Modern Lifestyles, Modern Disorders - Processed Foods, Mental Health & Cancer | Podcast EP 01

 Modern Lifestyles, Modern Disorders - Processed Foods, Mental Health & Cancer | Podcast EP 01

https://m.youtube.com/watch?v=Cj1OOOk0asY

https://www.youtube.com/watch?v=Cj1OOOk0asY

Transcript:

(00:00) they say that one in every 9 to 10 men and women are affected with cancer worldwide I think uh Deepa paron she played a very important role in U uh breaking those uh stigmas in regards to mental health the biggest problem is smokers shifting into vaping is lesser but people taking it as a fashion trend and coming into vaping is the greatest hazardous thing that we are seen correct correct [Music] hi everybody so today we are very excited to welcome you to the first episode of our oneof a-kind podcast series vared hospitals called Beyond

(00:45) medicine so in this we will try to convey uh expert knowledge through a very candid conversation we'll try to cover uh the pressing topics which are more relatable to you rather than just talk about medicine I'm Dr Vijay Karan ready I'm a radiation oncologist at arit hospitals Hyderabad and we are very lucky today to have with us a very good friend of mine and one of the leading psychiatrists in the city Dr Vinci hi vinchi hi Karen thank you so much thank you thank you so much for having me here today we thought we'll talk about the

(01:18) two most pressing uh topics I should say that are uh you know concerning many of us we see the increasing incidence of cancer and the increasing awareness about about mental health and how it's affecting our uh physical health so we have Vin and myself we'll be talking about the general lifestyle changes that we see in the society today and how it's affecting both cancer and mental health so talking about cancer now the easiest way to understand that the cancer incident is increasing is because we keep hearing that more and more uh every

(01:53) family like it used to be for covid every family every friend everywhere I go in my Social Circle also everybody has somebody who is affected with cancer so right now the incidents from the time that I have studied uh 10 years back from my undergrad days to now the incidents has gone up so much that right now they say that one in every 9 to 10 men and women are affected with cancer worldwide and in India itself last year we have seen about 14 lakh new cases and this is only going to multiply in the next 5 10 years so like cancer we are

(02:25) more and more seeing celebrities and uh prominent personalities talking about the importance of mental health so let's have Vin tell about the awareness of mental health these days well to see Karan I think uh very similar to the statistics that You' spoken about cancer in the recent times the number of cases that we see with mental health has drastically increased especially the postco era because covid was the time when people tried to understand and started understanding that mental health also plays an important role for the

(02:57) longest time we always focused on physical health issues shes but sitting in those four walls living with uncertainty I think gave us an understanding about what mental health is so do we have uh many of these celebrities to thank us for that because that stigma of going to a psychiatrist people used to think only because you're mad you're going to a psychiatrist but there's so much more you know acceptance to it right now do you think we have our celebrities to thank thank for that undoubtedly yes and especially when we

(03:24) talk about the Indian scenario I think uh Deepa Pon she played a very important role in um uh breaking those stigmas in regards to mental health that's true I think she's the one who actually kickstarted everything more and more people came out talking about so true and you know because you know for the kind of things that she's already achieved and the St that she has when she talks about it I think it gave way to many other celebrities also to come forward and talk about it and now when we look at the statistics the World

(03:57) Health Organization says that one out out of every four individuals are going to develop a mental health issue at some point or the other so that clearly explains that nobody is actually immune from developing mental health issues so I think we chose the right topics right one in 10 versus one in four absolutely okay uh so moving on uh what we thought right now the biggest I mean the one thing that we can relate from both cancer and mental health because of addiction is vaping lot of us don't know what are the adverse effects of vaping

(04:32) it has become more and more prominent in uh you know younger age group adolesence they're exposed to nicotine much earlier so can you tell us something about because I'm sure you'll see a lot of people who are addicted to smoking but how vaping has uh changeed that well if you ask me Karen one of the greatest misconceptions that people have about vaping is that weaping is safe so now uh like they uh say it in a quotation you know your eyes see what it wants to see and your ears hear what it wants to hear cor so that's denial right so very long

(05:08) back I'm sure you know most of the times when we go to family gatherings there is somebody who tells us my doctor told me to have two drinks so what the doctor actually said was don't have more than two drinks if you drink correct so similarly now when it comes to vaping yes we agree that vaping is less harmful than smoking nicotine but now the misconception is that people say vaping is safe correct and now if you look into the recent studies a study by the Johns Hopkins University in 2021 talks about more than thousand

