Ep. 130: Breast Cancer Detection: Mammography Versus Thermography Interview with Felice Gersh, MD

Robyn:                                Hey everyone. It’s Robyn Openshaw and Welcome back to Vibe. I’m bringing somebody back for you today she’s one of my favorite interviews, one of my favorite people that I met when I was looking for people who are over the age of 65 and still doing great work in our Learn From Our Elders series, it’s Doctor Felice L. Gersh. She is a double board certified OB/GYN, her other board certification is in integrative medicine. She went to Princeton. So she is a highly credentialed doctor.

And like so many of the doctors that we’ve interviewed here, she changed focus fairly late in her career. The more she studied, the more she didn’t want to do. I mean, she was delivering babies, there’s really nothing that’s going to compromise your integrity doing that usually, but you know, being up all night was really messing with her circadian rhythms. And as she got older, she got out of that kind of work. And now she does exclusively gynecology but a very holistic way in Irvine, California. If you live in that area, you would definitely want to listen to this episode and she might be a great choice for a physician.

My first episode with her, if you’d like to listen to it is episode 114. And as we go on, I pick up a thread that I missed from back then. She had told me she was a forensic gynecologist and I wanted to hear about that. So she tells us a cool story in this episode. Before I reached out to her, I posted on a page that I’m a member of with lots and lots and lots of functional medicine doctors who have a presence online. And I asked them, who are the best experts to talk about breast cancer issues, especially particularly related to imaging and diagnostics.

So I got a lot of responses that surprised me. I thought everybody would be all about thermography, but I had several colleagues saying that their clinical experience shows or their colleagues clinical experience shows that getting thermography alone, will miss some breast cancers. My friend, Dr. Lindsey Berkson said that she went to a hormone conference and a physician there presented and had put up around the room pictures of women who had died in his care whose cancers were missed during doing thermography.

And I was surprised to hear that. We get into this episode talking a little bit about what the difference is. Thermography is not actually detecting breast cancer. Doctor Gersh is going to talk to about how it detects inflammation. And the one time that I had it done was actually by another physician in Irvine, California, Dr. Leigh Erin Connealy. And they just showed me a hot spot. And hotspot being thermography. We talk a little bit about how people who do thermography don’t have to be doctors or nurses and so you just can have a technician doing it. And so getting it actually interpreted is another thing.

There can be real differences in how they read the results or how they calibrate the machines to do thermography. You’re going to stand in front of air conditioning for 15 or 20 minutes. One of my colleagues was saying it’s a miserable experience. I remember being cold, but I don’t remember it being a miserable experience, and I prefer it over having a breast smashed flat as a pancake, that really has always made me nervous.

So we’re going to get into these issues. I’m very excited to introduce you to Dr. Gersh again. So welcome back to the Vibe show Doctor Felice Gersh.

Dr. Gersh:                           Oh, Hi Robyn. So nice to join you here today.

Robyn:                                I feel like I’m talking to an old friend. I already learned all about you and learned about all the subjects that you’re so well versed in. So it’s really nice to have this second interview with you. And I’ve got to pick up a thread that we did not finish in our first interview. And that is, you had mentioned the very juicy subject of the fact that you’ve been a forensic gynecologist and you’ve been in jury trials as the medical expert. We didn’t get back to that. I’ve been feeling guilty about it this whole time. So tell us a juicy story or two of what that’s like. What do you learn in that process? And how did you help in those jury trials?

Dr. Gersh:                           Well, it’s quite an experience when you’re the expert and you’re on the stand and you’re talking to that typically 12 member jury. And you’re next to the judge and you have the prosecutor, so you have the plaintiff’s attorney, the defense attorney. Sometimes I’m in criminal cases, that’s why I mentioned the prosecutor. So I’ve been involved in a number of criminal trials as well.

So one was a case of a young girl. At the time of the trial, she was 11 years old. So obviously she was born 11 years earlier. And at the time of her delivery, it was some really strange things that went on that led to some major damage. And the case was sort of on hold because when you have a baby born, there’s a very long, at least depending on the state, 18 or even 21 years, that a suit can be filed on behalf of the child. So that’s how long it can sit out there before they can actually file a lawsuit.

And what happened was the doctor taking care of the patient when she was in labor, had his own child who was about to have a birthday party. And this is not typical, I want everyone to know that this is not what typically happens when doctors are caring for patients, not at all. And what happened was he apparently wanted to get home to the birthday party. So when the patient became completely dilated, he just really tried to rush the delivery and he put a vacuum extraction on the baby’s head.

So the baby became ultimately the 11 year old girl who was the plaintiff in the case. So what happened was he kept pulling and pulling and pulling on this head with the vacuum and it kept popping off. So he’d put it back on, and then he got a different type of vacuum and ultimately after several tries he pulled the baby out. But because it didn’t go through the normal expulsive maneuvers, like when a baby is pushed out naturally by the mom, it goes through different turning processes and the head molds.

And there’s this beautiful, amazing process that allows a baby the size of a full term baby to actually fit out of a female vagina. It’s like a miracle. Every time I saw it, I saw it thousands of times, but every time it’s a miracle. But you have to let it happen naturally. In this case, he pulled on the head and yanked the baby out essentially and it didn’t have any of the normal processes of turning and such and the shoulders, even though it wasn’t a large baby, the shoulders became wedged, what we call a shoulder dystocia and he couldn’t get the baby out. He was tugging on the head and when the baby finally came out, he had done severe damage to the nerves that serve one of her arms. So basically one arm was virtually paralyzed. We call that an Herb’s palsy, very severe case.

And ultimately she had surgery where they did nerve rearranging and so on with muscle flaps and things to allow her to have some limited use of that arm. But the amazing thing is this beautiful little girl became a gymnast. Isn’t that amazing? She actually became a competitive gymnast with only one really good arm. And she could only compete in certain events, right? She could do things like the mat, you know, and she could do balance beam, she could do certain things where she could manage somehow with one arm.

So, it’s really quite a phenomenon. She became quite a phenomenon this beautiful little girl. And then they ended up taking this to trial. I don’t know why the other side, the defendant didn’t settle the case, but they went to trial. And I did testify and I told the jury the whole story of how this happened and the injury. And in the end, the jury awarded this little girl $5 million. So it was a huge win on their part.

