The Crunchy Allergist 0:03
Sick of the fatigue and fog? Fed up with the unpredictable flares? Hangry from the super restrictive diets?
The Crunchy Allergist 0:12
Hello, and welcome to the Crunchy Allergists podcast. A podcast empowering those who like me appreciate both a naturally minded and scientifically grounded approach to health and healing.
The Crunchy Allergist 0:24
Hi, I'm your host Dr. Kara Wada, quadrupel board certified pediatric and adult allergy immunology and lifestyle medicine physician sjogrens patient and life coach, my recipe for success combined the anti inflammatory lifestyle, trusting therapeutic relationships, modern medicine and mindset to harness our body's ability to heal.
The Crunchy Allergist 0:46
Now, although I might be a physician, I'm not your physician, and this podcast is for educational purposes only.
The Crunchy Allergist 0:53
Welcome, everyone. Thank you so much for joining us today. On today's episode of the Crunchy Allergist podcast, we have Dr. Rani Banik. She is a neuro ophthalmologist and we're going to talk about what that is. She is based in New York City at Mount Sinai and has an awesome Instagram that we were going to we're definitely going to link to along with all of her other contact information. But I think we'll have lots to share. That will be a wealth of information for everyone listening. So thank you so much for taking time out of your busy schedule to join us today.
Dr. Rani Banik 1:30
Oh, and thank you. Thank you for having me. I'm really looking forward to our chat.
The Crunchy Allergist 1:36
Okay. So one thing that I was always confused about until I was in the medical field was what what are the different types of eye professional eye health care professionals? There's optometrists, ophthalmologists, and then what you are, which is a neuro ophthalmologist, can you explain a little bit to our listeners kind of what what are the differences?
Dr. Rani Banik 1:59
Sure, well, there are actually three O's in the world of eye care. So there's ophthalmologist, there's an optometrist, and there's optician.
Dr. Rani Banik 2:07
So I'll start with ophthalmologist. An ophthalmologist is a medical doctor. An ophthalmologist has gone to medical school, so four years of undergraduate education and four years of medical medical school and then has done an internship and then a residency in ophthalmology. So that's another four years a total of 12 years after high school. And then some people go on to do a fellowship, which is what I did in neuro ophthalmology, we can talk more about that.
Dr. Rani Banik 2:30
And optometrist has gotten his done undergraduate degree, and then does optometry school. And so in during that time, they learn a lot about eye diseases. They can diagnose certain things and depending on the state that they're in, they can prescribe medications and they obviously they did contacts, glasses, etc.
Dr. Rani Banik 2:53
And then an optician is someone who can take the glasses prescription and then make the glasses. So they're the ones who actually like fit the frames and make sure that's fitting correctly and it's you know, that you're able to see properly through them. So they actually transcribe that prescription into glasses.
Dr. Rani Banik 3:12
So again, those are the three o's and as an ophthalmologist, you know, I am fortunate to be trained in you know, the medical and surgical aspects of ophthalmology. But I really felt like during my residency, I wanted to learn more about the brain and the brain's connection to the eyes because I'd always also been interested in neurology. So I was kind of, you know, in medical school, deciding between ophthalmology and neurology, so doing a fellowship in neuro ophthalmology really helped me kind of bring those two things together.
Dr. Rani Banik 3:39
And so, I deal with a lot of vision problems that come from brain issues, like for example, autoimmune conditions, like multiple sclerosis can have vision loss like optic neuritis, or people who've had brain tumors, brain strokes can vision loss. Migraine is a big one, I deal with a lot of migraine. So as a neuro ophthalmologist, I help take care of all of that, you know, when the eyes are involved when there's neurologic issues. So that was an extra one year of training.
The Crunchy Allergist 4:06
Very cool. And I think you have something that I have kind of forgotten from years ago during medical school that comes back from time to time is just that the eye is directly connected to the brain.
Dr. Rani Banik 4:23
You couldn't have said it better. It's the direct extension of the brain. So it's really a part of the nervous system as part of the central nervous system and people don't realize that so.
The Crunchy Allergist 4:35
Even just thinking back to that first year of medical school, when we learn all the cranial nerves, which are for those who have are not in the medical field, they are these very specialized kind of nerves that help us to be able to see and smell and move our eyes in various directions, move our jaws and taste. But a lot of them all focus up in this eye area. So really can see some of those, if there's damage to any of those pretty easily through the examinations, I'm sure you're doing kind of in the office and with patient
Dr. Rani Banik 5:08
Exactly, so there are 12 cranial nerves, and six of those 12 have to do with vision or our eyes or eye socket. So it's really it's great to go through the anatomy, it's like solving a puzzle, and you're taking the pieces of the puzzle, putting it together to come up with a diagnosis. It's a lot of fun.
