We were really thrilled today to have Bob Johnson from Humana join us alongside Alois Reibauer from Dynatrace to talk about what running at scale looks like and what that means for a company the size of Humana. Come on up. Thank you Bob for joining us. Thank you. Nice shirt change. I like it. For those of you that haven't checked out the new shirt, move fast and don't break things. I'd like that's a good theme for I don't know maybe the last week for sure. Oh yeah. Sorry Facebook joke. Too soon. Too soon. But thank you both for joining us and I was really excited to talk to both of you because I do think for many of the users particularly here the work you're doing at Humana is super interesting and super important because we talked a lot about some of the other industries changing but health care is changing really quickly as well and digital transformation is obviously something you probably think a lot about these days and and it's been great you know we were talking a little bit earlier and you're like well we're not running that much but when I think about enterprises even if you're running just a few apps you're still running at scale because you still have thousands and thousands and thousands of users even if it's an internal application and that creates a whole different set of issues. So you tell us a little bit about the work that you're doing and really what your focus has been. Yeah thanks Abby absolutely. So we're no different from any other customer obviously in terms of wanting to go fast and and really doing it at scale focusing on pipelines and and delivery but we absolutely bring in a component of operational excellence and focus relative to operations to the table and specifically what can we do to make sure that we stay as resilient and as stable as possible and there are lots of components to that. The other piece of this is really when you think about the DevOps three ways the middle way being feedback loops which we've already talked about a couple times today tightening those feedback loops is of utmost importance from from our perspective. So we really look at a lot of different ways to do that we employ several different tools and several different attempts to go after that. Some of the things we're able to do is bring some of our legacy monitoring solutions to the table application performance solutions application performance management and you know Dynatrace is really a key piece of that as well but it's really all about what can we do to optimize our processes and and really tighten the feedback loop. How can we get as much information back in the hands of the developers as you know as we possibly can and from my perspective that's the most important thing that we're doing to really tighten things up. So just to hit on that point because I think it's important the feedback loop is the most important part. Absolutely so it's it's very important to go fast but again don't don't break things right that that's really a key thing and then the other piece of it I think is you know what can we do to employ shortcuts so a lot of IT is really focused on what can we do to drive automation and to optimize things that are sort of traditional IT. So how do we you know really take a quantum leap forward so if you think about the Boston marathon it's a 26.2 mile race think about if you can actually you know cut that kind of kind of in the middle or across the field a bit and save a little bit of time and that's kind of the concept that we look at relative to Cloud Foundry that's a key piece for us again using that for systems where it makes sense we've got several systems where it doesn't you know necessarily apply but that that's really been a key part of our strategy. Which is it's phenomenal and I know that's probably top of mind for everybody else in this room as well. I know Dynatrace has been a big part of that journey for you. Is that an asset that you're going to continue to build on or you know how what kind of difference is that making to your organization? Yeah from our perspective Dynatrace is really a capability that we've invested in for quite some time right so it was very fortuitous for us to be able to to leverage that technology and apply it as a feedback loop specifically to you know kind of to the new world if you will the Cloud Foundry world so having the ability to take an existing tool that we had built a number of operational processes around and apply it in the Cloud Foundry world was really key for us. So we've kind of talked a little about the tech but I feel like where you're also saying is the culture change has been an important piece of that change for humana as well and thinking about how do you make this change how has that journey been for humana? Yeah it's been a journey and it continues to be a journey right so obviously with any any group you've got a number of people that embrace the change that that you're looking to to drive but the desire for speed doesn't change I mean that's getting you know much more important as we as we move forward so I think the the need for acceleration is really key. Again it's like most other things you you roll out certain approaches to software engineering and development and some groups embrace that other groups are a little slower to the table but you know as part of our journey we're really focused on you know leveraging Cloud Foundry to really drive that and push that push that ahead. I'm gonna put you on the spot for a minute I know I told you I wouldn't do that but I am. What is what is one lesson you've learned from this journey so far that you think would be really helpful for other people that are maybe just starting down this path and are just trying to figure out what to do? Yeah that that's actually an easy one. The one thing that that we find has been missing in a lot of enterprise spaces specifically you you have and we all know this you have an operational world and a development world and it's very difficult to kind of find that common language so to the extent that we can leverage capabilities and tools to drive that common language to the extent that we can maybe take some of the tools that that people are using you know in the operational space and shifting those and putting those in the hands of the engineers that's probably the biggest lesson learned is to focus as much on that as possible so again don't just necessarily look at these tools as monitoring tools look at them as performance tools don't necessarily look at them you know for the use case that's maybe the most popular use case but try to find places where it applies to the developer and and I think from my perspective that's that's been our number one lesson learned. That's a powerful lesson and I love how you're you're putting the developer first in the story it's not the the tack first or the end game first it's you're putting the developer first as you build the solution around them and really absolutely make that fast. Yeah while still doing that under control.  