Break The Rules #75: Is Lab Testing Worth It? with Dr. Elizabeth Boham
Welcome to break the rules. We Dr Loren lacks podcast. Dedicated quieting the noise and the health food and fitness world. Doctor warned is leading nutritious therapist and Functional Medicine Practitioner on a mission to help others thrive in their own lives mind body and soul and now your host Dr Loren Mountains. Well Hello Hello Hello. Welcome to another edition. The break durose odd cast where we talk about quieting the noise and the health and fitness world day. Have Dr Elizabeth Boheme in the House? And Dr Elizabeth adoptable. Ham is a this nutritionist. Who Practices Functional Medicine at her center. The Ultra Wellness Center in Lenox Massachusetts and through her actors in lecturing helped thousands of people achieve their goals of optimal health and wellness. And I came across Dr Bones. Where just in the functional medicine sphere as a great leader in this movement of hundred medicine? She is a teacher within two functional medicine and in has just built up a great name in reputation or his clinician. Not just really helps. Your patients look to again addressing the root cause of disease in To also encourage your patients but they are not a diagnosis and to really help them find optimal wellness through the functional medicine processing experience than some of the tools in We're GONNA be talking about today. Will be assessing headed says a for underlying issues talking some about Lab testing how to get to the root causes of issues. That may be going on in your health as well as just the game. Changing simple things you can do right. Now without testing having testing are not testing to improve your health moments. So Dr Bam thank you so much for coming on the show and if you tell us a little bit about more about you got you doing the work you're doing in the world world. Lauren thank you so much for having me here today. And it's great being with you. Aw So my undergraduate and graduate degree is in nutrition and I love nutrition. It's kind of been less. I just loved all my education in the field the nutrition nutritional education in attritional biochemistry and I decided at a few years after being nutritious in practice practicing as attrition that I wanted to learn more about how the body worked and decided to go to medical school. And I didn't have any anybody in my family who had Md's so there's in my family but no MD. and so. I really had no idea what I was getting into. And so I really was interested in wellness and prevention and how to learn more about how the body works and then all of a sudden I was in medical school and I was like oh no it was such a focus on acute care medicine and you know naming the disease just finding the right medication to suppress symptoms and though acute care medicines really important. I that was not really where I wanted my focus to be so I was really lucky after I got out of medical school training. Did my internship in Family Medicine all in board certified in family medicine. I got a job at Canyon ranch in Lenox Massachusetts where I met Mark Hyman in Kathy Swift tablets in learned all about functional medicine. And that's when I went to my first course in functional medicine and Into thousand four and I was just blown away because perfect way that I could incorporate mine. Nutrition background with my medical school. Training really had the map in the tools to bring those both together. Which is exactly what I wanted to do so i. I was really thankful for that. I remember going up to Dr David. Jones one of the year's founders in functional medicine and you know in tears like. Oh my goodness I found my practicing functional medicine since then since two thousand four and my practices in Lenox Massachusetts eligible in this center. We have a functional medicine based practice where we see everything. From prevention wellness to cardiovascular disease diabetes prevention to chronic fatigue in autism end chronic infections and everything in between autoimmune disease. So it's it's it's really fun. It's a fun fun place to work. I'm really thankful to to be there. Yeah surgical story like serendipity that you wouldn't be all of those people at just the right time to write said. Y'All were all was everyone employed at that. Same plays exactly work mark. Hyman was working at the at Canyon ranch at the time as was Todd Levin and Kathy swift and so when Mark Left Canyon ranch a few years later he brought me over to the Ultra Wellness Center. Simple jumping into functional medicine. When you started your practice I would love to know you since you've been doing this for quite some time Almost fifteen years. I'm probably going on sixteen years. I mean how have you have you? All does the participation because I feel like speaking to a lot of the practitioners in the House even listening to us. We can jump into it. Functional medicine just like hit the ground running again. We were talking before the show. Running every test under the sign are just like completely anti conventional medicine as well. Unlike maybe finding time in seasons coming back to center of like the US just A less big on approach on the beginning but talk to me a little bit about the evolution of your practice. Yeah I think one of the things that I find over the years is that you just kind of get more comfortable with as you gather that history seeing those patterns those connections getting understanding of where these were the shift in that person's body may have taken place so where things may have gotten out of balance. You know what we always talk about him. Functional medicine that trigger and trying to understand what that trigger may be for that person right. Was it a stress? Was it an infection? Was it antibiotics right. You know what was it that triggered