Debra MacDonald ARNP-C: What is Bioidentical Hormone Replacement Therapy?

Bioidentical Hormone Replacement Therapy (BHRT) is something that many people know little about.  In this episode of the Invigor Medical Podcast, Chris Donovan is joined by Debra MacDonald of MacDonald Healthcare, based out of Kennewick, WA.  Deb describes exactly what BHRT is, how it’s administered, and why.

TREATMENTS MENTIONED

• Vitamin B12
• Vitamin D

Chris: Do you feel that you connect to your patients more, that you’re on the same therapy?

Deb: I do, yeah. And I also, since we’ve gone virtual, people are more open than when they’re sitting in an office looking at you.

Chris: That’s so true.

Deb: They don’t want to tell you what their real problems are, but you give them a piece of paper or you ask them a question where they don’t have to look you in the eye. They will tell you anything.

Narrator: Welcome to the Invigor Medical podcast, where our mission is to provide personalized medical care through scientifically backed education and wellness solutions. 

Chris: Deborah, thank you for joining the podcast today. How are you?

Deb: I’m good. Thank you for having me.

Chris: Yeah, know, we’ve been conversing back and forth for a few weeks now. First off, you are a medical professional, and the first question I like to ask all my guests is why medicine? There’s got to be a time in your life where you said, Yes, I want to help people and I want to spend a lot of time at school trying to figure out how. What was that? What was that like?

Deb: Well, I was 32 before I went back to school, and I had one son in college and two little kids. And I needed a career. So I decided a friend of mine was the nurse practitioner and she encouraged me to go to nursing school, and I did some kind of contemplating about it and decided to go. At the time, I was living in eastern Oregon and they had a new rural classroom and I did everything online videos, and then I did clinicals locally in the local hospital.

Chris: So you did that when you’re 32. So I was like three years ago.

Deb: Probably 30 years ago.

Chris: Well you look great. Okay. Well, all online and just kind of how old are your where your little ones?

Deb: Six and three.

Chris: I’ve got a 14 and 11 right now.

Deb: Yeah, now they’re 30 and 35.

Chris: So there you go. Well, it helps you head on. Okay, so you were in mainstream medicine for a while. I was reading your background, but then you decided to leave to do a more integrated practice. Right. Can you explain why you wanted to do that?

Deb: I when I first got out of school, I worked in the hospital. Then I went back and got my nurse practitioner degree and I worked for a gerontologist.

Chris: Which is?

Deb: With older people. And it seemed like all they wanted to do is take pills and they didn’t have any interest in life. And no, they didn’t want to stay alive. So I decided I needed to get to people before that point.

Chris: Okay.

Deb: And at the time, I was going through pre menopause symptoms and I did a lot of research on hormones and I found out the benefit of them. So I switched over and opened my own practice with bioidentical hormones and focused mainly on that after the first year.

Chris: And being that that is your focus, bioidentical hormone therapy. Can you explain exactly what that is and how it’s administered?

Deb: So bioidentical hormone therapy, we optimize hormone levels. Which is at the higher end of the normal range. For some reason that’s 40. So even if you’re 60, we want your hormones at 40. Because you stay healthier, you fight disease and illness better and your body operates better. So to administer them, we do lab work. Bioidentical hormones are made specifically for a person in a compounding pharmacy. So they’re not mass produced by conventional medications.

Chris: So then they would get the blood test and then the hormones would be created off that blood test? Okay. How do they exactly work?

Deb: So I ordered the hormones, depending on where their levels are in the blood test. We never start off with a great big dose. It’s easier to start slow and go higher because everybody absorbs hormones differently. They come in creams, capsules and rapid dissolve tablets. So there’s different forms that we can choose depending on with the person’s preference is.

Chris: Do you feel that the creams work better than the capsules or vice versa?

Deb: The Rapid Dissolve tablets probably work the best. The creams people tend to not use them correctly. So they’re the ones…

Chris: Why is that?

Deb: Because you tell them to use an eighth of a teaspoon a day and they’ll just put a little dab on their wrist and rub it in rather than measure it out.

Chris: And I’ll take it….

Deb: And then some some of them have to be in creams, have to be dosed twice a day. And people are consistent doing it twice a day. They want something quick and fast and just do it once a day.

Chris: And that’s the dissolvable tablets?

Deb: That or the capsules.

Chris: The capsules.

Deb: Yeah.

