Integrating Complementary Therapies Into Your Care
Beth Baughman DuPree, M.D., F.A.C.S., A.B.I.H.M.
September 22, 2014

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Beth Baughman DuPree, M.D., F.A.C.S., A.B.I.H.M., is a general surgeon and also medical director of the Breast Health Program at the Holy Redeemer Health System, as well as an adjunct assistant professor of surgery for the University of Pennsylvania. Dr. DuPree strongly urges her patients to consider complementary healing support, whether it's through lifestyle modification, spiritual assistance, grief counseling, exercise programs, reflexology, nutritional counseling, Reiki, yoga, or massage. She herself has participated in all these techniques and is a master level Reiki practitioner. She believes that "whatever it takes to help a person find healing and peace is the way to curing them."

Listen to the podcast to hear Dr. DuPree talk about:

  • how she became interested in complementary therapies and how she integrates them into her practice
  • the healing benefits of some complementary therapies
  • how it feels to see her patients heal their minds and psyches as well as their bodies

Running time: 33:42

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Show Full Transcript

Jamie DePolo: Hello, everyone. I’m Jamie DePolo, and I’m the senior editor here at Welcome to our latest podcast. Our guest today is Beth Baughman DuPree. She’s a general surgeon and also medical director of the breast health program at the Holy Redeemer Health System, as well as an adjunct assistant professor of surgery for the University of Pennsylvania.

Dr. DuPree strongly urges her patients to consider complementary healing support, whether through lifestyle modification, spiritual assistance, grief counseling, exercise programs, reflexology, nutritional counseling, Reiki, yoga, or massage. She herself has participated in all these techniques and is also a master level Reiki practitioner. She believes that whatever it takes to help a person find healing and peace is the way to curing them. Dr. DuPree, welcome. We are so excited to have you on our podcast.

Dr. Beth DuPree: Thank you, Jamie. I am really excited to be here and to talk about something that is very near and dear to my heart, which is helping patients find healing through their breast cancer journey.

Jamie DePolo: That’s great. And I know we’ve never done a podcast on complementary therapies before, so I’m very excited about this because I think these therapies can add huge value to people who are being treated for breast cancer. So, have you always felt this way about complementary therapies? Did you receive training for these in medical school? How did you come to integrate these into your practice?

Dr. Beth DuPree: Well, it’s really been an evolution. And in medical school I had probably a one-hour lecture on nutrition, I had really no…

Jamie DePolo: That seems typical, from what I’ve heard.

Dr. Beth DuPree: That’s pretty typical. I did not have any training whatsoever in anything that I would consider integrative or complementary. I went to medical school a long time ago and graduated in 1987, so that was way before it really became something that is now almost standard in medical schools. Complementary and alternative medicine programs are pretty much part of every medical school. It may not be a big portion of their training, but at least they get an introduction to it.

My entrance into integrative medicine really came through the process of going through cancer diagnosis and disease processes with physician friends of mine, physician colleagues diagnosed with cancers and diseases that were either considered not curable or those that had a very high risk of mortality, and participating in learning about what helped them to heal through that process. And so I really came upon it honestly because of the love and affection that I have for my colleagues who were feeling very… I don’t want to say left out by Western medicine, but they didn’t have all the answers.

And so when someone that you care about is diagnosed with Lou Gehrig’s disease, and they’re forced to leave the operating room and stop doing orthopedic surgery, and they come to you and say, “Help me find peace. Help me find healing in my heart,” you don’t turn a blind eye and say, “You know what? I’m going back to the OR to cut out cancer because I don’t have time for this.” You say, “How do we get to a safe place? How can I help you heal?”

And so through that process I was introduced to Reiki, or Japanese energy healing. I had previously done massages for relaxation but realized that therapeutic touch — there were other modalities that we could use to enhance the healing process. So, that was really the beginning of kind of my entrance into what I call bridging the gap between Eastern and Western medicine. So, it was really out of the love and affection for physician colleagues who needed answers and then needed help to get to a safe place.

Jamie DePolo: Did you then seek out this training on your own? Because it sounds like you integrate a lot of different types of therapies. So did you go to special training? Did you have people come in? I mean, it sounds like a lot.

