Dr. Christine Schaffner: Welcome everyone to the Spectrum of Health podcast. I’m Dr. Christine Schaffner, and today my guest is Dr. Amanda Wilms. We’re going to be talking about understanding PANS and PANDAS. Dr. Wilms and I have been working together for a number of years and she’s such a skilled, kindhearted, compassionate physician as well as a brilliant mind. She’s one of the team members at Immanence Health who’s accepting new patients, so please check out the information in the show notes and a little bit more about Dr. Wilms. Dr. Wilms is a naturopathic physician who graduated from Bastyr University with a special interest in complex chronic illness. She completed advanced training in intravenous therapy, injection techniques, ozone therapy, mycotoxin illness, autonomic response testing, environmental medicine toxicology, autoimmune conditions, bioidentical hormones, PANDAS, PANS, and Lyme disease. With empathy and passion, she’s committed to identifying the root cause of health issues and tailoring individualized treatment protocols. She enjoys helping people of all ages find their path toward wellness and happiness but has a special focus on pediatrics and women’s health. Dr. Wilms has the drive to stay up-to-date with new treatment modalities and is continually furthering her education in the rapidly evolving field of integrative medicine. I hope you enjoy my conversation today with Dr. Wilms.

0:01:18.3 DS: Before we dive into this really important topic, I think we’ve learned so much over the years that we’ve both been practicing about the underlying cause of a lot of the neuroinflammatory conditions that we see in our children as well as adult populations. Dr. Amanda treats a lot of these patients and has so much to share. But before we dive in, Dr. Amanda, for those who might just getting to know you in my community, I’d love for them to learn a little bit about how you became inspired to become a naturopathic physician and treat the patients that you see today.

0:01:54.6 Dr. Amanda Wilms: Well, I don’t have any wonderful grand story of how I became a doctor. It actually took a lot of other ideas and trying different classes and different career paths before I landed on the naturopathic medicine decision. I’ve always had a really strong interest in the human body and health and nature and plants, and I do think a huge part of it was my mom. She’s a nurse, and so of course, I always wanted to follow on her footsteps. So kind of moving through different ideas growing up as a kid and teenager and young adult, I was like, “Oh, I want to be a nurse and know all these wonderful things about the body,” but then you start learning, and it became, “No, I want to know what a doctor knows.” So then I started looking into going to regular, more conventional medical schools and it just didn’t make sense to me. I went to Bastyr and did tours and looked into that career path and it made a lot of sense. I was super interested in all the different classes that were offered and all the different topics that we go through.

0:03:01.1 DW: So it was just more a very strong interest. As far as this chronically ill patient population, when I first started practicing, even seeing patients while in school, when you go through school, you think you’re learning all these really fabulous things and putting people on a couple of supplements and like, “Oh, they’re not getting better.” So it was actually the patients that don’t get better that really started driving that interest in diving into what else is out there and what other treatment modalities are available. I started doing the…I call it the “boring” things, even though they’re really not to many people, but lots of well-child checks and gyn exams, and it just wasn’t for me. I wanted to dive into the more intense, complicated cases. It’s like putting a puzzle together. And then, of course, I’m a very empathetic person, and just getting to connect with people on that level and help them through this path and this journey overall is really important to me as well. It’s been really fun, and it’s just a never-ending learning curve.

0:04:11.1 DS: Thank you for sharing that. I know your mom very personally. She was at the birth of my daughter Ann Marie, so I know her to be a wonderful nurse. That was just by synchronicity. That wasn’t planned, but that was all very wonderful. I grew up in a family of medicine too, so it’s just how we’re imprinted, and I think we come to naturopathic medicine from all of these different angles. I feel, especially for the patient population you and I both see, that naturopaths are well-poised to treat the chronic illnesses that we see today because of the way that we look at the toxification, but also just clinical illnesses, they affect so many systems. It’s not going to be just this one size-fits-all approach. I hear you too when you say “Oh, just the primary care stuff.” I think our toolkit and our framework really poises us to see these chronic conditions, and I think that’s such a great utilization of our skill set. I do feel like a detective as well. We see these patients who’ve been through so much, but there’s so much reward and joy when we put the pieces together for them and then see them improve.