their shift and I think over over the years. My practices sort of evolved in terms of just having a better understanding of of figuring out what that where that trigger is end near. You're talking about testing beforehand. We do at the edge. Wellness Center duo a wide range of tests our patients if they'd like them and if it's necessary on we have a lot of options available to us to delve into but we also know that you know eighty percent of people just their body can heal when we just help them with those personalized lifestyle. Factors right the the base of the Matrix Really Foundation of our health issue. We're making the right healthy food choices and a good movement exercise program and managing our stress and an having nudity in getting good sleep right. Those those things are really can make a huge difference in terms of helping the body. Rebalance just myself. Yeah I like to say when given the right tools the body innately wants to heal itself and finding at the Guy. You're saying that statistic about eighty percent of people improved greatly just with the basics. And kinda give the listeners. In overview of what basics you would target and help people with say. Initially they were coming to you with a Health Problem Health Commission. Yeah I mean everybody's individual so I think that's what's the best part of functional medicine. The most fun is that we get to figure out for that individual person. What are the basics that they need to focus on right so for me for example? Like at I was diagnosed with breast cancer at the age of thirty so when I was like twenty years ago and for me I was. I was really into exercise. I think I was eating really pretty darn good healthy diet. Everybody hope be healthy. One right but for me. I was not good imagine stress. I was didn't know how to say no. It didn't stop. I didn't know how to slow down. I didn't know how to take care of myself. And so so that is you know from me what I needed to learn how to do right. And dumb and so for everybody. It's it's it's a little bit different for some one percent. Maybe they're sleeping. You know by four to five hours a night So we've got to say okay. You've you've gotta make time to sleep for somebody else. They may be you know eating fast food diet. They're not making time to cook or prepare foods for themselves. They're just going on. They're not taking time to let their body. Digest absorb the nutrients that they're eating and so we really have to just talk about. Okay let's let's get you on a whole foods diet right. Let's focus on sure. You're you're eating and you're eating real food and not just processed in quick junk food right. It's devoid of nutrients getting in those real real foods and then for somebody else. It may be that they're that they're not taking time to move you know and they're they've got all sorts of body aches because of it are gaining weight because of better so so. I think it's really important to to really get to know that person gather history. You can determine what the basics are for them to really focus on. Yeah that's really great High you mentioned the individualization something. I've been finding though in practice that most of my patients can benefit from an icon at one time was breathing. And just how a aluminium's time my patients initially for a minute and ask them to count the number of Branson a very average reading finding is between fifteen to twenty but I had another client dealer day. Forty eight breath in a minute and it was. I mean a type of ventilating telling your body. It's super stressed in ideal would be five to seven breasts. Pearson pathetic state talk a little bit about Just the stress component of disease may be in just help imbalances. We hear that word stress in. It's not joke. Sherlock heads like definitely a conundrum. But what does it mean to really address stress? I love how you work with breath with everyone because breath has such a huge impact on our health. And you know we know that when we are managing our stress. So I think it's important to have stress in our life but it's how do we react to that stress? How do we manage that stress? How do we? How do we respond to it? How does it impact us in? How does it impact our health? And so I think it's important that we that we start to have that conversation with all of our patients because we know that we're not managing your stress. Well that's impacting every single aspect of our health from the other lifestyle choices that we make as well to how well our immune system works right. We know the win were under stress. Our body's immune system doesn't work as well. We don't make as many of these natural killer cells that help our body Viruses and infections in abnormal cells in the body. We know that our digestion doesn't work as well. You know we know that. So many aspects of our health are are impacted. So it's really a great place to start for most people. Yeah do you have any favorite ways of encouraging clients to manage jazz or dislike? That actually tangibly looks like even in your own life. When you're going through your illnesses for me it was just sort of learning a lot. About how my body to the world around me and so one of the things that I started to do was journal. You know so. I said I was thirty. I was young. I had a aggressive form of cancer where it was serious. It was serious I needed to go through a lot of treatment and I was just sort of blown away within expecting this. I don't know family history of cancer. And so you know journaling was really helpful for me to write down everything. I was going through all my thoughts feelings. Experiences grief it really. It really helped a lot. It helped me move forward. I also started meditating on at that point in learning how to do breath work. And when you start to incorporate a meditation