Dr. Beth DuPree: Well, initially, when I first started and learned about Reiki I would trade time in my office with practitioners. When I was in private practice, I would let them use my space in the evening when I wasn’t using it, and, in trade, they would take care of my patients. They would give acupuncture, or massage, or Reiki, or whatever it was, or nutritional counseling. I would barter that time, because integrative services weren’t covered by insurance. So, there were people going through cancer care trying to pay their co-pays for their radiation or whatever and feeling as though they didn’t have any way to get to a safe place.

And so that was how that initially started. I then, in 2007, got together with some other community members, patients, and my sister Ann, and we sat down and we put together a plan to create a foundation, to create a nonprofit to provide those services. And that’s how the Healing Consciousness Foundation began, out of a need to — we wanted to be able to give women and men going through cancer a chance to heal.

And if we see a patient in the office and know that that person can really benefit from an integrative modality but they don’t have the money or the resources to have it, then I’ve basically just given them one more thing on their list to do, increased their stress, and I haven’t really helped them to heal. So, the Foundation really afforded me the opportunity to really jump in, both feet into the water, and say, okay, you sink or swim, and we swam, and we’re continuing to swim and do wonderful things.

And as the Foundation grew and when our practice joined forces with Holy Redeemer, we came together to create a really awesome breast health program. It was a natural fit, because Holy Redeemer, Care, Comfort, and Heal. Healing is right in the mission statement of the hospital. Because a lot of health care systems still treat disease processes, and they’re focused on just the disease. And we wanted to maintain our focus on the individual and make sure that that person got what they needed. So, I mean, I call it an evolutionary process, and it has been.

And 2 1/2 years ago, I decided that I needed to further my study and my training and become officially board certified in integrative medicine, which I did. And so now in addition to holding board certification in surgery, I’m board certified in integrative and holistic medicine. So, that gives me that opportunity to do even more things in the wellness front as we go forward. And two of my partners, Dr. Krisher and Dr. Carruthers, are both studying right now, and they’ll be taking their boards in the fall. And they’ve been inspired by watching their patients come back to the office having received those integrative service saying, “Wow, they’re changing their lifestyle, they’re engaged in wellness, they’re at a much better place spiritually and emotionally than they would’ve ever been had we just treated their cancer.”

So, I’m really proud, because they didn’t have to do that. And you lead by example. You set that bar at a place where you want others to rise to see the benefit of what we’re doing. And the great thing is, we are cutting edge, state of the art Western medicine. We participate in multiple clinical trials. Our patients get the chemo, and the surgery, and the radiation that they need to treat their physical cancer, but we’re able to bring together all of the other aspects that I think is so missing in Western medicine. And so it’s not an either/or, it’s a complement. It’s a complement to what we’ve already done.

Jamie DePolo: Let me ask you this. What sorts of healing benefits do particular therapies offer? Because I know we get a lot of those questions sometimes in the Boards, like, “Okay, I’m doing yoga and it’s helping with this,” or “I’m doing yoga but I’m not really quite sure what it’s supposed to help with.” Would you be able to just give a couple examples of some of the most popular ones, like massage, or yoga, or acupuncture?

Dr. Beth DuPree: Sure. With yoga, first of all, yoga’s all about breathing. People think it’s about postures. And when you can become centered with your breath and you can become centered in your heart, your anxiety level drops. It helps with blood pressure, stress. The other thing that yoga does is, with the gentle postures, patients are given the opportunity to regain mobility in their upper extremities after axillary lymph node surgery or after their breast cancer surgery or radiation changes. And so for a lot of our patients, the gentle yoga has given them the opportunity to not just get centered spiritually but also physically, to help to rehab after their surgery and their other therapies.

We offer a form of treatment here for anxiety, depression, and insomnia as well. It’s an FDA-approved treatment that is not a medication, it’s not a pill. But it’s helping patients to deal with their stress and anxiety of a diagnosis. And any integrative modality that helps a patient release the fear of cancer coming back and helps them to be present in the moment brings them peace, and that’s what it’s really about. So, when someone goes for a massage and they feel that physical touch, or they feel the release of the tension in muscles, it’s helping them to better handle the stress of a life-changing diagnosis.

The biggest changes that I see, I think, that you could actually measure would be — we have a wonderful wellness program. We’re actually starting a 12 Weeks to Wellness program, a pilot study with cancer survivors in September, to document and to identify the metrics that we can then say to an insurance company in the future, “Listen, if we give our patients this opportunity, in the long run you’re going to get the benefit of this.” So, in our support group we have the Wellness Warriors, and it’s a group of women who get together and they work on nutritional enhancement, meaning what we eat and how we eat is very important.

