Dr. Cook Roundtable Q&A Series: Cardiovascular & Autoimmune Diseases

 I've actually had some fairly good luck with, with, uh, chronic Lyme and with osteomyelitis is, uh, hyperbaric oxygen. Hyperbaric oxygen. That is, if you said what are the three things that it's best for, uh, osteomyelitis might be one of 'em. You're listening to a Bio Reset medical podcast with Dr. Cook. If you have questions, we'll wanna 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 hosts weekly calls with doctors. He's a new referral that, uh, came to me about a week and a half ago. He's a very active 69 year old male, um, who's had an extensive medical history involving multiple joint surgeries.

16 in total since 2005, predominantly even since 2005. Initially the onset was, you know, um, rotator cuff injuries and re injuries, um, predominantly on the right side. Um, it, you know, you would have surgery, it'd be complicated by infections after, and this has been going on in the Middle East since that initial injury in 2005.

Some of the infections have been p acnes and staph. He's been treated each time, each of these 16 times, uh, for complications of infection with IV antibiotics. He's had PICC line, uh, placements. He's developed chronic osteomyelitis. Um, at some point they had done a line test on him. I believe he was seen by somebody in New York for that.

He's from Toronto, but. He travels back and forth quite a bit. They did a western blot in 2019. It came back negative, but he did have a very suspicious history of night sweats. Um, and just these, you know, multiple joint involved involvement, um, progressing from their, you know, the right shoulder down to the right knee, and had the right hip.

He ended up having a total hip replacement. Um, so I sent, uh, about a week ago an infectious disease panel on him to Arman Labs and he came back positive for Boreal, Barella and Barbia. Um, had elevated T cells and decreased CD 57 cells. Um, this is my first. Case. This is all new for me, so. Oh, interesting.

What kind of doctor are you? So I'm a nurse practitioner. I tr tra tra traversed over to functional medicine in the last three years. I pr, previously I was in cardiac surgery, so more critical care medicine. Actually I was in San Francisco at one point. I started my masters at U C S F. Oh really? Yeah. Came back to Toronto.

Um, Dr. Monsoor Mohammed is the one that made the connection to me. Oh my God, he's great. He's fantastic. Yeah. So, um, so now I think in the last week I've had, actually this is like my most complex case, but I think I have two others that are gonna probably test positive. I had one that did test positive as well.

He's a 36 year old and was getting diagnosed with arthritis. So I think it's quite an epidemic where we are in this area. Just so then, um, So what was his most recent surgery? So the most recent one was the hip. Lemme just go back to my list here. And did his hip surgery. Um, what did, did he end up getting an infection after that?

And he, that was in thousand 16 and he had, let's see, yeah, he had an infection. He was on six weeks of antibiotics for that. Um, had a right hip irrigation and debridement with linear and head exchange. Um, yeah, he, yeah. And then it developed, uh, infection again in 2019. Okay. So what did he say? What does he want?

What are his symptoms now? What is he, what is he coming to you for? Uh, chronic fatigue actually is one of them. Um, joint pain. Um, he, um, I think, I think the main thing is that he's just, it's, it's almost gonna be like every year at this point he's having a new injury, a new tear. Um, he was referred to me by, um, an orthopedic guy who does a lot of work with P R P and he wanted me to kind of investigate further to find out what's going on.

Cuz he is getting a lot of, um, you know, p r p injections. But the, you know, the infection, the, uh, inflammation is, is not really responsive to these therapies. Does, has he ever, has he had benefit from p r p short term? Short term, so he will have some, does, does he flare a lot and then get a little bit better?

Or does he just flare or not flare and get better? I believe the flares are purely associated with when he has the infections. But if I go through his. History since 2005. The frequency of the infections, sometimes even spontaneous. You know, it's not, there's, there hasn't been as a surgery, he still is getting infections in as an example of the right hip.

Hm.

And, um, has he had like mold testing? Have you guys checked in, looked into this? I haven't yet. I literally have had him for about 10 days, so I'm, has anything helped him? And he hasn't done any Lyme treatment or anything like that? No, I'm, I have not. I haven't started anything. I got the result today. Oh, okay.

Good. Well, so this is a great case. So then the next question, did he, has anything helped him? Do we know anything that's helped him in his, did he say, oh this helped or that helped? Anything like that? I mean, to be honest, I haven't asked that. Um, As far as symptom relief, I mean, I know he is kind of had issues with sleep cause of discomfort and pain.