(05:44) chemicals which are not yet identified you know which we don't know what it does correct have been uh you know seen in these Vapes so that clearly speaks about how vaping as a culture has come into nowadays it's become a fashion trend correct that you know you carry a vape and you talk about vaping the biggest problem is smokers shifting into vaping is lesser but people taking it as a fashion trend and coming into vaping is the greatest hazardous thing that we are seeing correct correct so so that is the biggest thing like for you addiction

(06:20) when you're vaping apart from the chemicals that he h it has the main thing is nicotine right right so kids at a very young age are exposed to nicotine so it is hard for them to get out of the addiction of nicotine like if you see in the US Jewel was actually they suit the company they it shut down because that's what they found people children sitting in school in 10th 8th grade 9th grade 10th grade are having a way up in their hand and they're exposed to nicotin addiction at a much younger age group right now since you're talking about

(06:52) nicotin addiction I think it's important that we say that nicotin addiction is as bad as addiction to cocaine or because it is modulating the brain there are some changes that happen to the brain tissue and these changes happen both structurally and chemically all of it which is at the end making the brain weaker and weaker and like you said you know once somebody gets into that whole addiction of it uh it starts impacting the different dimensions of their health yeah and uh if you look into the latest studies uh people getting addicted to

(07:29) ecigarettes or vaping in the last 20 years has gone up from 7 million 20 years back to 82 million so that's a 12 times increase in the number of people who are uh vaping and most of them believe that uh it is absolutely safe uh and it is not causing uh any damage to them uh I'm sure you know while we are talking about the nicotin addiction vaping uh has a lot of uh other health hazards too but in your day-to-day practice do you see anybody you know who are using wapes and you know coming with any particular physical health issues so

(08:11) in terms of cancer it is I mean everybody is dying to actually work on it study on it it's too early to says that vaping causes cancer it definitely the kind of chemicals that you get through cigarette smoking versus Vape smoking is definitely lesser like you said there's still a lot of them yet to be identified right but we don't know the adverse effects of it yet so when you talk about a wape they we don't know what they put in it they add something for color they add something for smell they add something for flavor so we

(08:43) really don't know what is putting is put in it because there's no regulation and we don't know how it's going to affect our body so as of now it's too early to say that vaping actually causes any adverse health effects or even cancer but what do you think about vaping the positive the flip side of it vaping being used for treatment well I think this is again something uh you know very wrongly understood by uh most of the individuals it's very common when I see uh students or youngsters who come to me and say

(09:16) that I have started my own treatment of reducing uh smoking by switching into waves yeah I think uh something to be said in bold letters is vaping is not an FDA approved treatment for nicotin cessation now what happens is something very interesting that you said is the regulatory bodies of vaping now in a country like India there is no regulatory body for Vaping now these Vapes are bought from overseas or there are some local individuals making it so we do not know how much nicotin is there in it correct I could be believing that

(09:53) I am consuming lesser nicotin and I continue using it throughout while I do not know if that nicotin is more than than what the conventional cigarette has correct and on the other hand uh an interesting study that I was uh reading uh which was done by ohu University was when they tried to compare people who had conventional cigarettes versus people having cigarettes and vape okay in these two groups they saw more cancer uh risk at cigarettes and weave okay so now what are these chemicals that are causing that four-fold increase is

(10:34) something that has to be discussed because like you said there is very little evidence but there is so much that is unknown so you need to tell us if there is you know anything that is known which could be causing cancer or is Vape actually cancer-free so next topic that you would be talking about is basically to keep it very simple you would call it zato and swiigy but you know you should not find fault with them because it's just delivering the food but processed foods is what we want to talk about how it affects mental health

(11:06) and how processed food also can cause cancer so we'll start off with mental health so how do you think see when we order food from somewhere or when you buy food in a supermarket we really don't know where the food is coming from right right swiggy there are many restaurants but at the same time there are many Cloud kitchens we don't know how in what conditions they're cooking and what kind of material that they using so how this has become a daily thing for everybody whether you are because being a professional you don't

(11:37) have time to cook for yourself you're living away from family you tend to order more food get more food from outside so how do you see this affecting mental health does it actually affect mental health undoubtedly it does Karen firstly when we talk about these Foods uh for basic understanding let's try to divide them into four categories you know unprocessed food you know the fruits and vegetable vbl that we order correct second are processed culinary foods which we use in adding into the real foods it can be honey or it can be

