[00:00:00] Speaker A: Welcome to the heart rate variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast. For your informational use and not medical advice, please see your medical provider to apply any of the strategies outlined in this episode. Heart rate variability. Podcast is a production of optimal LLC and optimal HRV. Check us
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Welcome friends to the heart rate variability. Podcast. I am Matt Bennett, here with a very special guest, Dr. Sarah Jeffery. Today I came across Sarah's work in the most recent edition of the AAPB Biofeedback Special Edition, and I reached out immediately because I really loved the work she was doing and have gotten to know her a little bit, and I'm excited to share her journey with you as well. So, Dr. Jeffrey, could you introduce yourself briefly to our audience before we jump in?
[00:01:07] Speaker B: Yeah, absolutely. Thanks so much, Matt, and you can call me Sarah for the sake of the interview.
So I am a naturopathic doctor. I just finished my education at Bastier University at the San Diego campus and have started my first year of residency, where I'm located at the Bastier San Diego Clinic while I was in school. And as I continue into my professional practice, my main focus is on patients who are too overwhelmed to implement any of our treatment recommendations. And that helped me find my way towards biofeedback is a great tool.
[00:01:41] Speaker A: Excellent. So can you just my ignorance here, but I'm sure I'm not the only one. When I saw Sarah Jeffrey indie, I had to Google it to see what is an indeed. Can you maybe just give a little bit and then once I Googled it, I did stop and I went on an obsessive rabbit hole to save maybe those like myself.
What is this Nd? Could you give a little bit of background about that designation? Because I found it really exciting.
[00:02:19] Speaker B: Yeah, absolutely. I'm very passionate about this. I could talk about it for hours.
So a naturopathic doctor is a primary care doctor, like our medical doctor colleagues with the MD credential, we actually have the same number of hours of training in anatomy and physiology and pathology and pharmacology. So our hours of training actually meet the same standards as those had by a medical doctor, but then we get additional training in homeopathy botanical, medicine, counseling, nutrition, and chiropractic type work. So we tend to have a more holistic focus, although many of my MD colleagues also do.
We focus on prevention, on finding the root cause, and on doing the lowest force intervention possible. So that means we're going to start with somebody, say, with diabetes by talking about lifestyle, talking about their diet, their stressors, talking about why they haven't been able to change their diet in the past, what food means to them. We have a longer visit too than some of our medical colleagues. We tend to spend about an hour with the patient at a time. So it means that we actually have time to dig into the lifestyle factors and really make lasting root cause type change.
[00:03:26] Speaker A: And my follow up question is, do you have a plan to take over the medical world? Because I want that. Where can I get indie? I want an hour long appointment. I want this stuff. So is this a growing like there were dos I know around too. Is this a growing movement or am I just a little bit late to the game?
[00:03:51] Speaker B: It is growing. So currently I think we have scope of practice in 18 states. I might not be exactly correct on that. So in some states we can practice and in other states we're actually not recognized yet. Naturopathic medicine is really big in Canada and in Australia, and it's growing here in popularity in the US. Kind of as people hearken back to the past where they had a general practitioner who knew them and knew their family well. And you know what? I think there's room for both. If I get hit by a car, I'm going to the Er and I'm going to see a medical doctor. But I think for day to day primary care, having that established relationship, having time to sit down and talk, is really meaningful for patients and it's something people are really looking for.
[00:04:31] Speaker A: Well, I know there's a whole range of us who have been toiling in public health for years who are ready to advocate that it's in all 50 states.
Thank you for that piece. So kind of not a surprise that in Indy came across HRV and HRV biofeedback. But for you personally, when did this sort of come into your thinking?
[00:04:59] Speaker B: It was actually just lucky because I started out as a yoga teacher. Well, no. Okay, I'm going to give you a little bit more background. So I actually worked in healthcare administration after I graduated from college, and I was a director of strategy for a community hospital in Connecticut, working through service line growth and helping the hospital prepare for the you know, I think many people are aware in America, our healthcare system, we're tied to the model where hospitals only make money when patients are sick. And everybody knows that's not good, even the medical doctors, even the hospitals. But it takes such a big change to get there and I can be a little impatient. And so the change wasn't happening fast enough for me and I wanted kind of a more global system and found myself dissatisfied by that work. So in the years I was figuring out what to do next, I taught yoga as kind of I'd go and I'd crunch spreadsheets all day and I would do work that didn't feel like it served patients and then I would find my peace by teaching yoga in the evenings or on the weekends.
