finally I texted her one day and asked about that And she said no, no.

Dr. Su: 26:43

I'm sorry, No it only it can assess, like, how much acid is coming up into the suffagus, but it's not actually measuring acid in the stomach. There's no test for that, there's nothing, and I'm not familiar with anything on the. on the.

Dr. Carver : 26:53

Have you done any? ever heard the burp test? they do that with the baking soda.

Dr. Su: 26:59

Yeah, i mean, i think there's some. Yeah, i'm sorry, i guess I mean like. I guess I'm thinking like in terms of I don't say procedural, but like something objective right.

Dr. Su: 27:07

Something that comes out in a paper form of a report or something else like that. I don't. I don't think there's anything like that. Yeah, no. So unfortunately I think I'm both. no, yeah, whether it's what you're referring to or a lot of people will just use.

Dr. Su: 27:19

Well, one story to me is when people say a lot of people just do this on their own at least patients I have. I use apple cider vinegar and I feel better, right, well, okay, that doesn't add up if you got too much acid, right. So at least it opens the question about what's going on there. And then other people will just use some kind of a betaine as a supplement or something else that is basically assisting with gastric acid, and if they feel better than it becomes a real question, right. And, of course, people who do energy testing, which I think you do that right, Yeah, yeah. So I mean those of us who do energy resonance testing, whether it's muscle testing or resonance testing or whatever that's.

Dr. Su: 27:54

that's a whole another. great, we have a tool, but, again, who's open to that or whatever? that's another story. So you got the first topic about low acid and too much acid, and then, and then there's the I think for me. the other next big topic is that I've had a number of patients who, well, let's just pinpoint on, i mean, let's give a moment to the mind body piece. Stress is not to be discounted. Yeah, sure, i definitely feel like it's over, overblame, overaccused, i guess, by a lot of practitioners. right, like we blame everything on stress because you can't prove it right or wrong And it's an easy answer.

Dr. Su: 28:28

And it's not to say it's not true, but is it really the only cause or is it 90% of the cause, or even two-thirds of the cause? I'm not so sure in a lot of cases. So besides the mental health piece, then we could also SIBO is definitely a big thing for me, right, So the small test on bacterial overgrowth. I've definitely had a number of patients where when we find and address SIBO, the heartburn symptom, or at least that, goes away.

Dr. Su: 28:53

Or I've had a couple of patients who have medically we call it globus a sense there's something stuck in my throat or something there And I remember at least one, if not two patients like they were totally convinced that cancer in their throat because it just like something is there Saw two different. One person even saw two ENTs scoped bow time. It's like sorry, you're fine, there's nothing there, there's got to be something there, feels like it. But we dressed the SIBO and all of a sudden it's gone.

Dr. Carver : 29:16

What is what causes that SIBO? I know I tested my husband and he tested positive. I'm like, no, i'm not really sure what to do about that. I expected it and then I was like, now what?

Dr. Su: 29:28

Yeah, so now we're going down further, further, deeper layers right.

Dr. Su: 29:31

Because I think let's SIBO a lot of people. Anybody, who's most anybody, i'm sure who's might be watching this later, whatever or the late public like SIBO has become a much more again. It's on the curve up with adoption, right? I mean, I have GI friends who test for SIBO now, and 10 years ago it was like give me a break, that's again, that's all hogwash.

Dr. Su: 29:51

Well, so this is where just too much bacteria in the wrong place, right, too much bacteria in the small intestine that shouldn't be there. It's a form of what we call dysbiosis. Just in balance of the ecosystem. There are tons of bacteria in the colon. Shouldn't be that much in the small intestine, but in this case there's too much And there are certain kinds that the work messaging I have with my patients is some, some of those bacteria, they off gas when they're metabolizing food.

Dr. Su: 30:13

They off gas And that's why we feel the pressure, the, the distention, the bloating and some that, depending on which gas it can create, cause also diarrhea or constipation. It just depends on which gas. So this is a hard thing to measure. We can't, we don't again, the best I think the only test we have for is a breath test of the gases. We can't even measure the bacteria Right, okay, the school tests aren't, are not accurate for bacteria in the small intestine. Good luck trying to look for the yeast or mold in the small intestine and even beyond that. I mean good luck with that, objectively anyway, so concretely, on paper, quantifiably.

