Episode 89 | Jul 11, 2024

Fixing Thyroid Problems, With Dr. Amie Hornaman

What role does the thyroid play in your health journey? In this episode of Health Coach Talk, Dr. Amie Hornaman joins Dr. Sandi for a deep dive into all things thyroid, including the role of T2 thyroid hormone and its potential impact on metabolism and weight management.

“[The thyroid] runs your entire body. It’s controlling our metabolism, our blood pressure, our body temperature, our heart rate, our gastric motility. Why wouldn’t we pay attention to this master gland?”

Dr. Amie Hornaman

You may already be familiar with the hormones T3 and T4, which work together to influence metabolism, energy levels, and other body functions. Dr. Amie, aka the Thyroid-Fixer, introduces T2 as a powerful yet lesser-known thyroid hormone that can significantly influence energy metabolism and fat burning. She and Dr. Sandi explore the revolutionary potential of T2 thyroid hormone in enhancing metabolic rates and promoting fat loss. This episode challenges conventional wisdom about thyroid treatment and offers a promising avenue for health coaches and practitioners to explore with their clients.

Dr. Amie’s 15+ year journey into the world of thyroid hormones began not just as a scientist, but as a patient grappling with her own thyroid health challenges. Faced with the complexities of thyroid dysfunction and the limitations of conventional treatments, she became a researcher, determined to find more effective solutions. This personal struggle fueled her passion to innovate, leading her to formulate nutraceuticals like Thyroid Fixxr and Metabolism Fixxr, which integrate advanced thyroid science with her clinical insights. Her discoveries offer a new approach for individuals struggling with weight management and low energy, emphasizing the importance of comprehensive thyroid care in holistic wellness approaches.

Dr. Amie understands first-hand how frustrating it can be to look for answers to a thyroid problem and leave every appointment empty-handed. For health coaches whose clients are going through the same thing, understanding the implications of T2 supplementation can be groundbreaking. By highlighting the role of T2 thyroid hormone in boosting metabolic rates and promoting fat loss, health coaches can guide their clients to deeper and more specific questions, ultimately opening up new potential treatment paths with their providers.

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Episode Transcript

Dr. Sandi: Welcome to “Health Coach Talk.” You are going to love this episode because we are doing a deep dive into thyroid functioning. We talk about how you come to be diagnosed. I share my story where I was going to my new internist, brand new doctor that I just started seeing, and he said everything looks find but there’s one lab value that’s out of whack, that’s TSH. I had no idea what it was at the time. This was many years ago. And before I knew it, I had my prescription for Synthroid and sent on my way and was told, “You just have to be on this for life.” I wish there had been other options. I wish I had the opportunity to work with a health coach, because if I had, then we would have worked on lifestyle and I would have realized that my life was pretty out of whack at that time—high-stress levels, I was overexercising, I was eating badly, and it’s possible that my thyroid health could have improved with lifestyle change, with some natural supports.

And we get into Dr. Amie Hornaman’s story as well because she is my special guest. I have admired this woman for some time. She is the brilliant Thyroid-Fixer. Let me tell you a little bit about Dr. Amie. Dr. Amie Hornaman aka The Thyroid-Fixer is host to the top-rated podcast in medicine and alternative health, “The Thyroid-Fixer.” She’s the founder of the Better Thyroid and Hormone Institute. This is an organization with transformational proven approaches to address thyroid dysfunction and support people returning to full health. She has been prescribing thyroid and bioidentical hormone replacements. She has the ability to do that in all 50 states in most of Canada. She’s the founder of the Fixxr supplement line, which is a supplement that specifically addressed the struggles that Dr. Amie sees in her patients such as inability to lose weight, fatigue, low libido, hormone imbalance, and more.

She is on a mission to optimize you and give you your life back. Her passion for thyroid health was borne from her own personal health challenges. She was competing in NPC Figure competitions and encountered severe symptoms, faced multiple misdiagnoses, and ineffective treatments. This experience ignited her commitment to helping others who are navigating similar health struggles and the often confusing medical landscape. So, we are going to talk all about hormones, specifically thyroid, although we touch on how it’s connected, how the thyroid is connected to other hormones. So, I hope you will enjoy this conversation. I know I really enjoyed recording it.

Welcome, Dr. Amie. Can you share how you got into this, how you became the Thyroid-Fixer?

