Menopause, IBS & Gut Health in Midlife Women: What Your Doctor Isn't Telling You with Dr. Mary Pardee

27:13So there's, like, that caveat where it's like, if I wasn't getting great results, I'd still try other things. But if I don't need to use them and I don't have to have people on really restrictive diets, then I'd much rather stay there. For sure. Do you, when you say the, did you say it was visceral pain? yeah visceral hypersensitivity is the term is that just in the gut or are they i'm just thinking i'm thinking of the people that i know not gonna name any names and i feel like their overall pain tolerance is like this big and for me i mean every every time they're sick it's such a massive ordeal and i want to be like i walked around with a broken leg for two days you're fine I mean, you just don't have any.

27:58And then I'm just not sensitive enough. But I'm like, I wonder if that translates to just pain overall. Well, so I don't know. The answer is I don't know. I haven't looked into that. But I wouldn't be surprised. But I would also bring in like this other term, which we use in the IBS treatment. We have visceral hypersensitivity. But then we have the term hypervigilance. So hypervigilance is a key kind of, if you're my patient, you've heard the term hypervigilance a million times because we talk, you have to understand the process to be actually able to treat it. And hypervigilance is when you are scanning your body for sensations because you don't feel well.

28:38So somebody with IBS, bloating, distension, cramping, they don't feel well. And the last, we're not going to, you know, gaslight people saying you do feel well, you're fine. Like they really don't feel well. And what happens in the brain when you don't feel well is it tells your brain to start scanning your whole body. Where am I not feeling well? What else isn't feeling it well? What's going on here? How do I fix it? So your brain becomes hypervigilant, scanning, scanning, scanning. We also scan our environments for potential stressors. And this hypervigilance can 100 % increase pain signals elsewhere too.

29:16Because if you scan enough, you're going to find something else wrong with you. So the analogy I'll use sometimes, if you're on for like a trail run, you're in the woods, you cut your leg on something when you're running, but you don't even see the cut until you get back to your car. But when you see the cut, your brain puts the attention on the cut and says, oh, we should be in pain now. And maybe then you can actually feel it. But when you were running, you couldn't feel it much at all. And you weren't paying attention to it. You also had adrenaline hormones going on there too. But when we put attention onto a discomfort, our brain goes into survival mode and increases the pain so that we make sure that we fix it.

29:56And so it could be anywhere kind of pain, but if we keep paying attention to it and it's not a threat, that's the key is pain with IBS. If you have an actual diagnosis of IBS, this isn't like if you've never been diagnosed, go make sure that it's IBS and not something else. But if you know you have IBS, the pain associated with IBS is not harmful at all to your body. It doesn't increase the risk of other chronic diseases. It doesn't increase the risk of cancer. It's a pain, and we want to treat that, but it's not a threat to your life. And this is one that we really have to start to ingrain because if we can actually start to ignore that pain using other coping strategies, divert our brain's attention away from it, we can start to tell the brain, hey, we're actually safe.

30:44You can chill out. And then hopefully it's going to turn down the hypervigilance, turn down the hypersensitivity so these sensations actually get better. So are you a big fan of, I mean, clearly the breathing, which I'm a big fan of too. I just came back from a yoga retreat not too long ago. and I always just thought meditation and breathing was like oh cool you do that but I never ever would have made time for it I was just like not not my thing don't have time sounds great whatever and then when I went there like all of this stuff came up and I'm not saying I'm perfect at all like I was going to do it 66 days solid was what we were supposed to do and of course I've missed a whole bunch of days, but I'm telling you that 10 to 15 minutes in at any point during the day, if you're super stressed or you just feel like it is such a good reset, I cannot believe I've waited 48 years to try it.

31:46I love your story. And I hear it all the time too. And we can extrapolate that. Like the breathing is incredible. The diaphragmatic breathing is not something to like, just be like, Oh, it's not going to work for me. My symptoms are so bad. Like you really have to try it and try it more than once. Yeah. Because I see people and then people also hear me say like, so you were just going to talk about my symptoms and they're going to get better. And I'm like, uh-huh. And they will, if you're open to it, because really our thoughts and beliefs change how our body responds from a hormonal standpoint.