Dr. Su: 30:48

So what's the underlying cause of SIBO? Well, in a lot of cases it's it's actually problem with dysbiosis in the colon Right, and so here's where we can throw in other back to this three part framework. So, or we could think globally, i should say. Now there's a there's definitely a school of thought that for people who have enough ecosystem imbalance in their large intestine, if they also have a weak ileo seco valve at the terminal, the end of the, the end of the small intestine where it links to the large intestine, if that valve, the sphincter, yeah, and for those of us who are young people, oh, he said sphincter.

Dr. Carver : 31:25

Okay, fine, yes, it's sphincter.

Dr. Su: 31:28

But if that valve is not tight, one of the arguments is that we get reflux at that valve and some of that bacteria is finding its way up and migrating up upward. So for a lot of us who are doing stool testing, like with the GIFX, gi map or whatever the case may be, there's, there's a number of people who, if we see methanobreva vector as a particular bacteria there and it's in a high level or even a high normal level, there's question of whether that might be a reflection of what I'm talking about here. Right, and who has a poor sphincter tone at that valve. Well, chiropractors often will talk about that.

Dr. Su: 32:06

I've had a number of patients, interestingly, when I mentioned this to them, then they kind of go that is too weird because my chiropractor told me that down there that got this like weak valve down there and they did something to me and I could tell that something happened. But like I didn't mention to you and bubble up, i've had that happen a number of times. But who else is at risk for that weak valve? Well, that's where we start thinking about people who have they're like over flexible, they're hyper lax, and this is another topic I don't think has been talked about a lot in cell core. So if anybody in the cell core is like eventually later watching this like couple topics we can bring to the table somewhere Yeah.

Dr. Su: 32:40

Hyper laxity. This is like the people who kind of have an earlose Danlos like condition.

Dr. Su: 32:45

It's not earlose Danlos per se. They can do weird things like make their thumb touch here and they can make their pinky go 90 degrees and they bend their arm out and it's oh, that's a little too far, and they're constantly kind of achy in the neck. They don't heal well from sprains, they injuries, whatever. These folks, they're connected to shoes week and include likely including their valve, and they're more apt to have that, you know, reflex. So that's one of a couple of different schools of thought with the SIBO. But you know, going back to your oral cavity thing, right, i mean, the question also might be Hey, is it from top down instead from bottom up with the colon? Could it be top down? They've got a bunch of imbalance and ecosystem imbalance up here And it's finding its way down. That's. That's very plausible as well. And then we could get into that whole H pylori topic, which is kind of muddy waters. But I suspect that has a meaningful role with SIBO as well.

Dr. Carver : 33:33

Yeah, absolutely, and it's interesting. So what I had my husband do the try test and he the only one he was positive was the hydrogen, so he didn't have the methane or hydrogen sulfide.

Dr. Su: 33:45

I think it's very rare. I don't know if I can remember anybody actually having two gas. I might have had a couple of people have two gases. It's usually just one. The trio smart breath test Yeah Yeah, it's usually one.

Dr. Carver : 33:55

Yeah, so so I'm like, and so there are a lot of treatments for that too, like antibiotics is one. What other do you need to enhance the microbiome of the colon to like animals and things like that help.

Dr. Su: 34:11

So this is a great example about the root cause thing. Right, there's almost always deeper levels of root cause that we can at least talk about And we don't want to unnecessarily put ourselves in the weeds and overcomplicate life beyond what is necessary, and that's up to the patient as to how far to go, but in my opinion. But SIBO is a good example, all right, because it's out there enough and we can go online and find all kinds of practitioners, programs, teaching courses or blah, blah, blah, programs of educational course, blah, blah, and a lot of it is centered and I'm not jabbing anybody or anything at all, but a lot of it is centered around. You got to knock down, as I call it to patients. You got to knock down the brush border. There's too much the grass in the weeds, it's an overgrown yard, there's too much bacteria here. We need to knock it down, all right, but it's not like we're looking for a sterile field and knocking it down to zero. And so then the next question is again what's causing this? And we could talk about leaky gut, we could talk about all the things we just talked about. Is it top down problem? Is it bottom up from the colon? Is it in the middle with the HPI lower and other stuff, all kinds of thoughts.

Dr. Su: 35:21

But a big topic people talk about online is the fermented foods. Right, because the fermented foods are what feed these bacteria. To that then off gas. So then you got all this talk about histamine foods, in particular, but not exclusively, i'm sorry, fermented foods. There's often times across over there, but nonetheless let's stick with fermented foods. And so a lot of people end up on this kind of FODMAP. They're trying to avoid FODMAP foods for some period of time.

