014 - Karsen Delgado
Karsen Delgado is a nurse practitioner at Body Balanced Care. She joins us to talk about integrative medicine, amino acid therapy, bioidentical hormones, and nutritional counseling. How these issues can lead to addiction, and make it more difficult to find sobriety. Enjoy.
The Illuminate Recovery Podcast is about Mental Health, Mental Illness, and Addiction Recovery. Shining light on ways to cope, manage, and inspire. Beyond the self care we discuss, you may need the help of a licensed professional. Curt Neider and Shelley Mangum are a part of Illuminate Billing Advocates. They are committed to helping better the industry and adding value to the lives of listeners by sharing tools, insights, and success stories of those who are working on their mental health.
Karsen Delgado is a nurse practitioner at body balanced care she joins us to talk about integrative medicine amino acid therapy bioidentical hormones and nutritional counseling how these issues can lead to addiction and make it more difficult to find sobriety enjoy welcome to the illuminate recovery podcast we shed light on mental health issues mental illness and addiction recovery ways to cope manage and inspire beyond self-care we will discuss you may need the help of a licensed professional my name is kurt neider i'm a husband father entrepreneur a handyman and a student of life i avoid conflict i deflect with humor and i'm fascinated by the human experience and i'm shelley mangum i am a clinical mental health counselor and my favorite role of all times is grandma i am a seeker of truth and i feel like life should be approached with tremendous curiosity i ask the dumb questions i fill in the gaps we are so excited today to have carson delgado with us carson is from body balanced care and she's been working in the substance abuse and mental health industry for quite some time carson thanks for joining us today oh thank you shelly it's such a pleasure to be here thank you well it's fun and we've worked a little bit together in the past and so we know each other just a little bit but maybe give um some background to the listeners as to how you ended up in this field um you know maybe maybe what drove you and what got you here and a little bit about your background okay thank you yeah so i graduated in 2008 with my degree in family practice and it was all allopathic medicine that was all that i ever knew um so then i worked five years in uh a clinic a family health center and i just found that i was writing prescriptions like five prescriptions on average per patient and then they would come back and have side effects and i would write more prescriptions and i just felt that that wasn't the way i wanted to to hone in my my care my practice i wanted to really try to get to the root of the matter so i began to have a passion for mental health and wellness having dealt with some postpartum issues myself and i started to look into integrative ways you know alternative therapies to help with the mood and the challenges that people face and then that kind of i launched my own practice in 2012 body balanced care and i work with hormone imbalances thyroid dysfunction mental health you know and mood disorders and i really just try to get to the root of the issue and help support people so that they can feel their best and it's been really rewarding and jared casey he he approached me a few years ago and discussed his need for a medical director for i am recovery and i i just loved the whole you know plan that he had and what he wanted to do with with the patients that were dealing with addiction and so i said absolutely of course like i jumped on board and i've been serving as a medical director there for the last few years and it's been very rewarding and and i have worked with jared i do really love the program that he runs over there and and kind of like you he wants to get to the underlying problem he wants to really address what's causing substance abuse disorder right because it's a symptom it's not the core issue i don't think it's ever very very rarely is it ever the core issue right right there's always an underlying reason and there's always something that can be treated whether you know medically with prescription drugs or with something natural to help someone overcome an addiction and so in in the people that you've treated um and i'm always curious about this because i know we know that mental health and substance abuse really correlate closely together how often do you see somebody that just has a substance abuse disorder and it's not connected with some sort of mental health issues i would say never there is always some depression anxiety bipolar disorder schizophrenia by borderline personality disorder there's always always another diagnosis attached with the addiction okay here's another question i like to ask because i'm always i'm always wondering this in the back of my head in my in my practice when i was um starting off as a therapist a mental health counselor i started working at a halfway house for women coming out of prison and it was life-changing for me right to hear these stories and i'm like you know one nine-year-old i'll tell these stories someday but one nine-year-old who said she said at nine years old i was safer on the street than i was in my home and she wouldn't talk about the trauma but right i can see your eyes getting big and going what in the world what nine-year-old wants to be on the street as opposed to at home and what kind of trauma and i'm like these women don't belong in prison these women need and i get why they're there but they need help right they really need that mental health and so my question that i always have in the back of my mind is how much of our mental illness is attached to traumas even if it's not big t traumas right those really you know rape and abuse and all of those kinds of things but the little t traumas those insults that we get you know on a daily basis that we might just think are normal because it's all we've known how often would you think that mental health is connected to trauma i would say almost always and i believe that it's it's learned like the behavior at a very young age if you come from a family with addictions then your environment