Dr. Amie: Well, thank you, Sandi. It’s my pleasure to be here. Like so many of us in the space, we’ve had our own health struggles that led us to a place of helping other people with that same thing. So, no different from me. If we back up more than 20 years ago, I was competing in fitness and figure competitions and doing fitness modeling. And for those of you who don’t know, basically, you have to diet down and you’re on a really strict diet, and you’re hitting the gym twice a day. I mean, logically, I don’t care whether you believe in calories in, calories out or not. The body should lose weight on that kind of very strict calculated regimen. And I had done many of them.

Oh, my gosh, I’ve done maybe 20 different shows and photoshoots, and I would approach them the same way dieting down. This one show in particular I was getting ready for, I would step on the scale to report back to my coach. And every time I would slip on that scale, it was going up. And I’m talking 10, 15, 20, finally 25 pounds. At the 25-pound mark, I stopped getting on the scale because of course, at that point, depression, self-blame, embarrassment, all of that starts to set in. I feel like I’m being judged at the gym, as people are like, “Oh, she’s eaten the donuts, didn’t she?” Instead of asking me, “Hey, what’s going on? Are you struggling?” Nobody cared, they just judged.

But my body was literally rebelling against me. So, I dropped out of the show, and I started going to doctors because that’s’ what we do when our body rebels against us, right? So, I started of course with my family doctor. my PCP. And I remember him telling me, “Oh, you’re normal. Everything is fine.” And I went down like, “I’m not normal nor am I fine. Literally, there’s something going on inside me that I can’t control. I can’t control the weight. I can’t control my lack of fatigue. And I was only in my 20s.”

So, I went to get a second opinion, and I ended up going to six different doctors who all misdiagnosed me. And now we hear the term medical gaslighting that I can totally apply back then at that time. That’s exactly what I was being given. It’s just medical gaslighting terms. It’s all in your head. Just eat less and exercise more. Ridiculousness. And finally, the seventh doctor actually touched my throat and said, “Swallow.” And when she did that, she goes, “Oh, you have a goiter. Okay, we’re going to ultrasound you, but here’s a pill. You have hypothyroidism. You have Hashimoto’s. Here’s a pill.” So, I left her office and I was so excited. I had a name for what was going on with me. I had a diagnosis and I had a pill.

So, I thought this pill was going to do everything for me. And I gave it five months and no change. I mean, I did not even lose a pound. So, I went back to her and I laugh. I joked that… Back then, I think it was the big Gateway computers that I was on, right? So, I started Dr. Googling like we all do as well. And I find, oh, this pill that I was given is T4, that’s inactive. That’s the inactive thyroid hormone. And then there’s another thyroid hormone called T3. There’s another one called T2. Those are both active. Why am I taking the inactive form of a thyroid hormone when I need the active form?

So, I went back to her and I said, “I did some research. And here’s these other thyroid hormones. Can we maybe implement that?” She goes, “No, I don’t do that. I just do standard of care. And this is what we’re told. We check TSH. And if that’s high, we give T4. End of story.” And I said, “Well, I’m going to find somebody who does.” And I kept hearing the name of, and I heard it more than three times, when God or the universe gives you something like multiple times from multiple different sources, you’re like, “Okay, I’ll listen.” I kept hearing the name of this functional medicine practitioner. Back then, we didn’t even use the term functional yet. I think we were still on integrative, alternative, right? And I went to see him and he spent 90 minutes with me, which was like 82 minutes longer than any other doctor had spent with me and did a bunch of labs. Let me understand my labs or he would say, “Okay, well, this is low and this is high and this is what we’re looking at,” and put me on a treatment regimen that actually worked. Totally changed my life and thus, changed my career. So, he became my mentor. I studied under him. I now treat patients the same way. We start with this 90-minute visit. We’re deep diving into labs. So, he basically was the catalyst for changing my career path.

Dr. Sandi: Thank you for sharing that personal journey. And what I heard was your perseverance. You didn’t stop with one doctor. You saw a lot of them. You didn’t stop with just getting that one medication. You dug further. You kept going until you found the right doctor and the right treatment regimen. I wish I had your courage and had been as perseverant because in 1986, I was 36 years old and went to a new doctor and he said, “Oh, everything’s fine but one lab marker is off, your TSH.” I had no idea what that was. And, “Oh, I’ll put you on Synthroid and you’ll probably have to be on it for life.” And that was that.