Um, he's tried so many different things. It, I don't think he's been on different, you know, different types of pain medications that I don't think anything's really been effective. Where is his biggest area of pain? Or does it move around? It's everywhere. Yeah. Generalized. Okay. Uh, let, let me go through like six things.

Six or seven things. Okay. Um, and then we'll sort of process it like a situation like this. I think the first thing is to, um, start small and slow and carefully and thoughtfully and not do too much that's gonna rock the boat and see if we can do a, a thing or two that can be helpful. Um, I, I would say,

When you have a history of more than 10 orthopedic surgeries that are all complicated by infections, it's interesting. You have to think infection. And so I commend you that you did a great job of thinking about doing a more comprehensive line test. And, and so then boom, you know, you have that. Mm-hmm. Um, uh, just, just as a reminder, just because I also know that probably close to you, you may have access to this, um, one thing that I've actually had some, uh, some fairly good luck with, with, uh, chronic Lyme and with osteomyelitis is, um, uh, hyperbaric oxygen.

Okay. And hyperbaric oxygen. The it. If you said, what are the three things that it's best for? Uh, osteomyelitis might be one of 'em. And so for example, like when people get chronic dental infections and they'll get osteomyelitis, uh, hyperbaric oxygen is one of the, it's like a fairly traditional normal therapy that hyperbaric oxygen is done for.

And um, it will typically take like 30 or 40 sessions to do it. Um, and, and so I'm not necessarily saying I'm gonna start there, but I, I might bring it up to him and know that it's something that it might be worth trying once or twice. Are you familiar with hyperbaric oxygen? Yes. Yes. It's, it's kinda interesting because when they do these studies where they can show your, the, the partial pressure of oxygen and a tissue, and once the pressure goes up in the chamber, The partial pressure of oxygen goes up and then it'll stay up for like a couple hours.

Mm-hmm. And then it'll stay up after the therapy. And that oxygen you could think of as a drug that has antimicrobial effects. And the, the reason that I just mentioned that because of the osteomyelitis issue is that he continues, it's like there's a stealth infection, like almost like an addition to Lyme, that every time he has something done, he ends up with an infection that was never cleared.

And so as part of a long-term strategy, that may be a really good thing. The issue that you have to be careful with is some people can't tolerate it in terms of their ears. They have to be able to equalize their ear pressures. And so I would ask him about that and then you might just try one or two sessions and just see how he does.

Um, knowing that that's an intervention that's relatively easy to do and may have some benefit in terms of getting him started. I think Thymosin Alpha one is probably the best single thing that you could do, and I would, I would, I, and the reason I like that is I like that for Lyme. I also like that because if he's traveling back and forth between the US and the states and he could get exposed to Covid, we know that.

He's had this many infections, I would consider 'em somewhat immunocompromised just from a Lyme disease perspective, and also from the fact that he is had chronic intermittent infections, uh, that are out of proportion to the, the, the interventions that he's had. And, and so, uh, seeing how he did with IUs novel one I think would be good because then if he, if he happened to get sicker, then we could go up on the dose.

Um, I would start him. Just because so many things have gone on. I'd start him and I would ask him, find out if he has any lightheadedness, when he stands up, if he has any postural symptoms. Um, if, if anyone has ever, if he has dizziness, if he has low blood pressure symptoms, if he has any of those symptoms, I'd go very carefully and I would start at a dose of like 250 micrograms.

Um, on a TB syringe, 500 micrograms, I think is 17 units. And so 250 micrograms is like half of that. So like seven and a half, um, uh, uh, eight and a half, uh, uh, units. So it's a, it's a small amount. And then if he did fine with that for three or four days, then I'd go up to, uh, 500 micrograms a day, which is like 700, um, or, or 17.

And then I would work my way up to. 750 micrograms and maybe just keep 'em on that for maybe a month or so. Um, uh, the valuable thing about that is some, I will start some people on, on peptides with chronic Lyme and a, a percentage of those people will start to have some less pain and, and feel a little bit better early on.

Um, uh, some will flare, but most won't. And particularly if you start low with this dose and, and, and you get started quickly, that can be great. Um, uh, the, the, um, if. That works well then I would, after somewhere between two and three weeks, I'd add in thymus and beta four thymus. And beta four is a, is great.

Um, because it's a, it's a, a peptide that is, has some anti-inflammatory effects. It seems to have some immunomodulatory effects and particularly around nerves. And, and so I use it a lot in when I do nerve hydro dissection. But, um, what is, what's interesting a about that is, is that you can start to do little subcutaneous injections where you can, uh, well you can.