practice or breath work practice like you start to realize how crazy your mind is and you know how how much the mind can keep mind all sorts of crazy things that are just not true. Right mind is not always right as one of my good friends always says right going going. Go and come up with crazy thoughts that make really soon Worried and it's not always based in reality. And so when you incorporate a meditation practice whether it's you know you're doing an APP or you just put on some nice music or you're learning from somebody who can teach you or you're going to a class you get to really start to understand and appreciate how much stress is causing like to be not not as as wonderful or fine. I would say the one of the greatest things that I did. My My journaling was with a gratitude practice where I started to write down three things every day that I was grateful for and I started that when I watched a guy was going through treatment and I watched an episode of Oprah and you know she was it was back then when she was on TV. And you should write three things. You're grateful every day and so I started and I was like okay. This is really hard. Could think of anything grateful for and that I would just write down like simple things like this. You know I got better at it. And what's amazing with the with the gratitude journal is it just changed my whole interaction with the world around me and really helped the fear of having this really life. Threatening illness kind of dissipate. It helps it helps me feel more happy and joyful in life is much more easy for me to kind of come up with things or to recognize all the things that. I'm grateful for every day at this point. Sound not yet a question. I started asking patients to as two really distinct on a daily basis. What's one thing that sparked joy today to begin to like think about this gratitude? Just like the bigger world outside of our little monkey minds as well right now. It's beautiful this tickly. Eighty percent of our thoughts repeat or negative thoughts and so am not always true. Like you said often that true a hundred percent so kind of in your practice as you are continuing to address these things with individuals and guide them through that process. Let's kind of switch shit scares over to. What testing looks like from Medicine Perspective Not Severi for our listeners. That are may be on the patient side an practitioner side as well. What would a standard testing workup look like for an individual wanting to know the records? Are there some initial tests that you find show you the most important give you the most information for individual in general? That's such a huge question. Because I think that we really gear test based on that person's story that patients history where they're coming from but you always want to start with some basics right you know. Who Does somebody have iron deficiency and? That's why they're tired or losing hair with their firearm. Look like they've signs of Mala. Absorption what's their zinc level in protein levels in their body. You know some of those real basics I think. Sometimes they're not even getting done by their conventional doctor and can be and should be. We'll often been just delve deeper. We sometimes do a nutritional panel. We often do. It's called the ion panel But it looks at everything from amino acids to be vitamins to The different steps in the Mitochondria markers of oxidative stress gives us a sense. Of how the bodies detoxifying you may look at Omega three levels to get a sense of. Is that person getting enough? Omega threes with an Omega quant. If they're having digestive issues you may do a test We do those a lot in our practice but we were talking earlier about how I think with every test. You just take it as one piece of the puzzle right into get the whole history from your patient. Understand where they're coming from and then take. That test is heart of their story. Because there's no one perfect test out there whether it's a conventional test store or what falls into that category is functional medicine testing but just or or another type of test. There's there's no one perfect has so we really have to always take that? As part of the whole story I just beginning said Yeah Maybe definition exert is well defined conventional versus functional testing. 'em Scott have patients come to me. They've been to. Maybe four doctors brier where they've had the GI testing done. They had like a breath. Tests done For Lung function they're having shortness of breath. They've hide Just standard bloodwork conventional. But we're talk a little bit about the differences in functional versus conventional testing. Nyc Times these conventional tests. Do come back normal are that they can miss things as well. When patients come in still filling not great at is a great question so really. There's no official difference between conventional functional tests. We always divide them just because because conventional tests are really what more conventional doctors are doing but in reality what insurance often will cover more likely. That's kind of in a in a sense how they get separated a lot of times it in reality. That's not completely true. Like I might. A functional tests may be a with gives us a sense of how the body is functioning. Even though conventional doctors can order it and do ordered all the time for example we could use. Homocysteine is a good example so a lot of times when a patient wondering okay. What'S MY B? Twelve level like so a serum B twelve level be done and Serum B twelve. If it's really low okay. We know that person's deficient in B twelve but sometimes we miss B twelve deficiency. If we're just looking at Serum B twelve and so it'll look fine but when you look a little deeper you can get a sense okay. There really is something wrong