32:22And this isn't woo woo. I mean, this is cognitive behavioral therapy. It's one of the most studied things we have in psychology. and it has great results for people. We're talking better results than most of the medications for global symptoms. So we have really great meds to slow down the gut for diarrhea, speed it up for constipation. We don't have great meds for the abdominal pain, cramping, distension, bloating that are there. And this is where like the CBT and the gut-directed hypnotherapy, but all these things that are not medications work really well for those symptoms and quieting them down.

32:58I love it.

33:00Dr. Mary Pardee:I'm doing it for till the end of time. I feel like I always say there's nothing three deep breaths can't solve like in a stressful moment. It doesn't even have to be 10 to 15 minutes. But if you ever just like stop in those moments and take three super deep breaths, you can feel the physical change. Yeah, I'm a fan. I will continue to be a fan. You know what? It sucks to be bored. But when I get on my phone and play real casino games on SpinQuest.com, the time flies by. That two-hour wait at the DMV seems like 10 minutes. Play your favorite slots. Live blackjack, live preps with a live dealer.

33:43New players,$30 coin packs are on sale for$10. Play SpinQuest.com and you'll never be bored again. SpinQuest is a free-to-play social casino. Void where prohibited. Visit SpendQuest.com for more details. Okay, so moving on. When we look at finding a good physician like yourself, I guess when people come to you with a variety of different issues that you're training or you're answering, what how do you do you ever um maybe dissuade someone from going back to a physician if they're getting really whack-a-doodle i mean i feel like our health care system there's great physicians there's incredible physicians there's physicians that are probably good but they only have 10 minutes and so you can't really get a lot so there's a whole different bag here that goes into finding a really good physician, but what should someone look for in finding a really good physician that they need to go to?

34:54Yeah. For IBS specifically? I would say for IBS, for menopause, the things that we've been talking about today, I mean, can't possibly cover everything. Totally. Totally. I mean, what I would say is you want to interview your doctor like you would any other kind of position. You want to come at it a different way. I've heard stories. I'm like, they're not going to respond well to that. They're going to get really defensive if you're just kind of berating them, right? But you want to ask questions in a kind way. And I would also really push people to get a specialist. If you're looking at IBS, get somebody who knows IBS in and Now, I'm a naturopathic doctor, so I'm not a gastroenterologist.

35:42But as a naturopathic doctor, I've then subspecialized in chronic GI issues, mostly irritable bowel syndrome, chronic constipation. And there's many GIs who also really specialize in IBS, even more so than other GI conditions. But that would be my biggest thing is get somebody who really specializes in what you're looking to treat. some things you don't need a specialist. It's like, even for MHT, you want a practitioner who prescribes a bunch of menopause hormone therapy. But if you're, if you've never tried it, you may do great with like the standard kind of first line thing. So you can see an OBGYN or sometimes your primary care doctor for that.

36:22But if you've been working on something and haven't gotten good results, like most people with IBS, you really want to find like a specialist who really understands that condition. And that's where I see people going awry in like the functional medicine, even like the naturopathic medicine space is that you have people who, if you look at their website, they, they treat everything. They treat autoimmune conditions. They treat IBS, they treat mold, they treat Lyme, they treat, I'm like, I don't know how you can be a specialist on that many conditions. That feels really strange to me. So it's also why I only do preventative medicine and chronic GI issues.

37:02I don't see anybody for anything else. People come to me with autoimmune all the time. I'm like, I'd send you to a rheumatologist. I don't actually treat that myself. So preventative medicine. And if we go to heart disease still being the biggest risk for women, which everyone thinks it's breast cancer, what, where, how many is, how big of a deal is that to you? Do you see a lot of patients coming in and what's the treatment or what's the recommendation that you're giving there? Yeah, heart disease is still the number one cause of death for both men and women. And women are more likely to be undertreated compared to men.