Exactly. Because I think that would make it easier though right. It might. But you know it's been such a fascinating to hear that because I think what we hear a lot about is starting that journey but how do you get started and how do you get the momentum and then how do you do it and still able to meet the demands of your customers both internal and external if you're a large company and I think Humana really hits on that because this is a journey you've been on for a couple of years but you know to your point there's still a little road left in that journey. Absolutely start small and then scale which is the name of the game. And don't break things. And don't break things yeah. Anything you would like to add from Dynatrace's standpoint around this journey I know you've been working quite closely with Humana for a while on this. We're working quite closely with Humana and a lot of other enterprises and what we have really seen happening over the last year that cloud really goes mainstream in the enterprise as well. So we have really seen it also back to that statistics that you showed before that it's no longer that pet project inside the company but cloud is a core building block of your future application and strategy. And that's also why we how we see Dynatrace really fitting well together with Cloud Foundry. So the analogy that we use is autonomous self-driving IT and the idea is you want really like a self-driving car. You want it to get you from A to B right? You don't care so much how you get from A to B. You don't care when you have to shift, when you have to change lanes, when you have to change direction but you want it to happen in a safe way and that's how the two technologies play well together. So what we provide is more or less the software behind to tell you okay something's going wrong along the way. You should go somewhere else or it's not so smart to change lanes right now because there's a car coming right after you but what we also tell our customers along the journey we're not running applications. That's not what Dynatrace does. We provide a platform that helps you to manage and optimize your applications but not run them and that's why we tightly work together with Cloud Foundry and also tell our customers in order to really go down that vision of having your IT infrastructure managed and run itself and only get you into the game in the case of any exception. You also need to have an underlying platform that's actually able to do that if you have an application that's your so nothing against legacy technology but a 25 year old GE application that you still deploy via FTP on a Solaris system that's more or less out of warranty right now. It won't help you to have the smartest systems realizing that there's a problem going on because the system is not able to do anything with this information by scaling up by changing things by rolling back changes and so forth. So I just learned something my Solaris system's out of warranty. You can't do it on Solaris. Okay that's gonna be a problem for later but yeah I think that makes sense is really you know how you help that how you package that up but you know one of the things we start talking about is as we're running at scale what does that look like how do you manage that how do you orchestrate that and also you know what happens when there's a failure how do you know there's a failure how do you you know really you know pinpoint that. I think the key difference is you don't manage it yourself you have to really change your approach towards operation so what we've seen in the past that would obviously what we refer to more or less a data on glass approach so you have this big knock room so this room so there's no daylight pretty much like in here. Hey we have daylight this yeah back there. So a lot of screens you watch those screens and then when something happens you kind of act on reactive. You're purely reactive it's a scripted action and you have people watching screens but that doesn't scale it's fine if you run at say 100 servers it's already a lot of work to do with 100 servers don't get me wrong but what we've seen what happens when people approach move towards a more cloud native approach that their environments tend to get 20 times bigger so it's 20 times the size even for the same applications because you break it down into microservices it's more individually-scaled components which is great it just adds complexity. Does it now mean that you will also add 20 times the people? No you don't so you also have to make this part of looking at data analyzing data and automate it as well and that's where really the approach that we have comes in where we have built an AI component and I know today everything is AI but think of it more or less building a system that does a lot of the analysis that a human would do into a software system and automate these processes because as you automate how you run your replication it's also automate how you manage your replication and human intervention should be the exception and not the rule like today if you have to SSH into your pass platform something is terribly wrong right now and it's the same for when you push something through your pipeline if a human has to look at what you're pushing through your pipeline something is most likely wrong as well it should be wrong that should be the reason why human intervention is needed we heard before about shifting left security we see pretty much the same happening for performance it doesn't help you to develop and that at the very end realize once your first customer hits your side oh this thing is actually slow or they cannot log in or they cannot perform any other tasks so that shifting left piece is also part in there and what we've also seen that this additional visibility to Bob's point what we've really seen that visibility also creates responsibility you can't expect your developers to feel responsible for things breaking into production if they have no access to their data how can you feel responsible for something that you don't know about and the positive side is then responsibility creates a lot of entrepreneurial thinking with people okay this is how I can improve it it starts to be really fun seeing okay this change really had that positive impact so I think that's how we have to rethink how we work with data it's not just keeping the lights on as we've heard before it's only how do we move forward and what's the next step for us and don't break things move fast the cautionary tale don't break things you know maybe you should some of those don't mark Zuckerberg well I find myself hilarious but that's also I think a great example here to like that example you should know when things happen and said and those were a way of things coming to play for the enterprise we talked about security also before and especially in the observability domain and the monitoring domain security also plays a vital role so back to that point so like historically we see usually you had like monitoring individual for individual apps so you were looking at apps individually but now you have a platform that runs pretty much full stack a lot of stuff so how do your segment so how do your segment there and how do you ensure that people only see what they should see so I think that security topic is also extending into monitoring as well and we have for example introduced a concept which we call management zones so we're directly extracting organization information and other information out of cloud foundry and dynamically create access rules for for this type of information which is also key because the two of us might be able to look at the same dashboard but we might be only able to see different types of data so yeah that's awesome and I love how you know you're talking about being proactive and and really taking a proactive approach to the way you're architecting and deploy interaction you're tying that with your the way you're really putting that feedback loop in I think combined those two things really put you in a powerful position to not only deploy new apps but scale and for the for the Humana case you run a lot of you have a lot of very critical data like other companies you were choking about in this case even more critically but you're on the one hand you talk about like information democracy making information available which you also want to do for a developers but still you need to ensure that they only see the information that they should be seeing right right well that is a super powerful story and I'm I'm really thankful that you were both able to join us today Bob thank you so much for sharing the story that man has been on I know that everyone is is taking notes about the journey you're on and all of us always thank you thank you for bringing the t-shirt thank you both for joining me


