Rheumatoid Arthritis: How a Functional Medicine Approach Can Ease Your Sore, Achy Joints
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Rheumatoid arthritis can make you feel powerless. The pain and fatigue are relentless. And the medications you’ve been prescribed to control the disease leave a lot to be desired. These meds often don’t fully control your symptoms and even have some potentially scary side effects.
But you’re not powerless over your RA. There are steps you can take now to feel better while reducing your dependence on these powerful medications.
I spent her early career working in a rheumatology clinic, learning what works (and doesn’t work) for rheumatoid arthritis.
Watch the video as we dig into RA:
- Discover how functional medicine can reduce your RA symptoms, including pain, fatigue, and inflammation
- Find out how to lower your risk of medication side effects
- Start living a higher quality of life without the use of additional medications
- Learn how to tell if your pain might be a sign of RA
Your sore, achy joints shouldn’t keep you on the sidelines. Join us for this group visit and start enjoying your life again.
Navigating Rheumatoid Arthritis: A Functional Medicine Approach
Living with rheumatoid arthritis (RA) can be an uphill battle, impacting not only the joints but also the overall quality of life. In this discussion, Mary Scalf, a passionate physician assistant with a background in rheumatology, shares insights into the challenges faced by RA patients and introduces a functional medicine approach to ease the burden of this autoimmune condition.
Understanding Rheumatoid Arthritis
RA is a progressive autoimmune disorder characterized by chronic inflammation that predominantly affects smaller joints such as hands, feet, wrists, and ankles. Unfortunately, there is no cure for RA, making effective management crucial for a better quality of life. Scalf emphasizes that RA is more than just uncomfortable joints; it can lead to a range of issues, including decreased mobility, increased risk of chronic diseases, and a significant financial burden.
Conventional Treatments and Limitations
The conventional approach to RA typically involves medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs). While these treatments can provide relief, they come with potential side effects and may not address the root cause of the condition. Scalf delves into the challenges of conventional treatments, highlighting the need for a more holistic approach.
The Evolution of Functional Medicine
Scalf’s journey led her to functional medicine, a paradigm that seeks to address the underlying causes of diseases rather than merely alleviating symptoms. She recounts her introduction to functional medicine through a rheumatology journal, sparking her interest in alternative approaches beyond medications. Functional medicine explores the intricate connections between lifestyle, nutrition, and overall well-being.
Functional Medicine Approach to RA
The functional medicine tree metaphor illustrates the comprehensive approach practitioners take when dealing with patients. Instead of focusing solely on the diagnosis, functional medicine considers the individual as a whole, taking into account their unique experiences, traumas, and lifestyle factors.
Key Pillars of Functional Medicine for RA
- Antecedents and Triggers: Scalf encourages patients to reflect on when they were last well, helping to identify antecedents – events that set the stage for inflammation. By understanding past exposures, clinicians can uncover triggers that initiated the inflammatory response leading to RA.
- Mediators: Functional medicine addresses factors that perpetuate inflammation and hinder progress. These include lifestyle choices such as poor sleep, lack of exercise, stress, and inadequate hydration. By mitigating these mediators, patients can support their immune system and alleviate RA symptoms.
- Nutritional Considerations: A critical aspect of functional medicine involves analyzing nutritional deficiencies and their impact on health. Scalf advocates for a gluten-free diet, emphasizing its role in reducing inflammation. She also highlights the importance of a colorful, nutrient-rich diet, including omega-3 fatty acids, to support the immune system.
- Environmental Factors: Functional medicine explores exposure to environmental pollutants, heavy metals, and mold. Smoking, a known risk factor for RA, can contribute to inflammation. Additionally, Scalf suggests investigating potential infections and considering nutritional supplementation to counter oxidative stress.
Empowering Patients
The core message is that individuals with RA are not powerless in the face of their condition. Functional medicine empowers patients to actively participate in their well-being, addressing not only the symptoms but the root causes of RA. By adopting lifestyle changes, nutritional adjustments, and exploring innovative therapies like IV ozone or hyperbaric oxygen therapy, patients can change the trajectory of their RA journey.
Closing Thoughts
Scalf expresses gratitude for the opportunity to share insights into RA and functional medicine. She welcomes questions and emphasizes the importance of ongoing dialogue. Functional medicine offers a promising avenue for RA patients to enhance their quality of life, reduce dependency on medications, and address the underlying causes of their condition.