37:41So it's a huge focus of my practice. I'm going to do a advanced lipid panel. So I'm going to actually run LP little a on all my patients, APOB, full lipid panel, and then all the metabolic and inflammatory markers that could be fueling the fire with cardiovascular disease as well. We're also going to look at blood pressure more in depth than most primary care offices would. So we want to do a full risk assessment of where somebody stands from a cardiovascular disease point, men and women. And then I always will sit down with people when we have their results and I'll do a risk assessment with them and basically just ask them, how risk adverse do you want to be?

38:20Do you want to completely take the ability to put down plaque in your arteries off the table? Do you want to go with the American Heart Association guidelines, which actually just kind of shifted? Do you feel good about like staying within their guidelines and just being really regimented about being in those levels? Where do you stand? And people are all different. Some people are like, no, I'm good with the standard of care. Let's get my level down to a 70. And then I have other people that are like, I want to take it off the table. I want to get my level down to like a 55 LDL, we're talking.

38:53Dr. Mary Pardee:so what are some of the things you do for that patient when they say they want to be totally risk adverse yeah so first we're running their levels see where they stand so we're going to look at their ldl cholesterol level and lp little a if lp little a is high they automatically go into the high risk category and we want to get their ld level closer to 40 for those individuals and we're using diet changes reducing saturated fat in the diet making sure they're eating a lot of fiber in the diet, but then also most of the time we're going to have to put in a medication to get people's levels that low too.

39:28We have a slew of medications that we can use at this point to reduce cholesterol levels. And so there's a lot of people that are still scared of statins. I try to get people not scared of statins because it's one of the most utilized medications that we've had. They've been studied forever. We have really good safety data on them, but we still have other options if people want to do another class of medication to use. Whether it's slots or live dealers, SpinQuest.com has the fun and action you're looking for. With SpinQuest exclusives, blackjack, roulette, baccarat, and even live dice with craps and bubble craps.

40:04The games never stop, so you don't have to. And right now, new users get$30 coin packs for just$10. Play now at SpinQuest.com. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit SpinQuest.com for more details. yeah it's always interesting to me and i mean people are coming from all over the board but i mean i know some people that i love who have had this blood work come back that's not great and a lot of diet and exercise would solve some of these issues but it doesn't ever like the behavior never and the habit never change to actually implement that? Do you see patients that come in that are like, okay, cool, got the news, just give me a drug and I'll go that route.

40:57And you know, I think this is where I see a different group of people. Like I think once you look at my website and I always get on a screening call with people and I tell them what we're going to do. And I think I scare everybody away who's not going to do behavioral stuff. but before when I worked in you know more like the insurance model a hundred percent every day I would see people that they just want the men they don't even want to know why and they don't want to do any of the behavioral things if I can get enough time with somebody who's somewhat open-minded and go into the education around it that's when I can really see people who just want in the med go to oh I get it now there's a lot of people who think exercise is just to lose weight And they're like, I don't really care about that.

41:43And then when I talk about, okay, do you know what happens actually physiologically when we exercise and that your muscles are more of an organ system that secrete anti-inflammatory and cardioprotective chemicals to improve your physiology? If I go through all of that stuff, they're like, oh, interesting. This is much more than just weight loss or body composition optimization. It's really around heart disease prevention, diabetes prevention, cancer prevention. that.

42:12Dr. Mary Pardee:Yeah. Interesting there. What else do you do for longevity?

42:22That's a big question.

42:26How do you keep people alive longer? Yeah. I mean, cardiovascular disease, that's one of the big ones because that's the number one, but then we also go into like cancer prevention. So what do we know are risk factors for cancer? and we start to talk about nutrition, exercise, for sure. Exercise is a huge topic. That's not even a one appointment for me. We're talking about exercise almost on every single call, but I'm doing a ton of education about, okay, resistance training versus cardio, high-intensity cardio versus steady-state lower-intensity cardio. I'll geek out as much as somebody wants than that.