And of course, all I do as the expert is educate the jury. I’m not an advocate, I’m not doing anything more than explaining the medical story and really the sequence of events so that they, the jury makes the decision. It’s the lawyer who is the advocate who actually pleads the case on behalf of his client. I am just an explainer of science, of medical fact. But that’s why I only take cases where there’s clear merit on the side that I’m working for. Otherwise I would never take it. But here was a beautiful case of justice served where this beautiful girl got this big award. But she prevailed in spite of her injury, that was the part that really moved my heart the most on that case.

Robyn:                                What a resilient little girl. And what an amazing story. I just binge listened to a podcast series called Dr. Death and the series is done very well. And it’s about a neurologist, but a surgeon trying to think what kind of doctor that is. But anyways, he’s in Dallas and 33 patients died or were severely injured. And it turns out he had participated in less than a hundred surgeries before completing his medical training and residency. And it’s kind of the story of how the hospitals and all of the medical organizations working with him and many other doctors, just kind of passed the buck and kind of just kicked him out of one hospital and so he’d go to another one and go to another one and go to another one.

And to me, the point isn’t that we all should be terrified of doctors so much as it should be like, let’s get really involved in our healthcare. Let’s ask a lot of questions. Who would think that a doctor would do something to harm our baby because he needs to get to his daughter’s birthday party. I mean at the same time like, and not to justify his behavior at all because that’s clear malpractice that was the outcome of the trial. But you know, our doctor who pulls the baby out, he has a life of his own and his wife’s been giving him a hard time because he misses too many family events and he felt the pressure. And you must handle stress very well if you sign up to be a forensic gynecologist and go to jury trials.

Dr. Gersh:                           Well actually that’s a very good point because when you are being grilled, that’s how I think of it, by the opposing attorney, their goal is to make you look like an idiot. That you don’t know what you’re talking about or that you’re full of hot air or that you’re just doing this for money. And that is not the case. I do what I do as a forensic gynecologist because both of my parents were attorneys and my dad believed in the legal system. And he said to me, you know, if you really want to have justice, you have to have honest, qualified experts because it’s only the expert that can explain the real story to the jury who ultimately has to make the decision.

So I look at this really as a public service, as part of my give back at this stage of my career to help justice on whichever side that I’m working on because I don’t care which side it is. I work on the side, what I call, truth, justice and the American way, you know, to help real justice be served. And that’s our system. If you believe in our system, then you have to have qualified, honest experts. So that’s one of my hats that I wear.

And someday when I stop doing this, because some cases I can never talk about because they’re sealed. But others, when they go to trial, everything is actually public record, and then I’m going to put together, I think probably, if I get any bestseller, that would probably be it, because it will be interesting to everyone. It will be sort of like the inside scoop of being a forensic medical expert and telling stories and what it really feels like when you’re in the courtroom. And maybe when we do other podcasts down the road, I can share more stories because I think they really are just phenomenal to see what goes on in our legal system for people that really don’t have an active role in it as I do.

Robyn:                                Yeah. I actually would love to have you come back and talk about what you learned as a forensic gynecologist. Even in the cases where maybe the three that went to jury trial that you told me you could talk about, there’s probably others that you could talk about without names and details, things like that. And I absolutely think you should write that book, Dr. Gersh, because right now, like true crime podcasts and medical podcasts are going completely crazy, just hundreds of thousands of downloads a week.

A lot because crimes are being solved right now, 20 and 30 year old crimes because of DNA, the emerging ability to not just match DNA to the actual perpetrator of a crime, but you could even put into genealogies, everyone if you didn’t know this, these genealogy programs and you can find people with, you know, a lot of their genetic snps matching to a family. And if there’s a couple family members of the perpetrator of the murder or the rape in the genealogy, they can track those family members down and then hone in on who lived near the victim of this crime or whatever. It’s fascinating. So there’s a lot going on. That would be a really great book. I’ll be your first buyer of that book.

Dr. Gersh:                           Oh well I definitely have to do it because it’s a really a piece of my career that I actually don’t share very often with anyone. It’s sort of like this little secret compartment of my life. But I’m definitely, now that I understand how people are so interested in it, I should definitely share it.

Robyn:                                Yeah, and it really is a public service because somebody has to advocate on the medical side and, well I guess you weren’t advocating, but that would be just terrifying to be grilled like that. I know that they like try to find what’s wrong with your credentials and all kinds of stuff.

So we had Doctor Gersh on the show the first time because we reached out to her because she’s over 65 and so she was in our “Learn from Our Elders” series, which was lots of fun. I just feel like folks who are still doing great work after the age of 65 have so much more to give and so much more to tell about. So I’m excited to dig into this topic today. I posted in a private page where we have a thousand colleagues, many of him, most of whom actually, are functional medicine doctors, and said, who is the best expert here to talk to us about breast cancer detection and imaging?

Because the debate is ferocious and there’s lots of intel coming out now that I think 10 years ago when people were like, Hey, let’s just do thermography. That’s the answer. Now we’re not sure about that. So I want to dive into this subject with you about mammograms versus thermography versus ultra sound. What are the risks, which is the direction to go? So let’s start with, we know how common breast cancer is. I think it’s one in eight women now that will get breast cancer. I don’t think that that should scare us as much as it needs to. There’s lots of preventative things, we will definitely ask Dr. Gersh about that.

But, you know, women fear it. And you know, I met a man with breast cancer, when I was doing a water fast when I was away at the Ashram in Texas a year or so ago. So it’s not even just affecting women now. But what health benefits can a woman expect if she decides to go with a mammogram? It’s been sold to us as it’s going to save your life. What do you have to say about that?

Dr. Gersh:                           Well, I have to say that the chance of a mammogram saving your life is probably similar to the chance that you’ll win one of those big lotteries. You know, it’s not very high and it does vary with your age. But even at the most we’ll say beneficial age group, which is around age 60, it’s still pretty low probability that it’s going to save your life. So, it’s something to consider, but, I am a very big believer in giving informed consent so that women can make up their own minds and very few women go to their doctor, whether it’s a family doctor, an internist, or a gynecologist, and are really given true informed consent. That’s why I’m so thrilled about this podcast because they don’t know that there’s really a downside. They only think there’s an upside. And they also think the upside is really huge.

So yeah, for example, if a woman is age 40 and there are many doctors that are starting mammography at age 40 and we can talk a little bit about that because the US preventative services task force is not recommending that routinely. But it turns out that a very high percentage of doctors are recommending starting annual mammograms at age 40. But say you are age 40 and you get a mammogram and you are of average risk, so you’re a typical woman. What’s your chance that you will have your life saved? Well, you would have to be one of three out of 10,000 women tested. So that is a very, very small number of women, 3 out of 10,000 who are tested.

