Dr. Cook Roundtable Q&A Series: Benefits of NAD & Peptides to Treat POTS, Lyme & Gastrointestinal Issues

 The secret to anti-aging then is to say, well, what's going on? Because even the most healthy people that are doing great end up having like 10 or 15 things going on. You're listening to a Bio Reset medical podcast with Dr. Cook. If you have questions, we're gonna talk more about your symptoms and issues.

You can always reach us at 650 888 7950. The following is a q and a hosted by Dr. Cook, where he weekly calls with doctors. The first question is, um, I'm a functional medicine doc and interested in, uh, uh, the use of high dose melatonin for covid 19. Um, and I'd like to hear if there's any experience or clinical trials using this.

Um, and that's from, uh, Michael Chang. So that's, that's actually a good question. Um, I don't, I don't think I have the perfect answer for this. Um, I have not traditionally used a lot of high dose melatonin. Um, I have a friend named John Laurenz who has, uh, this was this funny kind of hilarious joke, um, because he has a product called The Sandman.

And so it, it's, uh, when, uh, Ben Greenfeld came to visit me, he, he gave it to me. And these are high dose melatonin suppositories. And when I say high dose, I think they're 50 milligrams. And, um, I, uh, I normally like pop, I sleep like a baby and then wake up easy. And so then I, uh, I barely got out of bed at 10 o'clock the following day.

Um, uh, I, so I'm not used to using those high doses. Dr. Schoenberger uses those doses fairly frequently with a lot of people. Um, uh, and, um, uh, there's an experience that's a, I think. I'm hearing more and more people who are suggesting that, uh, melatonin can be helpful for people, um, with, uh, covid and, um, and so, uh, and I'm hearing that from a variety of sort of good, good practitioners.

I haven't used it in active cases at high doses. I've been, everybody that gets covid that I've been treating, I've been having 'em take 15 milligrams a night. Um, uh, I, Kristen, let's do a literature review on this and see what we can come up with. Um, okay. It seems like a reasonable low risk thing to add on in, in such a way that giving someone a, a, a, a suppository a 50 milligrams I think would be a reasonable thing and probably relatively low risk to add.

Um, and I'm open to any input Jan. Do, have you had any experience with, uh, the high dose small toner? Do you have any thoughts on that for Covid?

Um, I remember, uh, Helen and the functional medicine group that say that it is helpful mm-hmm. Because it does, it does increase, uh, the immune surveillance uhhuh and, and typically that they say you only have to go too high. I mean, if it's, if the person's not just sick, you can get away, away with. Like three milligrams, so, right.

So that's what I, traditionally we were always using three or four or five milligrams. Sometimes one milligram would do the trick, but, um, but, and so I think, you know, the question is in high dose. I, I think it's a, it's an interesting question. And so we'll do a little research and see what we can come up with.

Um, uh, I know up at Sophia Health Clinic in see in, uh, in Seattle, they're doing some, they're doing using quite a bit. And so I'll try to reach out to them and, um, and, and see if we can get some feedback on that. But that's good. That's a good question and it's an interesting thing to, to think about. Um, here's a question.

Um,

I have an 18 year old with postal ortho orthostatic tachycardia. Uh, pots and, uh, syndrome and, and toxic mold that I'd love some input on, um, peptides from Dr. Gutierrez. So that's a, that's a good question. That's a, um, that's a, it's a, it's a great question and it's a, uh, I, I think, yeah, I think we've talked about POTS a little bit.

Uh, and I think that, uh, POTS is probably one of the most challenging, um, conditions that I know of to treat because it represents fairly profound, uh, dys, autonomia and autonomic. The autonomic nervous system is fairly profoundly dysregulated. Um, I'm still basically a hundred percent of everybody that I've ever treat seen with pods.