So through my work of studying yoga and teaching yoga, I really began to appreciate the mind body connection.
So, of course, when I'm at Bastier University, I think it was in my second year, and there was an elective called Mind Body Medicine, I signed right up. I had no idea that it was going to be biofeedback therapy. And it was. We were taught by Brad Lichtenstein, who's one of the leaders in the heart rate variability space, and it was just such a pleasure to learn from him. And I quickly fell in love with this.
[00:06:39] Speaker A: And then, you know, I come across and again, of course, if it's a journal article, it has to have a title of Resolution of Panic Attacks in a Patient with reoccurrent Miscarriages Using Biofeedback Therapy a case report.
And I would love you to outline because it's an end of One, which is with our podcast, it's kind of a repeating theme of early episodes. It was the end of one for Matt as I experimented with myself a lot. So our longtime listeners are very familiar with the end of one, but just an absolutely remarkable data set that you were able to achieve with this patient. So I would love for you to just give an overview of the case report and some of the insights that you gathered from it.
[00:07:36] Speaker B: Yeah, absolutely.
So for the sake of transparency, this was actually my second ever biofeedback patient that I saw when I was a green third year student clinician on the biofeedback shift with Dr. Maya Roth. And I started seeing our protocol. Here at Bastir is a seven week protocol, mostly breath and HRV biofeedback focused. And I started two patients the same week on visit. One of the protocol, one patient I wrote this case report about, and she did remarkably well. And the other patient did okay. And I'll talk more about kind of why that was and that's kind of why we chose to do a case report. And since I've seen many more patients, and I do find that with heart rate variability biofeedback, the results vary, and it's mostly due to patient engagement and patient willingness to practice outside. So in some ways, I did get very lucky with this patient, that this patient was very motivated because she had had I guess I'll go back and give a little background on the case for those who haven't read the article. So my patient was a 40 year old female. She had been experiencing recurrent miscarriages. She had had five miscarriages and then finally was able to carry one pregnancy to term, had a baby boy. And at the point where we saw her, she had gotten pregnant again and had an onset of severe panic attacks. Just so afraid that she would lose this child. She really wanted a sibling for her son.
And because she had had so much pregnancy loss, she really didn't want to try any pharmaceutical interventions for panic attacks. The research shows there are medications that are deemed safe enough for pregnancy, but she wasn't taking any risks. And that's what many women feel through pregnancy, is that they just want to stay as natural as possible to maximize the health of the fetus. So this woman was having 14 panic attacks a week. Very debilitated. She ended up in the emergency room at one point, but didn't want a pharmaceutical intervention. And that's how she found our way onto our shift for biofeedback.
[00:09:37] Speaker A: Because I'm looking at the data right here, and am I reading she was having 14 panic attacks or more a week? Is that yeah. Wow.
I can't imagine. Almost like sitting with her in that state, introducing them to biofeedback. Was she receptive to that?
I picture this ball of anxiety sitting across from you.
I can't imagine having one panic attack a week, much less, more than one a day. So as you're sitting with her, what's that just kind of feel like that level of anxiety to sit with her and connect with her therapeutically.
[00:10:29] Speaker B: Yeah, it's exactly what you were talking about. Definitely a ball of tension kind of at the end of her rope because she didn't know what tools to turn to next.
This was a patient who had a lot of emotional releases through our sessions. There was a lot of crying, a lot of really needing to pause the session and regather. We actually relied heavily on meditation throughout the session. Sometimes she would come in and just be too wound up from the journey to get here that we couldn't go right into biofeedback. So we would do mindfulness meditation exercises. We did some progressive muscle relaxation with her just to kind of get her into a state where she was comfortable even proceeding and engaging with the biofeedback.
So, yeah, I was in awe of this patient because she was so affected when I started working with her. But she dedicated herself to her practice. She practiced 20 minutes twice a day from week one and saw very quick results, even just with the diaphragmatic breathing. We coached in week one. As you can see in the data, by the first week, she was down to one panic attack a week.
[00:11:31] Speaker A: Yeah. Can you explain?