This year's world-famous mud run at Camp Pendleton drew roughly 6,000 participants June 11th. Five-person teams navigated tire obstacles, river crossings, two 5-foot muddy walls, a tunnel crawl, a slippery hill climb, and a 30-foot mud pit. Major General Michael Regner, the commanding general of First Marine Division, and a competitor at the mud run explains the importance of teamwork during the annual 10-kilometer race. Families and Marines that train together are cohesive. There are better units, less challenges and some of the other challenges you face in life. So between physical toughness, mental toughness, and just good camaraderie is what this is all about. The Mud Run is an annual charity fundraiser that benefits all programs and services offered by the Armed Forces YMCA at Camp Pendleton. From Washington, I'm Corporal Michael Krasinski.


Hello everybody, you're here this afternoon with us and Dr. Nefisa, and I am so excited today about today's topic because I know a lot of you struggle with chronic fatigue, fibromyalgia, and we're gonna do a really deep dive into some of the mechanisms behind that. You're gonna find some really fascinating information from Dr. Nefisa today that her practice, Gordon Medical Associates, was actually instrumental in some of the research behind. So stay tuned for that.  If you don't already know, you can find all of these videos on my YouTube channel. So just go to YouTube and find my name, Jill Carnahan, and you can find all the 50 plus interviews there for free. And I'd love if you subscribe or leave feedback there or share those videos if you find them helpful. You can also rewatch them here on Facebook and on the podcast. So just all things medical here. And then if you do want information about blogs, information about Lyme disease, co-infections, fibromyalgia, chronic fatigue, other topics, you can find that on my website at jillcarnahan.com. And if we do mention any products or services, you can find those at drjilhealth.com. So Dr. Nefisa, I would love to formally introduce you and I'm so glad you're here today. Dr. Parpia has spent the last decade treating patients with complex chronic illness from all over the United States and the world. Her specialization is patients with tick-borne illness, environmentally acquired illness, mold, mycotoxin illness, autoimmunity, fibromyalgia, and chronic fatigue. Sounds real familiar. External factors to the body such as environmental toxic burden, pathogens, diet and lifestyle affect the balance of internal factors. And we'll talk a little bit about that today. Over or under expression of immunity, infection susceptibility, epigenetic expression, and cellular and biochemical function, mood and the microbiome. All of these things are some of the things that we're gonna talk about that affect our mitochondria which expresses fatigue and some of these other things. Each of these aspects is different for every patient we see. Investigating to discover and remove the underlying cause while providing symptom relief. She uses cutting edge lab testing and deep intuition applied to the full range of scientific data to unravel the mystery of each patient. She then creates a carefully treatment, sorry, creates a carefully crafted treatment plan highly personalized and healing. She uses a synergistic blend of regenerative medicine, oral and IV micronutrient therapies, peptides, botanical medicine, pharmaceutical injection therapies, functional nutrition, and lifestyle counseling. She sees patients at Gordon Medical in the San Francisco Bay Area and previously worked in Dr. Klinghardt's clinic. She's also, as I am, on the ICI board in Scientific Medical Advisory for the Neurohacker Collective.  Thank you so much for joining me today. Thank you, Dr. Jill, for having me, such an honor to be here. Yeah, so, and we kind of met through the ICI board, but I know this about the work you've done and it's just like I said, it's an honor. It's so parallel when I read your bio, we're all doing our things in our corners of the world trying to solve the mysteries of these chronic illnesses. Before we dive into chronic fatigue and fibromyalgia, I'd love to hear just a little bit, and I know our listeners would, about your story and kind of how you got into medicine and healing. Tell us just a little bit about your journey into this field. So I always knew that I wanted to help people in their healing. I began as a yoga instructor and the more I taught yoga, the more I realized I wanted to go deeper with people, particularly in illness and in health and restoring illness into health. And so I went to Bastier and I studied naturopathic medicine there. It wasn't until I was in the offices of Dr. Dietrich Klinghart when I graduated and I saw people who were very, very, very sick. And that was when my heart just went out to these patients. I could see that they were suffering, but they weren't treated at other clinics before going to his clinic with very much respect. They were told this is all in their head or they're just aging and there was minimal treatment or minimal diagnosis offered to them. And I could just feel the depth of their illness. And it was painful to see the judgments that were put upon them. So I wanted to help in helping create treatment and protocols and really dive deep with these people and help them out of the suffering that they're having a hard time coming out of. Yeah, gosh, I love that. Because most of us who go into medicine of some form, it's this healer within us that really does want to just help and understand. And I think especially those of us who end up with environmental toxicity, mold, pathogens, chronic illness, no one in their right mind would choose this unless they were a healer, right? Exactly. It is definitely the hardest, most complex form of medicine. I'm sure you agree. I love it and I know you do too. Like I love the complexity. I would say the more complex, the better, but it's really, really difficult sometimes. And these are not, these are the cases that the most conventional doctors don't want to see sadly. So it's good that you and I are welcoming them to our practice. So you've had such a great experience with some amazing medical partners. You were with Dr. Klinghard originally. Was that right after you graduated? Yeah, right after I graduated. Excellent, fantastic. You probably got a little bit of good information on Lyme and co-infections and all of that there. And he's so good at some of the environmental toxicity and the stuff that's on the cutting edge. I always feel like the Europeans are way ahead of us. And because he's originally from Europe, he, I love his perspective. He's not jaded like many, right? Exactly. So it was really wonderful. That's where I first learned right after school really how to work with this population about the tick-borne illnesses and mold and detoxification therapies. And then from there, I really made it my own. Yeah. So yeah. You probably really, was there anything in particular with that experience that you've learned as far as how to approach a chronic infection? Well, first of all, we're talking about chronic