Now if you go to age 50 then the chance of your life being saved by mammogram goes up to one out of a thousand or 10 out of 10,000. So you have to do a thousand mammograms on a thousand women to get one life saved. So when we talk in medicine about benefit, we talk about the number needed to treat. In this case it would be like number needed to test or screen. So this is a very high end, like for age 50 to save one life, you have an n of 1000 so that that is not a very high benefit yield. So, and then that’s where you get into, well, if there’s no harm than what the heck, you know, I might be that one in a thousand that actually has a life saved.

But unfortunately, and we’ll go into it of course, that there are some potential harms. And in fact there was a very large meta-analysis done looking at over 600,000 women and what they found at every age, no matter what the age of the woman was, that there was more likelihood of harm then there would be of benefit for every age group, which is a shocking thing. This was a very respected study. This meta-analysis of over 600,000 women that showed, unfortunately once again that the likelihood of harm was consistently higher with doing mammography at every age group then was the benefit. So everyone needs to know this so that they can decide if this is something that they would like to do or not because certainly some women’s lives are saved, but it’s a small number and very much smaller than what most people think.

Robyn:                                So if for 40 year olds, only 3 in 10,000 lives are saved in that age category at 40 and then it’s, I think you said 10 in 10,000 if your 50 years old, why is that? Is that because the mammography is not detecting most breast cancers or is it some kind of complex algorithm where they’re assessing the risk of so much radiation you’re exposed to at the mammogram against the detection of the breast cancers? What does that even all mean?

Dr. Gersh:                           So when they look at the issue of harm versus benefit, then you’re looking at issues of false positives over diagnosing cancers which would never become clinically evident or kill anyone. Unnecessary biopsies, which actually do create harm and biopsies are actually listed in the Gail model of predicting breast cancer risk. Having multiple biopsies of the breast is actually considered a risk factor because you’re actually creating inflammation and damage every time you start biopsing a breast.

So when you look at harms, you’re going to look at all of those things. And also the potential injury from the radiation, which is very hard to measure because as everyone knows radiation, and this is ionizing radiation that’s involved in mammography, is a known carcinogen. But it’s not a something that creates an effect rapidly. So it’s very, very difficult to prove cause and effect from radiation exposure. But we know that in general, we now think that about 6% of all cancers in the US are in some way related to medical radiation. So you know, CAT scans are a very big deal and a standard mammogram is far less than a CAT scan, but it really adds up because people are getting mammograms on such a regular basis.

In terms of why it is that only three lives out of, or even if you go to a 50 year old, which is more common, for example, as far as mammography goes, that if you only would save 10 out of 10,000 or one out of a thousand women, it’s because our whole concept of the mammography benefit and how breast cancer grows was probably wrong. So the whole idea, the concept of a Mammogram, how would that save you? Well, because the idea is that breast cancer starts very little and then it grows and gets bigger and bigger and it hits some magical size that nobody knows what that is, but some magical size and suddenly it metastasizes, it spreads it’s cancerous cells and it can go and then grow metastatically in other organs of the body, like the lungs, the brain, the liver, the bone and so on and ultimately cause death.

Because nobody dies of breast cancer that’s sitting in the breast, they die of breast cancer that becomes metastatic. The idea of a mammography is that you’ll find it before it gets to that stage. Well, the reality is that model was completely hypothetical. It was not based on science. The idea that it would get bigger and the bigger it gets, the more likely that it would metastasize. Well, it turns out that every cancer at any size can metastasize because it obviously has some kind of blood flow and lymphatic relationship because otherwise it wouldn’t be alive. Right? So you can’t grow cancer if it has no blood. And we know that in fact cancer tends to create its own blood supply in sort of interesting ways it grows blood vessels to it.

So, really as soon as you have a cancer of any size, the potential that it could metastasize exists. So you could find a breast cancer with a Mammogram, but that doesn’t mean you’ve saved that woman’s life. And fortunately, many, many breast cancers that are diagnosed do not end up in the woman dying. And it turns out that the difference in finding the breast cancer, whether it’s through examination or some other way, that it was sort of found by chance or through a mammogram, the actual mortality rate isn’t terribly different between the two. So that’s just the whole philosophy and understanding and theory of how breast cancer works was probably erroneous.

And that’s why finding a breast cancer even, you know, nobody says you can’t find a breast cancer, but that doesn’t mean you’re saving anyone. We also know that, for example, for postmenopausal breast cancer, which is the bulk of breast cancers, unfortunately, premenopausal breast cancer is growing quite significantly, and that’s probably due to the environment that we live in, full of endocrine disruptors or known as xeno-estrogens, these chemicals that are interfering with the normal function of our hormones, particularly estrogen. They’re not estrogens, they’re chemical mimics that actually harm the body’s actual function of estrogen. And that’s why it’s growing in younger women.

And birth control pills are another issue that can increase breast cancer. And that’s widely accepted, that’s not an alternative medicine or integrative medicine understanding, that’s a conventional understanding is that it increases breast cancer when you use birth control pills. So there’s this whole philosophy about it that’s wrong. And then in menopausal women, it turns out that we now know that breast cancer, by the time it’s detected has probably already been there for a good 20 years, maybe even more.

So breast cancer actually in a woman can grow very, very slowly until it actually reaches the point where it’s detected. So that’s why, you know, getting a mammogram may find it, but it’s been there for a long time and it may definitely, if it was going to metastasize, it may already have done so maybe years before. And then it just grows at its own whatever rate it wants to grow. So there’s a whole way of understanding breast cancer that we probably need to rethink.

Robyn:                                So this reminds me of a couple of very related issues to what you’re saying. And one of them is that with all this detection ability that we supposedly have, breast cancer survival rates are much higher. But what the average patient doesn’t seem to know is that that may be because of so many stage zero and stage one breast cancers detected, which now even standard of care medicine who has invested $11 billion a year worth of mammography going on. They’re not likely to announce to everybody that they’re going to just junk all of that equipment and stop doing it. They’re not going to do that. But even standard of care medicine has said, we don’t consider these small DCIS breast cancers to even be cancer anymore. They’re even admitting it’s a pre-cancer, if that, it’s a calcification or whatever I’m going to have you clarify that.