43:01That's the most common one where people are like, I'm good now. Like, we're good. um and then and then sleep you can't talk about longevity without talking about sleep if somebody's not sleeping you kind of throw away the rest of it like that's got to be the one of the biggest priorities there bone health we have to look at that because you don't want to break a hip men or women the outcomes for breaking a hip are not great so we really want to focus on that it's going to come back to exercise and diet as well though and then there's some environmental things that we'll look at in terms of like air quality, water quality, and then relationships and mental health.

43:41Huge factors on your longevity. Social interactions, people who feel lonely versus people who feel supported and like surrounded by people they love and can count on. Very different outcomes from a longevity perspective. What about peptides? So we know peptides are everywhere. And I'm not just talking about GLP-1s, although that is part of the conversation for sure. But I think that some of these peptides, name it, a lot of them don't have this massive background of incredible results and information, but they are, people are buying them left and right. And just today I was scrolling on, on Facebook to answer a message.

44:28And this ad got popped up that was like, Oh, you want to know why everyone looks great in Hollywood. It's this, it's this one specific supplement. I'm like, they've all had access to whatever they want. I don't think it's the one peptide. No, I mean, if we look at longevity, socioeconomic status is one of the leading indicators of how long and how well somebody is going to live. How much money you have matters in terms of health. And I don't say that to be rude or dismissive. I say that to really highlight that people are telling you like it's this one peptide, right? Or it's this one other thing.

45:12And it's like when people have access to personal trainers to good, healthy, whole food sources for the time to exercise because they have financial freedom, the access to see doctors who can spend more time with them. I think it's really important that we realize that socioeconomic status has a huge influence on it and that we need to improve other people's ability to access good care, food, and exercise as well, because that's where we see big discrepancies that are affecting the health of our nation. That's just a tangent. Oh, no, I was just I was just going to go there and say I remember watching and I really don't watch TV at all and haven't for, I don't know, 20 years.

46:00I can't even I don't think I've had channels for for 20 years. But I remember I must have been somewhere where I saw this interview of someone talking about it was some somewhere in the south more of a lower economic area and they were like well of course I have to go to McDonald's and feed my family I can feed them for$15 I can't get anything I go to Whole Foods and I walk out with two pieces of fruit for $15. Like I have to feed my family of five or six with this food. And so that, I mean, that could take up a whole other podcast, but if you had one message to send, um, about just, um, the healthcare system, I know that you're a concierge doctor, what would it be?

46:51Oh, I don't know. And my expertise is not in public health. Um, I'm really interested in it. At some point, I would love to learn more and get involved more in it. But public health is very different than one-on-one medicine. And I think actually that's what we're seeing politically kind of go awry here is you can't necessarily insert what works with one patient to a public health standard because that's not how it works. But I would be misspeaking if I kind of commented on it just because it's not my expertise. So I'll leave it for the public health people.

47:27Dr. Mary Pardee:What about other myths? I heard you talk about colostrum and how it is not linked to longevity. It's not linked to improved immune health. It's not linked to longevity. Yeah, I have an Instagram reel on colostrum taking down a very common colostrum company who I have nothing against. I just think when you start to use sales tactics that are completely out of integrity, I have no problem calling you out because there could be somebody there who has in the lower socioeconomic status who would be way better buying fruits and vegetables for their family, but they may get coerced into buying this freaking colostrum supplement that's, I don't even know how much money and going to do nothing for your health.

48:12And so you can tell it like gets me fired up because you have, you have a responsibility when you have a platform and you have a product to, yeah, you can sell it, but you got to be integrity with your claims. Like your claims better be actually true. And if you're trying to trick people, like I'm not for it. And I just, yeah, I have zero patience for it. I've also like, this is kind of how I came to be where I am as I was the girl in her twenties getting tricked by all this stuff. I was super naive. I was from a small town in Massachusetts. I thought anybody who was on a podcast must be telling the truth and was good intentioned.