to help you learn coping skills and mechanisms to deal with stress and you know self-worth and identity those those will go by the wayside and then you are more prone to having an addiction yourself as you get older and you're exposed to these little and big traumas because you don't know how to handle it you don't know how to cope with the scale of what what has happened to you yeah and it's so true and so talk a little bit about how you approach treatment with clients that's not and and granted i know insurance companies they want to see us give medications right these these clients have high acuity sometimes and and they really they need to sleep they need to you know have less depression less anxiety they need to be able to manage some of that maybe with medication for a while so that they can actually go in and do their work what's your approach and how do you manage some of these symptoms that you see people coming in with so i i meet them where they're at i'm a big believer and you've got to meet where they're at what they can do and what they're able to do financially as well so like you said indeed i will prescribe sleep medication i will prescribe antidepressants and anti-anxiety medications to help them get over the hump of withdrawal from the drugs and i mean there's a huge imbalance in the biochemistry of the brain when someone stops using drugs especially if it's been for a prolonged period of time you're going to have low dopamine levels you're going to have increased adrenaline you're going to have drops in serotonin and so a lot of times there's a deficiency of gaba so i'll treat them you know symptomatically with the medications and then as they're able you know they start to to have a job that they're holding down they're able to have an income and they can afford a little bit more as far as supplements go then we can approach things from the root cause of the issue so for example a lot of alcoholics they're drinking because there's a gaba deficiency in the brain and the alcohol temporarily affects that imbalance for the for the benefit so what i try to do is put them on high doses of gaba they need significantly more than the average person um to rebuild and restore those gaba stores um somebody who has typically been taking a lot of xanax and alprazolam will also have low gaba so we work to restore those methamphetamine use is typically somebody who's low on dopamine i can't tell you how many patients i've had that come in and they said as a little boy or a little girl i had adhd i was on medications for add and adhd and then they went to the methamphetamines because they were trying to fix an imbalance of low dopamine so we put them on l-tyrosine and the cofactors like vitamin d and ashwagandha and vitamin d and a bunch of cofactors to build that dopamine back up in the brain and so these aren't immediate fixes but over the course of several weeks to months the patients report like i do feel better i can tell a difference and they're less prone to using drugs to fix the imbalance because we're doing that for them it's really really rewarding i love it i love to hear that and and i've heard um a lot of different ways that you can approach that and we'll talk about it a little bit more i'm wondering um what effects do you see because you know i'm thinking about a client who comes into treatment and they you know a doctor will spend months and sometimes sometimes nine ten months a year trying to get them on the right medication the right you know uh depression medication or anxiety medication that fits their needs and does what they need what a reason so you say you know it might take um a couple of weeks or a couple of months but i see people trying to get their depression balanced out or their bipolar balanced out taking a long time to get on the right combination of medications um so how what what results do you see when you're working with these clients yeah unfortunately when someone is presenting with a really difficult case and they're not responding to those medications like the dopaminergic drugs or the serotonin drugs they have a deficiency they have a deficiency that's so so far gone you know because drug use they don't even have enough for the medication to take effect so in those situations i would would use like some 5-htp or l-tryptophan with cofactors because typically they have nutritional deficiencies that are tied to the drug use right because they generally don't eat much when they're on their drugs so they probably are low on magnesium low in zinc low on their b vitamins low on vitamin d so those are all cofactors to producing serotonin in a lot of these other neurotransmitters so i really try to to use those supplements and encourage them to to wait it out give it a few weeks you know they typically will see benefit for sure there's also problems with i don't know if you've heard of the mthfr gene before it's it's called methyltetrahydrofolate reductase that's a mouthful but affine is very prevalent in our society today and the mutation of that gene affects the way that we use folic acid and b12 and so if a patient has that genetic mutation they won't really find much benefit from taking folic acid and b12 and they'll do better to take methylfolate and methylcobalamin the form of b12 and folate that will best benefit them with their mood and with their energy and just their overall health how often do you see that deficient that uh genetic you call it a mutation genetic mutation how often do you see that showing up in the population that you're dealing with i would say 99 of the time patients have this gene um it's it's quite expensive to test for and insurance that don't like to test for it unless there's a real reason that we can find so i often will base it off of their history but anybody who has dealt with depression anxiety every single patient that i have ever tested with that picture comes back with this genetic mutation sometimes one sometimes they have two copies of the genetic mutation so it just depends on the patient interesting so how often are you prescribing methyl folate a lot often again in the patients that have the the means to do so and the desire to try to treat the root cause i'll do high dose methylfolate one to two