fatigue and fibromyalgia. So say you had a patient, fibromyalgia, chronic fatigue from your early days. Was there anything that sticks in your mind about lessons that you learned about how to approach them? Absolutely. So the first was to detoxify them first. So to find out what the toxic burden is, so testing through different labs, so looking at different heavy metals or different chemicals, glyphosate, different pesticides, and understanding what that burden is, because if we detoxify them first, then we can get the immune system to be more modified. We can get it to be more able to handle the killing of infections. What a great pearl. And for those of you listening, you've probably been to doctors or like, oh, let's start these antibiotics. But what you're saying, which I've seen that as well, it's like the body of its toxic load, if its bucket is full, and that's usually the ones that are coming to see us, because some of that pain and fibromyalgia types of stuff, again, we'll go deep into why that happens and some of the reasons behind it is from the toxic burden and the tissues, right? So if you take a person like that, they have infections that need treating, but you throw these even herbal antibiotics, but for sure medications, it's too much for their system to handle, isn't it? Right, they'll actually backfire. A lot of times they've got this hyperactivity in the immune system on one hand, they've got a hyperactive immune system in on another hand of the immune system. It's too weak to even mount an appropriate immune response. So many times, if we try to treat them with the antibiotics, herbal or pharmaceutical first, they'll be sensitive to those treatments. So we have to decrease the toxic load and get the mast cells in order first, and then they can't... I love that order, because it's so important. I've noticed that with my own practice as well, where again, if there's infection and toxin and mast cell activation, which is a common trio and chronic fatigue and fibromyalgia, and you really can't go to treatment until you start with getting that mast cells calmed down and the detoxification at least under control. What are some of the things when they first come in like that, would you, what kind of testing panels would you do for the initial assessment? Yeah, so I like to do the Great Plains panel, where I'm gonna look at their glyphosate, mycotoxins, most of my patients do have a high mycotoxin load, and also their toxin while I'm looking at a lot of chemicals. We'll also do the doctor's data, having metal provocation, but I'm also gonna look at metals unprovoked first, just from lab core, just urinate in a copper to have their blood taken at lab core, looking for the ones that lab core will look at, like mercury, lead, aluminum, arsenic. By the way, I'm seeing a lot of arsenic in the blood, and I think that's from the fires. It's not something I saw in previous years, it's all of a sudden this year. Whoa, lots of arsenic. I bet you're right. I suspect with the fires, there's definitely a lot of metals that were released, and I'm seeing more and more aluminum in all of my patients. Me too. Yes, well, which I didn't see. Isn't it? And I'm like, where else is it coming from? Because we know like vaccinations over time can be a source, aluminum cookware. What are some other sources of aluminum that you think of when you see aluminum? Is there anything else that you think of?  I have a drummer in my practice, and he drummed barefoot, and there was aluminum on the pedal. Wow. And aluminum was through the roof, I just measured it, so. Wow, that's so, that's so fascinating. Isn't it funny when you find one of those where you're like, oh, I think this is from this. Yeah. And arsenic too, and I think it's more in the rainwater, but probably from the fires and then the rain and the soils, and yeah, so wow, very good. And then one thing we kind of glossed over, we talked about, you know, like how you got into this medicine, but is there anything else that interests you about this population? I mean, we talked a little bit about the helping the healer within you, but because again, this is a population that is very complex. And, but you must love to solve problems. Is that one of your? I love to solve problems. I love to solve human problems. Yes, yeah, exactly, right? Not the smart stuff, or the... I'm not an engineer, you're an accountant, but the healing, you know? But it is, it's very much a mystery, it's very much a puzzle, and each person is their own mystery. So while I run the same labs for everybody, I'm gonna find different pieces and one person will react very differently than another to treatment or from the same exposure. A lot of that has to do with the genes. So speaking of labs, I like to use the Intellex DNA lab. So I found that they've really looked at how the SNPs will interact with one another, as opposed to just here's a SNP or there's a SNP, they'll look at them together, and they've really called the research to look at what diseases are related to which genes that are acting in symphony with one another. So it's an expensive... Great, I just started doing this, I have a couple of patients pending, I did it on myself and it's pending, and I've got Sharon coming on, so stay tuned for the show, because in about a month, I've got Sharon on, and I'm so excited, because we'll have her talk about that. She's the expert, the medical director of Intellex DNA. I love that you're using that, because I've done so many genetic tests out there, aren't there? Yeah, I found the last one, this one is the most informative. I agree. So say you have someone, and again, we're gonna get to five miles of chronic fatigue in a moment, in the cell danger response, which I didn't want you to talk about, but before we go there, I say you do have someone arsenic or metals, so say they have some, a little bit of mass selectivation, they have chronic pain and chronic infection and toxic burden and all these things. If you do find metals, are you gonna do that early on? Detoxification, are you gonna do maybe some treatment? Where would you order that in your treatment plan? It depends on the person, but most of my patients, I have to treat mass selectivation syndrome first. Usually they come to me with that, they don't even know, they have it, so I just wanna calm down the immune system, that's the hyperactivity system that I wanna calm down. I'll use peptide therapies very often with that. I like to use thymus and beta-4 to help calm down the immune system. I'll use BPC-157 as well to help with decreasing inflammation. I'll give them sleep peptides, often they need to sleep before they're even ready to detox. Sometimes they're constipated, so I need to deal with the constipation before they're ready to detox, or else they'll just be a backlog of toxicants that aren't exiting the system. Sometimes they have issues with their kidneys, so we have to work with that. So often with these patients, I'm calming down their immune system while I'm working with other systems that aren't quite ready for detox. I'm doing like a pre-tox for them, like in herbs to support, right? And then I'll retest some labs, see where they're at, and also see where they're at with the way they're feeling, and then we'll begin chelation therapy. That's tremendous. And I always admire some of my best learnings that are from my naturopathic friends, because I feel like you guys have such a great training in some of those detox. What's the name of, from naturopathic medicine of the detox pathways? Is there a name? The emuncturis? I like that time, because I mean, I've learned that over time, but like traditional