(12:09) butter correct and then comes the processed food that we have you know where we have these foods which have a shelf life uh and you know then you bring it to the kitchen and then you start using and then the last one is the ultr processed food uh especially when we talk about uh you know the carbonated drinks or you know uh the most healthy breakfast cereals that we talk about these are ultr processed foods now research worldwide done on cancer and mental health especially one study done by the University of via clearly speaks

(12:44) about how ultr processed food has the greatest risk for developing mental health issues as well as cancer I'm sure you know better about the cancer part one thing is all of these foods have something beyond what we usually use in our kitchens or what restaurants give us yeah you know bhagat Gita says eat food only up to 3 hours of shelf life so when it is going Beyond those 3 hours you need to add something and what we usually add is excessive artificial sweeteners or sugars correct and then we use oils and then we use starch and all

(13:22) of them cause immense inflammation in the brain and all of this can lead into greatest mental health ISS issues two studies one from the USA talks about a study done on 10,000 individuals spoke about how ultra-processed food can cause depressions and anxiety another study done in the year 2022 in Mexico 11,000 individuals were studied and Ultra processed food was clearly shrinking the brain so there is a cognitive decline happening in youngsters which normally happens after 70 years that's so that's scary actually right I mean I've never

(13:59) heard of studies having so many people 10th 11th so you can't deny it so true and cancer is something that is not much spoken about in regards to these Foods uh but you're the expert to talk about it so good that you brought that up uh I have seen like even when during my uh teaching or postgraduation days I used to come across patients who come I used to work in a government Institute so many of these uh people who from you know lower social economic group come to me they are not exposed to ultr processed foods what they eat is regular

(14:38) food right so I have many patients like that who come to me and say I've never had nonv in my life I've always been a vegetarian I've never smoked in my life I've never drank in my life how come I I'm a Brahman and how come I got cancer right so apart from actually getting these foods from a restaurant doesn't mean that you have to be rich to get food from a restaurant even when you buy your fruits and vegetables outside the kind of fertilizers pesticides that we use so it starts at that level right so you're getting it from the farm it goes

(15:09) to a supermarket then you get it whether it's coming directly from the farm to you we have so many Farm to Table Concepts today but still within the farm what is happening it's not regulated the farmer is desperate what pesticides he's using to get more gain we never know so this regulation has become a big issue so like you say you know your body is a temple you have to be aware of what is going into it one is through the nose that is smoking that we spoke about the other is through the mouth right so that

(15:38) is the food that we are eating so when the food comes to you be aware even organic farming that they talk about they say organic but nobody really knows what organic means right at up to what level you can call it organic so right from the time that you get your food where you're getting it from how you're cooking it how you're processing it every step matters I know know as much it is very difficult to keep a track of everything because you have your own daily life to go ahead with but to be aware when you're buying something read

(16:08) the label read the box when you're ordering something make sure that you know where it's coming from so little small steps that you can take I think processed food has become one of the largest causes of the increase incidents when you talk about lifestyle more than smoking smoking has been there for what 40 50 years and people used to smoke more back then than they are right now right but I think processed food actually is the main reason why the incidence of cancer is going up and as indirectly when you have all these

(16:40) processed food with all these additives obesity comes into picture now you're sitting at home you're ordering food having wrong food and then you're sitting at home having that wrong food is causing you to put on weight right right your fasting glucose goes up uh now when we talk about the uh medical link to process food and cancer main thing is that you have to maintain an alkaline uh environment in your body as soon as it becomes acidic the more acidic it is the more chances of you getting cancer so when you talk about

(17:14) alkaline simple things I mean we was just going through that was very surprised now you mentioned breakfast cereals right so breakfast cereals actually a like processed food and we have all the celebrities talking about how healthy this is how healthy it is and we feel very healthy when you talk about breakf cereal so we having breakfast cereal in milk the commercial milk itself is again processed and you buy bread it is processed we have salted peanuts thinking we are eating something healthy that again is very acidic so try

(17:44) to keep more and more fruits and vegetables in your diet rather than these processed food so instead of peanuts you have dates uh when you talk about fruits if you want to have uh juices or fruit juices lemon orange Apple all these bring in you know alkaline properties alkaline environment a cell in your body is safer if it is alkaline right it gets riskier if it is acidic so I'm not saying completely stop having nonv or completely stop going to uh KFC or McDonald's you can do that but you need to compensate your body you