In conclusion, the functional medicine approach to RA presented by Mary Scalf provides a beacon of hope for those grappling with this autoimmune disorder. By embracing a holistic perspective and addressing antecedents, triggers, and mediators, patients can take charge of their health and work towards a life with less pain and greater vitality.
Are you ready to take charge of your health? Schedule your free 20-minute discovery call with our New Patient Coordinator to see how you can become a patient at MaxWell Clinic and start your healing journey today.
so thanks for joining me on this discussion of rheumatoid arthritis
and how a functional medicine approach can ease easier store achy joints i’m mary scalf
and a physician assistant here
so i started my career in rheumatology
and i’m so glad i did and i’m so passionate about treating patients with rheumatic conditions and
but rheumatology taught me a lot and it left a lot to be desired
because what i would find and specifically with all my patients i treat a lot of different medic conditions but
in rheumatoid arthritis it’s it’s like i saw that my patients that that just have the
struggle we struggle to get their disease under control and they might have been on multiple medications to
control their condition and these are medications that you know talk about a little bit just have side
effects that can compound and put them more at risk for certain things
and so it just didn’t make sense to me it’s like shouldn’t this patient be living their best life if
if their inflammation is down that their pain is down
but they’re still have this fatigue and they still kind of achy and stiff and sore
on the other hand i had some patients that i could see less frequently follow up
safely instead of every three months i could see them every four to six and they only need one drug to control
their ra or manage it per se and i think about those patients
i think about how they used nutrition and dietary dietary changes and also
exercise to help um change the way their disease presented
so and then as i reflected what i did for my own health
and my own challenges i got a lot better with uh changing my diet into a paleo
diet and beginning consistent exercise and enjoying a hobby namely crossfit and
mountain biking so um it just didn’t make sense to me and
then i learned about functional medicine and i was really excited i remember
seeing a rheumatology journal on the desk of the doctor i worked with and
that there’s an article about how there’s a couple bacteria in the gut that were associated with development of
systemic lupus and i started mentioning this to them before trying to get them over to the
side of things and i felt like i was this crazy person
like this like look look look see this we can do other things for patients like because he originally told me that
nobody wants to exercise or change their diet well
that’s why you come to us because you’re willing to and you see the amazing changes that this can happen that can happen for it
so i want to just go through the basics of rheumatoid arthritis
so what is it so it is a progressive destructive
chronic autoimmune inflammatory disorder primarily affects the smaller joints
namely the hands the feet the wrists and the ankles it also can affect the
knees the elbows the shoulders as well and sometimes the hips rarely ever the spine though
there is no cure for it unfortunately
all right and i mean not immune diseases are and are alarmingly more common than we want to think
uh and the annual incidence of it in our country in northern europe is
about 40 of every 100 000 persons that’s a lot um and the half ra
is more than just uncomfortable joints you can be out of work
uh you won’t be able to enjoy some of the things you once did before and thus
gets to reduce quality of life because you can’t uh do your job and send a hammer you
can’t ride a bike or grip your grip strength has decreased you can’t get on the floor with your
grandkids or your kids you’re also going to increase risk of other chronic diseases namely heart
disease and other vascular diseases and issues with lungs
your high higher likelihood to get joint replacements or joint fusion surgeries
and it’s just arya is just a really expensive disease to have between office visits physical therapy appointments
blockchain occupational therapy appointments um labs
medications
so what’s going to put you at risk ferrari if you don’t already have it
so if your mom or dad or brother has r.a you are a three-fold increase for having
it if grandmother uncle aunt something like that had it you’re at a two-fold increase of having it
typically this is going to happen and middle to older age however the patients that i have treated for this are all
younger than that at our clinic you’re going to see this
twice as much in females than males and then also there’s association with
lower socioeconomic and educational status smoking
if you are smoking and you have ra or you have any kind of joint pain or even if you’re at your clinic in general we
need we need to stop because it’s just going to create inflammation and smoking is the
strongest known lifestyle factor for our a
so you have joint pain but how do you know if this is inflammatory or not
we have a couple we have so many different types of arthritis and it kind of kind of comes down to inflammatory
and autoimmune there’s inflammatory and non-immune and then you have this mechanical wear and
tear and degenerative arthritis so you’re gonna have pain swelling warmth or redness and
and joints on both sides of the body if you have in your fingers you’re gonna have it on your right hand you’re gonna have in your left hand if you have any