Dr. Su: 35:48

The question becomes how long does a given person have to avoid those foods after they knock down the brush border, whether with pharmaceutical or herbal antimicrobials, et cetera, antibiotics, and how long is this going to last before they have to repeat the antimicrobials? because a lot of SIBO patients, it keeps coming back, right? Well, you got to ask why does it keep coming back? And if the answer is going to be, it's because they're eating fermented foods. I'm not loving that answer, right? We're not all born as humans to be negatively responding to fermented foods. We could argue okay, the foods have changed in their production and blah, blah, blah.

Dr. Su: 36:27

But usually there's deeper reasons. They have SIBO, right, either they've. There's a lot of topics. Again, we could go back to the H pylori topic, we can go back to the colon or the upper. There's deeper root issues. So, as you said, we can treat initially to help people feel better. But again, if the patient's willing and they usually will be willing if they keep having recurrences over time or they get tired of having to be so restricted in their eating, then you got to look for those deeper root causes that we just talked about. Top down, bottom up in the middle, where's the resource, the source coming from? And a lot of times it's not just gut related, right? A lot of people they have gut issues because of more systemic problems as well. So now we're going even deeper and it gets even a little more complicated. And boy, the possibilities are just. There's a lot of possibilities.

Dr. Carver : 37:21

Yeah And so, and again, it's very individual. But I love what you said about the chiropractor, and it goes back to what we were talking about earlier, that it takes a village right And so having the chiropractor a lot of times if we have bugs or systemic issues, we don't hold our chiropractor adjustments right And so we have to keep kind of keep going back, and so that's why it's important that chiropractors know their MDs, that MDs know the chiropractors, and we each have our own little air of specialty, but it's so important that everybody work together so that we can help get people well. So let's talk a little bit. We have a little bit of time left and I think we'll definitely have to do part two. There's so much we can go into.

Dr. Carver : 38:02

But so the other two major things we always see is the high blood pressure and the cholesterol, and so many of my patients they see they have that. They're on all the drugs. So in your, do you see any infection that you can be part of the root cause of those things? Obviously, everybody always attributes stress to those things. Everybody always attributes eating too much red meat to cholesterol. So talk us a little bit about your thoughts on those topics.

Dr. Su: 38:28

Yeah, high blood pressure is a that's a tough one. I mean we definitely and easily can talk about that in that same framework, right? I mean the term I guess that we haven't used here is chronic inflammation, right? So whether we're talking about fibromyalgia, even SIBO, definitely hypertension, these are all forms of chronic inflammation. And so for me, when I just methodically think through that three part framework, inflammation by definition is immune system reactivity, and the immune system has two pieces either responding in defense to bugs and toxins back to that other category or it's responding in to help heal injury, right, tissue repair.

Dr. Carver : 39:13

So I just want to stop you right there, because I just want to reiterate what you said about that, that the hypertension is immune system activation. I don't think the majority of people, maybe even doctors, would consider blood pressure having anything to do with immune system, but people would believe, yes, i have to do with inflammation. So I think that's that's an important what. What is activating the immune system that's causing the high blood pressure? Because most people okay, we'll just put you on one of these five different kinds of blood pressure medication. Oh, that one's not working. We're going to put you on another one. Oh, you know how many? I have tons of patients who are on two, three different kinds of blood pressure medication And there's no, there's no thought to the inflammation. Maybe we should treat the inflammation and that will help. So I just want people to hear that piece.

Dr. Su: 39:57

Yeah, and I think if we hold in on the terms just a little bit more right, if a patient went to, if any given patient went to some practitioner in conventional world and said I'm I just heard that my high blood pressure is due to my immune system, then that practitioner is probably going to give him the stink eye at least internally or kind of like.

Dr. Su: 40:13

But if the patient, if we're going to get the infection we're going to give the patient, if we said to a practitioner, high blood pressure is due to inflammation, i don't think there's going to be much argument at all. I mean, because high blood pressure is all part of that whole, like heart disease, high sugar, high cholesterol, and we call it metabolic syndrome or just metabolism. That's all chronic inflammation. No one's going to argue that. If you then say and inflammation, by definition, is reactivity of the immune system, so by sort of what we call a math transitive theory, right A, then B, then C, yes, so I mean, high blood pressure is a result of the immune system. There's some kind of overactivity. Okay, now we can buy that. So if we, if we skip inflammation, we'll probably get the stink eye. Right, if we say inflammation, we'll get buy in. Okay, so, agreed, agreed.