with this person's B twelve level. And if you do something homocysteine which really is functional tests because it is telling US functionally the body able to break down homocysteine. Does it have enough? B Twelve and fully of B. Six to breakdown homocysteine or you can do mathematic acid. Which is a test specifically for twelve? Does the body have enough? B twelve to breakdown mathematic acid. You could put that in a functional category. Even though it's a test that insurance will cover in so I know that using answer to your question but I think that sometimes when somebody is has had some basic tests done and everything looks okay. Really have to step back and say okay. I need to get more history from this patient. And then sometimes that means. I need to get more testing done. Eighty the right tests weren't done yet. Yeah no that's great information. I guess the part two to that would be just like. How does the patient no So I oftentimes get patients that have come from. Blake with there. Senator Blood work is like Oh. My doctor ran a thyroid Margaritas. And my you know we just did some blood work in. It's all okay Around the thyroid for instance. There's just a T. S. H. Done or there's just like you said the ceremony. Twelve done or the interpretation of testing as well there is some out of range markers but they're not in the chronic chronic of disease Mark State either by Conventional Standards. So it gets very confusing for the patient. How the patient know what testing even get the answer to that too so I think that I think that you know we really have to trust our intuition and you know we. We know in a lot of ways had to take care of our bodies especially if we do some of those Breathing exercises do things to calm down the body. Listen TO OUR BODY. We can kind of get a sense. We often know okay. I need to move. I need to get another opinion. I need to ask somebody else. I need to look deeper. I don't think I'm getting all the answers with this practitioner right now and I. I think I need to go deeper and I need to have somebody really get a further evaluation on me. I think it's I think it's trust the intuition. 'cause it's it's the amount tests out there. It's so expansive. Nobody can really get to know all of it. I get this a ton as well with gut testing so a Lotta Times the GI world likes. Let's talk about testing for a minute. Perhaps like a DNA type test is run in the League. Looking for over pathogen. So is there equal? I am the sole France but in functional medicine allow. We'll do more of a microbial picture to just look at the school as a whole as opposed to just looking for that one pathogen talk a little bit about the nuances of stole testing in. Why perhaps things got wise can be missed as well just with some of the conventional approach to testing or what insurance is covering adjusting. Well I think that the first thing that we need to do is sometimes. It's just rule out some of the really bad things that can be done with with with conventional tests as well as some were what would fall into the category of functional or testing. There's no perfect test out there you know unfortunately and there's so much that we don't really understand yet about the microbiome those bugs that make up or you know the line our digestive system and align our zen so much we don't really understand but sometimes if you look a little deeper you can get information about how you're digesting absorbing your food you can get some sense of if there's imbalances in the different micro in your guy. Some some tests are looking at things like Ackerman which is bacteria that is in lower inflammation. You can get a sense okay. Do we need to work to build that UP WITH CERTAIN FOODS? Maybe certain probiotics you know. There's there's just such a it's it's it's a complex area where there's a lot that we don't completely understand or get yet and so. I think it's really important with any test including testings. We'd just no. We don't just hang our hat on one result we need to really look at. Ho- pitcher yeah in using looking again for patterns or if things are matching up can you speak a little bit to the differences in the types of stills has things out there even available so we hear about Gi map or we hear about doctors. Data broke using different methods. For instance the Molotov method with doctors data comprehensive analysis versus the DNA PR based recently heard about another company called a perio mix in there doing like more DNA. Expensive gene testing gut microbiome. It can be quite complicated refusing to know like again the validity of the results if they're coming back differently on Iran's side by side sole task There are also different testing methods. And so just kind of like for the lavely ended perhaps for the practitioner minded as. Well how do you distinguish between which Test Tirana? When which ones are valid clinically. You know it's just it's just clinical experience. It's really a lot of clinical experience. I think sometimes what we see with. Dna based testing. We might get a what by phone. The categories false positives. You know it's going to pick up. Because it's it's going to pick up a bugs that may not be active or may not be causing the symptoms. That person has because it's so sensitive So though I sometimes use those kinds of Central use DNA based tests. You also have to keep it with a grain of salt and go. Kay is really the issue is do. We have to eliminate all these positives that come up of. Do we have to just treat them all? Is that really? What's important sometimes? It is you know sometimes patients are not getting better with with the Diet that you've put them on or you shifted and you need to kind of find out okay. Is there a bug that I need to treat and they testing can be really helpful for that? Do use genetic