Chris: Are there are the majority of patients, female or male?

Deb: It’s about half and half, actually.

Chris: And do you find that this bioidentical hormone replacement therapy helps with you said obviously I was looking for upsides for menopausal patients. Does it help the brain fog when it comes down to that?

Deb: It does, yes.

Chris: Okay. Yeah.

Deb: There’s a lot of symptoms of menopause. And in women, they start at the age of 40. Your hormone levels start dropping then. Or if you’ve had a hysterectomy or a lot of stress in your life, that can happen before then.

Chris: That was what I was going to ask you. My wife did have a partial hysterectomy. She still has her ovaries, but she has most of the symptoms that you listed on your site. Is there a test I can get for her?

Deb: We would test all the hormones because once you have a hysterectomy, the ovaries are still working. But the brain says, “Oh, the uterus is gone. We’re not going to be able to have babies anymore.” So it starts turning down the ovaries. So you go into menopause faster.

Chris: Okay.

Deb: So then you start having all the menopause symptoms.

Chris: Is that test covered by the insurance?

Deb: Yes. If you have insurance, we test estrogen and progesterone, testosterone, all the thyroid hormones. And we test DHEA sulfate, which is in adrenal glands. And those hormones are the ones that run the body.

Chris: Which hormone in the men and which hormone in the women do you see the most depleted?

Deb: In men it’s testosterone. That’s their main hormone. In women it’s the estrogen and progesterone. But anybody over the age of 50, I find that their T3, the active thyroid, is low.

Chris: Growth hormones. What do you know? Do you help replace those?

Deb: The human growth hormone. I have done that with a few patients, but it’s very expensive, so there’s not a lot of many people out there that can afford it or are willing to do it.

Chris: Can you elaborate what the advantages are?

Deb: Well, the human growth hormone is like the icing on the cake. It helps to all the other hormones work better and it helps with new cell growth. So it helps to repair bones and joints and stuff.

Chris: And have you subscribed that before?

Deb: I have, yes.

Chris: How often?

Deb: I’ve probably done it ten times in the last ten years. Not very often.

Chris: Because it costs a lot and people don’t have insurance. So you said the male hormone that’s depleted the most is testosterone. And when you do the bioidentical hormone replacement therapy, what are the dosages that you start with for the male testosterone?

Deb: It’s usually 200 milligrams per ML in a cream, and they apply one ML twice a day.

Chris: Okay. And that’s all, that’s all in a cream?

Deb: Yes.

Chris: Okay. No shots.

Deb: Shots are not bioidentical. Shots are conventional hormones. And they’re synthetic.

Chris: So then it’s always tablets or always creams?

Deb: The next one is the tablets. And they usually are 200 milligrams tablets. And they dissolve one under the tongue twice a day.

Chris: And the benefits of that is, you know, making you have more energy. Does it increase the sexual activity? I mean, do you see…

Deb: It does it helps men with their sex drive. It also helps with erections already, and it also helps with controlling blood pressure, cholesterol levels, maintaining muscle mass and bone density.

Chris: Wow. So you help a lot of patients get off of their blood pressure medicine and cholesterol medicine.

Deb: A lot. Yes.

Chris: Scenario here I was to go into your office. I have cholesterol medicine and I have heart blood pressure medicine. I have it all. What, you can guesstimate or just give me the average, how long would I have to be on this bioidentical hormone replacement therapy? You need to, like, make that shorter.

Deb: HRT.

Chris: There you go. How long would I be on this before you would think to get me off or try to take me off of the cholesterol, blood pressure medicince.

Deb: So you should, takes about six months to get you back to optimal levels. And then after that, we can check your cholesterol levels. See where they’re at, if they’re still high. I don’t like cholesterol medication. There’s too many side effects with it. I usually recommend red yeast rice instead, and it’s an over the counter supplement that works as well as cholesterol medication.

Chris: Say that one more time?

Deb: Red yeast rice.

Chris: Red yeast rice?

Deb: Uh huh.

Chris: Okay.

Deb: And it helps with lowering cholesterol. Also, omega three fish oils help lower triglycerides and push the good HDL up. So a lot of times they’ll switch from their cholesterol medication to those two supplements. And then with the blood pressure, black fermented garlic works really well to lower blood pressure. And you can completely get off your blood pressure medications if it’s just high blood pressure. If it’s not, you know, something to do with your heart like A-fib or something like that, then the hormones aren’t going to help that.