A lot of people don’t have a lot of training in nutrition, understanding how to divide their meals in a day, what types of foods to eat with certain specific benefits. So, a wellness program combining exercise for strength training, and decreasing body fat, and decreasing BMI, combined with the nutritional counseling to increase the benefit of the foods that they’re eating, that’s a lifestyle change that not only changes the patient, it changes the spouse, the partner, the children, and it’s kind of the pay-it-forward mentality. Breast cancer risk mostly comes from lifestyle right now. I mean, the genetic-based cancers and familial cancers are about 25% of the cancers that we see. Most of the cancers we’re seeing can be — you know, Think Pink, Live Green. Think about the fabulous information that’s been put out by that we give to all of our patients. Everyone that comes in our office leaves with a Think Pink, Live Green.

Jamie DePolo: Nice.

Dr. Beth DuPree: And so when you take those 31 ways to decrease your risk of breast cancer with lifestyle, and you use that as an educational tool, you’re giving patients the opportunity to be empowered, to change their life. And although that is not Reiki, it’s not massage, it’s not guided imagery, it is empowering someone to promote wellness. And wellness is all part of integrative care, because if we look at the future of healthcare, the more diseases that we can prevent, the healthier we’ll become as a society, the less money we spend in GDP, and as a country, we’re going to be a whole lot better.

Jamie DePolo: Well, and it seems fair to say, too, with the Think Pink, Live Green, as you said, it’s a healthy lifestyle. So it’s not just breast cancer that’s…

Dr. Beth DuPree: Absolutely.

Jamie DePolo: …that’s being reduced.

Dr. Beth DuPree: It impacts cardiac risk, it impacts diabetes, hypertension. And if we only treat the cancer that a patient walks into our office with, then we are so narrowly focused on that one thing, and you’re not taking care of the big picture, you’re not looking at the psychosocial aspects. I mean, we learn our patients’ stories, and that’s something that’s system-wide at Holy Redeemer. We want to know the story of the patient that came in the office. You want to know what life stresses they have, you want to know what wonderful things that they are proud of in their life, their grandchildren, or what they’ve done for their career, or what their children have done.

And so when you identify that in a patient and you can make their story part of their healing, it gives everybody a chance. Number one, you connect with that individual on a very different level. And you know that you’re not just going into surgery to excise a cancer, you’re going into surgery to take care of a grandmother who, her responsibility is to her grandchild with special needs so that her children can be out making a living.

So, understanding that and understanding the stresses allows us then to tailor that person’s care. So, in that woman’s instance, she’s someone who I would probably set up with one of our practitioners to do guided imagery prior to surgery, so that when she goes into surgery, she knows that she needs to focus on her healing and herself. Because if she can be healthy and well, she can be around longer to take care of that grandchild that needs her.

So, guided imagery is really using someone’s own focused mental energy to focus on a specific mantra, a song, an image, something to allow them, as they go off to sleep or as they go in for their chemo or radiation, to visualize that healing process instead of having their mind race about all the things that they’re not doing or what they haven’t been able to accomplish. And so, guided imagery has been an amazing tool to take patients into surgery.

And they have their affirmation cards, they come to the operating room with the music that they want. And studies have shown that patients that have used guided imagery as a tool — less pain medicine post-op, decreased cost to the hospital and to the patient, earlier discharge from the hospital. I mean, those are real numbers, those are things that impact the future of healthcare. And guided imagery is an integrative modality.

Jamie DePolo: What are the reactions from your patients? I would assume that most people are very receptive, but I’m also wondering if anybody’s a little resistant? And if so, how do you overcome that?

Dr. Beth DuPree: Well, one of the best things that we’ve done is, we have what I call the a la carte menu of healing. So, when a patient comes in I don’t say to them, “You need to do this, this, and this.” I give them the list of, “Here are practitioners that are at your disposal. And here are healing certificates that you have to use when the time is right for you, when you feel safe.” For some patients, I will encourage them to go before surgery because their level of anxiety is so high that they really will benefit from what I call the preemptive strike.