Was it just that I've seen biofeedback and HRV biofeedback. I'm such a huge fan and advocate for it, so you don't have to convince me that HRV biofeedback is potentially life changing, going from over two panic attacks a day to the following. I see session two. I don't know if that's the second week of you were going down from over two a day to one in a week period of time, just that drop. And I think the reported anxiety level of seven out of ten to a three out of ten, that's from me. As a mental health professional, we don't even dream about those kind of results. So what was your experience as she started to integrate these approaches and just seeing some of these amazing outcomes?
[00:12:31] Speaker B: Yeah, like you said, you're a mental health professional. You're really heavy into this space. Her results were particularly good. It was just one week. We do see people have that kind of results over the seven weeks. I've never again seen someone respond that quickly. I think part of it was this patient felt completely out of hope when she started. And just the power of hope is so huge. And I think just in coming and meeting myself and Dr. Roth, our supervisor, and having a protocol that we said, evidence shows this can help with your panic attacks, it's drugless, I think, just restored hope in her.
And also the woman like people with anxiety, she was breathing so poorly.
She was breathing out of her chest. She was tensed up. And we gave her tools right in that very first visit to breathe functionally, to posture herself functionally, and then it's all credit to the patient. She went home, and she practiced it that's great. Regularly. So I think that really helped. And she also intuitive, was very intuitive. And from the first visit, in addition to the practicing twice a day, she also used that diaphragmatic breathing right from week one, the moment she felt a panic attack coming on.
We didn't coach her to use it as a rescue tool. We actually don't recommend that patients use it as a rescue tool when they're just learning. But this patient chose to do that, and I do think it was effective for her.
[00:13:54] Speaker A: Amazing. I have to kind of think about your Nd approach, your sort of that naturopathic approach. Do you feel like you were able to meet her in a different way, that if she was thrown into the big health system that I made, I just kind of want to get like, I pay a lot of money for my health insurance, and I never use it. I want an hour long physical. I want, like, a workup. I'm about ready to turn 50, and there's no way in my system that I can get more than 15 minutes with my medical provider. So I wonder, was there something about sort of your approach, your philosophy, the program that you're in that allowed you to say, okay, we've got somebody who doesn't want to do medication, obviously a fairly severe, severe case?
Was there something sort of about your approach, your program, that allowed you to be creative in a way that I don't think I would have gotten this necessarily if I went to my traditional medical provider?
[00:15:05] Speaker B: Yeah, I mean, I do think that the luxury of time. So the 60 minutes, that's what we do for our follow ups. We actually spend an hour and a half with our new patients. And so it gave me time to talk to this woman who was stressed out at the end of her rope so we weren't rushing through. Okay, quick, do a gad seven, do a PHQ nine.
When did this all begin? She had time to cry. She had time to tell her story.
I was able to just sit in silence with her and let her say everything that she needed to say before we got started.
She found her biofeedback, so she self referred into biofeedback. So in some senses, that was left gate was a shift that was particularly geared towards helping her. But I think as naturopathic doctors, we are evidence based. We do follow protocols, but we're less tied to them, and we have a little bit more room to be creative. So I added a lot of ingredients into our standard protocol with the meditation for her.
[00:16:00] Speaker A: Well, the thing that when I work with a lot of medical providers in the traditional arena, if you only have 15 minutes, that relational component of the healing hardly ever gets to kick in. I think the providers I work with would say I don't have time. I don't have time to ask an open ended question, much less do anything. Like an hour and a half intake where I actually get to know the person. I may be able to check some boxes off. So I know we can't necessarily pull apart how much I mean, just talking to you a few times, I could imagine the support she felt from you in that interaction as well. And we know that that can promote healing along with the correct breathing, the biofeedback and everything else as well.
[00:16:55] Speaker B: Absolutely. I think as humans, we're relational beings. I think we have a rich history through our past of storytelling and of being heard. It's something we don't get to do so much in modern know. There's the book called Bowling for One that talks about the loneliness epidemic in the United States and how many people have maybe one if they're lucky, close friend or confidant. So even just having that space, and you could call it placebo effect, but I don't I think there's actual real medical value in just sitting down and having your story heard.