I've never had anybody not test positive, um, for, for Lyme. Uh, and, and I've never had someone not test positive for mold. Uh, and a hundred percent have had high levels of mold in their urine and, uh, uh, high levels of mold antibodies on the Myco. And so I think, uh, as a baseline, I think it's reasonable to probably get that test, uh, to try to gather a history in terms of tickborne, uh, illness exposure, uh, and to, to try to sort to sort, sort that out and work that up.

Uh, what, uh, you wanna know? Is this the, uh, the, um, These are very sensitive patients. And so this is, and they're more sensitive, I would say, than almost any other, uh, patient. And so I want people to realize that they need to be exquisitely careful, thoughtful. And if there was ever one time to start low and go slow, this would be the case.

Um, there's a very high concordance between pots, uh, and, um, also with mast cell activation syndrome. And so, uh, the pa these patients can be very sensitive to foods. They can be very sensitive to histamine related foods. And when, when I see, uh, mass cell activation syndrome and this constellation, I generally see a lot of gastrointestinal issues as well.

Um, The, this is, this is probably review, but I just bear, I would say that it bears repeating. I just talked to, uh, a, a person who I super, um, uh, love cuz she taught me a lot about ma um, about pots just because we've been working on it for the last couple of years and she's, it's been a experience of getting a lot better, but often it is the case of two or three steps forward and one step back, um, in, in terms of, uh, the, my approach to peptides, the, uh, my, my thought.

And so interestingly what I was gonna say is I talked to her and she said, of, of everything that I've ever done, if I could say the number one thing that I, I, I got benefit from, uh, was from n a d and from intravenous n a d. And I think that that's a, uh, super interesting and important point here for you to think about.

And the, the reason why I think that n a d is, is quite helpful for these people is, is that the, imagine a blood vessel and imagine that the blood is flowing around inside that blood vessel. And you've got a, a catheter in that, uh, blood vessel in this vein, and N A D is going in there. And so you've got now a relatively high concentration of N A D compared to normal in the, um, in, in your blood.

Now what will happen is, is that n a D is gonna start to dissolve and try to get from an area of high concentration to low concentration. So it's gonna start to get absorbed by cells in the first place. It's gonna get absorbed is by those cells that line the blood vessel. And, um, and so then, uh, I think that by, if, if the n a D gets absorbed by those cells that are either the endothelial, uh, cells or even the, the cells and the lining of the arteries and stuff like that, uh, once you start to increase the n a D in those cells and those cells get healthier and their mitochondrial functioning gets help better, then they tend to function better.

And as they function better then and their health goes up, then they're able to do their job. And if they're able to do their job, uh, that, that is where the autonomic nervous system is really acting at the, at the end points of the vascular treat. And so, if I can improve vascular health with n e d, uh, and interestingly, you know, I just have a, a pa another person who I super like who's kind of hanging out for.

Uh, a couple months was in town and, you know, I, I put an IV in him late last night and, uh, it was amazing because I looked at him and, and, and I was all, I put all of his IVs in cuz he is a friend of mine. And, and it was because when he came there was no veins. And after, you know, a couple months of doing IVs, it's like, I was like, do you realize how easy it is to put an IV in for you?

All of your veins are like, look amazing. And that's a typical experience that we will see where people's veins start to get way better. Uh, they'll be softer and, um, it's easier to put catheters in. And so I'm, I'm. I'm quite impressed with n e D in terms of its effect on the vascular tree. And so then as a result of that, uh, doing, doing n e d, uh, as a, as a modality for, um, for treating that and then having a benefit in terms of the effect at, at the autonomic nervous system, right where those nerves are actually impacting, uh, the, at, at, at the blood vessel is, is I think doing something.

And, and now in parallel to that, probably some of that a d is getting absorbed by various, uh, nuclei in the brain and the brain stem that may also be, uh, having, having a positive effect on the, on the dysautonomia. So I think there's probably a variety of different mechanisms, but when I, when I see someone with.