grams daily there is a prescription strength medication called deplen that's 7.5 or 15 milligrams which is excessively high in my opinion but that is something that we can prescribe for patients as well if the insurance will cover it um so that they can but i mean i have a b complex i give to a lot of patients it's 15 for a two-month supply so it is relatively inexpensive and it's also very effective in covering the bases interesting um when you treat men versus women what kind of variables do you see happening there so um in in men versus women women don't need as much methylfolates we'll say than men need typically and the other thing i like to look at is the hormones because you know men who've been on heroin for a long time or opiates for a long time there typically their testosterone levels are in the toilet they're extremely low and testosterone helps with dopamine in the brain so they'll become depressed coming off their heroin because now they have no testosterone and they're just depleted of all of those nutrients to build it so a lot of times i'll test men for their testosterone levels i'll test their adrenals like the dhea hormones the cortisol levels to see where those are at because there's definitely a problem with the adrenals getting fried and just completely depleted because of amphetamine use or stimulants and things like that so that's what i'll do for men and i also screen for thyroid i had a patient who he had come off of heroin and other medications and supplements well not supplements but medications and drugs and he was feeling horrible just horrible he was dragging every day he was depressed just felt terrible and a lot of people just assumed well this is you coming off of the drug so this is this is what it is um but upon further investigation he was telling me how his mother had been diagnosed with hashimoto's thyroiditis and i said has anyone ever tested you for that he said no so we did some blood work and you know sure as shooting he was low in in a thyroid and he had hashimoto's thyroiditis so we put him on third medication we put him on his adrenals were gone so we put him on adrenal support and it was just so neat to see he became hopeful like i can feel better i can actually feel better this is going to be great and so it's been really rewarding to kind of follow him and see him improving over time but um but yeah for women likewise i'll test their estrogen their progesterone levels i'll look at their hormones and their adrenals because people don't realize this but hormones are tied to our chemistry in the brain they're tied to serotonin they're tied to dopamine and so if if just treating them with the amino acids like the l-tyrosine and the 5-htp and co-factors is not enough um then i always always will look at the hormones because they're tied to the mood as well that's fascinating and and i you know i think people i guess in my head and this is my own personal opinion that people generally feel better and i know there's a stigma in the substance abuse industry of if you're on medications that are helping you you know stay sober then and different medications than you're talking about then you're not really sober and and i think that stigma is getting addressed and is becoming less and less but people seem to do better if they feel like they're on a supplement that their body really needs as opposed to a medication that's dealing with you know an illness a mental illness of some sort would you agree with that yeah and i i do love the fact that the natural products work they really miraculously work they take time they'll take longer than just a couple of weeks generally so you know when you want a medication right away to help i i agree i understand that and i support patients with that but but getting your body weaned off of those and onto the natural therapies and supporting a deficiency and helping your body to build back up is it i think it's empowering for patients to feel like i'm taking control of my health and i'm actually fixing the problem i'm helping my body to heal versus i'm just kind of bandaging the problem and again i with all of your listeners i don't want them to think i'm against medications because i have used them and i continue to use them and sometimes that is the only option that actually works i understand that but in a majority of cases we can use natural therapies to help them wean off the medications and get on the right track for healing overall well and i imagine you you probably and you talk to this probably get a lot of pushback maybe from the medical community that you know this is hocus pocus this is you know this is quackery because i mean that's been out there how do you what is your what is your experience with that do you get pushed back and and how do you address that so if i if i find a provider that is not a believer or doesn't know that i think the biggest thing is is they don't know you know when i went to school i was not taught any of this i wasn't taught about um the cofactors needed to build serotonin and dopamine in the brain i wasn't taught about the amino acids i wasn't taught about adrenal function or how the hormones are interplayed with this so so for a lot of them i just you know we have good working relationships they do what they do best and then i do what i try to do best and and we work kind of side by side because i feel like every patient on their healing journey has a path and for some people it's going to be medical like allopathic right for others it's going to be all integrative i have some patients who are like i don't want to be on any medications i want to do this all naturally and then there are patients in the middle that want to do a little bit of medical and a little bit of out of um integrative and so i just try to meet them where they're at and physicians i try to just be friendly and open and kind and you know listen to their story and whether or not they want to listen to mine um i still try to respect them because they they've worked really hard to become what they are today yeah definitely and and i agree it has to be a co-mingle right we've got a we've got to learn to utilize this multi um i'm losing the word but but we have to come at it from a lot of different angles