Chris: Then it’s a different scenario. Okay. So black fermented garlic that’s over the counter.

Deb: It is.

Chris: Okay. I’m asking for a friend. Do you teach much?

Deb: I don’t.

Chris: You don’t. Do you want to?

Deb: Haven’t thought about it.

Chris: Well, I see in your eyes right now, you got all happy when you’re like. Yes. He uses me as a reference.

Deb: Yeah.

Chris: I mean, you’re very knowledgeable.

Deb: But she’s a long ways from here, so. They live in Nevada.

Chris: That’s not that far. My family’s in Southern California.

You said that the hormones help ED, libido is obvious there for female, it increases the libido for females and helps them. Do you see a substantial amount of increase on women or men?

Deb: I do. I had, in fact, the other day, I had a patient that I talked to and she says this is the first time she’s ever had a sex drive in her life and she’s in her fifties. And so, you know, there’s a lot of different factors that influence sex, drive your lifestyle, you know, cholesterol and blood pressure, diet. Everything affects how you feel, your image, how you perceive yourself.

So hormones help you feel better in a lot of areas. But then there’s other things that you need to work on, too.

Chris: Is there any side effects that you get from having this therapy?

Deb: Not with the bioidenticals. Usually the side effects are dose dependent. You may be getting too little or not enough. And then we just adjust the dose and the side effects go away.

Chris: And you seem to be able to dial that in pretty quick?

Deb: Yes.

Chris: Does it affect sleep that much? Does it help you with your sleep? You know, all this is connected.

Deb: It is. Everything is connected to hormones. And when you don’t have the correct amount of hormones, you’re not sleeping very well or you go to sleep and then you wake up wide awake at one o’clock in the morning, can’t go back to sleep. But the hormones help you keep asleep at night. And if you do have to get up in the middle of the night to see kids or go to the bathroom, then you can go back to sleep.

Chris: What do you suggest to go alongside this therapy, like everybody you talk to, there’s always like, you know, start walking more or get a better diet or cut out carbs or what not. Is there something that you suggest your patients do alongside the therapy?

Deb: Healthy diet is very important and exercise. And even walking 5 minutes a day to begin with is a great way to start.

Chris: Now, define healthy diet, because that’s different from every doctor. Some doctors say low on the carbs. I know sugar is a big bad thing. So we want we don’t have to go over that.

Deb: So I also checked thyroid to see if they have Hashimoto’s, which is an autoimmune disease caused by gluten intolerance. So if I have a patient that is gluten intolerant and they don’t know it, then I have them stop eating gluten. Sugars are bad for everybody. You shouldn’t have any sugars in your diet unless it’s something like honey or maple syrup.

To eat healthy, I think you need to balance your carbs and your proteins. You can’t have more than one or the other because then some part of your body isn’t going to function correctly.

Chris: Yeah. It’s always working harder than the others. What piece of advice would you give someone that is wanting to feel better but is not wanting to take the next step to come see you?

Deb: Well, if they don’t come to see me or someone else, then it’s very hard to say, “Well, you need to get your hormones checked because…”

Chris: There’s no diagnosing them.

Deb: Right. So exercise and diet is a big thing no matter what age you are.

Chris: Now, this doesn’t all coincide with obesity, though, right? It could be for people or any shape and size. Just depends on their hormones.

Deb: I have a lot of very thin people that are in the practice, that are on hormone therapy. You don’t necessarily gain weight just because your hormones are off. If your thyroid is working, you’re that’s really the main control of your weight is your thyroid.

Chris: Now, can you can you explain some of the telltale signs or what people to look out for if they think they should come see you for the hormone therapy?

Deb: So in men, if you start feeling tired and you get off work and you go home and all you do is lay down and go to sleep, if your sex drive has dropped, you don’t have that interest anymore or you’ve lost your morning erections. Also, if you’re not sleeping well, you have brain fog, can’t think clearly. All of those are signs that hormone levels have changed. Dry skin, brittle nails, hair falling out.

Chris: Dry skin, brittle nails hair falling out are all things that people don’t necessarily pay attention to. I mean, with their hair falling out they do.

Deb: They think, “Oh, well, I’m just getting older.” I hear that every day. “Oh, I’m just getting older.” Well, if you’re on hormones, you shouldn’t feel that way.