With pots. Then I, my first thing, and, and I think this has been consistent for me, the first thing that I wanna do is I wanna try n d now. That's great. That's one. The 0.2 that you have to remember is, is that these are very fragile patients that you gotta be a little bit careful with because they're highly susceptible to, if you turn on detox reactions for that to flare them.

And so, and so this is a interesting kind of to process through, I've mentioned this before, but I'll just say this again. Somebody that is drinking a bottle of vodka a day. Almost always, you can give them as much n d as you want. You could give them 1500 milligrams and they would feel like they came back to life.

Now, a person with pots and, uh, ma cell activation syndrome and mold and lime can't drink a bottle of vodka. They couldn't even drink a shot of vodka probably that would lay them out. And so when I first treat them, I'm very gentle and I started doing this. This is kind of an update of, of how I started to approach this is when if someone's in my office, uh, and.

I think that they're sick. I'll, I'll typically do some IVs and I won't give them any d. Once I do two or three IVs and they're doing fantastic, then I'll give them, and a lot of times if I, I might only give them, you know, 50 milligrams or a hundred milligrams at a hundred ccs real low dose and prove that they can do good.

As many people as we do that for, we've got probably twice as many people who are remote. And so I'm doing a lot of remote subcutaneous, n e d and the subcutaneous, n e d, uh, I think is a fantastic alternative to an IV because it's, uh, it's in subcutaneous tissue, but it's gonna get absorbed by a vein and then basically do the same thing as if it it was iv.

Now, my new little wrinkle that I started, because these patients are super sensitive, is that, uh, I, I have people use the insulin syringes, the same pep, the same syringes that we use for peptides for the nad. And so, uh, uh, 50 units on an insulin syringe is half a cc, which means 25 units. On a insulin syringe is a quarter of a cc.

Now the, the, the subcutaneous N na D that we have is buffered. That stuff from archway is buffered. And so I think that's, and it's the for sure. And so if you take half a CC of that, that's 20, uh, that'd be 50 units. So 25 units is, um, and so half a cc, so just these numbers, half a cc is 200 milligrams per cc.

So half a cc or 50 units would be 100 milligrams, and therefore 25 units would be 50 milligrams. 50 milligrams is a super low is a relatively low dose. And then 12 and a half units would be 25 milligrams. And so for my. For, for people that either have mast cell occupation syndrome or for people who have POTS who are just starting, what I'll do is I'll say, give yourself 2012 and a half units of n e d and do that for two days, and then I'll go to 25 units, and then I'll go to 35 units and then maybe 45 and 50, 50 units eventually.

Now, what I get out of that is I, I end up being able to give them a very small amount where they ramp up over the course of a week. What I've noticed is, is if I pred dose them with some trimethylglycine, so they have some methyl donors on board, and then I'm starting at at a dose of. 25 milligrams of N A D and I'm working my way up to a hundred milligrams essentially over a week.

Uh, I found that basically I can onboard people to N A D and they have almost no side effects and, uh, they don't get any of the detox reactions. And so if I had a patient who had this, I would follow some kind of algorithm like that where I'm, I'm slowly, um, slowly increasing the, the dose of, uh, the N E D and I think that that's super helpful.

I think that. I have a strong feeling just from our clinical experience and, and also from tracking and watching labs on people that any d is helpful for detoxing things in general, but I think it's particularly helpful for detoxing mold. And so then if I have an 18 year old with toxic mold, that any DS could be helpful.

Obviously we're gonna wanna develop a total program for detoxing that. And, um, uh, the, and, and also I wanna, if I have an 18 year old, I wanna onboard them to something where they're gonna have a good experience because if, if they, if they feel detoxy and sick and, and have a bad experience, they may not, uh, stick with the program once I had them up to a dose of a hundred milligrams.

These patients respond so well to the, the n that. I would, I wouldn't mind even for two or three weeks doing n a d almost every other day. Uh, and, and doing it at low dosing and then tracking to see how they did in terms of their, um, their symptomatology and, and, and in terms of, of, of how they do. Um, uh, as a, as just a couple grab bagg, kind of interesting kind of, uh, things.