allopathic medicine, we're not taught about this. Which is why most doctors, unless they go extra education, they don't even know. Like I feel like you guys have a lot to teach us in this way, so tremendous. What are the things would you do? Because we know some of the homeopathic remedies or drainage remedies or things. What about non herbals, non homeopathics like other, like maybe epsom salt baths or alkaline water. Do you have any sort of just environmental or lifestyle things that are good for detox that you like for most of your patients? Yeah, most of them actually do well with coffee enemas. It's strange that sounds. I actually know. It helps their liver to continue, detoxify. Yeah. Saunas I think are really important or at least getting the sweat going because the skin is the largest organ of detoxification and of course, making sure that they're not using products that have chemicals and toxins in them that they're eating organic as much as they possibly can. Fantastic, yeah. And do you do castor oil packs or dry brushing some of those? Yes, yes. Castor oil packs, dry brushing, oil pulling. Yeah. We'll use a combination of a very classic naturopathic techniques along with this patient population. I have to use a lot of medications. Yes, yeah. Definitely. If you do the MCAS, you really sometimes need to layer four, five, six things. Yeah, so it turns like, when I went to naturopathic school, these were the treatments that were taught to us and they're wonderful for the population that's not extremely sick. Yes. And for the people that are extremely sick, they're excellent supportive and I consider them foundational. But then I have to go into stronger. Right, right. I love it though, because we're like pulling from both worlds because I like learning from the homeopathic, naturopathic world and then, but we still need medications, of course I'm both in. So that's really great. So we talked about your interest and kind of, and so let's dive into what's behind these illnesses because there's so many, I'll just let you talk a little bit about what's behind and then after that, we can go into the cell danger. I definitely want to talk about that. So behind these illnesses and what was so great is the bio that I read for you, you literally kind of listed what's behind these illnesses in your bio. I love that, but talk a little bit about what, so someone has fibromyalgia, chronic fatigue and is listening, what might be some of the causes behind that? Right, so in classic fibromyalgia, they say there's no cause, right? And then you give them Lyrica and they're supposed to be better. Most of my patients are not like that. They're not, if I give them Lyrica, it's not going to really help me a little bit for a couple of weeks and then nothing. So usually I'm looking for pathogens, often parasites, viruses, tick-borne illnesses, mold, dental occult infections. That's very common, right? Sinus infections, which I think is overlooked a lot. And I bet you're thinking the same thing actually about the sinuses. It's so close to the brain. And I'm finding a lot of funguses or mark-ons of people's sinuses. Once I treat that, the brain fog begins to resolve. So I think of the inflammatory cytokines, the bugs that are in the sinuses. I find this to be one of the biggest missing pieces that people have been to more mold treatment in other places. And I'm like, did anyone treat your sinuses? And they're like, no. No. This is a really big deal, so I totally agree. Yeah, and I'll treat the sinuses the same way I treat the gut actually by killing the infections, restoring the whole thing. And let's pause there real quick, because what do you like to use? I mean, I have some herbal favorites and some prescription favorites, but what is some of your preferred ways to treat the sinuses? Do you do irrigation? Do you do sprays? Do you compound? Do you do herbs? Yeah, I do compounding very often. I'm going to start with Argentin silver. I found that if people do this, if they nebulize it, not just spray it, but they atomize it so it really goes up high, then I've seen that really reduced brain fog. If they do this, and this is a tall order, like four or five times a day for two weeks, it's changed people's lives. People who are not chronically ill, but they have brain fog, that has changed their life. Just doing that. And you do with just plain silver or with EDTA? Would you use both? Well, I start with silver, and then I also have them do at night, a nasal probiotic flush, and then also I'll have them put coconut oil in their nostrils because it's hard to kill infections in the sinuses when they're dry. So they'll do that for two weeks, and then I'll move into using chelating PX, which is EDTA to bust up the biofilm, and then if they have a fungus, might use amphotericin or beg spray if there's more cons. So whatever antibiotic they need, I'll use that while we atomizing that. Oh, that's tremendous. And I love a couple of things you mentioned. First of all, that you start with silver without EDTA, because I think sometimes that biofilm busting is way too much. They get headaches or they get really sick because often it's a dumping of the dead material I think of the biofilms, if you're listening as pond scum, it's like this kind of gross covering that keeps everything hidden from the antibiotics or the silver. So you need to bust that up to clear it out, but if you bust it up too much too quickly, the system gets overwhelmed, and the mast cells get angry too, right? I sure do. So I think of it as a gentle way before I, in fact, that's the way how, that's how I'll treat most people. I'll start gently and ramp them up. Oh, tremendous. And the other thing to mention, the dryness, because most of us aren't flying a lot nowadays, but just flying in an airplane, it's so dry. That's why people tend to get more sick or used to, again, now things are just very different, still toxic, because they spray all these chemicals, but the dryness of the air, and here I am in Colorado, which is really dry, that really makes a difference, the moisture. I love that you recommended.  Yeah, just have them take a Q-tip and just put it in. Yeah. Vaseline, which is petroleum-based, right? Right, exactly. Oh, this is a great, great pearl. So we talked about nasal, and then I interrupted you. What else would be the underlying factors in the chronic fatigue and fibromyalgia? So definitely heavy metals, which we already talked about. I think of this, it's a whole soup, so it's not salad like, here's a tomato, here's a piece of celery, it's the whole thing together in one soup. So metals, usually there's a high viral load. I'll measure people's nagalase. I love the infecto lab test, by the way, because now we can use T cells to look at if the infection is active right now or not, as opposed to looking antibodies where we have to kind of guess, right? So I'll look, I'll use that test to see if there's a high viral load. If there's mold, I like to look at the mold IgG allergens as well as mycotoxins. So I'll look at that on lab core. So basically I'm hunting for different infections and different toxins, because those are the two things that I think hijack the system.  