Dr. Su: 40:58

But but that's where high blood pressure boy, it could be, dude, who knows what that's due to, right, i mean, could it be due to, as you say, like infections and bugs, like absolutely. But it's not that it's due to one thing. That's another principle we have with our practices, like the more the sick of the person is born, cases like high blood pressure. It's never due to one thing, right. It's never even due to two things the sicker you are, or especially high blood pressure. It's just a whole host of stuff. And there are some people who I look up to as mentors and authoritarian clinicians or researchers who would argue that in some cases you don't even have to address the bugs and toxins. But if you can write and balance the immune system, people at least feel better. Or you could arguably like, improve or reverse the condition without even addressing the bugs and toxins. I don't know how much I'm willing to go that far yet until.

Dr. Su: 41:50

I see with my own eyes, but I've seen a few examples of that. But case in point is just, it's more than just bugs and toxins, it's the whole picture. Because, as I say to people, look back to the information topic, look, okay, thank you, that's a normal thing. Okay, in COVID, whatever we want to call it, if the people why did some people contract COVID by testing, but they weren't feeling that sick? Well, we've read it in laymedia and I will easily tell people like well, if you have an immune deficient system, then that's a bad sign that you didn't feel symptoms. Right, because the immune system is meant to react. And if you don't have an immune system, you're not going to have information, you'll die, but you're not going to suffer much along the way. All right. So inflammation is meant to be there for a reason, but when it's chronic and ongoing, then that's not good.

Dr. Carver : 42:39

Right, so I think some people wear that as a badge of honor, right? I never get sick And I tell patients we're supposed to get sick. The measure of a good quality immune system is how fast you recover. Right, so you're supposed to get sick and then you can recover well. But if you never get sick, there's things the biggest one like mold, right, we're talking about bugs and infection, stuff that chronically suppresses the immune system. So everybody else can come on in because there's no nobody's surveilling, right, there's no bouncer anymore. So you're one of those people. It's not necessarily a good thing.

Dr. Carver : 43:10

We want to make sure that and I agree with you that the immune system is the crux of all of our health. And these things like high blood pressure, that's just a result of the inflammation from whatever it may be. So when you have, when you're thinking in that way, when you want to be thinking, okay, if I fix the inflammation, then my blood pressure is going to go away, i don't need high blood pressure medication necessarily, something maybe acutely, obviously. But if we, if we don't want to be on that long term, let's get at that root of that inflammation to help. And cholesterol is kind of the same thing, right, and the way I look at it is that's inflammation. That's your liver is producing more cholesterol because of the, because of injury right Into the body, so it's a natural response to make cholesterol. You're responding to something, but you're over responding.

Dr. Su: 43:58

Yeah, The cholesterol one for me, yeah, So, just for the sake of who we mentioned, like cell cord mitochondria and all that stuff. So again, yeah, I love what you said about the immune system, the response how fast do we rebalance and recalibrate? that that's key, right? Aristo Vigdani, I very much look up to him. He's a researcher, well published, well decorated published researcher, That's. He talks about that a lot, especially post COVID. Hey, you're intended to res and be inflamed due to whatever bug, toxin, COVID, whatever. But how fast do you recalibrate? That's, that's the ultimate. That's a huge marker for health right And resiliency, So that we could talk about the immune system. We could also say that about the mitochondria on a micro level.

Dr. Su: 44:39

Now, going back to your topic about the cholesterol, right, So with with high blood pressure, it's just the number of potential causes of bugs and toxins and the immune system stuff that it's just expansive. And I don't even I don't even know if I could tell you that I've identified that with any given person, because for a lot of people they don't feel high blood pressure, So they're not motivated to go digging expansively because it's a big shotgun approach to to just deal with that, to come off one or two medications, All right. So that's, it's just the nature of the beast, So I can't even tell you that, but that's conceptually how to go about that. Cholesterol, to me is a little more targeted, it's a little more focal because we're, as you just said, this we could kind of pinpoint into the liver here, Right? And so I think there's meaningful argument to be made that, yes, the liver makes and metabolizes cholesterol.