left wrist you have your right hand um and so on and so forth
however it may not always look the same and that would be a picture-perfect world but if you have pain in the right hand you’ll pay the left it may not be
the same finger you’re going to have effect of these joints that’s where ra
likes to to affect and hear re never attacks these these are called
dip joints when you wake up in the morning when you
have r.a you feel like a 10 man you it’s difficult to walk you feel like
you’re much older than you should be and that stiffness will last around 60 minutes before you loosen up and really
feel like you can move for the day kind of we may all feel stuff in the morning to a degree but it usually is not going
to last that long the pain and stiffness is going to improve with movement
and the warmth so if you get a hot shower you’re going to feel much better you’re going to put your hands in a warm
water your hands are going to loosen up and if you’re sitting still or sedentary you’re
going to get worse again usually with a mechanical arthritis activity is going to make it worse and
rest is going to get better muscle can have systemic
symptoms like fatigue and loss of appetite and maybe even fever
so treatment with re has come a long way
and at one point to have a diagnosis of rheumatoid arthritis
menu probably were going to end up in a wheelchair and that’s just not the case as much
these days are people completely cured and held and not having joint damage no that’s not
happening either so usually when before people come to
see a rheumatologist or they try to manage their pain with nsaids
nsaids those are going to be your your ibuprofen your naproxen meloxicam
diclofenac and the like so these block these all all of these medications work to block a specific
signal in that immune cascade or the pain cascade
and so the the downside of the use of things like ibuprofen
is that chronic use of those are going to put you at risk for ulcers and bleeding
i see changes not only to the liver function but kidney function with individuals
especially when we think about what we do in functional medicine this is just going to cause gastrointestinal inflammation
and it’s going to increase intestinal permeability or that leaky gut particularly with ibuprofen
there’s other side effects for instance too that just itself is more commonly
steroids steroids are going to be like your prednisone medical dose pack and usually everybody feels good with a
steroid i had some people just felt they felt crazy on it they’re not really good to take at night
they can really disrupt your sleep you may notice weight gain in it because you get this insane appetite
you just want to kind of eat everything not everybody does but some do you might have swelling and retain fluid
your blood pressure may increase if you’re on steroids chronically you’re gonna see an increase in um
osteoporosis which i’m having toward arthritis you’re already at an increased risk
you’re also gonna have increased risk for infection and you’re gonna have delayed wound healing so it’s hard to
get well when you’re on a steroid yet it helps to decrease your pain and your symptoms it kind of
kind of doesn’t make sense does it the game changers and and treatment
rhetoric arthritis came with the introduction of dmards and that stands for disease modifying anti-rheumatic
drugs so a lot of these drugs some of them are
actually chemotherapeutic like methotrexate and that’s one of the main season therapy and rheumatoid arthritis
jewels taken once a week uh many of these drugs like heterozygous plaquemine
we can see white blood cell changes uh increases in the liver function so you think about this is toxic to the
bone marrow into the liver people are usually noted especially without the trux8 fatigue or just
everyone’s not feeling well the day after they take it so it kind of ruined their their saturday if they took it on a
friday you get nausea vomiting hair loss it’s also going to increase your risk
for infections also um methotrexate is really interesting i just want to point out when you are prescribed with the trux8
you were given folic acid to take one milligram every day because of the way that methotrexate is going to
inhibit um or kind of use up that folate that your body needs what’s interesting
though is that not everyone is set up well to be able to use that folic acid
it’s not bioavailable to them it’s not the usable form your body has to do another step with methylation to make it
into methylfolate which is going to be the acceptable form to your body
so one of the things we like to track here to look at that for like nutrient deficiencies is because your mcv
tells us about the size of your red blood cell and if that size is greater than 92 then we’ll think of that lack of the
vitamins or that need for b vitamins and so if you have like these vitamins that may play into some of the fatigue
there’s a lot more concerns with demards than i listed here
and um and then kind of lastly the the game changers come along
probably in the last 15 or 20 years are your biologics and these things
are some of the number one selling drugs on the market these are like humera
embryo actemra rituxin remicade
all of these are zeljans aluminium all of these are going to end up and usually in the in nab or ad
these are really good drugs and i really saw those turn around a lot of people like their
they went from really hurting to a lot of improvement and quality of life
but only for so long because eventually they ran into getting an infection it
may not be a serious infection that needed hospitalization but we’d have to stop therapy and initiate antibiotic
treatment when they got sick so they didn’t get a serious infection