Excellent, so pathogens, toxins, infections. Hormones, hormones, and oh, this is great. And the gut, of course the gut. Yes, and you always do like stool and organic gases or how do you like to test the gut? Yeah, I like to look, I like the GI map test. I find it to be the most sensitive. So I'll look there and most of my patients also have SIBO, which I generally like to treat first. I like the TRIO SMART test because they're looking at hydrogen sulfide SIBO and no other test has done that before. So that'll look at, that'll give us a chance to find SIBO in ways we haven't been able to before. Yes, now the key is then what do we do with hydrogen SIBO? I've read a little bit about some of the pearls for treatment, but if you do find the hydrogen sulfide, is there any particular things you do differently with treatments or herbs? You know, for sure I'm having them decrease sulfur in their diet. Yeah, and then, but I'm using the same treatment as I would for regular SIBO, which is the Cyphaxin, Vagel, and the Bismuth to bust up the biofilm, Golden Steel to prevent yeast. Yes, oh, fantastic, sounds so similar and so important because again, that gut, like I love that you mentioned two things that I think are so critical that you really can't get past in that sleep and constipation. So if you have someone coming in that has insomnia or constipation, no matter what kind of protocol you put them on, if they're not sleeping and they're not pooping, you're not gonna get very far, right? No, no, exactly. What else for sleep? Because a lot of these patients have sleep issues and it's related to everything else we talked about, but any tips or tricks that you have for helping patients sleep? Yeah, so I have an IRA Day Sleep Team, which I really like, there's Cardamom in it. So Cardamom helps people stay asleep, there's Ashwagandha and Chattavari in it, that can help people. Now there's some people who that doesn't help or the regular, like Valerian or Gabba or Athenean, that's not helping them. I'll go to peptides for them. So I like Epitalon for sleep or Delta inducing sleep peptide. Those really, really help people and it makes me not have to use, I like to not use benzos for their sleep. I found that peptides can be a way around having to use benzos for those people who just can't sleep, no matter what herb I give them or no, no matter what sleep hygiene techniques we give them. So this can be tricky in the tick-borne infections complained to that too in the activation of the immune system. So it can be, I find that sleep issue for some people is really hard to hack, but like you said, screen peptides and herbs, and then there was some, oh, I was thinking anti-histamines can be like hydroxazine and those can be really helpful. Yeah, Ketotaphine actually, I give Ketotaphine for Masal Activation Syndrome and it really helps them to fall asleep. There's the odd person I found in my practice that makes them groggy in the morning, too often but sometimes I can't give them Ketotaphine. Yeah, great tips. So let's talk about this cell danger response because I know you're, so Gordon Medical Center was where you had told me right before we got on live that you guys had actually done some of the research with Dr. Navu. So tell us first what is it? And then you can just dive in, I can ask some questions, but I definitely want to talk about this. If you haven't heard about the cell danger response, this is groundbreaking. Yeah, so at Gordon Medical, we provided the patients that Dr. Navu did research on and this was right before I joined Gordon Medical, but Gordon Medical and Dr. Navu were involved in the research together then and wrote the paper on this and it is groundbreaking. So the cell danger response, it's modulated by mitochondria, which is the energy producing part of the cell. And it's, but it's also sensing when the cell's not getting the nutrients it should be getting. So that means that the cells in danger that's signaling the immune system to take action, that there is danger. It happened when there's a virus in here or a toxin that ties up nutrients. And the mitochondria will then send a signal to other cells, but that signal is that it starts to send ATP outside of the cell. So actually around the cell membrane instead of inside the cell. The important thing to remember is that it's not an on and off signal. There's a little bit of the signaling every day to help your body pay attention to when there is an invader or pathogen or a toxin or stress, whether that's emotional or physical stress. So it doesn't have to be a disease. So it's really actually happening constantly as a normal defense mechanism. But when the signal persists, that's when illness occurs. So it's like there's a healing response that's stuck in this loop and it just can't stop. Mass cells are constantly activated. The immune system is constantly activated. So it's like trying to understand where do I cut that loop? How do I stop the cell danger response from happening? Speaking of chronic fatigue, Dr. Navio and Gordon Medical, the research occurred on chronic fatigue syndrome itself. He's associated cell danger response with Lyme disease, with autism, with chronic disease. Yeah, so it's been really wide. It's one of the things that I know you and I, we can see it unifies a lot of these complex chronic illnesses that we see almost all of them actually. Exactly. Yeah, they're stuck in this repeating loop of incomplete recovery and re-injury and they're unable to fully heal. Talk a little about the, because there's the cell danger at the part phase one, two and three and each of those, if it gets stuck there, there's different sets of illnesses and things. Do you want to talk a little bit about some of those and the differences between them? Sure. So part one involves the innate immune system. So the neutrophils, the macrophages, natural killer cells, monocytes, the mass cells. So these cells come out and the mass cells come to prime the immune system, right? And then the other cells will come out to begin the killing and may actually do the killing, right? But the infected cells at this point, they stop making normal amounts of ATP. And this is when they start to export the ATP to the cell membrane outside the cell. And that's the danger signal, usually signaling the rest of the body and cells. Hey, there's a danger here. There's a toxin, there's a bug that's activating the innate immune system. So we see if it happens in a lot of cells, that's when we start to see the sick behavior, fatigue, brain fog, body aches and pains. If it only happens a little bit, we're just gonna get a stuffy nose, right? But at this point, they're depending on glucose for energy instead of ATP because the mitochondria now browning out. So it's anaerobic respiration. They're producing little energy. So we'll see illnesses here. If we're stuck here, we'll see HPA, access issues, allergies, asthma, chronic infections, which are often underneath the chronic fatigue syndrome the fibromyalgia that I see. And so it can be stuck here. And in part two and part three, which I'll talk about in a minute. So it can be stuck in different parts and different systems of the body. So part two is when we start to rebuild tissue damage and that cell proliferation. So the mitochondria, they start to go back to producing more ATP but it's still anaerobic.  