(18:18) have to add that alkaline to bring it down bring down that alkaline devil so we I spoke about obes uh process food causing obesity causing cancer now I want to ask ask you about how obesity is again related to mental health because when you talk about cancer obesity causes almost all cancers risk factor of almost all cancers most commonly breast cancer right so how does that you know affect mental health well I think something interesting that you said was in a house of four members there could be one smoker but all the

(18:52) four of them are eating the same food and if it is the ultra processed food it's four people at a risk compared to that one person at a risk undoubtedly obesity has uh adverse effects on the brain's health I think one of the most important things is like we said the added sugars is causing a lot of inflammation which is slowing down the brain and once the brain slows down biologically we see a lot of neurochemicals that are necessary coming down and this is a cyclical process there is a lot of sugar slowing the

(19:25) brain and this slow brain in a state of stress craves for more sugar so all the sugar Cravings that happen during stress is because of this slowing of the brain which could be again being done by the sugars itself it's it's like having a tub of ice cream when you break have a breakup absolutely absolutely so that way uh undoubtedly the brains are becoming weaker and now when the brain is weaker uh slightest of the environmental stress can cause a big risk of developing serious issues like depressions and anxieties so undoubtedly

(20:01) obesity has a very big role while talking all of this I want to ask you on a lighter note I understand if you go out there are these lot of negative impacts like smoking Vapes if you sit at home in order also you are saying you know the food coming from outside is bad yeah can sitting inside four walls be safe so there's sedentary lifestyle versus actually staying indoors so people stay indoors because of their work we have so many I it companies everybody's 9 to5 staying indoors but you try and do something to compensate

(20:35) that so one of the most common deficiencies we see is vitamin D deficiency right so almost everybody has that because most of the times we are sitting indoors in the AC correct there are studies that say uh Ron gas because of the sunlight all these buildings and the Earth can emit radon glass which you which is one of the toxins that you could inhale staying indoors so that also can cause any aerodigestive tract cancers or lung cancer but I don't want to get too much into detail because people it's very hard to actually

(21:07) counsel them and give them a suggestion don't stay in don't go out you know you're not letting them live what is the point of living so the point of this discussion is that it is not about how much you do or how much you don't it's always good to be aware right right you know you have to be uh Devil's Advocate you can't say I'm always indors I'm not exposed to pollution so I will not get cancer so it is important to be aware of all these factors how all of them together like I keep stressing about physical health but I've never known

(21:39) that the kind of effect that processed food can cause obesity can cause on depression and anxiety and it is that you know would you say dopamine release is the cause of that sugar addiction yes right absolutely so our entire lives is about chasing this damin release you know it's like a per of Happiness what keeps makes you happy you keep doing it so whatever you do don't do it in excess true right everything in moderation is good for you correct so that is I think should be the bottom line for uh this discussion true yeah well something

(22:13) interesting that you spoke about was vamin D deficiencies Dr Karen because off late we see a lot of researchers as well as in our regular practice I clearly see most of the times the severity of the depression and the low vitamin D levels are correlating and many of times correcting the vitamin D levels itself are reducing a lot of these mental health symptoms and now when we talk about vitamin D it's unfortunate that most of the individuals are not getting exposed to the sunlight okay and when I talk to them about it

(22:47) they talk about how they are sleeping between 2 a.m. and 10 a.m. which is their 8 hours of sleep and that's the reason they can't get sunlight so there is again a great misconception about sleeping 8 hours okay people uh argue with me saying that I am sleeping 8 hours but the important aspect is sleeping the right 8 hours correct so when you have the Melatonin levels in your blood if you sleep that is a good quality sleep the reason I'm talking about this is sleep disturbances are one of the greatest risk factors for

(23:22) developing mental health issues so somebody who is having a depression normal with medicines right now no symptoms just has a few bad sleeping days and develops the illness again so sleep disturbance can actually break the whole treatment also so sleep is something again something that I've been seeing off late in most individuals it is unfortunate that some people are working in the nights but most of the times people who are not sleeping in the nights are sitting with their gadgets I've seen many of my friends these days