Chris: Wow, that’s amazing. The human body is crazy because we live, we get older. We’re you know, we start using our body different ways because the body changes and all of these really cool supplements and therapies and stuff are out there for people to not feel like garbage. I know a lot of people that feel like garbage just because they don’t know how to take care of themselves.

What what are the resources do you suggest people look into when looking into possibly coming and visiting you?

Deb: So there’s a lot of information on our website. And then if you call our office, we can also send you a video about the hormone therapy that we have made. And then there’s a lot of different books out there on hormone therapy. Dr. Northrup and Suzanne Somers, they’ve all written books on hormone therapy. And I know Suzanne Somers is a…

Chris: ThighMaster!

Deb: Yeah. And you’d think, “Oh, well, what would she know?” But she’s interviewed so many doctors and she’s been on hormone therapy for as long as it’s probably been around.

Chris: Yeah. I mean, she’s an actress that everybody knows from Three’s Company, right?

Deb: Right. Yeah.

Chris: John Ritter. That guy’s awesome. Okay. Do you? You don’t have to answer if you don’t want to answer. But do you personally take any type of hormone therapy?

Deb: I’ve been on it for about 25 years, and I wouldn’t do anything other than take it.

Chris: And you feel great?

Deb: I do. I’m going to be 65 this year.

Chris: Yeah, you don’t look it, you look amazing!

Deb: Thank you. And I’ve got kids and grandkids in college, two of them. And I have to keep up with them.

Chris: Yeah, that’s what I was going to ask you. You can keep up. No problem.

Deb: Yeah, well we did.

Chris: Your diet’s probably in check, and you’re pretty good about that?

Deb: I try to stay healthy and watch my diet.

Chris: Do you feel if people were to do this therapy and then just go eat garbage, that it would work less or not work?

Deb: It probably wouldn’t work as well.

Chris: Yeah. So then diet is a big deal.

Deb: It is.

Chris: And then sleep. What do you suggest? How many hours a night?

Deb: I would say 8 hours a night. I know some people get along with less. Some people need more. But 8 hours is probably a good average.

Chris: Now, I have I’m a part of another podcast about cancer, and a lot of my friends that have had cancer, whether it be breast cancer or what not, they have what they call chemo brain, which is basically just brain fog now, not knowing a whole lot about what you do.

What do you think that the hormone replacement therapy could help breast cancer patients with chemo brain? Or is this something they can do because they had cancer?

Deb: If their cancer was estrogen and progesterone positive, then we can’t do the hormone therapy for them. They can take vitamin B12 in high doses that will help with brain fog and also melatonin at 20 milligrams at night can help a lot with brain fog.

Chris: Okay. And then B12, we have that here at Invigor. Do you do you find that there’s a difference between injections or just oral?

Deb: You don’t ever want to swallow B12. You want to either do it sublingual, which means it melts under your tongue, or you can do injectable. There’s two types of B12. There’s cyanocobalamin and there’s methyl B12. Cyanocobalamin does not absorb as well as the methyl B12. So you try to get your patients on methyl B12.

Chris: And then that would be the under the tongue?

Deb: You can get it in both forms. You can get in the tongue or you can have it, you can get it through a compounding pharmacy as an injectable.

Chris: Yeah, we have the injection here. But do you see one works better than the other?

Deb: The injection works a lot better.

Chris: Injection works a lot better. Do you suggest, besides B12 or anything like that, what other type of supplements you would suggest people to take just to be healthier and feel better without having to necessarily, you know, start with the hormone therapies?

Deb: Vitamin D is really important in the body. It helps to boost your immune system and keeps your moods in check, and it also helps with your bone density.

Chris: Okay. And then vitamin D, do you suggest oral or injection for that?

Deb: I usually do oral on that. I’ve never done the injections personally.

Chris: And then with that being said, diet, sleep. Do you feel like your anxiety and stress levels are down when you when you’re on this therapy?

Deb: I do. Personally, I do. I have a lot of people that have very stressful jobs here in town and they said they couldn’t handle them without being on the hormone therapy. They come in and they’re having panic attacks and usually within a week or a month, they’re feeling better. Their panic is less. They’re handling their stress levels are better.

Chris: That is amazing. So we went through the process a little bit. So they come in, they see we get the tests, you find out what they need and you administer it. How long is that process?