0:05:24.0 DW: Yes.

0:05:24.5 DS: Amanda, you see anyone who walks in your door that is struggling with a chronic illness. However, you do see a lot of children and within that patient population, there’s been more awareness, as I mentioned before, and more acknowledgement of what we call PANS or PANDAS. If this is still a new term for people, what are we talking about? What is PANS and/or PANDAS?

0:05:51.9 DW: So PANS and PANDAS, thankfully, it is becoming more and more well-known and there’s actually a lot of really well-known research centers out there putting more information out. PANS and PANDAS are the acronyms. PANDAS is Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep, and PANS is Pediatric Acute Onset Neuropsychiatric Syndrome. So as you know, alluded to in the beginning, in the pediatric population, these are neuroinflammatory conditions that produce neuropsychiatric symptoms. They’re typically these abrupt onset, OCD, anger, rage, anxiety, mood swings, hyperactivity, things that normally parents will say like, Oh, my kid just went to bed, and woke up a completely different child. They had this whole different symptom picture that they had never had previously. Or they’re at school and came home, and had this huge shift in their overall emotional well-being. It’s typically an abrupt onset of these different neuropsychiatric symptoms. A lot of times it’s actually missed. There may be other factors involved, there may be life changes or an injury or some other stressor or reason that could justify these changes that the parents are seeing in their child. A lot of times, that abrupt change is actually missed, and a lot of times it’s accompanied by physical symptoms as well.

0:07:25.2 DW: Along with this OCD and anxiety, it’s very common to have bed wetting, tics and GI upset, insomnia, and then just overall developmental regression as well, where kids start acting much younger than their age or the child will start losing eye contact or their speech or writing may regress. It’s an abrupt onset typically, but like I said, a lot of the times, people come in and we can’t actually go through the history and track where that change actually was. Also it can be kind of waxing and waning symptoms. There can be flares where they have an episode where they have a strong worsening, where they can’t go to school or just can’t function, or the tics are so bad that they can’t actually function as they were previously. The symptom pattern is definitely can be missed, but it’s actually a very strong symptom pattern that we can use clinically to try and navigate that diagnosis.

0:08:22.6 DS: That is a great explanation. We have these conversations in the office a lot. Part of the presentation of a lot of patients that we see is what we would call neuropsychiatric symptoms. We see a lot of these patients specifically, and then of course with the other patients, we treat anxiety, depression, OCD, these flares of rage, and anger. When people are dealing with more mental health symptomology, there’s this whole trajectory they can go on, such as the psych medications. The psychiatric route serves a purpose for some people for a period of time, but I think what this work and what you’re going to further explain gives us the language to look at these symptoms from the lens of these being neuro-inflammatory symptoms. Neuropsychiatric symptoms are often triggered by neuro-inflammation. PANDAS is associated with strep, and PANS, they use that term to cast the net a little bit wider that there could be other triggers. What are some other infections that you’ve seen be triggered for PANS over the years?

0:09:41.3 DW: You know what’s interesting is, I don’t feel that with PANDAS the strep is such a big focus, I actually feel like so many other things are bigger triggers than the strep is. For PANS, that acute onset neuropsychiatric syndrome, it can be so many things. It can be toxins, it can be molds, it can be viruses, parasites, mycoplasma is a really common one. Also Lyme Borrelia can be a very common one. It can be a whole host of things, and then the other complicating factors, even if we have really figured out, diagnosed, even if it technically is PANDAS, where strep is the initial trigger of this autoimmune brain inflammation, I’ve had multiple children where they have an exposure to some sort of fragrance or they accidentally have their clothes washed in some really fragrant laundry detergent or something, and that triggered this huge regression or triggered some new tics or something. So it absolutely can be a combination of things, or it can be, like I said, other things like heavy metals, environmental toxins, and many other different types of infections.