from the mental health the medical side right we've got to look at all of those factors in order to get somebody really healthy right their their health their their exercise all of those pieces are really vital and i think we have to learn to work together i know there's been in some industries there's been some conflict between one professional you know who does you know one type of service and one who does a different type and i don't i don't think we have to be that way i think we need to do it together right and i feel like if we can leave our ego at the door and i think that's that's challenging for some of us because and myself included sometimes right we we think we're right and we think that what we're doing is the best way but i've been learning like the more i meet providers and i hear what they're doing and the different modalities they're using and how creative they are and innovative they're being i'm just blown away by we have this incredible you know a community of healthcare providers with different talents and abilities and gifts and we should use it i think we should just help support each other and use what someone else has and you know if i don't feel qualified or competent enough to treat a person you know because they're a difficult case or what we've tried hasn't worked i am more than willing to send them to another provider who i feel has the qualifications to do so yeah super important to be able to do that because we all have limits right it's important as as providers to know that know our limits know our weak points and and to be able to have other providers that can fill those in i love that thought yeah yeah i just it's exciting i love the time that we're in because there are so many new modalities that are being developed that i i don't have the brain power to know everything about everything and i love the fact that we have providers that we can refer to or that i can call and ask them like what would you do in this situation or what would you recommend and they're more than willing to assist so i just i love i feel like our community of medical providers is becoming more fluid and more open towards each other in a collaborative form which is what we i mean we've been working on that for a long time and i think it's like you said it's an exciting time because i think we're finally kind of getting into that space where we realized this is for the client we've got to do this for the client it's the best piece you know it's the best for them to coordinate all of these different knowledge bases right we're our specialties in different areas so that's fantastic um i i've heard a lot about functional mris and using functional you know testing like that to see where somebody's now i might be wrong because i'm this is not my specialty but to test you know looking at their hormones and looking at some different pieces like that and their brain function how do you determine test wise what kind of tests do you rely on to help you hone in on what's going on with somebody so i'm a lot of it i based on history so i you know hear about their history growing up and like how old were they when they started to use and typically it's in the teenage years and we always think oh it's because the teens are so hard and rough but that's when hormones are starting that's when adrenals are starting to shift and they're starting to need that support to help with hormonal balance um and so i ask about their history and they'll ask about their exposures potentially to things i ask about um you know their their birth history like were they born premature or did they have any problems or complications at that point so history is really big and then you know that kind of helps to guide my and their history of drug use and what were their drugs of choice and how long did they use and how heavy was the use and that kind of thing and how many treatment programs have they been in how many times have they tried um and then i'll do lab work you know i look at the hormones and the adrenals and all of those things and then i kind of base it off of the history and the the objective data that i have from the lab work but also intuition because sometimes i just in my gut i feel like something's missing or i feel like maybe we need to test something different than i typically do so it's not always a cookie cutter approach but trying to use that intuition and knowing like what supplements to recommend or what medications should they try you know they've tried x y and z for sleep and it hasn't worked so so what do we have left and what would be a good choice for them so i really do try to use intuition based on all the other data that i gather i think that's really fun i know that i'm a fan of daniel siegel and dr daniel siegel right and he he's i've heard him share some stories of this of this inner knowing right this intuition like you talk about and he talks about the gut brain and that we've got all of these neuro neurons firing in our gut and in our heart and that there's information that's coming from there and it's not just hocus pocus it's not just it's there there is science behind it um and firing that's going on in our bodies if we can pay attention there is some validity to that that we've seen show up in the science so i love i'd love to hear you talk about that you know that your gut feeling and and the intuition i think it's valuable yeah and speaking of guts like most patients who have a history of drug use have really messed up guts so that's another part of the picture right and i'm just getting into that more in depth but but the challenge is is you can't have a healthy gut if you don't eat healthy and so a lot of them are just getting by a lot of them are just eating what they have available which is going to be the processed food the sugars and things like that but um but several of them many of them when they're in you know a program they're really trying to make an active effort to eat healthier more fruits and vegetables and you know avoid caffeine and refined flowers and sugars and these kinds of things and that that can transform their gut just by eating differently you know i could try to give someone all the probiotics in the world and l-glutamine and all these things