these medications also may increase increased risk for um malignancies
so thankfully i didn’t see any of those serious side effects so i hope to say that this is less likely
however the things i did see were those mild infections that happened
that need to come off when you come off the medications you will usually flare um and then you would fight to get the
disease under control again it was a very like touch and go kind of thing
but i still like through all of this i just thought
because because r.a is so aggressive in some people
that if we didn’t have to be on one of all of these medications to improve quality of
life to reduce pain to improve function then i thought that would be a win and
so i my my aim and what we do here is to try
to reduce the amount of medications that you need to fight this disease
and reduce the doses of these or how frequently you need them
so i was listening to a internal medicine podcast the other day and without rheumatoid arthritis for the
primary care physician and this rheumatologist was saying how
he explains to patients how rheumatoid arthritis is your immune system turned on or it’s attacking
itself and and he he talks about when he was asked about dietary modifications or other kind of
supplementation helps to reduce these symptoms he said it was all kind of pop science
and and then the next breath he he literally said i you know i don’t know what turns on your
uh turn on your immune system to cause this and and and honestly that is what we do in
this clinic like we are working to find out what turned on your immune system
and kind of what pissed it off
so i’m very thankful for conventional treatment was necessary needed then there’s no shame in using it
but i just still believe there’s also a better way to do things but we want you to have a good quality
of life we don’t want the disease to progress so sometimes it’s a both and not either or and what we do
so i don’t want you to hear them saying these medications are evil
and so now let’s get to functional medicine this is how we do it
hope you remember that song so
what is the root cause of nearly all if not all chronic disease
i’ll give you a hint of inflammation inflammation in acute processes is
necessary chronic inflammation is another
another thing altogether chronic inflammation is going to be linked to several things
[Music] dementia cardiovascular disease diabetes cancer
even depression certain neurological conditions
audio immune conditions arthritis so
we want to see kind of where you stand with inflammation
and we want to work to bring that down and that’s some of why some of us maybe namely these are kind
of incessant about checking either inflammatory markers because i want to see
that what we’re doing is working i really care most that your symptoms are getting better and you’re noticing
changes in improvement in your life but we’ll make sure we’re on the right track
so we work to go as far upstream as possible
to find out what triggers keep this kept or started this in the
first place and what is keeping this information going
and if we address these things we change them
we can help support and change and modulate these mediators
with nutrition changes with lifestyle factors
and so by decreasing inflammation we support your immune system and rheumatoid arthritis is an immune
problem and so by supporting the immune system we are supporting it becoming wiser and
less reactive to self i like to think of this as we’re letting the dust settle as we do this work to
really uncover what is underlying the underlying
so when we start to take over like take off these things and uncover what we do we may find
what the different routes are to why this is
that’s really important to work with whoever it is at your clinic and if you’re my patient then of course with me
one of the to answer these questions to try to figure out
what factors play into your ra and how this all started for everyone
everyone here the question when were you last well probably one of the most important questions that we ask
because if we can learn if we can remember when we’re last well we know what it is like to feel well if we can
remember when we last well then we can kind of put together what
events what happened the circumstances
that surrounded this that triggered this onset before you started to develop
whatever it is namely here joint pain when we care about what happened in the
past and and what exposures you’ve had and how you grew up
and your family history these are things called antecedents that kind of set the scene
that maybe had this fire of inflammation smoldering before the disease actually
kind of caught fire and really started going and then there’s things in our life that
we do that keep things going and from getting better and maybe even
getting worse and those are those mediators
this is the functional medicine tree and we think about you know when you come to see us
that we already have a diagnosis of a certain organ system
and maybe you fit into musculoskeletal um immunology but we don’t think of you as
a diagnosis we think of you as a whole person and that whole person
comes with so much more than a name of what is going on you bring with you
so much experience bring with you so much knowledge
you bring so much longing so much hope and and quite a few of you have a lot of
deep hurts that contribute to what is going on
so we we do look at all the leaves of the tree but we want to look down at the
bottom here where all the roots are
this is kind of where we want to start to try to to peel away
really what is going on here because if you don’t
sleep well you don’t