So, for patients who may have resistance, sometimes the resistance is fear. And when you can break in through to that fear and find out that what they’re scared of is not being able to care for the people they need to care for — which is why you need to know their stories. And very few patients resist that loving, caring process. I think if they did resist it, they would probably go someplace else for care, because they wouldn’t feel comfortable here. Nobody is ever forced to go anyplace that they don’t want to go. But I think giving them the opportunity to either go to a support group, have a one-on-one with a survivor, to have that relationship, and just to know that they have someone that they can call to talk to makes a really big difference.

So, I think that we are seeing far more patients who come here having been in other practices and other institutions, and they seek us out because they know that when they come to us they’re going to get the package, they’re going to get the integrative care, they’re going to get state-of-the-art Western medicine, they’re going to get the total synthesis, they’re going to get the best, newest radiation therapies, and the best chemotherapy, and clinical trials. But they also know that in that process, they’re going to have tools and other practitioners besides their doctors who are going to help them on their path to healing.

Jamie DePolo: Do you have to do a lot of education? I’m assuming that most people might know what yoga is or massage is, but maybe not everybody knows what Reiki is, or guided imagery, or anything like that. I’m assuming when they get these healing certificates it’s explained to them?

Dr. Beth DuPree: Yes. What we do is, when a patient comes in for their consultation or a second opinion — we get a lot of second opinions because patients will have a diagnosis. And I send my patients for second opinions. They go freely, and I have a firm belief that you need to be where you need to be. So, if a patient feels that they’re going to get something someplace else, they should be there. Just like when patients come for a second opinion, if it resonates with them and they like what we do, they’ll stay.

So, in that packet — we have a beautiful little binder — and within the packet is a letter explaining that these healing certificates are gifted to them from the Foundation. And Holy Redeemer graciously has created a beautiful space so that we can allow them to receive their services here. And what happens is, there’s a list of all the practitioners with their phone numbers and emails, and at the bottom of the letter they have the opportunity to have a one-hour session, an educational session, with Lauren Loverde. She is our services navigator, and Lauren is a cancer survivor. She is a radiologist that, I kind of give her the credit of, she was the one that banged me over the head with a 2x4 when she was diagnosed with a brain cancer. She introduced me to Reiki, she introduced me to healing. I wrote about her in my book. Her story’s amazing because she is a healer through-and-through, but she started out as a radiologist, and it took brain cancer to kind of shift that process for her. So, we have a printed page with one paragraph about each different service, so it’s kind of very short and sweet.

And then the patients are able to call her, set up a time with her, and she will help them to pick what works for them. Because everybody needs something different, and I wish, as a physician, I always had the luxury of spending two hours with every patient to go through that process with them. But what we’ve done is, we’ve created the opportunity to have as close to that as we possibly can by giving them access to someone who has actually had a service. Lauren has gone to every practitioner, she has had a service from everybody, and she helps by talking to the patients and seeing what is going to be the best fit for them.

And it has been an incredible gift to have her as part of this program, because she allows the patients then to really come up with their plan of action for healing. My nurse navigator Amy helps me to come up with the plan of action from a medical perspective for the surgery, and the chemo, and the radiation, and makes sure that the patients get to where they need to be from their Western medical perspective, and Lauren helps them navigate through their Eastern medicine.

And I’m kind of the bridge between the two, because I think that without the support of the integrative services, I think that healing is something that may not occur for years and years, or may never occur. And without the Western medicine to cure the cancer, to actually remove the cancer, and to treat the cancer, patients are often left… And I do get patients who, they’ll come to the practice, and they will refuse to do anything of Western medicine-origin to treat their cancer. And when they come here, they’re like, “Well, I know you’re an integrative doctor.” And it’s, “Yeah, but I’m an integrative practitioner, but integrative doesn’t mean that I do alternative treatments. I’m not going to give you a magic pill or a magic salve to rub on your cancer to make it disappear. I use state-of-the-art surgical intervention, and chemo, and radiation in conjunction with all of the other fabulous …” You know, our patients that go for radiation therapy, studies have shown that Panax ginseng, using Wisconsin ginseng, decreases fatigue with radiation therapy, which is a big deal because by the fourth or fifth week of radiation, patients are feeling sluggish. And what I love is that the article, when it came out, my radiation oncologist sent me the article and said, “Beth, you’re going to love this,” because they’ve been listening to me for years.