And I regret then not digging further and finally found natural thyroid. But still like always in the back of my mind, at the time, I was stressed out. I was eating poorly. I wasn’t exercising. I wasn’t getting the right nutrients for my thyroid. This could have been fixed. I could have fixed it with functional medicine. Even having a health coach helped me deal with all the lifestyle factors that I was ignoring at the time. But let’s talk about why is more focus needed on thyroid at this point in time.

Dr. Amie: Because it’s the master gland, and I’m actually shocked that more focus is not placed on the thyroid, even in conventional medicine. When you really look at what is the thyroid gland, it runs your entire body, so it’s controlling our metabolism, our blood pressure, our body temperature, our heart rate, our gastric motility. Why wouldn’t we pay attention to this master gland more than we are? And, I mean, it’s really interesting, I think back, I gave a lecture to a group of integrative wellness practitioners many years ago, but I was still talking about the same thing back then that we talk about now. Why don’t we test thoroughly for the thyroid? Multiple tests other than TSH. You and I, we got our TSH tested, right? And that’s the standard of care.

Dr. Sandi: Exactly.

Dr. Amie: If high, then give T4. But there’s so many other tests that much of your audience knows. And then I talked about being in the Synthroid box. And why is it that we only prescribe T4? We only prescribe Synthroid or Levo when there’s multiple other thyroid medications and combinations that we can really personalize for each individual. And the one doc raises his hand and goes, “That’s all we’ve learned.” And I really think that statement can permeate your question too as to why isn’t the thyroid gland looked at more thoroughly in all aspects of health. It really is what people learn. And even functional practitioners. I mean, I think a lot of functional and integrated practitioners need to step it up too when it comes to the thyroid because they overlook it or else they’ll only give Armour Thyroid because it’s natural. They know we have to personalize this treatment for the master gland.

Dr. Sandi: That is so important. And we train health coaches, and I really believe that if you’re listening to this and you are a health coach, of course you’re not going to be prescribing for the thyroid, but you can heighten awareness. You can be that person’s advocate, to help them to take charge to keep going until they get the right answers until they feel better, and just like you, weren’t satisfied with the first doctor, the seventh doctor, finally found someone. So, can you share a bit about what is the proper way to treat the thyroid, given that it is not one size fits all? And that natural might not be the best route for somebody.

Dr. Amie: It’s not always. There is no one size fits all whatsoever. So, many of the health coaches listening right now. So, you have, let’s say, a client who you know is struggling with hypothyroidism and let’s say they are…we’ll call it stuck on T4. They are on T4 only. So, I’ll give you some stats just to keep in the back of your mind that you can then share with your client as well. Two percent of the population “do well…” And I’m going to put “do well” in air quotes and come back to it. Two percent of the population “do well” on T4 monotherapy, T4 only; 98% need T4 and T3 combined or T3 only. Ninety-eight percent. Now these are stats directly from A4M, and they pretty much fit. Now the only thing I would question is the do well in the 2%. When you ask a person how they’re doing, I think much of your audience can resonate with this because we’ll ask our clients, how are you feeling? How are you doing? Or even the person on the street, the person next to me in the airplane I had a conversation with, and this is what really sparked my brain into thinking through this “do well” scenario. I sat next to a woman and she said, “Oh, yeah, I have thyroid issues.” She asked what I did and I said, “What do you take for it?” She says Synthroid. She goes, “But I’m great. I’m doing great. I don’t need to change anything. My doctor says my labs are fantastic and I’m fine.”

Meanwhile, I’m looking at her. Her hair is thin and straw-like as I’ve ever seen it. She’s carrying around maybe an additional 50 to 60 pounds, looks completely unhealthy. And I’m thinking, “Is this your norm? Like, you believe that this is doing well, doing fine.” So, of that 2% of the population who claim, “Oh, I do well on T4 only,” are they? Like, do you have hair loss? You have constipation? You have fatigue? You have weight that won’t budge? Are you putting on weight? Do you have memory loss or brain fog, dry skin, dry hair, or losing the outer corners of your eyebrow, joint pain, muscle pain? That’s not doing fine to me.