Dr. Su: 45:26

And so if the liver is not functioning properly for any given reason and there's just a lot of room to talk about what could be going on there because everybody, or blood goes through your liver. Your liver is the filtration system, the detoxification center. So if you think about like a filter in a fish tank or a sponge, like when it's too full, it just it gets overwhelmed And then you're going to get back in, you're going to get pushed back in overload to the sources that are trying to feed the liver, that blood, with whatever toxins and bugs and byproducts. And so when the liver is not functioning properly, we're going to get those things like fatty liver, we're going to get the higher cholesterol we're going to, and on, and on, and on and on. So yeah, with the cholesterol topic, for me there's more, there's more targets to talk about. It's a little, it's less of a just random shotgun approach.

Dr. Carver : 46:14

It's a really big deal, right, because I think unfortunately correct me if I'm wrong I'm not an MD but we don't have a lot of great tests to check the function of the liver. Now we have some genetics and we have the two enzymes, but you know, i think we live in a society now where we are bombarded. What is it? Over 80,000 chemicals in our environment And those of you, this is we're filming this just a day after all the wildfires, and I'm sure all of you saw the haze and gosh only knows what was in the air. Our livers weren't designed to be able to filter that many toxins, so I wish there were some other way that we could test this. I mean because we're even seeing children now with fatty liver, right, but there's no good conventional tests to really check those. But correct me if I'm wrong Other ways that we could check that.

Dr. Su: 47:05

No, i think you're right. I've thought about that for years also. So obviously we have the ALT-AST conventional labs that are looked at a lot, but those are not sensitive enough. The GGT is even more sensitive but weirdly I've had times where the GGT not only it's intuitive to think if it's more sensitive than the GGT can be really high or high, but the ALT-AST are normal. But I've seen the opposite too And I don't know how to make. I don't know what to make of that, but there's plenty of people who've had normal ALT-AST and GGT but yet on an ultrasound or CAT scan they've got a fatty liver, right. So I don't know how to make sense of all that. But no doubt there are people who, when we address liver health, even with normal CAT scan, ultrasound, blood tests et cetera, things work out for the better. And if we want to go back to the cell core thing, their big proponents, i mean that school of thinking. They're very big proponents.

Dr. Su: 47:59

On the whole drainage topic, right, a lot of practitioners call it detox, but I love the separation of the terms. I do too. So I mean your audience may be familiar with that, but just in case for repetitiveness or second, third, past, whatever, absolutely Drainage. For me, the difference is detox is we're identifying specific topics, binding them and removing it, actively pursuing those topics, and drainage is just opening the funnel for just natural flow of toxins out, whatever all comers.

Dr. Su: 48:27

And so when we talk about liver drainage and of course, pooping being the first level, and then the liver and biodex system is level two, yeah, i mean maintaining, reducing the intake of toxins and we have some control over that, like with our foods and stuff and oral hygiene big topic of course, top down, as we talked about before, those are all things we have some control over. Things like forest fires and stuff that we don't have control over. Okay, well, we got to do what we got to do, but we can't control everything. But yeah, there's been plenty of people we see when we do drainage work of the liver. Yeah, i've seen their cholesterol numbers go down, this and that happens. They feel better, they have less pain, et cetera, et cetera. Yeah, there's a lot of It's not well able to be assessed quantifiably in conventional or even root functional medicine testing.

Dr. Carver : 49:19

Unfortunately, And because the liver has so many different functions, a clogged, sluggish liver can have many, many, many different ways, like for me. My clogged, sluggish liver created eczema right, we talked about the up funnel, right. I was always chronically kind of constipated, not terribly, but always sluggish in that area And so because I wasn't pooping well enough, my kidneys were sluggish, my liver was sluggish, everything was backing up into my skin And the lymph, my lymph, was all clogged. I recently kind of had another batch coming back of my eczema and I muscle tested for lymph drainage and two days of a homeopathic and boom, it was able to drain. Instead of now that toxins coming back up into my skin, they're going out the way that they're supposed to go. So that's again a huge, huge topic, but really real important.

Dr. Carver : 50:09

A lot of people who try to detox and get sick It's because those drainage pathways aren't open. If you want to get rid of something, you need to make sure your kidneys are fine. You need to sweat. When I first started on this health journey, i bought a sauna and I never sweat because those pathways were just not open and so I never was really getting better. I kept just draining myself and trying to drain myself, but those pathways weren't open properly. So so again that that cloggy system creates a lot, of, a lot of these symptoms that we're talking about. Well, we're coming up to the end here, and I think we'll definitely have to happy back because there's so many more topics I'd love to dive into. But how about last thoughts, anything you want to leave the audience with for this conversation?