0:10:49.6 DS: Thank you. As you mentioned, it can be this whole combination of a pathogen or a toxicant or both. Not to just skip to this, but I’m sure people are already thinking, how do we test for this, how do we know we have this? They might have a kiddo that’s listening at home that might fit this picture. Where do we start with testing if you’re feeling like this potentially explains the set of symptoms someone’s struggling with?

0:11:19.9 DW: A lot of times it’s just diagnosed as more of a clinical diagnosis, just by the symptom picture and the history, but especially if it’s a PANS-type situation, because it can be really hard to find. I definitely start with the strep because a lot of the time that is the low-hanging fruit to test for. You can actually run the blood titers to look at the different strep titers like the ASO, anti-DNA antibodies. A lot of the times, we’ll do the strep cultures just to see if there’s an actual infection presently going on, and you can look at the sinus culture, throat culture, also stool as well, because strep infections can be anywhere in the body. It can be in the gut also. So definitely go down the strep road first, but I absolutely will also run different viral panels to see if we can get antibodies for HHV-6 or even Epstein-Barr, cytomegalovirus, I look at mycoplasma, as I mentioned before. And then of course, definitely in our world, we’re always looking at Lyme as a background or opportunistic infection. So we’ll do IGeneX lab testing for Lyme. I also will run mold markers, mycotoxin urine tests just to see if there’s any clear indicator of any type of other infection. Or a heavy metal urine test, that type of thing.

0:12:40.8 DW: So there’s a whole host of things you can run through, and I know thankfully in our world, we use the ART testing, an energetic form of muscle testing, so that we can try and pinpoint and fine-tune a little bit more so we can be more deliberate and more focused with which tests we’re actually looking at.

0:13:09.3 DS: Perfect. Also with the PANS and PANDAS patients, it seems like there’s a concentrated reservoir or focal infection in the tonsils or in the sinuses, and that proximity is why we see the neuro-inflammation. Could you share what you’ve seen, like how the sinuses and the tonsils might play a role in this illness?

0:13:45.6 DW: That’s a really good point to bring up. Yes, any infection that’s in the sinuses, there’s just that proximity to the brain. When you have an infection, whether it’s yeast or bacteria or some type of MRSA or staph type infection in the sinuses, it’s very easily transmitting those inflammatory cytokines into the brain and potentially even breaking down the blood-brain barrier, which can lead to a whole host of other inflammatory issues. So with the sinuses, it is a bit trickier because even if you do systemic antibiotics or some of these other systemic treatments, sometimes you don’t reach that reservoir, same with the tonsils as well. I will absolutely have people do a lot of the sinus sprays and sinus treatments in order to try and really get that reservoir treated, and address the tonsils as well. I know we talk about the tonsils as the main lymphatic tissue, but there’s five others. The adenoids and so many other immune active tissues in that area really need to be treated and evaluated as well for keeping these infections in check. The dental piece is important too.

0:15:00.2 DS: People just think “Oh the tonsils” but as you mentioned, there’s that whole ring of lymphatic tissue that seems to be such a common theme and pattern in our office, whether people have PANS and PANDAS, for sure, that plays a big role. But even our chronically patients, this is an area that we often focus on treating in order to recover health.

0:15:32.2 DW: I completely agree, it’s definitely a bottleneck, that area, that tissue.

0:15:38.3 DS: So we started talking about some treatments. Let’s take a step back, because you mentioned because of the proximity to the brain that there could be some blood-brain barrier disruption or auto-antibodies that are affecting the brain. What test do you like to use to look at that? I know there’s a few on the market right now, but what are you using most commonly right now?