48:48And then I got out to the West Coast and I started to like meet some of these people and like the curtain fell for me. And I was like, whoa, some of these people are just trying to make money. I'm like, I was the girl listening to the podcast, believing everything they said, buying every digestive enzyme and probiotic and like doing all the things. Cause I thought that they said that I was going to get better. And they, they sounded so sure about that. And I didn't. And I spent thousands of dollars that I didn't have on these supplements. And so I'm just really protective of people now where I'm like, I want to help be a signal amongst all the like the super noisy stuff of social media.

49:27A lot of which isn't going to get people the outcomes that they're they're hoping for. I'm here with SpinQuest where you can play and win from the comfort of your own home with hundreds of slot games and all of the table games you love with real cash prizes. Right now $30 coin packs are on sale for$10 for new users it's all at SpinQuest.com that's S-P-I-N Q-U-E-S-T dot com SpinQuest is a free to play social casino. Void where prohibited visit SpinQuest.com for more details I so appreciate that because we see in the health and fitness space too. I was at this menopause conference and there was like this, um, this cellulite removal cream that was, or like there was one that was like a electrolyte slash this will take away cellulite in this little powder.

50:23And I was like, who's buying, you're selling this at a menopause conference. Like you're selling it to women that are already super stressed out and very potentially very insecure about certain things as our bodies change they don't need a powder that's promising cellulite removal yeah so many things wrong with that and just like body shaming first right cellulite is completely normal in women period like it's not to pathologize cellulite we just have it. And then not to mention, it's not going to work. Cream would not work for cellulite. So just like preying on vulnerable population. Yeah, I would have a hard time not getting very.

51:02I did a photo shoot with this photographer who, who mainly like shoots physique competitors that are going on stage. So these women are, I don't even know the body fat percentage, but minimal, not even a healthy amount. And they don't stay there. And he said, Haley, every person I've ever worked with, the people, the women that are winning these competitions on stage, every person I've ever shot has cellulite. Yeah. You can be super, it's a normal thing that the female body does. It's really just like structurally how fat is deposited and how we have these kind of fibers that trap it in and that's all it is.

51:48But yeah, I mean, the more that we sell those supplements, the more that they tell women they need to get lipo for it, the more we're perpetuating that whole loop that we need to keep fixing the normal female body. And like the over pathologizing that we see in the wellness industry is insane to me. And it's one of the things that I work with patients on because people will come to me and they're like, I'm a little bit bloated after some meals. And I'm like, does it go away pretty quickly? They're like, yeah. I'm like, that's human. We're not treating it. But the wellness industry has made you think that every little thing, there's something wrong with you because they want to sell you something to fix it.

52:28And that's really where we need to see a shift in the space, hopefully, or people just start like blocking those accounts and don't give them any of your attention, time, or money.

52:38Dr. Mary Pardee:okay so can you take a pill that helps with bloating because we see this all the time everyone trying to sell us a pill that can help with that yeah if it's a supplement i would just say no um bloating you need to get really clear about what you mean by bloating because i have people come in they say i'm bloated the more questions i ask they mean that they're holding more fat around the midsection that goes into the weight loss category and we treat that the same as any other weight loss, caloric restriction exercise. Very different than I'm holding gas in my intestines that gets worse after I eat meals.

53:16And then I wake up and I have a flat stomach again. And then after I eat meals throughout the day, I get more bloated and gassy. I'm passing gas. It feels better when I have a bowel movement. That's more the intestinal bloating. And again, just for like coverage, always talk to your doctor about this because bloating is one of the first signs of ovarian cancer too. So we don't want to put something in a safer bucket than it should be in either. Most of the time it's going to be gastrointestinal gas. And for that, you want to identify why somebody has that bloating and if it's excessive. So it's normal to fart up to 20 times per day as a human.