Dr. Su: 50:54

Oh, we did talk, we did throw out the possibility, so we got to put a little plug in on the topic out thrush, bringing all back to the bringing back to the oral health thing, right, cuz yep, a lot of stuff was like deeper down. But, as we did allude several times that not only is the oral health piece, often it can be a Top-down cause, right, cause of what's going on down here or, contributor, at least what's going on down here. But it can also be a reflection of what's going on down here, right? So at some point, if we do this again Yes, like I'm gonna, i'm gonna ask you to put more time into talking, because I want to hear from you about like thrush.

Dr. Carver : 51:27

I'll just say something really for my daughter. She's 14 and She's trying to get really concerned about her parents and, happily for me, interested in her health. And she said, mom, i really need to have a cleaning. We're having a huge hygienist shortage in the whole state. It's really actually, i think in the whole country It's a problem. So it's very hard to get into a clean. So she said, i said, okay, come here, i'll, let me do it. And She had some tartar in the back for teeth a very common common spot And I'm like really needs more magnesium.

Dr. Carver : 51:56

And then I looked at her tongue White white tongue, and not that she had total thrust, but when I see that really pale tongue I'm thinking Candida. And she's a teenager who her Main diet is carbohydrates, much to my chagrin. But I have the faith that she will come back around. She actually did tell me yesterday I had a salad for lunch. Mom, are you proud of me? That's great, but yeah, i mean so both, both ways, right. So, seeing that, i know that she's got an overgrowth, so I'm doing some paras with her, trying to treat and kind of bring down Some that, because as much as I can try to change her diet, it's not as practical right now. So it's given her oral probiotics, having her use this certain toothpaste that I like. That's not killing but Creating the healthy environment. So she's swallowing the good stuff. So it's definitely related and, well, you can definitely talk about that that next time, because that's a very, very good topic too.

Dr. Su: 52:48

Yeah, it's an easy. It's an easy reflection when, when it's not a normal pink tongue, it's an easy reflection about Red lights on what's going on below.

Dr. Carver : 52:55

Well, that's what. That's the one of things I love about dentistry. I can assess so much about a person's overall health by looking at the tongue, by looking at the cheeks, the, the teeth, the, the, the sinuses. It's, it's really, and it's relatively accessible, right. You can take care of things here a lot easier than you can fix leaky gut, right. So so kind of a have an advantage there. But yeah, that's, it's exciting and what I want to try to teach more dentists how much more we can help, and then Have those connections to the MDs or naturopaths or whoever may be, be health coaches even to try to. You know, dentists don't need to know everything, don't need to know everything that I know, but to be aware so that they can help their patients seek the the proper avenues, right, that's one of my other goals.

Dr. Su: 53:39

Hey Rachel, you're you're. Your patients and clients are super, super fortunate to have you. We wish, we wish you were closer to where we are.

Dr. Carver : 53:46

I kind of ask you a couple times are you spending time in Boston or not?

Dr. Su: 53:49

So those of you who are following and working with Dr Carpere, you're in good hands, more than good. You're in, you're better than in good hands. I think I reached out to you initially after you presenting at the conference two years, the year prior, and, yeah, just big fan of your approach and thinking and advocacy and heart and passion. You know that's that's what I love about, not yourself, but also a lot of people in that community in particular, but not just not exclusive. But you know that's that's what, i think you know, i really Love about particular colleagues and the community when we go to these conferences It's really exciting.

Dr. Carver : 54:25

It's like your passion gets reunited. You're around so much of this energy and this passion and it It's important that we continue to do that, because we have so much to offer the world And so it's exciting to do this collaboration. So if somebody's interested and maybe working with you you now have a virtual practice Can you tell us a little bit about how somebody might be able to get in touch with you?

Dr. Su: 54:48

Yeah, sure, so, yeah, so the website would be wwwfunctionalmedicineconsultinggroupcom And there are two G's together at consulting group My direct email is dr MaRKSU at Gmail, and often we'll just respond and four people on our staff who are great at connecting with people.

Dr. Carver : 55:11

Fantastic. Well, thank you so much for taking time out of your busy practice to help us create the awareness and spread the love. Shine our lights and Look forward to having you back on again soon.

Dr. Su: 55:23

Thanks for thanks for the work you're doing, dr Carver.

Dr. Carver : 55:26

Thank you, mark. Talk to you again soon.