0:16:00.0 DW: I did jump the gun a little bit, so there’s two steps basically to what I look at with testing, the first one is really trying to identify what the culprit is, as in, what triggered this autoimmune reaction? The second piece is to try and diagnose that there is autoimmune activity, there are antibodies to the brain, proving this and showing that there is a PANDAS or PANS type reaction. So like I mentioned before, there’s a whole host of different tests and cultures that you can do to try and identify what the initial triggering event was, but then to actually look for that autoimmune reaction, we typically either use the Cunningham panel by Molecular Labs, or we’ve been using more recently the Neural Zoomer Plus, and both are wonderful. I do like the history, I think the Cunningham panel has been around a lot longer. That’s the one that tests for the five different antibodies, basically, against the brain to show that there is a PANS or PANDAS autoimmune reactivity happening. The neural Zoomer Plus is wonderful, and it has a lot of really good information, and it also looks at other potential infections that could be triggering these antibodies, so either one, depending on the person’s symptom picture and whatever else is potentially going on.

0:17:20.8 DS: Thank you. You mentioned a few treatments, and obviously we’re going to individualize and prioritize, but when you have a PANS or PANDAS kiddo in the office, what are some of the treatment strategies that you’re integrating, and how does that translate in your clinical experience to seeing them recovering better?

0:17:50.3 DW: Again, the three big things I look at, the first one is actually trying to treat the infection, stop the exposure, that’s going to be the biggest piece to start with. Well, I shouldn’t say always, but that’s typically where I start. A lot of times you do have to work on detoxification pathways, gut health, and reducing inflammation, just to get these kids more stable so they can tolerate some of these different killing type treatments, but that of course is the primary thing, treating the infection or stopping whatever that exposure may be that would trigger that auto-immune reaction. And then, like I mentioned, calming inflammation down would be the second thing, and then regulating the immune response. So it’s kind of a three-fold thing that needs to happen conventionally. I know they kind of have very limited resources, it’s antibiotics, steroids, anti-inflammatories, that’s kind of all that they have, in our world it’s a blessing to have so many different treatment options, but it’s also a little bit overwhelming because there’s so many things that actually need to be looked at and repaired.

0:18:56.6 DW: I think the gut is always where I like to start, because if that child is eating a lot of inflammatory triggers or eating and consuming different additives and MSG and things that are triggering inflammation in the gut, that’s just going to worsen this condition. There’s just such a huge connection between the gut and the brain. I typically start with supporting the system, removing whatever may be triggering added inflammation, work on healing the gut, and I like to start with the natural things, of course, first. So, antimicrobial herbs like berberines, biocidin, propolis, some of the different silver hydrosols, those types of things work beautifully for getting the infectious piece more under control. And then of course, again, more natural things to calm the inflammation down. A lot of the anti-inflammatory type things, also have or can have a neuroprotective effect as well, because that’s really the main challenge, protecting the brain during this time and trying to reduce inflammation. I use a lot of things like curcumin, high-dose vitamin D, high-dose fish oils, quercetin, phospholipids, glutathione, PEA, which I can never say. It’s the Palmitoylethanolamide.

0:20:20.2 DW: Then it really depends on the child, but sometimes you do need to pull in more stronger hitting things like ibuprofen. Like I said, the overall goal is to protect the brain and get inflammation down, so there have been times when I’ve used steroids if it’s needed and indicated. I wish it was just a couple of simple things, but it usually is this whole host of systems that we’re supporting, detoxification pathways we’re supporting, and it’s usually layer upon layer that we’re uncovering really. It’s usually not just one thing. It’s usually a whole host of things. Our bodies are so amazingly resilient that if you just had a strep infection, you probably shouldn’t have this condition. You probably shouldn’t have this autoimmune post-infectious syndrome. It’s also looking at the higher level of work as well, working on whatever past traumas or self-limiting beliefs, and other potential mental-emotional aspects that may be playing into it as well.