Uh, just pinch a little fat and then do a little subcutaneous injection over an area where you have pain. And so I've had a lot of people where somebody will say, oh yeah, I have pain in this part of my knee. And then they'll do a tiny injection either with BPC 1 57 or thymus and beta four. And I, I've had a real percentage of, of chronic, uh, Lyme migratory pain where they started to do some of these subcutaneous injections, which are super easy to show them how to do.

They're just doing it in the, in the, in the subcutaneous fat. And sometimes that can be helpful. Now, what I would, when you see these people, it's crucial to always start on thymosin Alpha one first and then evolve into the other ones. And thymosin beta four would be the second one that I would do. Uh, and then, I would say probably BPC 1 57 1 would be the third one that I would do, but I would start that last after you've started the other two.

Okay. Um, if they do well, they can start to do combinations where they'll drop a little BPC 1 57 and a little thymosin beta four, and then do subcutaneous injections with that. When I have him do that, I'll do, uh, I will typically do a ratio of, uh, uh, two, uh, thymosin beta four to one, BPC 1 57, so it's a two to one ratio.

Uh, that being said, I've had a lot of people who didn't have Thymosin beta four. Uh, and so they just did BP 2 1 57 and they still got very good results. Okay. Um, I, I would, I would try to get him started on, on peptides, uh, and, and start to do that. Number two. Um, In a situation like this, it's important to differentiate.

Is this mold and lime or is this just lime? And so there's a, uh, a blood test called, um, and there's a company, the best company, the company that I like the most is called Great Plains Lab. And they do, um, a, uh, urine mycotoxin panel. And I would, I would get that to see what that is. And then, um, uh, Andrew Peterson has a lab called Myco, and that is a, a mold antibody panel that looks to see how many antibodies you're making to mycotoxins.

And so then that's real nice because then, uh, I would get that and then we will see, is this predominantly something that is just, um, uh, Basically Borrelia and two co-infections, or is it Borrelia co-infections, plus mold. And we will see the antibody and then we'll see the urine. Then the next thing that I would do is, is since you're getting the, um, since you're getting the, the urine, uh, mycotoxin panel from, from Great Plains, I would, I'd get their organic acids.

Cuz that gives you, you know, at this, especially at this point when it's kind of hard to get blood tests and stuff like that with Covid, that's a urine panel and it gives a fairly robust assessment of, of someone's biochemistry. And so I would, I would do that. Um, and I like that test and that's a nice, um, a nice test to, to do.

And so then we have that depend what is, what did has, has he had any toxic or chemical exposures? I mean, I haven't done a full environmental survey intake on him, but not that I'm aware of. I went, you know, I kind of went to find tooth, come through all his records. He's, he's been a lot, so then, so you could call it good there.

The, since you're getting those urine tests and sending it in, they do have a, uh, basically a, a, a chemical panel that looks at organic, you know, pesticides and toxins and stuff like that. And so you could add that in if you wanted to. And I think that that's, that's not unreasonable. Um, then if I was to embark.

On, on treating him, I think number one, peptides, uh, which is easy and is subcutaneous and something that he can do at home and may begin to start to modulate pain a little bit. Number number two is, uh, uh, is is there a place where you, are you doing ozone or do you have access to anything like that? I know there's a clinic up the road.

I'm like downtown Toronto. I know there's a clinic, a neighboring clinic that it offers there. So, so then, you know, that would be one thing that would be interesting to try if, if you, if you were to go down that road and, and we, we teach classes and stuff like that, and I help for Dr. Shellenberger and I think Frank Shellenberger has a very thoughtful and wise approach to this, which is, is that he will do.

A, like one pass of i b ozone, so he'll do, um, which, and, and what the, the other term for that is major auto hemotherapy. So they'll take some blood out and mix it with a little bit of ozone and it'll go back in. Ozone has some immunomodulatory, uh, components and it, um, also is antibacterial, antiviral, antifungal.

Um, and so then you, he could try one or two of those? If he did, I would do one and I would, uh, maybe wait a week and then do another one. But I wouldn't do a five pass or a 10 pass. I would do something small just to make sure that he doesn't detox too much or, and have too much of a reaction. And then finally, and I'm just, this is, I didn't, I didn't read this before, but I'm just thinking about it off the top of my head.