you don’t set yourself up well for the next day sleep is actually adding to a restorative process that helps
support your immune function and your resilience
you will find data and research that shows exercise and movement will help to decrease pain and improve fatigue
so there’s a thing we feel that when we hurt or we don’t feel well we don’t move
we don’t exercise we fear it worsening that but the truth is with many things that
motivation doesn’t always equal action a lot of times motivation follows action
so we need to try to go with consistent movement and exercise that feels good and doesn’t cause pain to really help to
get better because as i said earlier one of the issues of rheumatoid
arthritis is when you’re stiff and you’re still that’s when things start to hurt and
that’s when those inflammatory mediators just group all in the joint and hang out there
nutrition and hydration there are things here to consider
about just deficiencies and what we might have
there are in the standard american diet it’s highly inflammatory
with autoimmune conditions you need to go gluten free until proven otherwise gluten is one of the most inflammatory
foods we consume in our diets and it may not just be because of the the proteins contained in that
sometimes it’s more because of how that grain is processed in our country and exposure to glyphosate
hydration it’s true if we don’t have adequate hydration our joints need that lubrication and
they use some of that from adequate hydration so if you think of some of the joint synovium as like a sponge
we need to have proper hydration um to help support that it also can help me
decrease inflammation a little bit stress and resilience how we deal with
stress is very very important and what i would see in practice in rheumatology
is that people would flare in their disease after stressful events
it just it never failed and and really no one was spared so kind of what goes
on with stress uh and how you deal with that you need
to have a practice at hand and mind body practice something mindful something that has you just there in the moment
present where you are something that helps trigger your parasympathetic nervous system to
help decrease that fight or flight in your body to help tell your body it’s okay to heal
that we’re not being attacked and and we have the chance and opportunity to just rest and
to get better in this process if we do not have support from your
family it’s really difficult to do the things we ask you to do here and i’m just amazed at the people who who are
able to complete this who don’t have family support so if you don’t have it i’m so sorry
and but i’m amazed at how capable you are
if you do have it that’s an amazing blessing and just express gratitude for that
there’s a connection with underlying trauma and development of r.a
there’s just there is so you have to think about the things that we go through we like to just stuff them
back in the back of our minds and think we’ll deal with them later or that’s just something that happened it doesn’t
affect me now well your brain never forgets and what happens is as the stressful
situations happen and we lose resiliency and the day to day gets to us
this opens up for that trauma to come out and work its way out and it works itself out not in the symptoms you would
think it would it can work itself out and pain and fatigue not necessarily just depression or
anxiety microorganisms
so this is kind of goes either way our immune systems haven’t been exposed to enough critters per se due to how
hygienic we are in our country but on the flip side we have these organisms in our gut
that help to improve our health if we feed our gut
when we feed our bodies we’re not just feeding ourselves we’re feeding this organism in our body known as your gut
microbiome so they will influence the formation of things to help support
your immune system gut health is going to be very essential to this process
environmental pollutants kind of what you are exposed to is going to be very important we
mentioned smoking as a number one risk factor um lifestyle wise to develop rna so if
you’re a former smoker i want you to ask your clinician about checking for heavy
metals and specifically you may have a higher level of cadmium in your body
and that cadmium can be contained in your tissues even if it’s not in your blood
and so that cadmium may be triggering your immune system and causing
your arthritis you also might have other viral
environmental pollutants certain pesticides
microplastics the skin can continue and go on
so i make sure you think through the question if you have it when were you last well i’m gonna think about what happened then
and then what happened and what happened and start to piece together kind of
what it is that may have
have started this um and it will help us kind of pinpoint where we need to do our investigations
i really kind of went through these but i’m going to mention this ton of specific things because again we are trying to
make your immune system more resilient we’re trying to settle the dust and clear up all that is
to decrease inflammation in your body uh to reduce those inflammatory cytokines
and that cascade so allergens i want you to think about if you have allergies it’s important to get those out of under
control think about um if they’re really bad think about doing allergy
drops at our clinic that’s going to be retraining your immune system to build tolerance to those environmental
triggers of allergens also think about food allergens
things like i mentioned gluten are kind of highly inflammatory and can
perpetuate that leaky gut also i see a correlation with dairy
causing some of this pain too so it’s good to try and remove all these