0:21:29.3 DS: I’m glad you brought that up, that’s the whole realm that we’re always exploring and trying to see how that can support our patients’ recovery and healing. I know that we all come to this from different angles, but ultimately we see that our bodies are barometers of these other levels of our being. Not to say the physical isn’t, of course, critical and important, but I think you and I both have seen that when families, kiddos and just any patient is open to just exploring these other realms, that’s when a lot of healing can accelerate and happen. So it’s a whole other toolkit that we have. Of course, we meet patients where they’re at in exploring that. Anything else to add around that piece? Or even, when we think about mental-emotional layers and the higher levels, there’s also that bridge to supporting the autonomic nervous system, and there’s different tools and therapies. I know even today, we were in our group discussion with the other doctors, and you were saying how one of the patients was using SSP work or there’s the Gupta Program. So more geared to kiddos, have you seen any modalities to bring in for this autonomic regulation?

0:22:51.3 DW: Absolutely. I do really like the SSP, as you mentioned. It’s the safe and sound protocol. It’s a listening therapy. A lot of the other higher level work, it’s really hard to get kids to do. But I will say, I have parents do it a lot of times, because kids are so closely connected with all of the baggage that the parents have as well. So even working on the higher levels with parents, it trickles down and helps with treating these children as well. I do like a lot of the different listening therapies for kids, and if they’ll do it, I do work on vagal-tone types, and other types of vagus nerve treatments, whether it’s singing or gargling. Like I said, it’s just a little bit more challenging to get them to do that. But then even just very simple things for kids, like listening to music or tuning fork therapies or a sound therapy, those types of things can be really, really wonderful for children. A lot of the times it’s just fun, it’s not necessarily a chore for them to do.

0:23:55.4 DS: Thank you. Maybe a little bit of a different direction, I feel like we can’t not talk about PANS and PANDAS, but sometimes thinking about the role of tonsillectomies. We’re both naturopathic doctors, so I know that we don’t just rush to that. How have you seen that clinically? Do tonsillectomies have a role in helping recover these patients?

0:24:19.0 DW: Absolutely. I know I started with talking about all the natural, lower intervention things, but you really have to meet the child where they’re at. If they are completely debilitated and not functioning and the whole family is miserable because of their behavior, OCD, and anxiety, you do need to consider the higher, harder hitting treatments. So absolutely, I’ve seen tonsillectomies be extremely helpful for children. There’s actually some research showing that it can actually stabilize them, because if these things aren’t treated, it can potentially just keep getting worse and worse and worse, especially after puberty. With the tonsillectomy, you’re taking a big chunk, like you mentioned, of the bacterial or viral reservoir out. So the strep or viral activity, whatever is in those tonsils, the body is actually more efficiently treating. You’re not having that basically dead tissue as just a reservoir. I’ve seen tonsillectomies be very helpful with improving symptoms. Definitely seen it more stabilizing as well, where people haven’t progressed to worsening and I will say it’s been helpful for adults even.

0:25:31.5 DW: I know both of these acronyms are for pediatrics but as you mentioned in the beginning, this is absolutely seen in adults, it’s just not quite as clear-cut. Regarding symptoms, I think adults sometimes have some better tools for controlling their behavior and controlling their situation. So, sometimes it’s missed, but it absolutely can be present in adults as well. I have seen adults do really well with tonsillectomies for treating PANS and PANDAS. And then along the lines of those bigger treatments, I have seen IVIG be really helpful as well. That’s a more conventional treatment but sometimes it’s really needed, just as a complete reboot for the immune system. I have recommended that, I know we don’t do that in our office but it’s definitely been a big piece for quite a few patients that I’ve seen.

0:26:24.2 DS: I agree. I think where we sit in our patient’s team and care, as you said, there’s this therapeutic order we talk about in naturopathic medicine, really meeting the patient with the right treatment at the right time, with the right support. And we’re going to be more inclined to certain therapies, but we’re going to really just do whatever the patient needs to recover better and not be too attached to what that looks like, because our goal is to make them better. I’ve been humbled by how tonsillectomies have been extremely beneficial for some patients–until we get the regenerative Pheno-Tonsil Treatment that we all want…

0:27:17.3 DW: I wish there was something.

0:27:19.2 DS: I know. I’m totally open to that and I hope we find that during our work together. Just do what works, right? So with treating children, we have to support the family and of course the parents, because the parents play such a big role in implementing the care and supporting the child’s recovery. Are there any clinical pearls or strategies or tips for anyone who is listening out there who is dealing with their child being sick in this way? What have you suggested to parents for how to navigate this illness?