Uh, finally what I would. Say is, um, I would really have a great conversation about is there, uh, uh, when people have long term chronic infections. So this is, this is a long term issue. So then, uh, I think about the places where we tend to have infections hide out. So one is the sinuses, and so I'd have a, a, a real good and and significant conversation about do you have sinus infections?

Do you have sinus symptoms, and have they been going on for a long time, or you or nothing at all, and everything's perfect in that category. If everything is perfect, I, I probably leave it alone, but still keep it on my list to go back and talk about later if something is going on. I would either a, embark on some strategies of like nebulizing and we do colloidal silver and hypertonic minerals.

Uh, you can do amniotic fluid, you can do exosomes, um, and you can do glutathione. Uh, and there are others. But, um, uh, the simple, cheap ones I like to start with and I feel like they're kind of the best first place to be and, uh, what I would, um, but, but often if I feel like they've got a lot of symptoms, I'll do a mark ons, which is a nasal swab and to try to see if there's a biofilm in there.

Um, and that often is, A place where stealth infections can hide out, and particularly that's people that have been exposed to water damage buildings as part of your workup. While you're talking about that and when you're telling 'em about the mold panel, I would, I'd ask them, are you sensitive to mold?

Do you have. Any, any issues with that? Is there any chance there could be a mold in your house, maybe do a survey and maybe even do something called an IRMI test where you, uh, they can test their house to see if there's any, any issues there? Um, then I would do a, a relatively deep dive in terms of a conversation about gastrointestinal issues.

I'm asking a lot about gas and bloating and upper abdominal symptoms, which would make me think, um, small intestinal bacterial, low overgrowth, or maybe small intestinal fungal overgrowth. So I'm a, I'm digging into some of those questions. I'm asking for other abdominal discomfort or other symptoms thinking about parasites, thinking about gastrointestinal inflammation or autoimmune disease of the gut and or dysbiosis.

And, and I'm, and so I would, I would think about that. And then finally I would think about dental and see are there any, any, any issues there. Um, and so then what I would do is, Basically try to ask all those questions, work some of those things up, get him started on peptides, and do a little bit more testing.

And then, um, uh, and then we'll help support you on dosing and things like that for the peptides or some other peptides that we could do. And then we, we'll get him started and then we'll get this, um, uh, we'll get the initial workup going and then we'll represent the case with the results and I'll talk through everything that we find.

And then we'll, um, we'll, we'll just continue to help him. That's amazing. Thank you so much. Oh, you're welcome. Okay. One, one down. Hey, nice to meet you. It's gonna be amazing. We'll do lots of interesting stuff. Okay. Hey, Dr. Cook, we have a question. Um, this is the question. What is your approach to patients with cardiovascular disease, specifically patients with significant coronary artery disease due to high small LDL particles or L p A has ozone plasmapheresis shown promise.

Who's this question from? And this is from, uh, Dr. Vent Jan. Oh, good. Is it? Hey, Jan. Tell Oh, come off mute. And, and then is this the case you wanted to talk about? Yeah. It's more of, more of a compound case. Quite a few patients, uh, 50 60 high colony CT calcium score. Um, some people with relatively good lifestyle factors, some people who smoked in their twenties, thirties.

So sort of a compound, some of the patients you actually have seen. Mm-hmm. Um, but sort of more of an amalgamation rather than a specific patient. It's like an amalgamation patient on the hollow deck. If we could just get, um, uh, Dr. Bones to sit and help us on the hol deck and go through, we would totally understand it.

Um, the, um, so this is a good question, Yan. And so then I'm gonna go back and talk you through this and then go, come forward to where we are and then kind of process through and kind of talk you through it as kind of interesting. Um, so

it is maybe one of the most interesting things that I ever heard in my entire life, and I've heard him say it about 15 times, and so I still am overwhelmed by that. With interest in this statement, and that's that. Frank Shellenberger says that he's never had anyone have a heart attack or die who he was regularly from coronary artery disease who he was regularly treating with ozone therapy.

Um, and I do think that Frank is a, a wise, and he's, he is everything that you would want in like a wise, thoughtful, kind of traditional like family doctor who happens to also know a lot of high tech stuff. And so I say that with as, as high of respect as I can say. Um, and so, so then that's been this interesting beginning part of a conversation of thinking about coronary artery disease and ozone.

Now the. I think it's clear. Um, I think it's, it's clear that ozone is scientifically felt to improve viscosity. And then interestingly, I, you know, I mentioned in the last case that hyperbaric oxygen can be helpful, um, for chronic infections and, and stuff like that. Um, uh, interestingly, a 10 pass ozone therapy gives someone as the, uh, the same dose of oxygen as a hyperbaric oxygen treatment, which is interesting.