I've had people with pods present where the slightest thing would trigger them into almost like a fight or flight reaction. And then all of a sudden, like, I've had a couple times when people would, would be, Basically in the clinic and, and something happened and all of a sudden their heart rate would go to like 150.

Uh, and I've brought that down with Ed. So I always have Ed available, which is a benzodiazepine, and if there's a trigger that happens, I've, ive been able to use Ed. To help bring that down. I've also, and, and, and had a few situations were a little sketchy, and I gave, uh, uh, a combination of some metoprolol, which is a beta blocker, and was able to basically break the, break the tachycardia and then they did good.

And then interestingly, I gave them n a d after that and then they proceeded to feel progressively better. So, um, n a D is, I think, super crucial in, in that, in terms of peptides, by far, the first one, sinus alpha one, it's gonna regulate the immune system. It's gonna hopefully start to regulate the mast cells.

And it's also going to, um, uh, It's also the one that has the least flare with this population. Um, the number two would be Thymosin Beta four. And then I would, I would start them with Thymosin alpha one and I'd, if it was an 18 year old, I'd probably think about doing this, this, uh, an ascending, um, dosing with the Thymosin Alpha one.

Where I would, uh, 17 units is 500 micrograms. And so often what I'll do is I'll, I'll cut that in half and I'll, I'll have 'em do eight units for a day or two, which is like 250 micrograms. And this, I do this for a hundred percent of the people with pots is i'll. So I would probably get them going on any D cuz any D's gonna make 'em feel better than anything else.

And then I'm gonna start with like, Eight units. So that's not much, that's like 250 micrograms. And what I'm uh, going for is to start them on peptide therapy where they can get started and not have any side effects. So then we slowly escalate them and once they're on eight units for two or three days, or four days or five days, and if they're feeling great, then every two days I'll let them go up, up to, so I'd go from eight to 12 to 16, 17.

And, and so then now I've got them at 500 micrograms a day, which is the, I would say the low end of the, the normal dose. And so I'm just doing an escalating dose over, let's say a week. However, you're gonna have some people with pots who you give. 200 micrograms and then they will have some detox reactions and so then you're gonna back off and you might have them do, uh, something as low as, as, you know, three or four or five units.

So I, I have some people that I started on Thymosin Alpha one at, at, at doses of basically like a hundred micrograms. So it's super low dose of TA one, and then I escalate them up. And, and then I'm letting them guide how fast they ex, they escalate based on how they're, how they're doing and, and how they're feeling.

I would, uh, once I got them up on Thymosin Alpha one, I'd probably do that for a month. Then I would add in th thymosin beta four. Uh, and I would, uh, I, I would start them again at, uh, at 200 micrograms and I would, I would try to escalate them up to 500 micrograms and I would do one. So I'd start with a TA one and get up to 500 and then, uh, wait there for a little bit, and then maybe a week, and then I would add on the, uh, thymosin beta four.

Um, then there's a whole bunch of other peptides that we can kind of start to talk about. And, and we're, we're playing with, um, certain protocols around this. And so I'm gonna have more. A lot more experience I would say over the next few months cuz we're, I'm testing a bunch of different approaches, but I would start with thy beta four and thy alpha one for that as well as doing all the traditional functional medicine stuff.

Um, uh, and, and see how they do. Do you have any more specific questions? Is Emily on here? No, I don't think she's on, no, that's okay. Um, uh, what peptide protocol would you use to treat a patient cover recovering from 19 or someone, uh, with autoimmune disease? So the covid, the post covid situation is gonna be, uh, like just about like the defining question that we are all gonna have to ask ourselves and have a good understanding of and, and then, You know, drive forward in the next two or three years.