Deb: Usually you get the labs back in a week and we go through those with the patients. They order their compounding through the pharmacy and it usually takes the pharmacy 7 to 10 days to get that out to them. We usually have them on it for six weeks and then we check their labs again and see how they’re absorbing the medications, then reacting to them.

And then we do adjustments. I charge $200 for the first visit. We go through all their history of how they’re feeling. I ask a lot of nosy questions about their symptoms, and then we give them a lab slip to go get their labs done. And then at the second visit we go through and explain what those labs mean, how it’s affecting them, and do recommendations for the hormone therapy.

And then if they decide to start on it, we order the hormones and they usually get them in about 7 to 10 days. And then we do labs again in six weeks.

Chris: How many hormones do you usually suggest or?

Deb: Well usually it depends on, really the person. Many…

Chris: You can do multiple?

Deb: So men would use testosterone, DHEA, thyroid, and women usually have estrogen and progesterone, testosterone, thyroid, DHEA.

Chris: Okay. It doesn’t matter how many of those you give them all at one time. It just it’s just they absorb into the right spots and you’re good to go.

Deb: So thyroid, you have to take alone in the morning. And then wait 30 minutes. Progesterone you have to take at night.

Chris: So there are some like stipulations and practices you need to get used to. I know that you’ve been in medical the world. I’ve interviewed plastic surgeons, even interviewed urologists and all sorts of people. And I’ve always asked them kind of the craziest thing they’ve ever seen in medicine. And most of it comes from early on or something that happened really weird in that didn’t have to do with necessarily what they’re practicing right now.

Is there anything that happened to you crazy in this world of medicine since you started? I mean, you did. I have friends who work in E.R. They found some really crazy things.

Deb: When I was working in the hospital. There was some pretty weird things that happened in the E.R. But there is things that I really wouldn’t want to talk about.

Chris: We had I had a friend of mine on here, a plastic surgeon, and his his craziest thing was a deer going through somebody’s windshield. And I would have never thought that from a plastic surgeon, especially since he was still in his residency or what not. And he was just working out in Philadelphia. And they and he said there was fur in places that shouldn’t be, but they got him back in, survived and was going good.

So well there people can go to your site for resources. What’s one thing that you’re most, I don’t want to say excited, but you’re proudest about with your medical career?

Deb: I think just helping so many men and women get their hormone levels back to where they should be and as they’re aging, they’re able to go out and do the things that they want after they retire. They can travel, they can stay healthy.

They don’t have to worry about taking all these other medications and just taking their hormones and being able to go out and enjoy life. That’s what’s important.

Chris: Yeah, it’s, I thank you for doing this. You know, any medical professional I am baffled by because one, you have to dedicate your life to helping people, which is one thing itself. Then you got to go to all the school and do all this stuff. How did that affect your family when you did go back to school at 32 and you had two little ones?

Deb: Well, my one son was gone to college and the two little ones, they I think it set an example for them to study at school. My daughter, when I remember I was studying one night for finals and I had forgot to fix dinner and she came in and brought me a peanut butter and jelly sandwich.

Chris: She brought you dinner. That’s awesome!

Deb: Yeah and she was three years old, so that was pretty good.

Chris: Was it a good sandwich?

Deb: It was good.

Chris: Did she got the crust off?

Deb: No.

Chris: Dang it! You said, we talked earlier before the show and you had walked away from, like I said, mainstream medicine, open up your own practice. But now you’re all virtual. Why did you decide to go virtual?

Deb: Mainly because of the cost. I wanted to cut down my costs so that I could keep the costs lower for patients. Things in this society are going crazy. Everything’s going up. And if you can’t afford your hormones, then you’re not going to feel good.

Chris: Yeah, I mean, in the stress of COVID, home schooling, remote working, all of that stuff is played hectic on everybody’s brain and body over the last few years. So you when, when now you’re all virtual. So then all these appointments are through Zoom, video face time?

Deb: Actually just do phone calls with people. We also have, if I have a patient that I think they’re pretty stable on what they’re doing. We have a questionnaire that we send out when they get their labs and they can answer all the questions and then I can compare it to their labs and adjust meds based on their symptoms and their lab levels, depending on how they’re feeling.

Chris: So you’ve got this down to a science?

Deb: I do

Chris: Pun intended.

Deb: Well, I’ve been doing it for 20 years.

Chris: So do you feel that you connect to your patients more, being that you’re on the same therapy?

Deb: I do, yeah. And it’s also since we’ve gone virtual, people are more open than when they’re sitting in an office looking at you.