environmental or potential ingested allergens to try to calm things down
toxins and then cadmium just a little bit ago so think about that and maybe other
heavy metals you may have been exposed to maybe if you were an artist or if you worked in a factory
kind of let us know about that stuff mold mold related illness
may be a predisposing factor here so if you have been in a moldy building have black
mold in your house talk about this with your clinician because we may need to dig down that
pathway infections
so infections that may kind of start rna
can be linked to infections in the gut
things like citrobacter enclaves yellow they have found such things as those
cell walls and and joint spaces and uh sometimes when you have
inflammation in the joint they’ll draw a fluid of it they have gone back to the cell wall into this bacteria in there i found this in the
stool and the gut of one of my re patients the other day so i think that’s a predisposing factor
here and if we get that gone then it’ll get better
also think about um if you’ve had a history of tick bites if
you’ve ever had a tick bite way back when and you develop fevers or rashes or joint
pains with that tick-borne illnesses can cause um r.a
also think about things like chlamydia or hepatitis those also can be predisposing factors for develops and
delving some ra like symptoms but they usually are transient and go away but still would be good to know about to
investigate make sure this is not underlying there’s other infections we can look into as well
nutritional deficiencies we like to see what your body is asking for and what it needs there’s
specific nutrients namely like vitamin d they’re going to support your immune system that’s a lot when at sufficient
levels antioxidants if they are low
that’s going to be a problem and alright i’ll talk about that with oxidative stress
omega-3 fatty acids maybe fatty acids we need to
those help to decrease inflammation in the body we really have too much omega-6s in our
diets to begin with omega-3s are going to again help reduce that inflammation help rebalance the omega-6s
omega-6s are pro-inflammatory in our diet so make sure you’re eating
fish or taking fish oil to help produce inflammation and dose here is really
important when you have r.a you need to take a really high dose of fish oil around the tune of like 3 000
milligrams twice a day you also want to make sure that you eat
a colorful plate you want to eat the rainbow i’m not talking about skittles so
eat lots of colorful vegetables fruits healthy fats nuts seeds spices herbs
they all have something called cytochemicals which can increase anti-inflammatory properties or they all
have anti-inflammatory properties to support health and they helped increase antioxidant
status i kind of already mentioned trauma and
stress i’m not going to belabor that i do want to mention oxidative stress okay so if you have a chronic
inflammatory condition and you do with rheumatoid arthritis you have a certain level of oxidative stress
and what this is is an imbalance of something called reactive oxygen species that your body makes
and uh and free and free radicals versus antioxidants antioxidants help
your body to deal with those things and to get them out but you accumulate these with rheumatoid arthritis and this
actually can just keep things going and
what would be good here that for some reason we do have available at our clinic
so and so aside from increasing antioxidants in your in your diet or in what’s happening
supplementation i want you to consider discussing this with your clinician about doing iv ozone
iv ozone actually creates a short oxidative stress which actually creates the body which causes the body to create
antioxidants to help combat oxidative stress iv ozone is really good
to decrease inflammation to impact total viral loads or
to decrease bacterial infections it’s anti-inflammatory
that’s a lot of good things and i’m actually going to talk to some of my patients about that
recently got we acquired a hyperbaric oxygen
therapy chamber and so hyperbaric oxygen actually has some very
good data to help improve pain and fatigue and ra and and there was a blog that went out
about this and i let you kind of read about it there but talk to your clinician about doing
these if you’re interested because if you’ve already done kind of all this work or looked into these pathways
then that might be a road to go down
i want you to know you are not powerless to your rheumatoid arthritis
none of you are powerless to the symptoms or disease you deal with
you are not just at the mercy of medications and their side effects
you do have the power to change the trajectory of what is going on
you must believe that you can
i just want to thank you for joining me rheumatoid arthritis and with rheumatic conditions are something i’m very
passionate about and i love i love working with all my patients
but they have a special place in my heart because i walked with so many patients
in this condition and i didn’t have the tools i wanted to help them more than i could
and i felt like i was coming running short with those patients coming up short and i want to do more for them and
then here i can do more for patients so
if you have any questions um let me know otherwise i’ve very much enjoyed
talking about this with you all and if you have any questions to follow
up later if you follow us on instagram potentially put a message into our private messages
and let me know i’d be happy to hop on and answer questions on our instagram or
other social media platforms so
great well thank you so much and
next time thanks for joining us
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