Cuz I think we're gonna have a lot, we're gonna have a very large number of people who have post, uh, covid symptoms. And I did a podcast, uh, with Mark Hyman, um, last week that was super fun. And he, he asked me, I, he said, well, what, he asked me the question, he said, what, uh, what works for post covid? And that was the, that was the question he asked me.

And then my response was, anything that works for acute covid generally works for post covid. And then it was interesting. It was kind of awesome cuz he smiled at me and he goes, exactly, that's exactly right. And so then if I. And so then that's gonna be an interesting question. And then interestingly, you know, the people who are at the forefront of taking care of Lyme disease, I think generally are more experienced and more used to techniques that work for people with kind of chronic complex illness and, and chronic viral things.

And then the constellation of everything that we're talking about, for example, like post, you know, autonomic dysautonomia. So in the, uh, Barb is on all of these Facebook groups for people with post covid and uh, disautonomia is a big one. And so then as we think about post, we're gonna have. And, uh, sophisticated approach to thinking about the, the spectrum of symptoms that people have, because it's gonna be a little bit like Lyme.

And so you could say someone has Lyme, but the, uh, someone who has neurological Lyme as opposed to Lyme that's in a joint as opposed to, uh, denomi are gonna be totally different. Um, although there tends to be a little correlation between neurological alignment and the denomi obviously. So, um, so then I think diagnostically it's gonna be very important that we have a thoughtful approach to classifying and organizing.

Um, how we think about post covid and just, I'm just kind of saying this out loud, but that makes me think that I'm gonna try to put together some classifications in terms of post covid, and if anybody has any ideas, send it to me. Um, because I think that is, that is a pretty good idea. Um, now then, how would I, how would I then think about, um, how would I think about peptides and how would I think about it?

I would think then what, then what I'm gonna do is develop some classifications and, and, and then think clinically about how people present. And then based upon that, develop algorithms that are probably somewhat derivative of our other experiences, taking care of, um, com, taking care of other problems. Um, now I'll give you some cases.

I, I, um, Uh, and I think this is gonna be illustrative of, um, of what I'm doing. And by the way, if anybody wants to duplicate what I'm, what, what I'm about to tell you, I'm super happy to do it. Um, and so then, um, I, uh, I was, I got a text from, uh, a friend of mine, uh, Duncan, and then he goes, I got a er doctor who's got Covid, who's super sick.

And it turned out that that guy actually had some, uh, exosomes and then treated himself and felt, uh, and then this is a useful kind of to talk through these cases because then he felt dramatically better. Like he told me, he thought that he was gonna go to the hospital and then he gave himself the exosomes and felt dramatically better.

Um, for, uh, about a day, a little bit longer. And then he started to get worse and then his wife Al also got it. And, and he's an ER doctor and he got it doing it er shift. So then, um, and so then he started to get worse again. And so I mailed him thymus Alpha one, and, um, I gave, I did what I always do, which is, uh, he is a young, young, healthy guy.

So I gave him 1.5 milligrams as initial dose. And then within, I ended up giving him, uh, four milligrams the first day and six milligrams the second day. And we stayed at six milligrams for like three days. And then I did the same thing, um, for his wife. And then basically he, um, he, as soon as I got him up to that high dose and I told him if he didn't get a hundred percent better, um, I, I told him that I.

I would take 'em all the way to 10 milligrams. And that comes from, uh, my experience. We've treated a lot of people remotely with 10 milligrams a day at thymus and alpha, one divided by three to four doses. And, um, and then as soon as he felt basically a hundred percent better, and that was a day for five, then I, I went down to three milligrams and I went back down to 1.5 milligrams.

And that comes from our experience. And Dr. Seeds has a lot of great experience and has been, uh, extremely helpful to me and I think in general to the world on this topic. And so I wanna thank him again for, for his input, like in this category. Um, and so then what? And, and so then I'm continuing to strongly feel that thi one is very, is the most helpful peptide.