And, uh, I can tell you that ozone dialysis and ozone plasmapheresis definitely give you much more oxygen than a 10 pass by far, because there's a, a much higher surface area and a much better, uh, Uh, a much better ability for, for, uh, gases to diffuse, uh, and, and be absorbed into the blood when, when that process happens.

Um, this a good one, Jan, cuz this is like a oral board question. Mm-hmm. It's kind of interesting to kind of talk through it like real time. Um, uh, the, I, Kristen told, or they told me, oh, Dr. Venner has a question. I was like, uhoh. Um, so, so then, um, the, then the next data point that I'll say in terms of cardiac, uh, is that when, and, and I, you know, I, you know Mark Yuson, right?

Jan, yes. Quite well. Yeah, I, I like just totally love Mark and I think I just have a higher opinion of him than anybody that I can think of from a cardiac perspective, you know? And you know, it's real interesting because they'll look at, uh, uh, plaque and cor and coronary arteries and they will see, um, they will see trace's, traces of herpes virus and other, other infections.

And, and he described, he described the physiology of this as a, imagine there's a, a blood vessel and there's a, a virus in the blood vessel and it's floating down, and then a white blood cell, a killer cell, will grab onto that and then, uh, it'll grab the virus and then pull it over against the side of the wall.

And then it's almost like, um, It's almost like a juujitsu takedown. It'll take it down. And then in the process of taking it down and, uh, working its way basically, uh, out of the blood vessel, it, it can, um, uh, sometimes viral particles or, or can get, actually get stuck in the plaque. And so they'll see that.

And so there's a concept that a chronic systemic infection can lead to coronary artery disease from, from infection, getting in plaque. And the, the classic example of this is, um, you know, like people for example, who have, uh, gingivitis and, and, and chronic dental infections. And so they're constantly getting bacteremia, conceding bacteria into their bloodstream and they're having, uh, uh, issues with.

Uh, higher infections. And so I would say in general, the patients that I have seen, and I'm thinking about, um, someone in particular is just doing amazing. And as I think there's a, a, a large number of people who get to be 56, 55 to 65, and they've got a variety of chronic stealth infections and some, some cholesterol and some lipid issues and some, uh, you know, of the six or seven main cardiac risk factors.

And, and Mark talks about 130 that he looks at, but of, of, let's say the, the, the top 10. I think that we see a lot of people who, who have maybe three or four of those top 10. Right? Uh, and, and what I have seen is a, I'd like to echo that statement that, um, Dr. Dr. Schullenberger makes that I, I personally have seen when I'm, I'm treating people on a fairly regular basis, uh, with some oxidative therapies, they tend to do quite well.

I, I think that when you give ozone and n a D together, I think that that's even better because I think that they both have mitochondrial benefits that have a potential to improve, uh, endothelial function. Uh, you know, particularly n a D, but I think synergistically they're, they're even better. And then I think that, uh, I'll, whether it be stealth infections or dental or, or, or what have you, I find that as those begin to come under control and go away, I think that that's actually a real risk that we're starting to begin to take off the table.

And then I think that there are immune things, COVID like is kind of a classic example, but there are a whole bunch of, uh, immune problems that are subclinical that ozone may help that, that, that are, are helpful on that front. Um, the, the, the interesting thing is, is that ozone has a, a very interesting effect on, on lipids because, and, and Frank talks about this a lot as well, that, uh, the ozone forms lipid peroxides with the lipids and it begins to modulate those lipids and then those lipids, um, can, uh, have other effects.

The Dr. Seeds went into a, a very long discussion of redox and, and redox balancing, uh, last week That, that I, I, I thought was, it was quite good. And, and I think this relates to ozone, and this relates to the vasculature and, and, and how we're thinking about it because there's, there's oxidative processes which our body is constantly doing.

Uh, that's how we kill infections. And then there's, uh, and, and then after we do an oxidative, uh, strategy like in our own body, then we have to do a reductive strategy. And so, um, that's constantly happening. That's the yin and yang of. Of our physiology. Uh, what I have found is when, when we do ozone, that drive drives the oxidative process.

And then, uh, and then when we, when we stop that, we give the body the chance to mount an antioxidant or reductive response to that. And I think it's, there's, there's, there's one philosophical concept of doing that, uh, oxidative today and doing reductive tomorrow. And then there's another philosophical concept of doing smaller versions of that.