So, really we have to look at the thyroid treatment paradigm as breaking out of the T4 only. If someone’s on T4 only, you need to encourage them to get further help. You as the health coach can do all the things in the world to increase that conversion of T4 to T3, proper diet, keeping insulin levels low, making sure their nutrient status is up, magnesium, selenium, vitamin D, iodine, all the things, keeping stress low, meditation, body work, breath work, sleep. All of that is important and will absolutely 100% help them. But if you do all of that and you still have that unsatisfied client that’s like, “Thank you. I feel better, but the scale still hasn’t moved. I am not growing back any hair. In fact, I keep losing my hair,” if they’re reporting that, then that’s when you have to look at their thyroid treatment.

If they’re stuck on T4 only, now we have to do something. Now we have to encourage them, “Okay, it’s time to get a new doctor. You really need alternative therapy.” If you want all of this to work together, all of the recommendations that you’re doing as a health coach to work and coincide with we’ll say not Western medicine but functional medicine can actually do for the person. And then it’s like this beautiful symphony where the person actually gets better and they’re praising you for it as the health coach. They’re like, “Yes, you saved my life.” All of your remedies and protocols absolutely work because they got on the right thyroid treatment.

Dr. Sandi: So important to have those conversations, to ask those questions. And that’s what coaches do best. They ask the right questions. And so someone’s like, “Maybe I need to go further. Maybe I do need to basically challenge, you know, like, okay, I’ve been on Synthroid. Maybe it’s not working and maybe I need to explore other routes.” I’ve heard you talk about T2. I’m literally clueless about T2. Can you describe what is T…? I thought it was just T3, T4, and you’re talking about T2. What is that? And who can benefit? Should we be considering this?

Dr. Amie: Absolutely. So, T2. So, the thyroid gland produces four thyroid hormones, T1, 2, 3, 4. So, we’ve already determined T4 is inactive. We know that T3 is active. T1 is also inactive. So, we can set that aside, put it in the corner with T4. We move over here to T2. It has over 30 years of research on it. I’ve been studying it for 15 years, but it has over 30 years of research. And it turns out it is a very potent thyroid hormone that affects our energy metabolism. So, T2 can actually raise your resting metabolic rate, the amount of fat that you’re burning, just sitting there, and it works at the mitochondria level. So, it does stimulate ATP production. It stimulates brown adipose tissue. So, it will turn white fat into brown fat. And there are multiple studies backing this up. They showed that it will brown white fat in the presence of hypothyroidism, which is interesting because when someone has thyroidism, obviously we know that they have low metabolism unless they’re being treated properly.

So, even in a hypothyroid state, we’re seeing this browning of white fat, white adipose tissue. And it was also done… Another study showed the browning of white adipose tissue in the presence of a super physiological high fat diet, so this was done on rats and they used a high-fat diet, which would be the equivalent of us taking in around a thousand grams of fat per day. So, even in that high caloric, extremely high-fat scenario, we still saw the browning of white fat. In human studies, we see an average of a nine-pound weight loss in 30 days and an average of a 4% reduction in body fat when you use between the 150 and 300 microgram dose.

Now you really can’t get that except in supplementation. Yes, there’s some T2 in things like Armour Thyroid. So, again, back to the treatment, Armour is great as a natural that contains T4 and T3. Obviously there’s Cytomel and liothyronine, which is T3 in and of itself. And we can pair that up. We can pair up T3 with T4. But when we add in T2, we get a little bit more of a boost. We get a boost in that metabolic rate. We get nice steady energy with that client throughout the day, especially those who are dealing with high and low energy surges throughout the day. And then we’ll also see that there’s no thyromimetic effect and no cardiovascular effect, meaning it’s not going to jack up someone’s heart rate like the fat burners of the old days.

T2 is really coming into the research space as a very potent and potential anti-obesity treatment because we know the GLPs have their place but come with a significant amount of side effects, such as lean muscle loss, paralysis of the GI tract, and then even facial loss. Like, we’re hearing about Ozempic face and Mounjaro face. So, with those side effects, we need something for the treatment of obesity. And T2 is really coming into the scene as a potential treatment. And the bonus is that it is in supplemental form. So, we’re not in the scenario of, “Hey, you need to get a new doctor who understands, and we’ll put you on T3 in addition to your T4.” And you as a coach, as a practitioner can use T2 with these clients who are stuck, whether they have a thyroid condition or not, to really help them get to that next level, especially in weight and energy.