Um, Initially now then what I'm doing is once they come down to 1.5 milligrams, generally what I'm telling people is that if you've had covid, I'm gonna keep you on this peptide for the next four to six months. And if, you know, these are relatively inexpensive, um, you know, a couple hundred dollars a month to maybe a little bit more depending on what, what dose you're doing.

And so I tell everybody to stay at 1.5 milligrams for the first month. And then if you're feeling totally great, then I'll transition down to, uh, 750 micrograms to 500 micrograms if, if you want to go down to a lower dose. But we've seen so many people have such a odd constellation of symptoms that I think from a.

Relapse perspective from a prophylaxis perspective and from a prevention of some of these long-term symptoms. I think staying on thymus and alpha one in the dose range of let's say 750 micrograms to 1.5 milligrams is great. And so that's category one is, uh, uh, peptide. It, it seems to work for prevention.

It seems to work for acute. So therefore, based on that logic, it seems like it's a reasonable thing to do for post covid. And I'm doing that and I'm having relatively phenomenal results with that. Then, uh, uh, I'm also, uh, giving everybody thymus and beta four. And so there's a couple algorithms of, of how to do that.

And uh, one is to take, um, One is to take 500, uh, to 750 to 1.5 milligrams a day. It modulates in a slightly different way to Thymosin Alpha one. Uh, and I find them generally to be synergistic. And so for people who are in the post covid, uh, situation, uh, uh, if they, if I was treating them, I would have them on Thymosin Alpha one and Thymosin Beta four acutely.

And I think the Thymosin Beta four acutely is helpful. And when I'm treating them in acutely, I'm doing a bolus dosing. So I'm doing, uh, uh, at least 10 milligrams. So that's a high dose. Um, and that, that comes from, uh, a little bit of the Australian experience where, uh, uh, some friends of mine over there were taking care of some, uh, had a, a, a relatively interesting experience taking care of H I V PR patients and, uh, and, um, in prisons actually.

And, uh, th they, that was their dose and they had, they had a long clinical experience of using that dose, 10 milligrams iv. And so then that was one of the, what led, what led me to start to go to bolus dosing of beta four. And so I'd like to give that, uh, if I can,

When I'm dealing with th with post covid, I'll have them take Thymosin Beta four every day, like seven 50 to a thousand micrograms. But then once a week I'll give them 10 milligrams as a bolus. And when I do that 10 milligram bolus, uh, if the, assuming that they're remote, I'll just have them do that remote, um, as a subcutaneous injection.

If they're in the clinic, I'll do that IV. And people, uh, have responded very well to that. So I think that Thymosin beta four is a great, uh, post covid peptide. Uh, I, I think that LL 37, uh, makes a lot of sense acutely. And so then I think you can also use it, uh, in the post-acute, uh, uh, session. And that's a hundred micrograms a day.

And, and you can do that a hundred micrograms twice a day, uh, in, um, acute and so, For, for, for the post covid. Uh, you could do a hundred micrograms a day, so come down a little bit on the dose, but I think that that's, uh, a nice thing to do. And then I, and, uh, uh, many other people have been using BPC 1 57, uh, both as, uh, in, in the acute, uh, as an, as an anti-inflammatory.

And then also in, in, in the post, uh, and we're, we're using doses, uh, in the ballpark of 500 to a thousand micrograms. And I would have no problem giving somebody a thousand micrograms in that first month of, of post-acute. And it's, it's interest is super interesting because. I, I'm now having more and more people that I'm talking through this stuff, and basically I'm just getting like texts from doctors and stuff like that.

And, and most of the people I'm treating with these protocols are doctors who just find out about me and call me, and then I'll basically, uh, help manage them. And so if you're a doctor and you want that, I'm super happy to do that if you want. Um, if your patient will just, we, we have a, a fairly reasonable approach where my PAs are, are managing this for people.