So if we went back to the, the case that we talked about earlier, remember I said, well, if you're gonna do ozone, I might just do a little tiny bit. And so then in that case, I might do a little tiny bit like one pass. And so that's a little bit of oxidation. And then following that up with, With maybe five grams of vitamin C and then 600 milligrams of glutathione.

And so then that's oxidation and reduction. But those are all in a relatively low dose range. And what I'll tell you is, is that I've never, ever gotten in any trouble in that type of low dose strategy. And so then you, and, and I think that as we begin to do those mod these modalities over time, we, we will begin to w we begin to train the body's physiological ability to drive those oxidation reduction, uh, processes in the body.

And I find relatively early on that people will start. Um, and they can't do quite as much. And then after we get them doing it, then their body just seems to tolerate it quite well. And then I think detox pathways start to come online, and obviously we're trying to take a multimodal and comprehensive approach.

I think that that whole process relates to, uh, endothelial function and, and, and to the, the vascular physiology. And, and in particularly, I find that when I'm doing ox these oxidation reduction strategies with an eye towards the, let's say a cardiac perspective, um, I find that N A D is super synergistic.

With that. Um, in terms of you, you mentioned calcium and, and what I can say is there, there's, um, that one approach is to, whenever I'm doing something like this, I'll always include magnesium as, as part of the, the strategy. And, and, and the idea there is, is that if you can give some magnesium, then you may be able to substitute some of the magnesium for some of the calcium in those, in those, um, blood vessels.

Uh, o over the arc of time. In, in, in, in cases like this, I, I will try to be a little bit comprehensive in workups. So, for example, if they're, if they have a lot of like, uh, organic toxins and stuff like that, uh, from that great Le Plains lab, I was, we were talking about, or a lot of mold, uh, which I think also can affect the vasculature.

I've seen, I, I've had, uh, people who, uh, you know, we'll, we'll use binders, but one great binder that I think is interesting is the modified cispec. And I'll tell people to just have them in their office and pop those, pop a couple of those lozenges a day. I had one guy who did that whose levels were like at the.

Totally maxed out 99th percentile. Uh, who just doing that, did that for like a year and a half and retested and it came back down to like, it was like 10%. It was crazy. And so, uh, having kind of a thoughtful approach to other detox things, um, I'm, uh, in the process of starting to do, you can do lip apheresis where you can actually run, uh, uh, blood through a dextran filter.

And then start to, uh, filter out L d l. And this is a basically approved approach to treating familial hypercholesterolemia. And so then for, for that cohort, you can begin to, uh, do some strategies where you're, you're pulling that out. Uh, and then, and then, uh, uh, they'll do that three or four times a year.

And so we're beginning, uh, our, our process of that, uh, it's interesting with, with, with ozone dialysis and ozone plasmapheresis. What I can tell you is, is that sometimes you'll, when you're pulling the blood out, you'll see fairly large, like, like large, like is almost like, it's like. Half the length of a fingernail lipid, uh, blob mules.

And every time I've ever sent those for live blood cell analysis, I generally will see infections. And so I think that, uh, from a, i I, I really echo what Mark Houston said, that I believe that there is a bigger component to a, in a infectious aspect of, of it be at least being partially involved in coronary artery disease than, um, than we realize.

And so I think that that's a, uh, And, and just, I think that's important for us to continue to keep our eye on. And so then, uh, and so then you say, well, if you, and so then if I'm, if I'm having a cardiac conversation, but I'm, I'm looking at that, then you say, okay, well probably like some peptides that are gonna work on immune, if they've got immune issues is a good idea.

So I'm thinking Thymosin alpha one. And, and I think that those have been home runs for some of the mutual people that I think we're thinking about. Um, in general. In general, I feel like those have been total home runs. Um, the, uh, and, and, uh, you know, I talked about, I, I had a great conversation with Bill Seeds on this one and.

And he told me that, uh, he has seen some, some benefit with liraglutide and some glide in terms of, uh, calcification and vessels. And interestingly, one, one thing that you can do to begin to get a sense of this is when you're doing, and I always do this now, is when you're doing your physical exam, I'll, I'll look at the coronary artery and I'll, I'll, I'll do all of that type of stuff.

But then I'll look at the, um, tibial artery and then I'll look at the dorsal pedal artery. And if, if an, if the artery was going up, like the, where, let's say it was going down towards the foot like this, uh, you can look, uh, for the artery and then you can turn Doppler on and you can kind of see it, and then you c