Chris: That’s so true.

Deb: They don’t want to tell you what their real problems are, but you give them a piece of paper or you ask them a question where they don’t have to look you in the eye. They will tell you anything.

Chris: Yeah, we have a quiz on our site that people can go up there and take, and a lot of people will just take it so they can find out exactly. That’s another reason we are doing this podcast is because a lot of people are shy. They don’t want to go up to, you know, their doctor and be like, “Hey, doc, my ED, I got ED it don’t work, or I have a low libido or anything like that.”

So being able to discuss those things here and letting people listen hopefully will help people feel more comfortable going to have therapy at your place or go to our website and maybe get some ED medicine or some B-12 or whatever. So I do think you for coming in. I have one more question. You’ve been doing this for a long time. You went in at 32. What were you doing prior?

Deb: I was a bookkeeper for a school district down in Oregon.

Chris: Okay. So you were helping kids?

Deb: Yeah, and I was the ranch wife.

Chris: Ranch wife? Oh like Yellowstone? No, I’m sorry.

Deb: Pretty much exactly like that.

Chris: That show’s crazy. So macdonaldhealthcare.com. Is there a wait to get your appointments, appointments in the week?

Deb: Usually can get you in within a week.

Chris: Within a week. Because I know a lot of a lot of people that are telemedicine they do if their individual practices they do have a waitlist and it’s harder to get in with them.

Deb: Yeah, well we take appointments on Tuesdays and Wednesdays. I only work three days a week now. Mondays I do labs, Tuesdays, Wednesdays I do appointments and I’m off the rest of the week.

Chris: Fridays you come here and record podcasts.

Deb: Right. And it’s working.

Chris: Now, you are virtual, so you can handle people in any state across North America?

Deb: In Washington they require you have a license in the states that you talk to people. So I have a license in Montana, Idaho, Washington and Oregon right now.

Chris: So Pacific Northwest. Nice. My family, my current family, my immediate family, my wife and my kids are down in California right now. And I’m up here handling this right now. So I want like because I want my wife to come in and see you, but I’ll have to have her come up here when she gets here. What is your plan for the future?

Deb: To continue doing this, at least probably another 5 to 10 years.

Chris: You think you’re going to have this off to your granddaughter?

Deb: I doubt it. She wants to be a teacher already.

Chris: I thought you said she was in medical school, but a medical teacher?

Deb: She is in nursing school and then she’s going to graduate this spring and then she’s going back to nurse practitioner school. Then she wants to get her doctorates and teach nursing school.

Chris: Well, I mean, you’re an inspiration to her and to anybody else that wants to get in this industry. And I thank you for doing this. What was the short term bioidentical hormone therapy?

Deb: BHRT.

Chris: BHRT. Okay. You can’t really say that like… Okay. Is there anything you want to say to anybody, people out there listen to the podcast right now?

Deb: I just think that you should, even if you think you’re balanced, you should have your hormones checked and get a baseline because in the future you probably won’t feel this way. And having the baseline is a good way to be able to figure out where you need to get back to without having to go and guess. Is this range better for you or is this range better for you?

Chris: Okay, let’s say somebody is listening in Texas right now. You don’t have a license there?

Deb: No.

Chris: What would they go and ask their PCP to test for? Just hormones in general or is there a word?

Deb: I would say that they needed to ask them to check their hormones and their thyroid. And do the antibodies on your thyroid because a lot of people have an autoimmune disease called Hashimoto’s that goes undetected. And if you can fix that, then you can change a person’s life.

Chris: That’s awesome. Okay, so say that one more time. What Hashimotos?

Deb: Hashimoto disease.

Chris: In that you know your thyroid, right to test the thyroid…

Deb: Antibodies.

Chris: Antibodies. Okay, so test your thyroid antibodies when you go to your doctor, ask them to get that and then you know, using your later. Okay. I don’t think I have any more questions for you.

I really appreciate you coming on the show. It’s macdonaldhealth.com for resources if you’re in the States that she’s in, please reach out to her. If not, go to Invigor Medical and check out some of the stuff we have up there. And thank you for being on the show.

Deb: Thank you.

Chris: You did awesome.

Deb: I appreciate it.

Narrator: Thank you for joining the Invigor Medical podcast. For more information on the show, Invigor Medical, or to get a hold of Chris, go to invigormedical.com.