And I'm now an enormously interested in doing these algorithms because I'm having more and more people who I talk to who I say, how's it going? Like in, at the end of a week? And they're like, I'm totally perfect. Um, and I think that that's not the average Covid experience. And, and we are, we're now in clinic on a.

Basically every couple days seeing people who are like, oh yeah, I had Covid in March. I basically, I've been having chest pain ever since then. Um, and interestingly, I have seen quite a few people who have intermittent. Uh, chest pain. And, uh, initially I had a couple people who came in with basically describing like they were having a heart attack.

I mean, people were coming in and there's this, there's a, when, when somebody has a, uh, a acute mi there's a sign called Levine Sign where they'll kinda grab their heart and, and bend over and they'll, um, they'll kind of squeeze. And, um, uh, so I had a couple people who were doing that and they were like, oh yeah, I have pain in the left side of my chest.

It's radiating down my arms. And, um, so then I, I felt like the only reasonable and rational thing to do in that setting was to, um, send them to the emergency room and they rolled out for mi. And then left the hospital with chest pain. Um, and so then, um, uh, on those patients, I ended up doing IBO ozone and then the pain went away.

Um, I have a, uh, a couple patients that I've had with that had chest pain, um, who, who I did subcutaneous and, and then I also had a couple patients who had chest pain and then, uh,

Uh, back pain basically that was like thoracic pain that was basically referring back. Um, uh, a few of those people I did, uh, vagus nerve hydro dissection at, uh, the C1 transverse process bilaterally. Uh, one of those people had like debilitating pain, and then I did the beal nerve height dissection, um, and, uh, with exosomes and then literally like as the needle before I could do the other side.

Um, they're like, oh yeah, the, the chest pain went away on the right side of my body. And, and then by the time I did the other one, the, the other side went away. Interestingly, this I think is, I, I predict, I predict that this is, Potentially gonna be a game changer for, um, pots because if I can start to, uh, reset, uh, uh, with hydro dissection, the vagus nerve, the glossopharyngeal nerve, and all of basically resetting, basically the autonomic nervous system from here down, um, I think that that's gonna be a game changer.

And I can, I can tell you as like one of the best things that I've ever personally experienced. Um, so that's, that's kind of a amazing and interesting, um, in terms of, uh, uh, and so then I think all of those are, are good approachable, uh, peptides, uh, that, that you can do. Um, the, it's interesting. So. You, I, I've also, uh, been doing for people who have some of the denomi, the, the chest pain stuff.

I've also taken just BPC 1 57 and Thymosin beta four. And, um, and, and then, um, just said, ask them where the chest pain was and then just injected the peptide kind of in the area where the chest pain was with, with the insulin needle. And I've actually had people on the phone who, uh, had them, uh, who I talked to like at night, uh, at like 10.

And I, I had them inject, uh, like one or two milligrams of, uh, BPC 1 57 and one or two milligrams of Thymosin Beta four when they were in chest pain. Um, and thinking about going to the emergency room. And then I broke the chest pain doing that. And so I think that, um, there's some super interesting algorithms in terms of, uh, and doing peptides to help reset in some of these acute, kind of an emergency type of situations.

And you can do that. I've also done it in the back, uh, for some of these patients and had very good results. The, um, the other thing that I've done, I see William Brown, um, sent a question and, uh, I think he's the anesthesiologist who I think asked this question. Um, uh, for the, for some of the people that presented with this, um, with.

The denomi, uh, chest pain stuff. I did, um, uh, an approach where I went into the inner spinous ligament, the thoracic inner spinous ligaments. It, but it would be like doing a, a thoracic epidural, but like, but, but like from a midline approach, which you technically can't really do, but with the 27 gauge needle, uh, you, you can get into that place and then going in and then slowly injecting as I'm going in, uh, not going anywhere near the ligament and flavum, but just staying superficial in that area.

And I, I was able to, uh, make the pain totally go away with that. So I've had quite a robust experience of having people come in