But I played a tennis match several years ago against a woman who we played on a Friday and on Monday she was going in for a double mastectomy for a, wait for it, stage zero cancer in one of her breasts. And I checked in with her team a few months later and she still wasn’t able to stand up fully and was really, really struggling post-surgery. And it just breaks my heart because in medical journals, as I understand it, they have been revealing that there are something like a quarter of a million women who were over treated and given you know, mastectomies, maybe even chemotherapy. What do you have to say about that and how that may manipulate women into thinking that the current approach to breast cancer when it comes to treatment may off?

Dr. Gersh:                           Oh, you brought up so many wonderful points. So in terms of the like ductal carcinoma in situ, that certainly has been diagnosed in great quantity and I’m sure that’s a big part of the over diagnosis and over treatment. We know the chance of dying from that, even untreated, even if you don’t know what the future’s going to be is still very, very low. And some of the treatments are very, very harmful. Of course surgery is harmful emotionally, and there’s also the risk of having the surgery. Then of radiation, we now know, and I used to think, well when they have a lumpectomy, which is the most common, more than mastectomy, although mastectomy has been growing in popularity as well.

But still the majority of earlier stage breast cancers are treated with lumpectomy followed by radiation therapy and the radiation therapy really harms the heart. It harms the muscle of the heart and the coronary arteries, the arteries that supply the heart. And they used to think, well at least when they have breast cancer on the right side, they’re not hurting the heart. Well, they had a recent study that showed that whether the radiation is over the right or the left breast, the heart is injured, it’s really injured. So the treatments are definitely harmful to women.

In fact, in terms of when they did the study, they found that the over diagnosis of cancer, now these are people who are told you have cancer, they’re not told you have like a funny something on your mammogram let’s go back and take another view or do a biopsy. That is a whole different world of over treatment. But in terms of over diagnosis of actual cancer, that is felt to be about 19% is what they came up with. So almost 20% of all the women diagnosed with breast cancer never would have died from their breast cancer. Though they’re saying that that particular form of breast cancer, whether it’s ductal carcinoma or even invasive cancer, was never going to grow to the point of becoming clinically evident and actually harming the woman.

But the treatments are definitely harmful. And it is huge. So when we look at the numbers, there’s a lot more breast cancers being diagnosed. But when you look at number of women per capita, like the same per 10,000 women, the same number are still dying from breast cancer in terms of deaths. But in terms of how many women are actually diagnosed, it’s much higher. So then they come up with these statistics and you know that you can play with statistics, so they come up with statistics that they say, well a much higher percentage of women are cured. And by the way, they use cure as five years.

So women are living longer, they’re having higher cure rates, but they’re all talking about these cancers that many of them, which we’re not going to kill the women in the first place. And also the cancers that they’re just picking up but the women are still dying so they’re not dying necessarily later, they’re just being picked up earlier. So the length of time that the cancer is known is longer. And then I do have to give credit to some of the treatments. And they’re now looking at immunotherapies and even some of the conventional treatments, the chemo treatments and the other pharmaceuticals that are now out there treating invasive terminal breast cancer, can keep women living longer.

But what’s been found is that it doesn’t seem to matter when these cancers are diagnosed. Once the treatment is started, the outcome seem to be ultimately pretty much the same. So it really is turning everything on its head about what is really the benefit versus the harm and what should we really do about mammography. Like you said, this is a huge industrial medical complex. And it’s like, is this too big to fail that no one is going to dismantle it? Like I don’t even know what the amounts are, but it’s obviously way in the high millions if not billions of dollars that are invested into maintaining this enterprise.

And so it’s really mind boggling what we’ve gotten ourselves into and how many women are harmed. And like I said, this study that came out and these are, you know, very respected researchers that are saying that unbalanced at every age you’re going to do more likelihood of harm than benefit. But of course some women will benefit. It’s just you can’t figure out who they are. So what some people are now saying, and this makes so much more sense, is that you don’t have a one size fits all screening program. That you really only want to do high intensity screening on women who have a significantly higher risk. So you really want to do not a reflex reaction, you’re at this age, go get a mammogram, You want to really think this through. And really evaluate each woman’s situation.

Robyn:                                Okay. So in a minute I’m going to ask you, so who would you say should get a mammogram and how often? I’m going to ask you that in a minute, but not yet because I want to point out that for those who are listening and saying, wait, what? She’s saying that only 3 in 10,000 lives are saved for the women in their forties getting mammograms. And she’s saying that these stage zero and stage one cancers are being detected now and then these women are put through these extremely invasive surgeries, removal of a body organ and this ionizing radiation.

Which side note we should point out that I don’t think most patients realize that those burning rays that are damaging or destroying or mutating, which is what cancer is, actually creating cancer, that are burning possibly millions of cells, it doesn’t stop burning when the treatment is over. It may burn for years. There’s clear evidence that these rays can burn for years and years.

We’re not setting you up and telling you this to scare you because I want to drive this point home and see what Dr. Gersh has to say. That your body is metabolizing cancer every day. And let me tell you something that on my rounds of 20 different functional medicine clinics and biological medicine clinics that I flew to Dr. Gersh, all over the world for three years, I went to 20 different clinics and researched there.

I had four different functional medicine doctors tell me, and I don’t know if there’s actual published research about this or if this is their inference from their decades of treating cancer. They said that you probably have detectable cancer on average four times in a lifetime that your body metabolizes and breaks down itself. And that your immune system, which is breaking down cancer cells right now and disposing of them where they will not, like you were talking about before, develop a vascular system, metastasize, go other places where it ends up compromising some organ that could actually kill you.

What do you have to say about the body’s ability to metabolize these very, very, very incipient pre-cancers that are being over treated? Do you agree with that, that your body, probably, if you were constantly scanning your body in some way, let’s say you could do it without radiation, let’s just say every single day you had a CAT scan, do you think that that’s possible, that we all get detectable cancer several times in a lifetime and our body actually can take care of it?

Dr. Gersh:                           Well, that certainly is one of the theories that our bodies are doing exactly what they’re designed to do. We have systems in the body that allow bad cells, whether they’re old, unhealthy cells or cancerous turning cells to kill themselves. There’s actually a process that’s called apoptosis where cells kill themselves off. Now, in olden times, remember we evolved a long, long time ago, and the lifestyle that we currently are leading is really not the lifestyle of our ancestors. Not even close as we know. So if we go back into prehistoric times, you don’t even have to go back quite that far, people did not eat the way we do. And they had times and we’ve talked about this, you know, of fasting.