I mean, you’re so in shape right now. You’re so tiny. I would never, ever think that you ever had a thyroid problem or a weight problem, but as a woman, right, you know that when you’re tired and whether you’re raising a family or not, if you’re not raising a family, you’re trying to get through your own day or run a business or have a career or get stuff done, when you’re tired, that almost brings on depression. And then add on top of that weight gain where your clothes just keep getting tighter and tighter and you’re busting your butt, you’re doing all the things, you’re eating well, you’re getting your workouts in and the weight still won’t come off, that is just such…weighs so heavily on a woman’s mind. If you can get her to lose a little bit of weight and feel a little bit better through the day with her energy, you have now a happy, compliant client who will now do all the other things. But if she doesn’t see progress in the beginning, she’s just going to throw the towel in with everything else that you’re recommending. So, I really think that this is a potent treatment paradigm shift that we can start implementing to ultimately have happy clients.

Dr. Sandi: This is good to know. So, this is supplement form. So, this can be something someone can go and get as a nutraceutical. And is this particularly sold in combination? So, you have products. Can you share a little bit about why you chose to create a nutraceutical product or products?

Dr. Amie: Absolutely. So, there’s a little bit of a story behind it too, so I’m glad you asked. So, back when I started studying this 15 years ago, it was in, we’ll call it, a bro science formula. The really angry supplements that are out there for body builders and power lifters, and they all have these really, like, crazy gym rat types of names. So, this particular product was called… Gosh, I even forget. It was like Chaos Cannibal, something like that. And so it was really hard for me, even though I knew it worked. I tried it on myself. I was trying it with patients. It was really hard for me to tell a 45-year-old woman to be taking this angry-named supplement and that particular one had caffeine in it. So, you did get the jitters, and it’s not really… I mean, when you’re dealing with adrenal issues, we don’t want to add on caffeine onto an already stressed system.

So, I knew I wanted to formulate this myself eventually to be able to use it with my patients. So, fast forward 15 years reformulated. So, yes, we have the T2 in it, which is 3,5-diiodo-L-thyronine. So, this is in my product, Thyroid Fixxr. We have 3,5-diiodo-L-thyronine in it. And then we have L-tyrosine, which also supports thyroid gland production and T4 to T3 conversion. It’s fantastic. Most people do not tolerate L-tyrosine. It’s very rare. I’ve had a couple emails from random customers like, “I can’t take L-tyrosine.” Like, okay, that’s an amino acid. You should be able to tolerate it.

And then I also have T2 in my Metabolism Fixxr product, which that’s a newer product that was just released about six to eight months ago. And what I added to that was Supresa, which is a trademark ingredient, that suppresses appetite because again, going back to the GLPs, this is the big thing right now. Everyone’s going on a GLP, and it’s suppressing their appetite, but it’s slowing gastric motility on top of it. So, if you have a hypothyroid patient that already has constipation and you put them on a GLP for weight loss, they actually could get paralysis of the GI tract. So, with Supresa, it’s taking the edge off their cravings and it works really nicely with T2.

So, yes, that is why I formulated these myself because for a long time, you really could only get it in these bodybuilding style of products. And to my knowledge, mainstream-wise, myself and maybe one or two other companies formulate T2. So, it’s still a very new nutraceutical to, we’ll call it, the normal health people. Like all of us, integrative, functional biohackers, we’re not the angry gym rats.

Dr. Sandi: Yeah, well, this is very good information to know about. Can you talk about how the thyroid is connected with other glands or other hormones, I should say, and how…? Don’t look at something in isolation, but look at the whole system and all the hormones and how they interact with one another.

Dr. Amie: Oh, they’re just so beautifully intertwined. I mean, I’m still fascinated daily when I look at blood work, and you put the pieces of the puzzle together. You go, “Oh, look, here it is. Here’s the story.” So, we know that the thyroid gland controls insulin secretion and blood glucose regulation. I see insulin resistance in easily 90% of my patients with hypothyroidism. And you do have to step back and go, “Okay, which came first? Did the hypothyroidism cause the insulin resistance?” It’s usually that direction. Although we also know that insulin resistance will increase reverse T3, and then it’s just very inflammatory to be in a state of insulin resistance or even full-blown type 2 diabetes. So, that inflammation could also trigger Hashimoto’s because that’s a stressor on the body. So, any stressor on the body, hormonal shift, infection, even just a divorce, a move, whatever that stressor is can flip that Hashimoto’s switch. Excessive dieting, like I did. Excessive exercise, excessive dining, that can turn on that Hashimoto’s switch. So, insulin resistance, for sure, is connected, both bidirectional.