We're still burning energy from glucose but there's less of an inflammatory signal. So here it's more proliferative disorders, cancers, hypertension, different heart diseases. Then there's part three where we're restoring intercellular communication. So the cells learn how to function as a part of the whole. So a lot of hormones are important here. Neurotransmitters are important here. So here we're gonna see illnesses like chronic fatigue syndrome and fibromyalgia. Autism, spectrum disorder, PTSD, anxiety, depression. So I love it, cause you really cover like all of medicine, right? This is such an underlying cellular like we're talking about at this cell level one of the things that goes wrong which is why when Dr. Navu really has presented his data all of us were just like, wow, this is I remember two years ago, right at ICI when he presented and you involved a little bit in the research. So maybe you knew some of the backstory, but for me and most of us who hadn't heard a lot of the research, it was literally like jaw dropping. Oh my goodness, this is amazingly cause it just puts everything together. And I'm gonna try to, I may not be exactly scientifically accurate, but for those of you who are listening and you're not super scientific, I'm gonna try to explain in really simple terms what's happening. You have a cell and when the cell spills its contents, it's broken, right? It like spills out. Then the contents get outside. That's what's triggering this is outside the cell. It's like, we call it like damage associated receptors. So basically the damage to the cell, the contents of the cell got exploded or damaged or leaky. And then the outside is getting the signal that, oh, there's cell contents outside the cell. This is not good. So I think of it real simplistically as you've spilled contents of a cell that was damaged and outside the cell, there was a signal because your body knows it's very smart. And it's like, this should not be outside the cell. It should be inside the cell. And that's the ATP. So the ATP is a cellular currency. It should be in the cell, making energy for the cell. If it gets outside the cell, this is the cell danger response. And again, super simplified, probably not completely scientifically accurate. But for those of you listening to understand, it's just the spilled contents. The cell's broken. It's damaged. And because it's damaged, it's telling the body, oh, something is dreadfully wrong. You've got to mop up this mess. You've spilled on the floor. And that's kind of how I think of it in a simplistic way. Yeah, exactly that. So then what do we do? Again, this is a cellular mechanism. There have been drugs studied to stop this that are highly effective. Unfortunately, they're not available. They're remain. Yeah, yeah. So, interesting things. I think in medicine, we're so good with A goes to B. Heart attack, broken bone, bullet wound. Medicine knows what to do, but Dr. Navigot calls what we're talking about the black box of healing, but the complex chronic illness. So this is where it becomes highly personalized. When we look at the genes, we look for the toxins. We're looking for what is causing the most irritation in the system. And for my patients, all of these things we just talked about, but usually it's the immune system that's the loudest first in the mass cells. So back to that, yeah. Treating them. Back to where we started, which is starting with calming the mass cells, supporting immune system, clearing infections, treating heavy metals, toxicity, and then going down the road. One question I just thought of as we were talking on fibromyalgia, I have heard some of the theories around having lactic acidosis, which is basically in the tissues you have a more acidic environment, which can cause pain. And again, that can come from everything. It's not a new theory. It's nothing that's different from what we're already talking about. But have you found any sort of alkalinization therapies helpful, like say mineral water, alkalisic acid gold, some of those things that are more, or even alkaline diets? Have you done anything along those lines? Yeah, absolutely. Alkaline diets, I think really help for intermittent fasting, for sure the detoxification is gonna help. Yes, excellent. So what else would we look at? So let's go back to, let's talk about chronic fatigue and fibromyalgia just slightly separately because they're very similar in mechanism, but we might treat them slightly differently. Let's start with fatigue, because fatigue is most people who are sick. They have some sort of, they may not qualify for chronic fatigue, most of them do, but even if they don't, they'd usually have, and it usually is associated with brain fog, which is kind of, and it's so funny, because those of us in medicine, brain fog isn't really defined, right? But every patient that we ever talked to, if we say brain fog, they know what we mean. So we use that term a lot. And how would you define brain fog or what would people be complaining of when they come to you with that? So most of my patients have brain fog, actually. So in tick-borne illness, I find that the brain fog is actually more tied to pain than in people who have viral, mostly just viral issues. So, but in both populations, the brain fog will manifest pretty, will sound similar or be experienced similarly. So I just, I went into a room and I forgot what I went there for. I went to the grocery store and I picked up peas, but I meant to get potatoes or things like that. Or I just can't think straight. A lot of them say, I think I'm losing my mind. I actually find it's more the tick-borne illness patients that it's that extreme when they say, I think I'm going crazy. But for women, a lot of times if they're not sick, we can just fix the hormones. That'll help them, right? But for these patients, if we fix the hormones, they're still gonna feel like they have brain fog. So that's another sign that there's something else going on. I love that, because I remember 15, 20 years ago when I started in Function Mass and I have a menopause patient or a patient with hypothyroid and it'd be very simple, straightforward. We'd replace the hormones or balance our hormones or give them thyroid and they'd feel better. Yeah. And I don't know when I've seen one of those kinds of patients lately because there's so many layers. I give it only that simple. Certainly there are people that, that's all it needs is just a little tweaking. But I find that to be kind of a superficial level. Not superficial, it's very, very important, but it's a superficial enough that what we're talking about here is usually way deeper causes. So just doing that alone, unfortunately nowadays, at least from my practice, doesn't usually 100% turn them around, right? Well, definitely not. I wish it would. And they wish it too. They say, okay, now look, the labs say that my progesterone and my estrogen are back into balance, but I still feel the same. I still feel terrible, right? Yeah. And I say, but that, you know, that's just a foundation for you now. At least we have this foundation set. Now we have to really get into the nitty gritty of working on the immune system and working on bringing out the insults. But what I also find is that once I can take the knife out, like the bugs, the toxins out, but the symptoms still persist. Yeah. Yeah, but there's also a memory, right? Even though you've got to cleaned up the terrain, the bugs are still remembers and can kind of stay. What do you do with that? I've seen, we may even go into this, but I feel like emotional trauma, emotional health, some of these Olympic system things are so critical. Tell me a little bit about your thoughts on that and what would you do in this room? Yeah, I think that that's really, that's a really big piece. That's when a lot of times I might start to use regenerative medicine actually, exosomes or biological allografts. Those I found can really help. NAD IV can help a lot at that point as well. That's looking at the biochemical piece, but you just talked about it. What I would consider such an important piece, which is the healing piece. These people have normally experienced a lot of trauma in their lives. That's what I find. They've had just like these illnesses of hijacked the different systems of their body. They've also had people in their lives do what I would call hijacking their lives in some way. So much trauma. And so that piece is really, really important. I like to give them craniosacral therapy and we have some amazing healers that we work with as well. So I send them to the healers for that kind of work, acupuncture. I love that you're mentioning that because I feel the same. And those aren't my areas of expertise, but I know people who do it. So whether it's somatic-based trauma therapies, whether there's programs like DNRS. Yes. They're programs safe and sound by porches or there's a bunch of programs out there that are really helpful. Love craniosacral, love acupuncture and naturopathy, some of the traditional, we have an emotional, what's the name of that? There's a couple of emotional remedies, types of things with homeopathic remedies and things. Again, not my area of expertise, but those altogether can be really profound at that layer because of what happens with these illnesses, even if you're healthy, you have a good family support system. The body subconsciously sees this mold or lime as a trauma.  