53:54Most people think that's way too high. And I'm like, if you're around that range and it's not interfering with your quality of life, we actually don't want to treat it. But then there's some people that come in, they're like, after I eat breakfast, I'm a little bit bloated. After lunch, I'm really bloated. By the time nighttime comes around, I feel like I'm nine months pregnant and it's really uncomfortable. Like I have like actual like pain because of the distension. That's the bloating that we actually want to target and treat. But first we have to identify why it's happening. You know, is this IBS?

54:24Is this SIBO? Is this functional bloating disorder? Is this just constipation that hasn't been treated? Because if you're constipated, you're not going back to the bathroom regularly. If we just treat the constipation, sometimes it will resolve the bloating as well. So if we touch on SIBO really quick, something that I really don't, I feel like I'm interested in knowing more about it, but I don't know a lot about it. But it's definitely a real thing. Is that a question? Yeah. Yeah. It's a real thing. It's a real thing. SIBO is an interesting one. Gastroenterologists will treat SIBO. I say it's interesting because we don't have a great test for it.

55:09You can send somebody for a SIBO test. It could come back negative, but you can still treat them for SIBO and they can still get better. And vice versa. We see people who have positive SIBO results that don't actually have any symptoms. so we wouldn't want to treat them. And so it's one that I feel like we still need to like figure out better testing and treatment tools for. But it's a real thing. It means it's small intestinal bacterial overgrowth. So you're supposed to have some bacteria in the small intestines, but most of your bacteria, your microbiome should reside in the large intestine or the colon.

55:45And when you have an overgrowth of normal bacteria in the small intestine, we call that SIBO and they start to produce more gases in the small intestine, which can either slow down the GI tract or speed it up, depending on which gas is being produced at higher levels. So this can result in constipation, diarrhea, but the key note of bloating and gas, that feeling of distension, especially with food. So if the distension starts in the morning after breakfast, gets worse as the day goes on, highest at night before you go to bed, but then when you wake up in the morning, you feel good again, that's kind of a pretty consistent story with SIBO.

56:23And we treat it with various different medications. We also can use the low FODMAP diet sometimes with SIBO. Antibiotics are kind of one of the mainstays with SIBO. And then sometimes we'll also use prokinetics to get the intestines moving a little bit faster to keep things flushing through. So it seems like there's some similarities with IBS then. Yeah, it's about 76 % of people with IBS will be diagnosed with SIBO, but not everybody with SIBO has IBS. 76 % of IBS? That's high. Yeah, but it doesn't mean that once you treat the SIBO, they don't have IBS anymore, unfortunately. They're just more likely to get SIBO, like have flares of it.

57:08Dr. Mary Pardee:Wow. Okay. so for people like hayley who have a lot of people in their life that have ibs and it really controls them would you recommend them going to someone like you that deals with the cognitive aspect 100 they have yeah 100 it's got to be so psychological also and the gut talks to the brain right it's not the other way around both it's bi-directional it's got talks to the brain Brain tux to the gut. We just have better ways of interjecting at the brain level. We don't have a ton of therapies that interject at the gut level yet, unless you're talking about changing motility patterns for IBS in terms of diarrhea, constipation.

57:56But 100%, we go in with the behavioral things that we've been talking about, like the thoughts and beliefs, that whole pattern, stress, that piece, but also nutrition, medications. I really think the best approach to IBS is this multi-pronged approach, not just meds, not just the behavioral stuff, but ideally a combination of a bunch is what I've seen have the best results for people. Okay. As we're wrapping this up as a concierge physician, what are the parting words that you would give to anyone out there that's kind of maybe wanting to go down the path of concierge medicine. I personally know in my network, so many of the collaborators that I work with have moved to this concierge medicine because they just can't practice the way that they want to practice in the normal healthcare system as it sits right now.