(23:56) in the recent past they're complaining of insomnia and it has become actually very common that very casually come and say that I don't sleep in the night I sleep at 5:00 a.m. 6:00 a.m. and then get up by 9:10 and I'm okay with that for fire sleep so what is actually causing this insomnia is there any particular factor that you can pinpoint well I think a lot of things that we do in our day-to-day Lifestyles have been impacting the Sleep Center in the brain you know starting from substance you especially uh stimulants

(24:26) you know like uh caffeine uh you know and nowadays people have these uh energy drinks which are again having caffeine a lot of supplements that individuals using are having a lot of caffeine all of which can actually keep the brain awake the second biggest thing is you know the electronic gadgets that we use because the blue radiation that is being emitted is activating the brain undoubtedly The increased levels of stress because every time there is stress there is higher cortisol levels in the brain and cortisol is keeping those areas of

(25:02) the brain which are necessary for being wakeful so the wakefulness is active so the sleep is automatically coming down and even if you want to sleep this is coming in between your sleep so uh undoubtedly stress and sleep disturbances are hand inand and sleep disturbances and mental health issues are going hand in hand so that's a good point that you spoke about cortisol Levens because what it does physiologically to the body is basically uh kills all the cells makes them very to be very simple was use simple words learic right and see the

(25:40) cancer is caused when there is a damage to a DNA of a cell right right and once is damaged to a cell the body identifies that this cell is wrong and immediately kills it but when there is a mutation in that it it hides from the rest of the body and it is not killed and it continues to mutate itself and try to survive and that's how cancer cell is formed right right so when this cortisol level increases it it'll make the cells more prone to you know or Shields them against the body so that DNA repair what is there

(26:17) it's supposed to be done that is not done and that is why these mutations occur The Continuous the cells continue to grow in a mutated Manner and that's how cancer is formed so that's how indirect like you said stress and sleep how it is you know links to the cortisol level that also is linked to cancer forming cells right so well you know for the last 30 minutes that I've been talking to you I clearly understand that a lot of Lifestyles that are present in the today's world you know starting from ordering processed foods to vaping to

(26:54) bad sleeping all of them are actually not just impacting the mental health but also are a risk factor for cancer yeah now keeping all of this in mind the biggest question that I have in my mind is who are these individuals who are at a risk of developing cancer and if there are a lot of people following all these Lifestyles yeah then when do we start looking for cancer because all I was told as a student was if there is a risk factor in you if there is a family history then you probably at a particular age you do

(27:33) these screenings so is this still the same or when do we start looking for cancer that's actually a very important question so there is this big uh misconception that only if you have you know family history of cancer only then you would get cancer I believe that hereditary cancers constitute only 5 to 10% of all the cancers and there are so many articles and studies that have come now where the incidence of cancer has increased the other misconception is the age if you're 20 30 years old before there is no health problem that you

(28:05) could get now we are sitting and talking about so many things and we have faced that in our Circle in our age group true so the incidence of cancer has also gone up uh in the younger age group that is below 50 years and the main cause I'm going to pinpoint this and say the main cause is Lifestyle Changes right okay it's very funny statement that I read which says the Richer the country is the more incidence of younger cancers right because you're exposed to so many different Lifestyle Changes because of more money before we used to

(28:36) think poor country poor hygiene poor health services you're getting cancer now it is all in our hands we are actually doing this to ourselves so when it comes to screening now because I said that younger age group has more cancers so forget about the hereditary part of it hereditary yes you are a risk of cancer you go see an oncologist they'll tell you what to do apart from that to the General Public first and foremost breast cancer has come at a very early age before the cut off used to be 45 50 even now they say

(29:06) 30 years right okay so 40 years if you don't have family history 30 years if you do have family history you have to get a mamogram done right most common is breast cancer second most common is lung cancer right lung cancer unfortunately screening is there only for the highrisk individuals so only if you are 50 and above and you've been smoking all your life right we talk about 20 pack years so if you're smoking a pack of cigarettes for more than 20 years then from the age of 50 onwards you're at a risk of lung cancer unfortunately lung

(29:40) cancer has cleaning has not come to the younger age group now because we're talking about vaping we're talking about pollutants all this like internal radon that I spoke about all this also cause lung cancer but they have not come under screening yet the other thing is cical cancer which is the most common uh screening one of the first screening methods that we started for cancer was survical cancer which is the papere so papsmear is now recommended from 20 years itself okay so papsmear as a test has to be done for every individual who's going