testing in your practice and if so what kind of information do you take from that testing in functional medicine? We LEARN JEANS. Load The gun environment lifestyle pulls the trigger on those. But how do you use that to be empowering for patients if you do use it? Genetic testing can be really a great way for us to help. Focus where we need to. Maybe use more supplements. So you don't want to you. You don't want to give every supplement under the under the sun for every patient racist way too much and may not be necessary so I think helped me know where I need that patient to really okay. This will really help you so for example for my self. I know. I'm not a really have a variation when in my glorify producing genes isn't really that much surprise when you get cancer aged thirty okay. Maybe you're not a great detoxifier but so for me. It's helpful to know that so I can really work to support could file my own. Good of our production with with taking things like sulfurophane for example in an a C. N. Even sometimes taking root and so I find that or testing that looks at genes there's variations in methylated which a lot of people are looking at that can help us know. Katie. This patient may really need to focus on getting more FO- late in their diet with more foliage in green leafy veggies. But if they're still not they're still low in energy. You're feeling low in mood. You may want a additionally add in some methylated full as a supplement and so. I find that genetic testing can really helped me a lot when I'm looking at what. What are the most important supplements for that patient? If you to an another common question around testing around food intolerance fussing and get a lot of patients that come in and they want the food in times testing. I don't actually always run it I like to do a lot more at home. Just experiment type of testing with them and Talk a little bit about fated on setting as well as the inaccuracies inaccuracies that it can show. Yeah I mean. I think that you know food intolerance food sensitivity testing as well as food. Allergy testing. Have false positives and false negatives. They all do. So there's again there's no perfect test out there so food allergy testing would be more of an I g loo looking for an immediate reaction to a food food sensitivity. Testing would be more than I G G looking for elevated levels of immunoglobulins against a I G immunoglobulins against a panel of different foods. And I sometimes we'll do food sensitivity testing but a lot of times. I'll do a comprehensive elimination diet or a partial limitation diet where you know if I'm concerned about food sensitivities I'll remove some of the common food sensitivities on somebody remove them for for three weeks in slowly the back end and it can be really really powerful I think that sometimes food sensitivity testing helps me convince a patient okay. Let's let's really do this but it helps me delineate. What's going on? In how hundred percent like a hundred percent they need to be or how much they really need to pull food away but it again. It's just one piece puzzle. Yeah you're right so all you again. Bottom line using testing as a piece of the puzzle but not bootle talk about elimination diets and when I'm dining in practices wells. A lot of times. People are on these diets for a very long time in not getting better and so really speak a little bit to what using an practiced a big philosophy that I utilize is like the eaten abundance mindset within a real context and then also eighty twenty eighty percent of the time eating real foods twenty percent of the time let life happen to allow the freedom of travel to allow for the freedom of weddings to allow for the freedom of chocolate. And so talk a little bit. About how food changing the Diet. Can you really affected and win? It can be also detrimental. Elimination rises while great-great-great points and so important for us to be paying attention to You know the idea of doing an elimination diet to determine if food is causing somebody inflammation is not to stay on it forever. It is a short term process where you're looking to see if somebody's having symptoms and and you know that's helpful for some people like you know for me. I didn't really have any idea why when I was twenty. Why had congestion constipation digestive issues? I took away dairy and Mike. Oh I feel so much better. It was it was the removal. And then the reintroduction where the symptoms came back that really helped me realize that that was an issue and I totally agree with your eighty twenty. So important that were for most of the people in for most of the time were were appreciating. The fact that first and foremost we need to eat may need to nurse the body and we WANNA nurse the value with whole foods and we do need to be careful about just pulling away more and more foods because that's not always the answer and if you're not feeling better and you're pulling away foods than we've got a step back. It's what's is there something we haven't treated that we need to treat like a gut infection right or eating enough calories so that your body can heal. I mean some of those things are really important. Maybe we need to just help you digest your food made. It's not the food itself. Yeah I maybe you're eating a diet. But just like liver. Gallbladder pancreas seeing some support digestive. Louis our stomach acid et CETERA. So really weird. The fine tuned importance of working with the practice nerve resort. Time can be really helpful. Absolutely absolutely you know a lot of times you can't. You can't always do this on your own. You WanNa get a good practitioner. Who has experienced in this in this area? I don't know if you've ever ran into this in your journey but I caught shooting in the dark where you're just buying the next supplement