[00:17:24] Speaker A: Yeah, well, you release that oxytocin that's calming different parts of the nervous system that often trigger with anxiety. So I don't know, even if we throw a little placebo effect in there in some way, shape or form, it is an effect on top of what I always like to see. There's an interesting study. It was Gabriel mate who I came across this. But if we have oxytocin, some of the dopamine serotonin endorphins, when those are released, the oxytocin makes those neuroreceptors more sensitive to those. So if I'm with somebody, I always like to say if I stumble out in a dark alley and I'm intoxicated, I haven't showered for three days, and I hand you a sugar pill, depending on how many glasses of wine you've had, maybe you take my sugar pill. Probably doesn't have much impact on you, but put on a fancy code, have Dr. Bennett on it, have you come to a clinic and now that sugar pill becomes an incredibly effective treatment for symptoms, maybe arguably the most powerful medicine we've ever found in a lot of ways. So that relational piece is so critical with that. I think sometimes we call that placebo when it's probably just the fact that somebody listened to me for an hour and a half, which is absolutely incredibly powerful.
[00:18:49] Speaker B: I think the other really interesting thing in this case, as you read the story, is this woman improved so much even though she had another miscarriage through the middle of the protocol.
[00:18:58] Speaker A: Yeah.
[00:18:58] Speaker B: Which was in visit three, she literally came in well, undergoing her miscarriage. That was a very emotional visit.
But it really, I think, doubled down for her how well the biofeedback therapy was helping her because she didn't increase in panic attacks as this event happened that she had feared so much.
[00:19:19] Speaker A: Yeah, I mean, the numbers throughout, I mean, at the session seven, she was a zero of ten on the anxiety. I mean, that's just like amazing results. No panic attacks, even though they're I'm not going to call it traumatic for her, but at least a highly disruptive, if not traumatic, tragic event. If nothing else happened halfway, you still saw the therapeutic benefits, which hopefully allows her to be successful in other aspects of her life. Pregnancy and beyond would be the absolutely.
[00:19:56] Speaker B: And in terms of pregnancy, she was successful through biofeedback therapy. She did conceive again. She did get pregnant again. Unfortunately, she lost that baby as well due to a COVID-19 infection, but she had no return of the panic attacks as she became pregnant. So when I last spoke with her, she had discontinued care because she felt like she had all of the tools that she needed, that she had navigated another pregnancy and pregnancy loss without a return of old symptoms and felt confident to continue working on conception.
[00:20:28] Speaker A: Amazing. So you mentioned that there were two people and one had just maybe not as world changing results, but I'd love to hear as you looked at the other case, just things, similarities, what was kind of different in that one that kind of stands out to you.
[00:20:55] Speaker B: Yeah, and these were just interesting because it was two cases at the same time. And I've since seen many other patients, and to me the biggest theme is practice at home. Right. Because we're with the patient for an hour, which is wonderful once a week. But for me, I find and I actually would love to do a study on this at some point. And I think it's been done, too, in the literature, how practice really enhances the outcomes of biofeedback therapy.
I like to be really permissive, though, how I talk to patients about practice because we're modern humans with very busy lives and I don't want them to be set up for feeling like they've failed or feeling like they have to lie to me about what happened. And so I kind of language it. The literature supports practicing 20 minutes twice a day. And some of my patients practice not at all, and some of my patients practice more than that. And most people end up in between. And whatever happens with you, we're going to get information about your barriers and we're going to get information about your case.
[00:21:50] Speaker A: Yeah, we hear that all the time. One of the things with the app that I've worked on, the optimal HRV app, is that there's a clinician's dashboard so you can actually see whether or not somebody practiced. And just that accountability. It's weird that we're mostly working with adults here. That little bit of accountability that I know my provider can actually see. Whether or not I practice, we see increases compliance, for lack of a better word. But following through with practice, that just little thing. But it is hard to find that time within the day to do that for a lot of people. And it's not the most exciting thing to practice, at least initially, even though I'm so glad I've got those thousands of hours of practice in my past now that I can pull from on a day to day basis.
[00:22:48] Speaker B: Yeah, absolutely. And I think having a system like you were describing would be such a dream here at this clinic. It's a student run clinic, and patients usually are coming because we're a more affordable option in the community.
We don't have them on equipment at home when they're practicing, they're using free apps like the Breathe Plus app on their iPhone. They're doing paced breathing work, but it's all without the technology. So they're only hooked up to the machines when they're here with us. So we don't know if they're practicing or not. But it does make it affordable, accessible to the community to do it that way.
[00:23:22] Speaker A: Yeah. So I would love to think about as you sort of progress now and looking at, I know just from our previous conversation, some next steps in your career because if I'm understanding correctly, biofeedback is sort of a part, but maybe it didn't sound out like, oh, I'm going to be a biofeedback practitioner. Nor is that necessarily where all your focus is going to lie. So it's going to be a part of that thinking just kind of how as you move forward with heart rate variability, heart rate variability, biofeedback, what lessons are you taking away from this really powerful introduction and success case that got published?