to help their gut to heal but if they're not willing to make the dietary change which i know is hard but it is the most effective way to help the gut to heal that makes sense because right if if they're not helping themselves then all the the nutrients in the world is not going to shift that and turn it around yeah yeah and we talked about the mthfr gene that methylation problem which is essentially breaking down the foods into smaller and smaller and smaller components so that they can be transported to the cells well part of that methylation process happens in the gut it happens in the small intestine so um so if they don't have good gut bacteria or they have an overgrowth of bad bacteria they've been on antibiotics you know many many times throughout their life they're going to have more problems with that methylation that mthfr gene than others definitely so so i'm curious talk about some of the successes that you've had what what do you see happening with these people that you're that you're meeting with so some of the success stories um like i've had i've had that patient that i told you about the hashimoto's who's doing really well right now and then i've had others that i put them they were on methamphetamines before and tapered off and they were off of methamphetamines and really really just struggling with focus and mood and some depression and things like that so i have a supplement called balance d and it's essentially l-tyrosine with the co-factors like n-acetyl cysteine and some vitamin c and things to help build that dopamine in the brain so i started them on that and they love it they love it they say oh my goodness this helps me so much and they take it twice a day and it's helping them with their focus and concentration instead of being on adderall right which would be an alternative so so i've seen a lot of benefit with that and then with anxiety and with sleep so i've had many patients that i put on the gaba and i have them do high dose gaba three times a day and that helps their anxiety a lot and it helps them to sleep deeper at night so that's been really really beneficial too when they come back and they're like i can think clearly now and my mind is not racing and i'm sleeping finally and my anxiety is down so it's just really rewarding to see these stories of people who are feeling better and they do feel more empowered i've noticed this they feel more empowered taking a supplement than feeling dependent on a medication if that makes sense and there's there's no problem with either like i say i i do prescribe both but there's just a different feeling when someone is taking a supplement versus the medication and how long on most of these supplements how long do people generally need to be taking them how long do they need to be on them so um typically it takes six months to a year to rebuild serotonin and dopamine stores as well as gaba so i will recommend a 6 to 12 month you know continued administration of the amino acids the really cool thing is we can track their progress another test that i failed to mention is we do urine neurotransmitter testing so someone the urine sample at various points throughout the day and then we send it off to the lab and it looks at all their neurotransmitter levels including like glutamate and histamine and you know the dopamine serotonin gaba and so we can gauge their progress we can see the deficiencies before treatment and then we can evaluate after treatment and they always go up they always go up normal ranges very cool and it's kind of fun to be able to see that things are shifting things are changing in the in the reports and and the tests and that they're feeling better as well that kind of i mean that's got to raise their hope levels yeah definitely yeah it's great to see the objective data but also that you know subjective report that they're feeling better and they're they're doing better so it is really exciting so what's next on the horizon for you i heard you say that you're trying to learn more about the gut and some other nutritional pieces what are you working on next yeah so it's going to be i'm focusing on the gut and the gut brain access and how to help heal a gut that's damaged right that has poor bowel motility or like diversity in the gut flora because there are stool samples that you can send off and look at all the gut flora like all the different bacterias that are growing and living and thriving in that in that biome right so i'm focusing on that i'm looking at i think the dietary piece is so big and so i'm trying to look into how can i coach my patients and encourage them to make healthier choices with their diet and help them to be more cognizant of the food that they're eating and what they're putting into their bodies right sometimes i think we we are using food as an emotional support or like to suppress other emotions or feelings that we have so looking at it more from the perspective like how am i going to fuel this body that i've been given and how can i support it best to help them just just to be able to make more more beneficial choices for them on a day-to-day basis um without having like an eating disorder or like you know going the opposite direction because we don't want that either yeah definitely it makes me um you were talking earlier about you know helping men make sure that their testosterone and their hormone level levels are well are good um or at a an acceptable level because i know that testosterone and you talk can talk about this a minute but testosterone levels being really low um what kind of health issues cause does that cause so it can cause the depression it can cause anxiety and sleep challenges it definitely causes more adipose deposition so like more fatty tissue of the chest and the gut um you know muscle mass will be decreased brain fog can also be accompanied by low testosterone levels low libido lack of drive lack of desire determination to do things um and so and heart disease i mean there's an increased risk of heart attacks and strokes when you have low testosterone and bone density issues can also accompany low testosterone if it's been a prolonged period of time so um so yeah a host of things high blood pressure um you know high cholesterol all of those