saying it can help with this symptom or you're trying this diet or cutting out this this week and it just felt like a very wandering like lowly journey. Yeah you think. Oh you know I. I've got to try this one now. I've got to try this now. I've got to pull this away. And that's that's not always. It's not always the best way to go. I would love to know about a couple of patient. Stories that stick out. You don't use their names if anything comes to mind is like just an evolution in your time as a practitioner that you've really gotten to see the power functional medicine work and just the process where with a client and also with the timeline. Look like for them as far as how long that took. Oh you know it can be. It could be across either so many such a wide range of what we see for example. I had a child who came to see me with autism in his parents brought him when he was three and a very typical autism story where he had Regression at fifteen months in you know a we redid some very simple things you know. When we changed his diet he needed to eat more protein. He we did pull away gluten dairy because they can be a problem for kids on the spectrum and then we did some simple testing just to start with and he had this real remember athletic acid earlier. He had a really high math monica acid and he had a really low vitamin D and we added in a few supplements to support his DiCaprio. We gave him a high dose of injectable. B Twelve 'cause summers. He wasn't absorbing or utilizing his twelve when we brought up his vitamin D and he responded very quickly. You know that is not a typical of what I see with kids on the spectrum but it was a it was a really really quick really quick turnarounds which is very cool We don't always see that but on the other hand we see people who are maybe a longer process right. I worked with the woman who started to have digestive issues wins. She was around twenty She struggled with a lot of stress in. I think she she got a A bug like A. She said I got really sick. I got I got a lot of diarrhea cramping and then since then. My digestion hasn't been the same and gotten to the point where she was really having a hard time eating. You know she every time she she would get really floated in her stomach and as a result she was eating less and less and ship boss way her her period had stopped. And so you know shoes really. Having a hard hard time. She's also becoming more and more anxious. Which recently sometimes see when digestive system gets out of balance. We sometimes see that the that you shifted turns your personality. She's getting more and more anxious than having a hard time sleeping and having a job eating and losing weight so we we did a test for small intestinal bacterial overgrowth in it was. It was positive and we treat. It retreated with medication with a prescription medication in her symptoms. Responded Really Nicely. She got better but it didn't. It didn't hurt. Her mood. Started TO REALLY IMPROVE. But it didn't get all the way better. Which is something we see a lot. We see that we see that very often. She was getting her mood was getting better. She was less anxious. Who's starting to eat more? But she still was having bloating and couldn't tolerate all her foods so we did a little bit more testing and we found out that she had these antibodies against the pride of cells in her stomach. She had these prices. Are the cells in your stomach? That made a healthier Ray Down your protein helps your body absorb twelve and She just didn't have enough of she was. Her body was fighting off those cells so she wasn't making enough acid in her stomach. We then started to okay. We know we knew. Can we've gotTA deal with this? So we added in some things to increase the city in her stomach. When she you can use things like bidders We also gave her some bad teenage C. L. to help her digest her food. And it's when we did that. In addition to treating the bacterial overgrowth that that her digestive really started to improve and it took about six to nine months. A little bit more where she started to regain that weight she had lost. Every you know every time I talk to her. She started to feel a little bit more better and better. She was feeling more calm and happy and able to maintain a good way or herself. Was there just a couple of examples now disagreeing examples and I think what you just like really highlighted is just that sometimes it's just a little game changers that can make a big difference like that's true just like finding the little things in just continuing to the practitioner not settle for just like okay? These are just gonNA be your norm like Julia. Continue to lean in and believe that the body does have those capabilities to restore in be made better in whole so. That's super awesome to hear of all of that. And how can people find more about your work doctor? Boheme in just like the work that you're doing it you're For one. I know you have a book write out as well or DVD DVD's so I have a DVD on breast wellness. So I put it together a couple years ago. The Functional Medicine Approach to breast health and wellness and wellbeing. So looking at all the different things that may be impacting a woman's risk of breast cancer in how they can then rebalance it and it also has a DVD. Because it has some yoga practices that you can do again that a friend of mine didn't Within the DVD. So I have that on. My website is Dr Boheme Dot Com and also I'm at the Ultra Wellness Center website. Ultras calm and I'm on facebook. Elizabeth boheme MD and Instagram Elizabeth. Bohannon thinking twitter. Dr Bohannon him something like that. They're all sorts of baystate. People can follow me. Yeah definitely Links in the show notes and thanks so much for taking some time to come on and break and makes them new roles wellness.