(30:13) to a gynecologist so whoever it is doesn't matter that you have infection or not infection you're going to a gynecologist for a health problem make sure that your gynecologist does a paps for all women 30 and above for all men 40 and above simple thing is get a health checkup done right right your full body check covers all this whether it's a mamogram or x-ray or an ultrasound it will cover everything apart from cancer we also see you know heart attacks happening in younger people so being aware of what is happening in your body getting a yearly

(30:46) health check done is very very important and is of Paramount importance one question that most of my known patients or family members ask especially who have a habit of smoking how do I know the impact of it falling on my body because again there is a misconception where they believe I'm smoking and I'm doing treadmill for 30 minutes so my lungs are getting purified so what do they need to do to understand what tests or what examinations should be done for them so the simplest thing is I'll send them to you because if they stop smoking it will

(31:28) actually reverse all the effects right so that effect the reversal is starts from about one to two two years posted to stop smoking and it is not reversal not only for cancer reversal for your heart problems reversal for your lung to re oxygenate and pure themselves so the first thing is coming to you stop the addiction stop smoking and it will reverse everything right okay but at the same time don't come back and ask me again that I've stopped smoking but I still got cancer that that could you know that could be so many other reasons to it and

(32:01) in terms of what is recommended right now everybody who is 50 years and above like I said what we do is a lowd dose CT scan okay like when covid was there the first thing that you used to do is a high resolution CT scan to see the extent of involvement of covid in your lungs so what we do is a low dose CT scan we do lowd dose because a CD scan repeated every year actually has adverse effects on your body we do a lowo CD scan to see if there are any infiltrates or nodules in the lung and so that after that we can you know follow it up

(32:35) accordingly but yearly lowd do CD scan for people who are high risk of getting lung cancer that is usually chronic smokers right so somewhere I think uh you know this is a very important aspect that you spoke about because we always believe in the concept of prevention is better than cure correct so this is something that is going to help us understand the initial changes that are going to happen happen to your system before you actually develop a Cancer and you are able to identify it we have that technology but I think individuals

(33:07) should start accepting it because we all stay in a denial you know a lot of people say I only smoke five cigarettes exactly so I don't smoke more so don't believe in that is what you are saying yeah so we also spoke about everything that is inside out we can't stop everything that is that you're exposed to but being aware accepting that you need to take care of your Health that itself will you know make a huge difference right and now since we were talking about prevention Dr Karin yeah what do you think you know because

(33:37) today's discussion has really enlightened me to understand that there is a lot that is happening around us we are just unaware about it we go to hospitals and ask the doctor many questions about what medicine he is giving us and we have a lot of Innovations but we unfortunately don't know what's happening in you know the commonest things that are around us correct how do you think you know an individual can protect themselves or prevent themselves from developing serious so when you talk about prevention first is primary prevention

(34:10) that is simple thing is what are the lifestyle factors that we spoke about stay away from it again don't sit at home and make a list saying I'm doing this I'm not doing this I'm doing that is this okay is this not okay just be aware everything in moderation if you want to drink drink have like you said one or two drinks a week still okay drink in mod moderation if you want to order food from outside eat in moderation if you want to have red meat then compensate that with more fruits and vegetables right so that is the

(34:36) primary thing like what I read is one in every four cancers can be prevented just by making these small changes okay that is the primary prevention that is there in your hands secondary is what I spoke about is screening so screening again the problem with screening and the acceptance is that you anywh you think that you're anywhere going to get cancer that's why you're screening yourself right but the important thing is even if you do get cancer getting it at an early stage catching it at an early stage is

(35:04) very very important so early stage versus late stage is 90% cure rates versus 20% cure rate so that makes a huge difference so whatever it is even if it is a heart attack you catch it early you can take care of it even if it is cancer you catch it early you can take care of it it's not a death sentence like it used to be before we can actually cure it but pre trying to prevent it and catching it early is what we need to look at you know like they say in this new era of 2020 Cricket you send your best batsman first correct so

(35:36) you bring the best uh available facilities in screening and the best available treatments and not wait till it becomes you know a very scary situation denial and ignorance right right so thank you guys for joining us hope this uh discussion was interesting enough for you thought provoking enough for you uh so we want to encourage you also to be a part of this discussion so try and place your questions and you know whatever you need to know whatever you want to know from me and Dr Vinci whether it's physical health cancer

(36:11) mental health please place it in your comments you'll be happy to respond to you and also please give us some ideas on what sort of topics what sort of discussions that you would like to have and we'll do our best to get that to you thank you