So it turns out when you don’t eat for a while, that actually triggers the body’s wonderful rejuvenation and you might call it survival systems to come into action and apoptosis occurs. So you actually kill off the cells that are maybe turning into cancer when you stop eating for a while because the body says, I’m not going to give nutrients to these crappy cells. So they just push this switch and it turns them into like suicide buttons and they kill themselves, so those bad cells die.

The other thing, is the amazing menstrual cycle of women and what that does. So if you have abnormally developing cells that may be turning into early, like cancerous kinds of tendencies in a cell. When have the menstrual flow, when your uterine lining dies and sheds, there’s actually been studies showing that biopsies of the breasts done at the same time show that there are breast cells that are turning bad that kill themselves. Just like the uterine lining is sort of like a rejuvenation, like a rebirth. So too that happens in the breast when you have real rhythmic cycles and the bad cells in the breast just kill themselves off.

And so yes, I hundred percent agree that we have beautiful innate mechanisms designed to get rid of these early developing cancers. But we don’t harness these mechanisms anymore, at least not very frequently, not too many people in our current society. And the other thing, you know, it goes into so many of these other things that we are doing wrong, like living against our natural circadian rhythms. So there’s the lunar rhythm that I just mentioned, the menstrual cycle. And then you have the circadian rhythm. We’re not living with our beautiful natural rhythms so these wonderful mechanisms are not coming into play as often as they really were designed to be utilized by your bodies. But our bodies are amazing in what they can do.

Cancer is a disease of modern society. Ancient peoples had their own problems for sure, that they had to deal with, traumas and infections. But cancer wasn’t really on their radar. They didn’t have to deal with cancer. You know, colon cancer, for example, doesn’t even exist in primitive type societies. It’s a modern disease. So we need to recognize that in talking about prevention that yes, our bodies can deal with cancers when they’re developing, but we have to harness our innate mechanisms to allow it to do it.

Robyn:                                I love that answer. And we are going to get to the question at the end, so what are the things that we can do to improve our breast health so that we just don’t end up in the situation in the first place? Or what are some of the ways that you would treat it outside of just, you know, cutting, burning poisoning. As my grandmother called it, who was diagnosed with breast cancer at my exact age right now. And took a totally different path. She didn’t do chemo or radiation. It was metastatic, it was in her lymphatic system, her breasts, well it started as a melanoma, or that was what was detected. And so big black melanoma on her arm that had tentacles all the way to her lungs apparently.

We will get to some of these preventative things, breast care things at the end, don’t worry about that. And by the way folks listening, the message is not here, Hey, don’t worry about it. Don’t worry about breast cancer your body will take care of it. There is lots of action that needs to take place for both prevention and what you do if you do have a mass in your breast. But we aren’t saying don’t worry about it. A stage zero stage one won’t ever become a problem. I think what I hear you saying is there are a lot of things that you can do outside of just radiation and chemo. We do have to be aware of the risks of those and how they’re both cancer starters. They’re gasoline on the fire of wherever the cancer is.

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Robyn:                                Who do you then think should get a mammogram? When you take this holistic view that you have, and I believe that you are very deeply steeped in the evidence, you’re not saying this as opinion. You said people who are at risk? BRCA1 and BRCA2? Anybody else? What age? How often? Tell us more.

Dr. Gersh:                           Well, I do want to just sort of repeat what you just said, that I’m not saying that when you have diagnosed breast cancer that you should change your path in terms of not following your doctor’s recommendations because that’s not what we’re talking about. You know, we were talking about early detection, diagnosis, and really what the propensity is for over diagnosis and over treatment. But in terms of like who to have a Mammogram, I’ll tell you Robyn, I struggle with this question every day. I mean you mentioned the obvious would be the people who have the clear genetic tendency.

Now those genetics are not destiny either. In fact people have had the BRCA gene since the beginning of time and they did not have such high rates, not even close of breast cancer. It’s our environment and the change in our lifestyles and everything else that is causing this much, much higher incidence of breast cancer in people who carry this genetic sort of tendency.

Other women would be ones who we don’t know what their genetics are, in terms of they haven’t been found to have a specific snp, something that we can test that actually says, Oh yes you have the statistical increased risk. But if you look at their family history, you just have this feeling like something is going on even though there’s no gene that we actually can test. If you have a family history where many of the women or certainly if you add men in too because like talk about a red flag, when you have a male in the family with breast cancer. And so if you have a family history with many members of your family having breast cancer, first and second degree relatives. So that would be siblings and mothers and aunts and cousins, you know they have breast cancer and you have multiple cases. I would say, you know what, maybe you could be that one in a thousand at age 50 whose life is saved.

So we can’t say that Mammography has no life-saving capability. It’s just that it’s a lot smaller than what we ever thought before. So I would certainly say people with that strong family history. I would also say people who have severe worry. You know we have to treat the emotions. There are women who really feel like, you know, I’m the one, I’m going to be that one. Why do people buy lottery cards? You know, do they think they’re going to win? Well, somebody does win. They feel like this is my lucky day or maybe for the breast cancer, they feel I’m lucky. And so, I really want to listen to my patients. And if they say, you know what, I really think that I could be that one in a thousand and I really would want to get this mammogram, I feel better having it. Then absolutely, they should have it.

And I always want to make sure that people know that the standard of care, what does that mean? It means that some organization said, this is what doctors should do. That I always want to tell people what the standard of care is. And they may say, you know what, I want to go with the standard of care. I don’t want to be an outlier and say I don’t want it. You know, so I will always do what my patient wants.

The other thing would be someone who I know had a lot of toxic exposures. I have patients who grew up on farms and this breaks my heart, when they were kids, they used to run after the planes that were spreading the pesticides and the herbicides that was spraying it out, you know, like this foggy stuff that was coming out of the plane. They would run and play in it. I mean it’s like, oh my goodness. We know now that people who have that kind of exposure, particularly when they were about 10, 11, 12 that they have significantly, dramatically increased risk of getting breast cancer.

So the other would be like women who spent most of their lives on birth control pills. We now know birth control pills increase the risk of breast cancer. And it’s always hard because there’s such a delay in time. You know, it’s not like you take something and you fall down dead. Well there seems to be more of a cause and effect. When you take something and nothing happens for 25 years, it becomes harder to prove cause and effect. But there is actually no controversy that birth control pills do increase the risk of breast cancer. So any woman who’s been on many years of birth control pills, I think they could be that one in a thousand at age 50 whose life is saved.

So I have to look at all these things. And people with other exposures to endocrine disruptors, like they tell me that they’ve been microwaving in plastic most of their lives. So I look at and take an environmental history because I know that these endocrine disruptors increase risk of all sorts of cancers, particularly hormonal dependent cancers like breast cancer. So I’m going to zoom in on that population of women.