0:27:54.6 DW: I think it’s huge to not go about this alone, because I feel especially moms think they can do everything and they just want to recover their child. They’re going to all these seminars and learning, which is fabulous, but you need a team. You really do need a whole team, so I would absolutely recommend building a team of professionals, not only to treat the underlying causes but for symptom management. I would absolutely have a neurologist on board, ideally a PANS and PANDAs literate neurologist but definitely a neurologist specialist on board. An immunologist potentially as well because a lot of these kids also have immune deficiencies. That’s another thing I will test for, is just to look overall to see if there are some type of genetic or acquired type immune deficiencies that are at play, as well. I have people see immunologists and neurologists. I really do think it’s important to have a child psychologist or psychiatrist on board because for very extreme cases, you need some rescue medications, potentially, like Xanax or some sleeping medication, something so when things get too bad, you have a fall back. I really do think talk therapy is huge, even for children cognitive behavioral therapy is very helpful.

0:29:17.2 DW: So just going through and having those types of supports, and there’s really great support groups, as well. PANDAS Network, if you just look at pandasnetwork.org, gives some really wonderful resources and family support groups that you can join, just so that you can not feel alone. Share stories, find certain little tricks to trade that work well for other people. Unfortunately, just like in our world of chronic illness, what works for one is not always going to work for others. It’s just such an individualized treatment. In an individualized situation I do think it’s really important to have a good support network. And there’s some books I really like, again, it depends on where the child is at, but I do recommend a lot of Dawn Huebner books. They’re CBT for children, so it’s going through and teaching kids. She has, I think, 10 different books out about what to do if your brain gets stuck or what to do if your temper flares, so the child actually has these different tools moving forward. So things like that can be really helpful and then also, a lot of these kids end up getting diagnosed on the autism spectrum. So again, if it’s that severe of a case, things like behavioral therapy and occupational therapy can also be hugely helpful.

0:30:35.0 DW: So, just a full team, good support, and then I also try and teach my parents about how to avoid triggers. Because like I mentioned before, what you’d think would be benign, such as washing your child’s clothes in Tide or something, can cause a huge setback or trigger new symptomology. I try and really educate people on mold exposures and toxins. I give them resources like the ewg.org, so they can try and use healthy cleaning products. Also during flares or if these children are around people that may have strep or something, I like my parents to have a plan in place, which may be antibiotics initially, just to avoid that huge inflammatory autoimmune condition. There’s a lot to learn for parents and it’s too much to go through alone. So just having a good overall primary person to support the PANS and PANDAS and then specialists kind of in each department. The more brains and eyes on it, the better.

0:31:42.7 DS: Yes, great advice. I think that moms, of course dads as well, but that mama bear energy that comes out for your kid if your kid’s suffering, it’s one of the most heart-breaking and most rewarding patient population, right? Our kiddos.

0:31:58.4 DW: Yes, it really is.

0:32:00.9 DS: Yes, they open our hearts so much, and to support them in all the ways that you’ve shared is some of the most rewarding work, for the kids to get their lives back, especially when they might be faced with diagnoses that don’t give them as much hope in different worlds. Like the conventional world, I’ll see the parents, the moms and the dads just, of course, pour their heart into this work so that they can recover their child, but we have to preserve the family’s energy and time and support them so they can get through this process and not feel alone. I think that’s really awesome. I didn’t know about those books.

0:32:39.1 DW: They’re really great.

0:32:40.3 DS: Yes, empowering the kiddos as well.

0:32:43.9 DW: Yes, and there’s another documentary too that I think is helpful, just to get a more well-rounded picture. Amy Joy Smith, the nurse practitioner who specializes in PANDAS, she was a part of this. It’s the “My Child Isn’t Crazy” documentary. I do think it’s a really good one, too. I sometimes will recommend that the families watch that, again, to not feel so alone, to feel more empowered. It’s just a complicated topic as far as insurance coverage and the conventional medical community involvement.