things can affect it diabetes risk goes up when you have lower testosterone as well so it's kind of it's a big deal to get your testosterone levels evaluated it is a big deal and i've heard i've heard men particularly be concerned that if my testosterone levels are coming up am i going to be more prone to trading you know my substance addiction for sex addiction do you hear that do men talk to you about that piece you know they haven't most of the men that i that i treat have been in a relationship or they're married and so um that hasn't been something that they've they've enlisted as a concern um but i mean it's i guess it could be a potential thing i know that when dopamine levels have been low for so long and testosterone's been low for so long the initial treatment phase men feel like they're waking up like their mind is more active and they're more alert and they're more focused and they're more energetic and they want to tackle projects and their libido is back right but it's kind of an all-encompassing feeling of wellness versus just one vocated part of um of the libido right and sexual addiction but that being said there are a lot of men the and women who have dealt with drug addiction and they have a subsequent sexual addiction right so typically they're in therapy concurrently for both of those so my hope is is that as they're receiving treatment for both of those things they'll have favorable responses to testosterone therapy yeah and and i love the way you talk and make the distinction between that overall wellness that happens it's not just the libido but i've heard people ask those questions any time you're talking about shifting you know upgrading i'm going to feel better you know how am i going to respond to feeling better because they've felt low for so long so i love that you address that um in very um in a very healthy well-rounded kind of a way is what they're going to feel which is cool yeah it is exciting it's great to see so let me let me ask you um about about your own mental wellness about your and a half years ago i felt horrible like i was just i was going through the motions of living day to day but i just was not able to focus well or concentrate i was so tired like bone tired but i just i couldn't nap i had to live my life so so i decided to do a urine neurotransmitter test and i had no dopamine critical levels of um my adrenaline like my norepinephrine and epinephrine were in the toilet very low serotonin my gaba was okay but i had so many like imbalances so i started amino acid therapy and that's that's why i'm so passionate about it it changed my life like it changed my life i started to wake up better my mind became more alert and active my memory was back my clarity was there my verbal acuity was back my desire and drive to do things to be with my family to go to work was back and so i mean it only took two weeks for me it was very quick and so i continued to take those amino acids because when we are under stress and we're all under a lot of stress right but when we're under stress then we burn through our neurotransmitters and so i feel personally that i need continual replenishment for those because i also have two copies of the mthfr gene which inhibits my ability to process and produce neurotransmitter to the other cohorts and so i i do that every day i take my amino acids i take my cofactors like a b complex that's methylated i take vitamin d i take vitamin c i take zinc i make sure i get enough sleep so i'm in bed by 10 and i'm up at six i exercise every day except sundays that's when i sleep in and use that time for rest and meditation um i work with my my family and i try to continue to have a positive outlook and perspective of things and and i take adrenal supplements so i take something to support my adrenals every day my stress glands so those are some of the things that i do and sometimes it feels like a mini part-time job [Laughter] all the things but it really helps me to be a better and more effective provider which is important to me because i really want to be able to dedicate my heart and soul to my patients and to everyone that i meet super inspiring carson i love i love what you bring to the table and your expertise um one other question that i have is i suspect that there's going to be a lot of listeners that want to reach out to you that want want to take advantage of your expertise and what you know and and because they're like you know they're probably asking themselves you know i'm feeling a little bit stressed i'm feeling a little bit like i'm struggling or tired and they're going to want to reach out what's the best way for them to find you so they can go to my website it's www.bodybalancedcare.com that's with an ed on the end and also my secretary corey has a direct line at 801 224 3031. awesome excellent is there anything that you would um leave with our listeners before we end this today and and i do want to thank you for coming because this has been fantastic information oh thank you shelly um i would just tell them don't give up don't give up keep pushing keep trying keep searching i feel like we all have a long journey and sometimes that journey is short shortened and we heal really fast sometimes it takes time it takes months to years right but don't give up don't give up and know that there is hope know that there are like there are a multitude of different modalities that you can try to help with your symptoms and the things you're struggling with and um and i would love to help you if you need help i am available and i i really do try to dedicate all that i have to my patients i love that message don't give up because there's always a we a reason right there's a reason to try something different and to get more help so i love that and and i'll also say that um you know in working closely with i am recovery at times and with jared and the program that he's doing i just hear fantastic things about the work that you do with with those clients as well as i know you're seeing a whole bunch of other clients besides that so carson thank you for your work and your your dedication it's making a difference and i sure appreciate it thank you so much shelley for having me i really appreciate it and it's great talking to you