Robyn:                                Got It. Okay. Tell us a little bit about the different types of mammograms. Should people go digital? Should they go 3-D? Should they go the really expensive fancy ones? Talk about pros and cons there?

Dr. Gersh:                           Sure. So not that many years ago, the only type of mammography that was available was called film screen. And that has been replaced by digital for, I don’t know, probably at least 15 years, maybe longer. So digital is probably the way to go. It seems to give a little bit more refinement compared to film screening. Very few radiology centers even offering the film screen now. They’re all digital where I am now. You couldn’t even find a film screen one if your life depended on it. So that’s pretty much like the standard mammogram now is a digital. And I mean by digital, you know you’re not taking a film and developing it. So that would be the standard.

Now the 3-D or the tomosynthesis is really a CAT scan. So, I don’t know why they just don’t call it a CAT scan of the breast, well, I kind of do, because it would scare women, they don’t want to say I’m having a CAT scan. They like the sound of I’m having a 3-D, somehow that that sounds better. But CAT scans are 3-D X-rays and that’s what a tomosynthesis or a 3-D mammogram is. It takes different slices. So it sort of rotates. It does this 3-D view. Now here’s the kicker. There’s been just a very few studies that have shown that they might be able to pick up an earlier cancer. There’s not a whole lot out there, but maybe. So, I’ll give them the benefit of the doubt, maybe they can pick up a slightly smaller cancer. It’s hard to say but maybe they could.

But they have not yet proven that they save lives. And once you get over this whole thing of size means risk for metastasis. Once you just accept that a breast cancer can metastasize at any size. Sometimes big breast cancers are found like multiple centimeters and they haven’t metastasized. Sometimes little ones, especially in the younger women, they’re very small and they’re found and they’re already metastasized and then the woman ultimately dies. So really you can’t say that finding is the same as saving a life. So we have no data on that.

But what we do have is the amount of radiation. Now I have tried to research this and I’ve asked, and I can’t get a clear answer. But if you go into a radiology center and you get the 3-D, by the time you leave, you’ll have at least double the dose of the amount of radiation that you would’ve gotten had you gotten just the standard digital. Now they do use the argument, well because it’s a better picture, you’ll be asked to come back for repeat views, which happens all the time. That happened to me in the past when I was getting mammograms routinely, cause you know, I bought into pretty much everything routinely that standard medical care dictated for many years of my life.

So, I was called back for repeat views multiple times. And that happens to all kinds of women and across all the different age spans that get mammography. And of course it’s greatly anxiety provoking. But then you also get an extra dose of radiation or more. So you know, it’s hard to say, but certainly you know you’re walking out the door with a minimum of two and I’ve heard as much as three times the amount of radiation. Now if this was something that you got very infrequently, you’d say, well, it’s not that big a deal. Well, it turns out that by doing this you’re getting about half the amount of radiation dose that you’d get from a CT of your brain. Now hopefully nobody has to have a CT of their brain, but if you did, you certainly wouldn’t be going back to get one every year or two for decades of your life. We know that that would be very harmful. So think about getting half that dose that you would get from a CT of the brain, but you’re getting it on a very regular basis.

Now, if you talk about women in their forties, women in their forties are still, typically with few exceptions, pre-menopausal. They’re still having their own hormones being produced and their breasts are very sensitive. So the breasts of a woman in her forties is actually more sensitive to the effect of the radiation in terms of its potential as a carcinogen than women in their fifties. So probably the safest years to get a mammography in terms of the damage and risk from the radiation is between 50 and 60. Once you start getting older and you start getting well into your sixties the problem is then the breasts become more sensitive to DNA breakage and damage from radiation. So if you get mammographies in great measure in your sixties and then into your seventies you are more likely to have injury damage and risk from having the radiation.

And in your forties when women have very dense breasts because they have all that estrogen still being produced, they tend to be pushed into the 3-D or the tomosynthesis, in my area, almost universally. Because they’re told, oh, you have dense breasts, you have to have this 3-D. And of course they have dense breasts. They’re making all this hormone and density in younger women is just a sign of having estrogen on board. When you have density on a mammogram in an older woman who say is not on hormones and she’s well into menopause and you have dense breasts, that’s a sign of inflammation in the breasts that’s causing estrogen to be produced in greater amounts than would be expected that’s causing proliferation of the ductal cells of the breasts, creating that dense picture on the mammogram.

So that’s why breast density is an independent risk factor for breast cancer, but typically as you get older. So anyway, the bottom line is that this radiation is definitely a risk factor. And I really hesitate to push the 3-D. I’m into a do no harm mode. It’s like, unless you can tell me that the benefit exceeds the harm, I’m going to say don’t do it. So to me at this moment, for the average typical woman, the benefit does not exceed the potential harm from the 3-D.

Robyn:                                Interesting. Okay. So a few of our colleagues said, I tell my patients to get a mammogram every other year and go get thermography in the years in between. You’re further down the spectrum. I’ve never had a mammogram myself. I am not saying that because I think that someone, I don’t want to have any part of telling someone else what to do. But, I have had thermography once. Where would you line up if someone were, you knew nothing about them, but they’re over the age of 50 thermography or mammography, but less often? Ultrasounds? Tell us about ultrasounds. So of those three, what’s good counsel for people? Everybody wants to hear something that you can really pin down.

Dr. Gersh:                           First, I just want to let you know and all of your listeners, the US Health Services Task Force actually came out and then reaffirmed their belief in 2016 that women of normal average risk from age 50 to age 74, was to get a mammogram every other year. So it’s only like the American College of radiologists that recommended every year starting at age 40. So there are these different organizations. And think who has a little more at stake here, who has more skin in the game here than the radiology.

So in terms of mammography, we already know. In terms of thermography. So thermography may turn out to be something much more useful than it is. So depending on what you think, you can have it. But I don’t want you to think that getting a thermogram is a screen for breast cancer. It is not. It is a screen for breast inflammation. Now there can be value to that. I’m not against having a thermogram, I just want people to understand what it is.

So say somebody says, you know what, I just want to know what’s going on in my breasts. I’ve usually have a pretty good idea based on many other factors that I can ascertain about my patients because of their weight, their diet and other labs and so on. So I’m pretty good at knowing what their general state of inflammation is. But say someone says, you know, I want to look at my body, cause you can do a thermogram of any part of the body, not just the breasts, so I want to see what’s going on with inflammation in my breasts. I don’t have a problem with that. Just know that it’s not a screen for breast cancer.