0:33:18.0 DS: Good pointers. Well, Amanda, I feel like we’ve covered it all. Is there anything else on your mind or your heart around supporting patients with PANS or PANDAS that you want to share?

0:33:31.7 DW: Not necessarily. I feel like I didn’t even talk about half of the treatments, just because it’s such a wide variety of things. There’s so much that we do in our world that I didn’t even mention, some of the really great immune regulating type things that can be hugely helpful, like low-dose immunotherapy which I use with pretty much every PANS and PANDAS child, because that’s the treatment where you’re basically doing a very, very dilute homeopathic version of whatever may be the triggering factor, whether it’s strep or parasites or molds, doing very low-dose, once every seven weeks or something to help with that immune dysregulation. Those types of treatments can be really wonderful. Even low-dose naltrexone can be really wonderful. There’s just so many things that we can pull from our toolbox for these kids.

0:34:26.5 DS: With the immune regulatory model, do you see mast cell treatment as well?

0:34:31.8 DW: Absolutely.

0:34:33.6 DS: Histamine support and that kind of thing?

0:34:35.2 DW: Yes. I’m glad you brought that up, because basically, yes, every PANS and PANDAS kid I have, they’re on some type of mast cell stabilization, whether it is actual antihistamines or more of a supplement version, like Vistaril and Vitamin C and nettles, things like that. They’re pretty much all on some good mast cell stabilizers. That’s always a big piece of it, because it’s never just one inflammatory trigger. With PANS and PANDAS, it’s typically the IL-17 pathway, that inflammatory cytokine. But I feel like it’s this downward spiral. You trigger one inflammatory reaction and it’s the whole host of things. So absolutely, those can be all be very helpful.

0:35:23.3 DS: Awesome. Well, you’ve enlightened many of the listeners today and shared a lot of great insight. A lot of this information you’re sharing, we don’t just read about it. You see this day in and day out. You’re treating so many wonderful patients and getting a lot of people better. I appreciate the experience that you speak from. We’re so excited that you’re part of the team at Immanence Health and that you’re seeing patients. I know that you of course specialize in this area and in children, but of course you see anyone really with a chronic illness or who wants to prevent one as well. We often see too, once we start working with the kids, we treat the family also, just to help support them to be strong through the treatment, but also to address some of the maybe preliminary things that could have set the child up epigenetically, which begin in the parent. So it’s an opportunity to support their health as well.

0:36:22.7 DW: Yes, that’s a big factor to it. I love seeing families because then you can treat everyone. You can test everyone, see if someone’s a carrier for strep or a couple of times a year, do a little parasite cleanse for everyone. I actually prefer to see whole families, just to get everybody on board and you generally get people better faster that way.

0:36:48.3 DS: Awesome. Dr. Amanda is licensed in Washington State and she’s getting her California license as well. But now that people are traveling more, if you live in a state outside of those, you can come and visit us in person and get wonderful care with Dr. Amanda and then she can take care of you in between appointments over the phone or through telemedicine. Any final words that you want to share, Dr. Amanda? This was awesome. You shared a lot of great info.

0:37:19.2 DW: Thank you. I don’t think so. I feel like this is such a big topic, you could just talk for days about it. But I appreciate you having me on your podcast and I love working with you at Immanence Health and I’m just very thankful for all of it.

0:37:31.6 DS: Oh, well thank you. And again, we’ll have all the information about Dr. Amanda in the show notes, and thank you for listening. Thank you for listening to the Spectrum of Health podcast. I hope you enjoyed my conversation today with Dr. Wilms. Please learn more about her in the show notes, and if you want to become a patient of Dr. Wilms, please check out our website, Immanencehealth.com, where you can book a discovery call with our team to make sure that she is the right doctor for you. Again, if you’ve been enjoying these podcasts, I would be so grateful if you could leave a review on Apple iTunes. Thank you so much and have a beautiful day.