And now I have my medical oncologist and radiation oncologist sending me stuff in their literature about integrative therapies going, “Hey, look at this. Look what we have.” And so our Integrative Journal Club is starting in September, and I’m very excited about it because one of my medical oncologists is board certified in integrative medicine. Family doctors on staff with me are board certified in acupuncture. So my Western medicine physicians who are embracing integrative care — I have a pediatrician on staff who’s also got board certified in integrative medicine.

So, the tide is rising, times are changing, our ability to provide the state-of-the-art care in a comfortable, safe Western medicine-environment with integrative medicine, it’s the new dawn. I mean, the time has come. And at Redeemer, I’m really thrilled because I’ve now been here for 5 years, and I kind of made a deal with the CEO when I came here years ago that, I said, “Listen, integrative care is the future of medicine. It’s what I want to be doing. I want to build a state-of-the-art breast health program, but we need to focus in the future on integrative therapies.”

And Jodi Hutchinson is a physician’s assistant who joined as our integrative administrator in April, and I love working with her because we are starting to bring integrative care throughout the health system. That’s the goal, is to not make it be one little tiny carve-out, which it is in a lot of hospitals. It’s a little carve-out space or a little carve-out concept that most people don’t even know about. So, I mean, it’s very timely for us to be doing this podcast because it’s something that, I’ve had it on my to-do list, and it’s been in my medical healing bucket list, and now it’s coming to fruition, so I’m really excited.

Jamie DePolo: That’s wonderful. I’m curious, too, do you see it in your patients when, I don’t know how else to say it, but when they start to heal? I mean, they have gone through surgery and the cancer has been cut out of them, but as you’ve said, they themselves are not healed. And can you see that happen? And that’s got to be so exciting, too.

Dr. Beth DuPree: It is palpable. And I have some patients who, I jokingly call them my energy vampires because they will come to the office and they will suck the life out of you if you let them. Because they’re scared, they are angry, they have all those emotions. And there’s nothing in the world that makes me happier than removing that little energy vampire tag. I mean, I know who they are, and I have to put them at the end of my office hours because I’m trying to keep my patients flowing, and I know that they need extra time. They need time with me, they need time to connect.

And when that shift occurs and they no longer are in that place of fear, I want to dance down the hallway and just scream to the rooftops that this new dawn has come, because this person is no longer in that deep, dark hole waiting for cancer to come back. They’re in the office, they’re there for an exam, and they want to be out the door and to go back to living their life. And that moment of realization is — years ago it was something that a lot of times they had to wait to see, because I would always wait until after they were done with their Western medical treatment before I even introduced integrative therapies. And now I do it from the get-go. And so for some patients, they’re already on the fast track. They’re there, and cancer’s just part of this spiritual journey for them. But it’s everybody’s time, there’s no judgment. Some people take a little extra time. But there is this sense of peace in my heart when I see that in one of my patients, because I know that I got to play a role in that, regardless of how big or how small. I got to help them in that process.

And I never really liked Facebook, but 2 years ago I got nominated for Be Well Philly’s Health Hero, and so I had to get a Facebook account because someone did enough research to find out it was a Facebook vote. So, I still have a Facebook account, and I have a lot of patients go on Facebook, and it was one of those, “Do I get off it, do I leave it there?” Whatever. But bottom-line was, I stayed on it, and I have to say that when I see Facebook posts from patients — I had one the other day. She was 8 years since her diagnosis, and what she wrote about — she didn’t write about, “Oh, she did this beautiful surgery, and I look really great when I look in the mirror,” which she does. But what she wrote that really touched me was, “She not only treated my cancer, she helped me to get to a better me. She helped me to get to a place where I no longer wake up in the morning scared that I’m going to die of cancer.” And for that reason I like Facebook, because when I see posts like that from patients, I know that what I’m doing makes a difference, and I know that the hours that I put into the work with the Foundation to have the money to do those services makes a difference.

Jamie DePolo: Oh, absolutely. And I wanted to ask you, too, about the Foundation, the Healing Consciousness Foundation. That’s a nonprofit. How exactly does that work? You said that when patients come in they get the certificates that are funded by the Foundation. But is it strictly for Holy Redeemer patients, or is that something that’s nationwide, worldwide?