[00:24:07] Speaker B: Yeah, absolutely. So I would describe myself as a naturopathic generalist, a true family medicine doctor who does not focus on one area over any other. The reason HRV Biofeedback I keep coming back to it is I just see so many patients who are so dysregulated in their nervous system and so busy that you give them a set of recommendations and they come back. And they're honest with me because I give them a lot of permission to be honest and say, sorry Doc, I didn't do any of it.
And that happens week after week, and they feel frustrated, they feel unsuccessful. Honestly, I feel a little frustrated, too, because I spent a lot of time coming up with those recommendations, right. And for those people getting reregulated through biofeedback therapy, if your nervous system is out of whack, there's no space to make change, right? So the reason I do biofeedback therapy is because I see that overwhelm as an obstacle to cure. Like, I can't do anything that I want to do medically, and there's lots I do medically, I do botanicals, we do custom tinctures for people, custom teas for people, supplements.
I also do craniosacral therapy, which is a hands on modality. So there's lots that I like to do with patients nutrition, recommendations, lifestyle, all of that. But if they're so overwhelmed and their nervous system is on high alert and they're in that activation, they're not going to be able to do any of it.
[00:25:30] Speaker A: Right?
[00:25:30] Speaker B: And I'm not going to be able to help them with whatever they came to see me for. Exactly.
That's really where biofeedback fits in for me, is not that I'm going to be soliciting people to come in just for biofeedback more. I'm soliciting general medicine patients who then need biofeedback to progress with general medicine.
[00:25:48] Speaker A: Right. And very familiar how I see this with my work, especially in the trauma world of mental health, kind of to me, it's like the greatest homework a therapist, like my dream homework, to give somebody if it's safe for them and they feel comfortable doing it. Boy, everything that I learned as a trauma therapist was how to help regulate that dysregulated, the nervous system that got dysregulated by trauma. This is, again, maybe not in of itself going to be the full healing picture, but what a supplement to help us reach our goals, especially, again, for those that feel comfortable doing that, even five or ten minutes of practice at home each night to build up that resiliency over time. And that's the exciting thing about where I see this technology and getting it in the hands of people like yourself is just really exciting to see where we'll go with this into the future.
[00:26:51] Speaker B: It's really incredible. I love it when patients can do it's. A bit of a time commitment for patients. That's the biggest barrier that I see coming in seven weeks in a row, especially if they have work that's less flexible. I'm really interested in working with a lower income community who maybe doesn't have a job where they have easy time off or flexibility. That's the biggest barrier. I have other tools that I use for patients if they can't come in. Have you heard of the dynamic neural retraining system?
[00:27:18] Speaker A: Yeah.
[00:27:20] Speaker B: So I'll do that.
[00:27:20] Speaker A: Can you explain that just a little bit though for our listeners who might not have absolutely.
[00:27:25] Speaker B: So our heart rate variability, probably all of your listeners are familiar with that's. Using breath work predominantly as a way to kind of calm the nervous system and increase the heart rate variability and it works more globally on the sympathetic and the parasympathetic nervous system helps tone the vagus nerve and all of that.
The dynamic neural retraining system works more on the limbic system of the brain, which is that like reptilian fear center and so it helps reset the limbic system. So if you're on high alert because of past trauma, it's typically used for people with trauma.
If you're on high alert, it can help kind of calm that fear response down. So it's two different approaches but with very similar outcomes I have found in calming that reactivity absolutely.
[00:28:11] Speaker A: So any sort of final inside feedback. I know you're looking at some of the next stages of your career, so just anything that we may not have covered, insights, epiphanies that you've had on some of your initial steps in your HRV journey?
[00:28:31] Speaker B: Let's see. I'm just continuously just blown away and I'm sure all of your listeners are just by how effective this tool can be across all of my patients. I've never seen anyone get worse through doing HRV biofeedback. I know theoretically it's possible and everyone really does end up getting some benefit, like some learning about themselves even just from the act of caring for themselves enough to make the appointments for biofeedback, that in and of itself is really powerful. It's something I wish more clinicians knew about just because so many patients get stuck without it.
I think it's something I plan to refer to as well as doing it in my own practice extensively.