So if you have a thermogram that shows no inflammation, that’s wonderful, but that’s not like a free pass that you have nothing going on. That doesn’t prove that you don’t have breast cancer. And if you do have some areas of inflammation, so what are you going to do about it? Well, you know, you can’t just cut all of these chunks out. So what are you going to do? Then you’re going to end up having to do either a mammography or we haven’t talked about it yet, but you can do MRI’s. And they have their own set of problems.

So if you use thermography for what it is, then I have no objection. It’s just when it’s used as a replacement and people think it’s a replacement for a mammogram. After we’ve just talked about all the low benefits of mammography, thermograms just give you a clue about the health of the breast, if it’s very inflamed or not. And I’m not against that.

The other problem with thermography is that there are no certification of any sort as to who’s doing it. So you could just do an online program to learn how to do it and then suddenly you could set up a thermogram center and who are you? Like you could be just, you know, nobody, you have no medical training, no background. So I’m always alarmed at people doing screening tests who have like we might say really marginal training and knowledge and they’re going to be interpreting a test that you can base your future health and decisions on. So it’s a problem in that it’s not really a certified type of a test. And depending on who’s doing it, and what equipment, it may or may not be reproducible. So I’m not huge on thermograms. If my patients want to get them, I just say sure. Because I don’t think they’re harmful in and of themselves. Just understand what you’re getting. So don’t think I’m not going to do mammograms, I’m going to do thermograms and they’re sort of comparable, they’re not.

In terms of ultrasound. There may be a future in ultrasound as a primary way of detecting breast cancer, but that’s not where it is now. Not close. Not yet. So an ultrasound is a wonderful tool, but it really is very limited. It really is able to tell density, like what you feel, is it a cyst or is it solid? So you think of it as if somebody found a lump on someone you could do a couple of things. You could stick a needle in it, and if fluid comes out then well obviously it’s a cyst, you just drained it.

If you do a needle and nothing comes out, then well it’s solid and then you could turn it into a fine needle aspiration, which isn’t done very much these days because the radiologist have sort of replaced the fine needle aspiration biopsy with the core biopsies, which are, you know, way more expensive involved and so on. But you do get much more tissue than you do with just a needle aspiration biopsy.

But really what tends to be done the most, if you feel a lump is you get an ultrasound. The ultrasound says it’s a solid or it’s a cystic mass. Or if somebody has really, really lumpy breasts because breast can be quite lumpy. And you just feel like I don’t know what I’m feeling. All I feel is lump, lump, lump, lump. Then you can say, well, let’s get an ultrasound. Especially in a younger woman, you don’t want to put them through a mammogram.

So you just get an ultrasound and it says, oh yeah, you just have lots of small cysts. So all those lumps that I’m feeling, they’re consistent with cysts. So you feel better. You feel better when you do that kind of an exam, like, well it’s just a very cystic breast that I’m feeling and then you could talk about how to treat it. But at least you don’t have a breast that’s filled with lots of solid lumps, solid masses.

So it helps you to know what’s going on because you know, you mentioned like melanoma, breast can be a site of not just primary cancer, but metastatic cancer. And I’ve actually had a couple of patients in my career, it’s not very common where I found a breast lump and it turned out to be a metastatic melanoma. And these were young women because we know melanoma can strike at very young ages.

So I do feel that there’s still a place for a breast exam. And that’s been also bantered about as if that is valuable or not? I think that if you do have something, we should at least find it. I mean even if even if you don’t save a life, I think we should know what’s going on. It’s just a breast exam, there’s not a lot of downside to doing that. And then if you find a lump, you do have to evaluate it. And when you find a lump ultrasound is typically the next step.

Robyn:                                Okay. And some of our colleagues were saying in this very long thread that many people weighed in on that you can’t really even get an ultrasound. I mean you might, if you call a bunch of clinics, you might be able to get one out of many to let you do the ultrasound without having first an abnormal mammogram and that you can cash pay for it, if you can get a clinic to do it, like a radiography clinic. And I was given prices from $150 to $600 so there’s the fancier ones and the cheaper ones apparently.

So it sounds like a lot of, sort of risk benefit analysis left up to the individual here with all this great information. You are really clear and open about the risks that you see about mammography. My guess would be that many, many of your colleagues have their concerns about it, but they kind of can’t speak up because they’re a little worried about losing their medical license.

Dr. Gersh:                           The reality is, there was a very wonderful article that you can access on the internet because it’s an open article, you don’t have to have pay to get to the full article. It’s available. And it was published in May 2018 in JAMA. That’s the Journal of the American Medical Association. You can’t get more mainstream than that. And the article came out of Harvard. You can’t get more prestigious than that. Right? So an article from Harvard published in JAMA, so that’s as mainstream as you can get.

And they looked at what is going on here. We know that the benefits of mammography are really overplayed. It’s not that there’s no benefits, it’s just that when you look at the balance of benefits and harms all in the potential world that it’s not really speaking too well towards mammography. So why is it? They did a survey of almost a thousand doctors to say, what are you doing? And it turned out that 80% of them were immediately without questions, without informed consent, without giving patients any options or discussion, were starting mammography routinely every year at age 40 in every single woman, that was 80% of this, almost 1000 doctors surveyed. And this was not long ago.

And they came up with their theories of why is it that this is perpetuated. And a big one, and especially as a forensic medical expert, is litigation risk. They figure you can never be penalized for recommending a mammogram. You could only be penalized if you don’t. And then the patient actually is diagnosed with cancer and whether or not it would have had any difference in the outcome, is really unlikely that it would have any difference in the outcome. But nevertheless, everybody sues everybody. So for litigation issues or concerns, they just order it on everyone routinely. They don’t inform, they don’t discuss.

The other is of course time constraints when you have a very small time allotted for a patient visit, you know, look how long we’re talking here. Right? But if you were, like a patient that came in and wanted to know all this stuff, that would be like five, six, seven visits, right? So they can’t do it. So they don’t do it. They don’t even want to do it. So they just say, here’s your prescription for your mammogram and have a nice day. You know, so nothing is changing as far as the process of screening for mammography and educating. And the article really thought this was a terrible thing. It was clear that there’s a problem here. And this is the folks out of Harvard saying doctors need to at the very least have a discussion with their patients and give them the facts and then let patients decide.