And then we move into the sex hormones. So, we know that when the thyroid gland is off, we will normally see lower than normal sex hormones. You might have a 35-year-old, which I just had yesterday. looking like she’s almost in perimenopause or menopause with her hormone values. And again, she’s been walking around untreated or mistreated for years that hypothyroid state starts to affect her sex hormones as well. So, progesterone drops earlier. Testosterone drops earlier. And then we have the other direction where testosterone is actually very protective against autoimmune.

So, there was one study done that took groups of men, although men are not as affected with Hashimoto’s as we are as women, but they took a group of men who had low testosterone and they found that low T was a huge trigger for Hashimoto’s, which this is one reason why women get hit with Hashimoto’s more so than men, because testosterone is very protective against autoimmunity. And since we have naturally lower levels of testosterone as compared to a male, we have more autoimmune conditions and more presence of Hashimoto’s. So, when men were given TRT, and their testosterone levels came back up to the optimal range, they saw a reduction in their antibodies. So, we can see that bidirectional association with hormones as well.

And then of course we know the adrenals. There’s a huge tie with thyroid and adrenals. Thyroid and cortisol. High cortisol and low cortisol will make someone almost be intolerant to T3. So, let’s say we have someone on T4 only, we want to start them on T3, whether it’s Armour or adding in liothyronine to their regimen. And they take a small tiny dose, and they are going out of their mind. They’re crawling out of their skin. They’re anxious. They’re jittery. Their heart’s pounding. And you’re looking going, “That should not be happening on that low of a dose. That doesn’t make sense.” But then you go, let’s say you do a saliva test. You look at it. Okay, they’re flatline low across the board. They don’t have enough cortisol to support them. And T3 needs cortisol. Cortisol needs T3. So, that is a perfect picture of, “Okay, this person is not going to be able to tolerate T3.” And the same thing when we see super high cortisol levels. And I’m not talking just one little marker in the morning from the cortisol awakening response. I mean, they are pumping out cortisol throughout the day. They’re almost flatlined high or their pattern is all elevated. That can also contribute to not only elevated reverse T3, but it can also contribute to the sensitivity when we start T3 therapy. So, it’s just, again, this beautiful interplay of hormones and thyroid, but we can see how… Like you said, we can’t just do one thing. We cannot just look at one thing and expect that if we fix that, everything else is going to be fixed. We have to do it all.

Dr. Sandi: This is so helpful. And I again think back to my experience. I was 36 at the time. I had a two-year-old. I was studying for the psychology licensing exam. I was five miles religiously on the treadmill. I think I even had a glass of water before I’d get up, run downstairs, do my five miles on the treadmill. I was eating poorly, binging on sugar, and high stress levels. I had a private practice. I was seeing patients at the same time. And no wonder I was out of whack. But, one marker TSH and we’ll put you on Synthroid. So, the importance of working with a practitioner who understands that there’s the interconnectedness and helping somebody with not just the medication but also looking at the importance of lifestyle and the symphony that of all these hormones and how critical that is. So, we need a lot of education out there to help people, especially women, become aware that they can take charge of their health and they can feel better. And you are leading the way, and you are really a trailblazer. And I just, again, admire your courage to take a stand in this space and really make a difference. So, as we come to a close, how can people find you?

Dr. Amie: So, you can go to my main website, which is dramiehornaman.com. And then the supplement website is betterhormonesbetterlife.com. On all social platforms, I’m @DrAmieHornaman on Instagram, on YouTube, on Facebook. So, you can pretty much find me everywhere. And then my podcast is “The Thyroid Fixer” podcast. And any practitioner listening that is interested in possibly connecting, collaborating, setting up an affiliate account, a wholesale account for T2, if you find that’s going to be beneficial to your client, you can also reach out at sales@dramiehornaman.com and we can set you up with that.

Dr. Sandi: Well, thank you. The Thyroid Fixer, so important to pay attention to the thyroid. Thank you so much for being on this podcast. I really enjoyed talking with you and learned a lot.

Dr. Amie: It is my pleasure. Thanks for having me.