58:53What would be your parting words. If somebody is like, I kind of want to look into this concierge medicine, what do you offer? That's different. I mean, time is one of those, but what would, what information that would you share with them? As a patient sharing with a patient. Yeah. The patient. Got it. Got it. Yeah. And naturopathic doctors are supposed to use the word doctor, not physician. It's like a whole political thing, but just, I just want to note that because I don't want to like misconstrue. um and so if I was talking to a patient in terms of concierge the one of the biggest things is time so the average doctor's appointments like 15 minutes long they try to cover five different topics they get six minutes for the longest topic if I had six minutes to help somebody with IBS with the cognitive behavioral stuff I don't I would like barely get through the diaphragmatic breathing exercise right it would take me a whole year to get through actual content with this person and so really if you're looking for more time with somebody I also give people access to me between appointments unlimitedly so they can message me in between and I actually prefer that they do because I want my patients to get results really quickly and if we have momentum in the beginning and you start doing the exercises and you come to me and be like hey I just did this what else can I do you're going to get better so much faster versus waiting to see me till the next appointment.

1:00:14We can also tinker with things between those appointment times as well. And then I also provide accountability like a health coach. And so if I see you're not doing your food log, because a lot of what I do is body composition optimization and weight loss for people who need weight loss. But it's really helpful to have kind of like a coach on your side and not just a doctor prescribing the meds saying like, how's the exercise going? Like any obstacles? You know, How was your run the other day kind of thing? And I see that really, because I used to not be concierge. And when I switched over that accountability piece, especially for weight loss, but also the IBS stuff keeps people engaged and rolling and on their journey a lot easier.

1:00:57And then what else? It's going to also be that we're going to do more comprehensive testing. So I'm not going to just run four lab tests. We're going to look at LP little a, ApoB, cardiovascular risk markers. And we also will do some longevity testing that's not technically in medicine, but it's more from my exercise background. So I do VO2 max testing on my patients. I do strength and mobility testing on my patients, cognitive testing as well. But I want to be more aggressive, more proactive to ensuring that people are where they want to be now so that they can also be where they want to be into their 80s and 90s.

1:01:36And oftentimes, we actually have to be much healthier than we think right now in our middle ages to end up at a place that feels really good for us in our 80s and 90s. Yeah. Do you do telemedicine or are you just in person one-on-one? I do telemedicine too. And most of my patients are in the LA area, but all over California. And even my LA patients who live like probably two miles away prefer telemedicine most of the time because they don't want to drive. So I do a ton of telemed regardless of where the people are at. This is funny that you say that because I had a client in Santa Barbara area that I was training.

1:02:17And she would just like the comment was always and I would fly out there and train her and she'd be like, I just can't get to the gym. I'm like, I can see it from your house. it's right there what do you mean you can't get to the gym everything into the house because going to the gym was not an option which was just it's um it's a different lifestyle say that well thank you so much mary for being here with us yeah how do women um find you yeah so my website is modernmed.com there's no e in modern so it's m-o-d-r-n-m-e-d.com my instagram is at dr.mary party. I put out a ton of free content on Instagram and I also have an email list.

1:03:02If you look at my website, you should be able to join it for blogs, podcasts, thoughts that I'm having. I'll send out there. But there's a link on my website to schedule a complimentary 30 minute call with me. If you're interested in working with me one-on-one, I did just open up a few more concierge spots and we will jump on a call and see if I'm a good fit for you kind of go through your goals and go from there and there's zero pressure to do anything after that call it's just an intro call I love that because I can tell from your personality and your vibe that you would not be a pressure person no the last thing I want to do is work with somebody who it's not honestly that call is two-part is number one can I do I think I can help you if I don't think I can help you that call is then going to transform to who do I think could help you and like I think you should see your rheumatologist or actually think you should start here.

1:03:53Cause it's, it's, I've, I'm of no interest working with people who I don't actually think I can get the results that they want for. And then also just to make sure there's a vibe and I'm their person. Cause we all have our different, you know, people that we work best with too. Yes. Well, thank you so much for sharing all of your knowledge today. It's been a pleasure having you on. Thanks. Thanks so much guys.

1:04:16Dr. Mary Pardee:Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five star rating and sharing the body pod with your friends.

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