Dr. Beth DuPree: Well, currently it’s a local process. We are a local Delaware Valley foundation. When we see patients that come here for a second opinion they get healing certificates. If they stay here that’s great, if they don’t stay here they can still access the services. We have been approached by several other institutions, and actually two in South Jersey right now where we’re entertaining the possibility of having HCF South Jersey or whatever. Because what we really need to have is, you need to have a core of physicians who are willing to participate.

We need to make sure that the patients have been referred appropriately. We have patients that come to our support group who are not treated by our doctors, but we need to make sure that their physicians are on board and sign off on that for them to be able to receive any kind of healing certificates. But we have programs that are Thrivers’ Retreats, which are weekend long, kind of intensive healing sessions. We’ve got healthy cooking classes, we’ve got exercise, and Zumba, and yoga. So, we don’t draw a line in the sand and say, “You know, you have to be a Holy Redeemer patient.” But somehow those patients are associated with Holy Redeemer and us because they get to us through word of mouth through other patients. When other breast cancer surgeons have retired in the area, we inherit a lot of patients because they come to us for their follow-up and their mammograms. And so that’s how they find out about us. So, ideally, would I love to be a national organization and do this? Yes. Do we have the bandwidth right now or the finances? No. But just like started out as a grassroots effort and now you have a worldwide reach, the sky’s the limit.

Jamie DePolo: Okay. That’s good. Now I know we’re getting a little bit tight on time, so I want to ask you one last question. You have also written a book called The Healing Consciousness: A Doctor’s Journey to Healing. So, I want to ask you, what does it mean to be a doctor and a healer?

Dr. Beth DuPree: I think that when most individuals choose medicine as a profession, they choose it because at the soul’s level they’re a healer. Their life is one of service, being of service to others. I think that when I look at my life as a physician and as a surgeon, I think I went into medicine because I’m a healer at my soul’s level. But there is a big difference between being a doctor and being a healer, because as a physician, particularly a Western medicine-trained physician, we’re trained to treat a disease. We’re trained to give it a name, figure it out, and give it a cure, give it a surgery, give it a pill, give it a whatever.

As a healer you look at the individual that you have in front of you as that complex mind/body/spirit. And where the physician typically — unless you’re a Western psychiatrist focusing on the mind — a typical medical doctor will focus on the body. And so, as a healer, when you look at the mind/body/spirit connection, realizing that if somebody’s very depressed, that depression may lead them to overeat and gain weight. So, kind of connecting those pieces and parts is what to me differentiates healing versus curing, where someone can be cured of cancer and live in fear that it’s going to come back and have never healed.

So, the healer in me identifies that aspect in the patient, so that I want to make sure that that mind/body/spiritual connection’s in alignment. The Western medicine physician in me wants to make sure that my margins are clear when I do my lumpectomy, wants to make sure that I’ve identified the appropriate sentinel node, and make sure that that patient get the chemo, or the antiestrogen, or the radiation that they need to treat that cancer.

So, it doesn’t mean that they’re mutually exclusive, but I think that unfortunately because of the changes in healthcare and the constraints on time, a lot of physicians burn out because they stop getting the time as a healer and spend way more time as the physician. And so, when you talk about “physician heal thyself,” the first thing that we need to do as physicians is realize, “What do we personally need to heal ourselves so that we can be better healers and physicians for our patients?”

Jamie DePolo: Excellent. Dr. DuPree, thank you so much for joining us today. It’s been very enlightening. I know I’ve learned a lot, and I do hope that you will join us again so we can talk a little bit more deeply about some of these topics.

Dr. Beth DuPree: I will, and Jamie, if you have September 27th available, at the Foundation we’re having a fundraiser, and it is called Your Genes Say a Lot About You. And it’s kind of the play on words because it’s our models, it’s genetic risk assessment. So, most of our models are either survivors or previvors. And given the New York Times article this week on the PALB2 gene and the new genetic testing, it’s brought up a lot of questions. And we did it kind of in response to the Angelina Jolie, you know, raising that awareness. Plus, it’s fabulous because we’re all going to be wearing jeans! I get to wear a very hot pair of high-heeled shoes, and a cute shirt, and jeans, so I don’t have to stress about what dress I’m going to have to fit into.

Jamie DePolo: Excellent. Well, I will put that on my calendar, and I will hope I will see you there. I hope it works out. And again, thank you so much for joining us.

Dr. Beth DuPree: Thank you, Jamie.

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