I think to any medical doctors listening or to practitioners who maybe are on that shorter time model, just knowing that this exists for patients, that I truly believe that your non compliant patients, they're not doing it to frustrate you, they're not doing it to self sabotage. Nobody chooses to be that way. They're doing it because their nervous system can't do any better, typically, or there's a financial barrier. But I do think it's our duty as caretakers to explore with people why they're not able to follow a treatment plan in a really open minded way. And for some people, biofeedback could be an answer to helping gain that compliance that we're all looking it.
[00:29:49] Speaker A: I love it. So I'll just put a quick plug out the Biofeedback special edition journal of the AAPB. If you're not an AAPB member and you're listening to this podcast, just Google it. I just get great stuff from them.
The journal comes on a regular basis and then I get some of these great juicy things with really great articles. And Sarah, I just got to say, the world is a better place. For having you out there.
I'm a little embarrassed you introduced me to the Indie, but I'm so glad you did because I do a lot of work with federally qualified health centers and others that are just really struggling to engage certain populations who, again, may struggle economically or with other issues, social inequities of health, all those other things.
And we're looking for models that are better than the traditional medical model where engagement is just really it's a struggle. And so just to my heart, knowing that this movement is really taking hold and I got something to where is it at in Colorado? And who can I advocate to will be some Google searches very quickly for me. After that, we record yeah, well, I.
[00:31:16] Speaker B: Can save you one Google search and say that naturopathic doctors are licensed in the state of right.
[00:31:21] Speaker A: All right.
[00:31:22] Speaker B: So they're out there. And I'm so grateful also to have a chance to give this plug to my profession because we aren't that well known. And as someone who used to work extensively with medical doctors, I don't think we have to work in competition.
[00:31:34] Speaker A: Oh, no.
[00:31:35] Speaker B: At first, they would say, like I said, I was a service line director. I worked with a bunch of surgeons. And when I told them I was leaving to study naturopathic medicine, they're like, you're going to be a witch doctor? I'm like, no. And then I sat down and I explained to them that I have an hour, that I have education in nutrition. And they're like, Whoa, I would actually send my patients to you because I don't have time to talk to them about their diet. I don't have the knowledge to talk to them about their diet. So I think there's a lot of opportunity for us to work hand in hand, not as competition. And I think patients will get better when they have the opportunity to be heard to be treated holistically with an eye towards prevention.
[00:32:12] Speaker A: Yeah. And I think that's a lot of our I will speak for us, whoever us is, but me, the folks that are really looking at heart rate variability, getting the autonomic nervous system just nerding out about optimal functioning vagal break.
We've got to focus on sleep quality, diet, movement, nutrition, all these aspects of it that I just know that my friends in traditional medicine don't have time or expertise. And if you don't talk about things like nutrition or movement or sleep quality, how are you going to help someone heal? Like, you can address disease states, but are you going to help them get healthy? And there's this growing frustration that we, I think, work with people because we just nerd out about this, and then there's not that kind of almost we're working against the medical profession. It feels like that in some ways. And to really have this movement which sounds like you encompass everything we're advocating for the holistic sort of health approach with a really strong scientific foundation.
It just does my heart good to know this movement is catching on. And shout out to Colorado for being one of those early adapters.
[00:33:42] Speaker B: Yeah, absolutely. It's exactly what you would think. It's the two coasts.
Yeah. The four corner states.
But it's growing. It's growing every year, and that's really exciting to see.
[00:33:57] Speaker A: Well, awesome. So we'll put a little bit of information about you in the show notes as well. People are interested in that. I'll put a link to APB in there, which is where I got to see your great work. So, Sarah, I really appreciate your time, your work, and good luck. I'm excited to see where you go with this, because, boy, like I said, that was just an inspiration. That article, that case review was such an inspiration. It's like, this is why we're doing this work that I appreciate you taking the time to write it up for us.
[00:34:32] Speaker B: Yeah, thank you so much. It was definitely a turning point case for me. I was deep in all of those academic classes at that point, and like, why did I do this? Why did I sign up? And then I had this patient who just improved so rapidly, and it's like, oh, yeah, you know what? This is why we do it.
[00:34:49] Speaker A: Awesome. Well, thank you so very much. And to our listeners, as always, you can find show notes at optimal Hrv.com. And Sarah. Thank you. And we'll see everybody next week.
[00:34:59] Speaker B: Thank so much. Matt.