And then the medical system, I think sadly, most of the time further traumatizes the patients. I agree, they really do. Yeah. Because they haven't been accepted. Yeah, they've been told they're crazy or go take this med for your mind or it's not, I mean, you might manifest as insomnia or bipolar or depression anxiety, but these are not primarily psychological issues. Exactly. Yeah, they're secondary to the issue at hand, which is usually the infection. Yeah, I wonder nowadays if all mental illness isn't really gut microbiome, cell danger response. I don't know if there's any pure psychological disorders anymore, because I can always find a root cause that's actually very logical, right? Exactly, exactly. And then once it takes some time to turn these people around, once they're turned around, I see big shifts in their psychology. And newest in relationships and it's amazing, right? The whole dynamic shifts. Yeah, it's amazing. Well, let's shift in our last couple of minutes because we've really covered a lot of ground and we talked a little about the limbic and some of these things, but what about just whether social support, isolation, especially with COVID and the pandemic and all that we've experienced, what are some kind of mental health tips or social tips or things that you might encourage your patients to do just to have a support system or anything in that realm that you would think about or encourage them or nature walks or things like that? Yeah, there's a lot of support groups out there. Sometimes I've heard patients tell me that, oh, that just really drags me into my diagnosis more. That's just not what I want. And other people say, oh, I needed to meet more people just like myself. So I think that really, I think that everybody who's interested should try to experience it and see if it's for them or not. Some people, it's great. Some people, they don't want that. And I think those are people who are more solitary people. And for them, for everybody, nature walks, I think grounding really helps just putting their feet in the sand, feeling the sunshine on them. I love that. And yeah, you're in the Bay Area, did you say? Yeah. You don't always get sunshine. Yeah, it can be cool down here. Yeah, exactly. I love the earthen and grounding. And then, do you guys recommend Pulse Electromagnetic PMF in your clinic at all? Yes and no. So I've seen it blow up a lot of our patients. They're just not quite ready for it. So more towards the end of treatment, I've seen it work really well. Kind of with that NADD and exosomes and stuff, some of the powerhouses that, yeah, for me personally at this level now, I love it. But I think it would have blown me out of the water five years ago. Yeah. That makes sense. Let's see, I was thinking, I wanted to go back to one other thing. You mentioned copy enemas. And I went to Switzerland for a detox. I think the last two years before when we could travel. And one thing that was there that they had these copy enema kits that were just so amazingly easy to use. It's a Swiss mountain clinic used to be Paracelsus. So we've actually imported those and I have them at the clinic. I want to be sure and let the listeners know if you want an easy way, because I agree with you. The copy enemas can be so profound. And you can get online kits and setups. And do you have those at your clinic that you sell or recommend at all? We don't, but you know, Ben Greenfield wrote a really good article. So I just send people that website. I'd love to hear about the winner. Yeah, I was gonna say, I'll include a link down here. I just want to mention, because it's such a unique thing that we have at our clinic and we can ship to you anywhere in the US. And then we actually import them from Europe because they're not made in the US. And it's a really simple setup with a bottle that's BPA free and then a setup with a tubing and literally an instant really, really clean, low roasted green coffee with a charcoal in it. So it's a German formula. It's cleanest thing I've ever found. And then you just put it in the bottle, warm tap water, shake it up and you're done. So super easy to use. So I'll include a link in case anyone's interested because it's just one of those things where I found being in Switzerland, I'm like, we need this in the US. And when I tried to figure out who had them, no one had them. So now we, yeah, so I'll put a link on that. Yeah. So last bit here, where can people find you? Where can people find more about you? Are you accepting new patients? Tell us a little bit more about it. Yeah, I'm accepting new patients and you can go to www.gordonmedical.com or just look up Gordon Medical Associates and all the information is over there. And so people come from all over the country, particularly for the IV therapies actually. And so we've got used to be when you were talking about socialization, used to be that we had a big IV suite and people would sit there and socialize and it would be their hangout time. People just like them and they loved it. Now we can't do it that way. People have their own private room and we take all the precautions that we need to to make sure that it's safe in there. But so you won't have company in there anymore. But you still do, that's great. And I have had patients that I've had been to. So again, nothing but good reviews and just been neat to share a few patients once well that have been back and forth. So I can attest to that, just the great care. Now the other thing you mentioned right before we got on, you're doing a summit. Tell us all what's coming up with the summit. Yeah, so Dr. Gordon and I are gonna be hosting a mycotoxin and chronic illness summit. Great. During doctor's summits, I'm very excited about it. And hopefully you'll be participating. I would love to. And it's gonna be in June. Okay. So we're just starting right now and we're hosting it with Dr. Christine Schafer. Oh, wonderful, cause I love this stuff. So if you're listening, I'll be sure. And if you go to the Facebook page, follow me on Instagram, just Dr. Jill Carnahan. You will see the updates there. I'll be sure and get information from you guys and share those links. So if you're interested in that summit, stay tuned. I will have it on all my social media pages for everybody and we'll share. And I would love to be a part of it. Thank you. We'd love to have you. Awesome. Well, this, I can't believe how quickly our hour goes. I knew. I think we've got some great information. Thank you so much for being here. We've got your websites. I'll be sure and include them. And thanks again for all the great information. Thank you so much for having me. It's such an honor.