I view myself as a consultant. I’m not a dictator. I never tell my patients, you must do this or get the heck outta here. No, I’m going to give them the facts. I consider all my patients to be highly intelligent and they should make their own minds up, but they can’t make up their minds if they don’t have the facts. Just like when I’m a forensic medical expert and I give all the facts to the jury. I don’t give them the verdict, I give them the information. And then they have to use their own wisdom to hopefully make the right decision. And that’s how I work with my patients. But doctors are not giving the patients the information, they’re just giving them a prescription and showing them the door.

Robyn:                                Well, I’m very grateful because I think that every woman who listens to this will be realizing, wow, I could go to my doctor five times and I would not get the amount of information that they just got from you. And you know, she’s not getting paid to do this. This is just a wonderful public service I’m so grateful for. Really the last thing that I want to cover is, how do we avoid breast cancer in the first place, or if we’ve had breast cancer, how do we keep our risk as low as possible? You’ve touched on some really good things already and I hope that if this is a subject that’s important to you, that you’ll listen to this interview again. It was very dense with information.

But you talked about circadian rhythm. Ladies, we’re not supposed to stay up till 1:00 AM and get up at 5:30 AM or whatever it is we’re doing where we’ve gotten way off. We have blue light telling our pineal gland that we don’t need Melatonin because we’re looking at light that tricks our systems into believing that it’s daytime. So many things like that, getting back to nature and getting back to the natural way that we used to do things, before we had hundreds of times more cancer than we used to. But what else? What do you want to say about diet and what other lifestyle things have you not mentioned that we really should cover?

Dr. Gersh:                           Well, there is a lot with diets. So we know that a high fat, very unhealthy fats, I know that fat has sort of come back into the good realm, but when you have a high fat, high sugar diet, which is very common in the US, that diet causes inflammation, it actually alters the gut microbiome and you get leaky gut. And leaky gut is a gigantic subject in itself, but that leads to systemic inflammation. So if you think about, like I mentioned that when you have inflammation in the breast, that can lead to DNA breakage. So chronic inflammation can lead to cancer. So we don’t want to do anything that creates a systemic chronic state of inflammation in our bodies.

Unfortunately, menopause itself is a state of chronic inflammation. So once you hit menopause, you have to work extra hard. And we know that menopause is the time of life when more women have breast cancer then they do before that. So one of the things that’s really key that they’ve associated with postmenopausal breast cancer is weight gain. So it’s so critical to eat a healthy diet at the right time and eat a very high vegetable diet that nurtures your gut microbiome. Lots of high fiber like root vegetables. So we want to have a healthy gut.

And I know that this has been very controversial for a lot of people, but there really is some data that if you have the organic whole soy that that actually is beneficial. And I mean it’s like another whole many hours of talking but estrogen does not cause breast cancer. Estrogen is the hormone of life itself. We didn’t evolve for our primary hormone to give us cancer, but it nurtures and can grow hormone dependent cancers because it doesn’t understand it’s cancer. So if you don’t have cancer, which hopefully you don’t and you’re trying to prevent it. If you eat fitoestrogens like flax seed and organic whole soy, and I emphasize organic and whole, the fitoestrogens can help maintain a healthy gut. We’ve seen that that can help to prevent leaky gut. Remember leaky gut is the enemy. So those are foods that can help in many cases.

So you want to eat a whole foods diet, you want to avoid a lot of animal because when you, and especially if you char your food, like if you barbecue, I know everyone loves barbecuing, but when you char meat and it could be any animal, okay, not plants, but any animal, if you char it you can create these carcinogens, these heterocyclic amines that are really carcinogens. You’ll also create increase of glycation aged products and that is really bad. So you don’t want to barbecue a lot.

And you don’t want to eat a lot of animal protein. You want to have predominantly a plant based diet. And of course eating at the right time along with our circadian rhythm, not eating at night. You know, women who work shift work like nurses at night or flight attendants have dramatically higher rates of breast cancer.

And you have to get polyphenols, these magical ingredients that are in fruits and vegetables that do a dance with your microbes and keep everything really working well. And you want to make sure you get plenty of antioxidants in your foods. Plenty of foods with vitamin C and A and E. And then of course you want to get the sunlight vitamin, vitamin D. And there’s an association between low levels of Vitamin D and increase rates of breast cancer. So we should all check our vitamin D and preferably get it from being out in the sun. But if that’s not going to happen, then it’s not as good, but it’s certainly better than not and that is to take a supplement with vitamin D along with K2 and magnesium. You really need like the whole trio to make this work.

So definitely nutrition, diet and then adding in spices. I love spices. There’s some data on saffron and turmeric. So these are wonderful things. And then you could take some of these things like curcumin as a supplement as well. So these are all things that can help lower your risk of breast cancer. You know, we can’t change our exposures from when we were kids. If you were dancing behind a plane that was spraying malathion or something or they sprayed it all over your house or something, we can’t undo the past, but we can certainly do a lot for the present to maintain health.

Robyn:                                Everything you’ve said has been so clear and grounded and useful. And ladies listening, this is probably the hundredth time that you’ve heard very, very similar nutrition advice from the amazing functional medicine doctors that we’ve had on this show. And it’s my original mission. It’s the Green Smoothie Girl mission from the very beginning. And right now I feel like I’m fighting a war with a lot of silly fad diets that are inflammation causing, leaky gut causing, liver damage causing fads. You know, telling people to overeat fats and these people eating Keto and now the carnivore diet is getting a lot of attention. They’re eating up to 70% of their calories are these fats and not even the good fats. So very frustrating.

I just have so enjoyed both of my conversations with you and I know that some of our followers are going to want to learn more from you over time. Where can they follow you?

Dr. Gersh:                           Well I just want to also mention I’m still a very old fashion brick and mortar practicing doctor. I actually have a practice where I see patients, that’s really my primary job. I have many jobs, but that’s my primary job is actually taking care of patients one by one. And that’s in Irvine. It’s the Integrative Medical Group of Irvine in Irvine, California. And then I have my practice website, which is integrativemgi.com and my little branded website, which is felicelgershmd.com. And then my Instagram, which I’m going to be doing some videos down the road. So please sign up because I’m going to be educating you on my Instagram soon. And that is Dr. Felice Gersh. And then my Twitter is the same only minus the period. It’s just Dr Felice Gersh. So I tried to keep it simple.

Robyn:                                Well, you are amazing and a wealth of knowledge. Thank you so much for being with us on the show today.

Dr. Gersh:                           Well, it’s my pleasure and I’m happy to come back anytime.