The Crunchy Allergist 5:28
I would imagine it's kind of the Sherlock Holmes aspect of your field.
Dr. Rani Banik 5:33
It is actually the whenever other eye doctors don't know what's going on with their patient, like let's say they've had some unusual symptoms, and they've had a huge workup, all the tests come up negative. They say, "Okay, send the patient to the neuro ophthalmologist and they'll figure it out." So we're kind of like a black box of ophthalmology and, yes, and optometry, because when people can't figure out what's going on, the patient gets sent to us.
The Crunchy Allergist 5:55
That's so funny, because that we I think we feel like in allergy immunology and probably rheumatology as well, that we are the black box of Internal Medicine.
Dr. Rani Banik 6:05
Yes, definitely see that. Definitely see that.
The Crunchy Allergist 6:11
And we were talking just a little bit before we hit record that there's a real need for Neuro ophthalmologists in the country. It sounds like.
Dr. Rani Banik 6:20
Yeah, it's a relatively small field. And I think in the US, there's probably less than 300 fellowship trained neuro ophthalmologist for the entire country, and very few across the world also. And it's estimated that for every 1.2 million in the population, we should have one neuro ophthalmologist. So we're significantly low in that respect. You know, when you think about the population of the US, there's just not enough of us. And it's challenging because it's a field that, you know, a lot of people will don't necessarily gravitate towards. Like people who do ophthalmology, they might want to specialize, they end up going into a surgical specialty like retina or, or glaucoma or cornea. So, again, it's it's, you can you can definitely do surgery as a neuro ophthalmologists, like I do surgery, but very few neuro ophthalmologists do surgery. So I think when people train, they want to kind of keep the surgical aspect more so they're less inclined to go into neuro ophthalmology, but it's a wonderful field is very rewarding. Get the most fascinating of patients. So it's very, it's always intellectually challenging.
The Crunchy Allergist 7:25
Awesome. So one of the things that I know you post pretty frequently about and had mentioned kind of seeing a lot are patients who have headaches and migraines. What can you kind of share a little bit about how those come together?
Dr. Rani Banik 7:44
I see a lot of migraine and headache, I would say at least 50% of my patients have some kind of a headache syndrome or facial pain syndrome or eye pain syndrome. And so, so I've and I myself have suffered from migraines, I kind of understand what they go through. And I think it gives me a unique perspective to care for them because I'm a migraine sufferer myself and, and so a lot of people don't realize this, but a migraine is a very unique neurologic syndrome. It's not just a headache, like some people think, Oh, you have a migraine, just take like a Tylenol and it'll go away. But it's not like that, because it really it has we don't fully understand it. But it really is a sensory disturbance disorder and all the senses can go on high alert, for example, people can be very sensitive to loud sounds, smells, lights, bright lights, even touch. There's something called allodynia where even like a light touch can really irritate someone with who has migraine. And the types of headaches people with migraine get are not like your regular headaches and they can last anywhere from four hours, two days, two weeks to even months. Like there was a point when people can have chronic migraine and I had chronic migraine. There was a point when my migraines I had migraines every day for two years. I mean, that was just a horrible time. So it's definitely not your regular headache. And many people can get other types of symptoms also, like for example, they can get a lot of gastrointestinal symptoms like nausea, vomiting, constipation, loose stools, and they may not really understand like what's going on and a lot of it is actually linked to migraine. So the vagus nerve, which is one of those cranial nerves we were just talking about connects the brain to the gut and so through the gut, there's a lot of crosstalk between what's going on in my digestive system in our brain. So the vagus nerve is definitely involved in migraine. It's really it's just fascinating.
The Crunchy Allergist 9:37
So I just had one of those like, you know, like the emoji with the head exploding moments because I've always kind of said privately that I've noticed when my IBS symptoms are flaring up that's when I will tend to have more headache issues and I didn't quite I like hypothesized like the you know, they were related but didn't quite. So that like sheds a whole new light. And I remember, as getting migraines as a young teen after just starting my periods, I would end up throwing up pretty often.
Dr. Rani Banik 10:11
Yeah, it's not unusual. And actually when even children can get migraines, and usually when children get migraines, they don't actually get a headache, they get the GI issues. They get the nausea, and then they vomit and then they feel better. So there's definitely some crosstalk they're probably through the vagus nerve. And it's, you know, even though migraine has been so well researched and studied, we still really don't know what's happening, like we can hypothesize about what's happening, we still don't know exactly like what one's triggers are. Because there's so many triggers, like for example, you're mentioning hormones. Hormones, or changes in hormones or trigger. Foods can be triggers. Lifestyle choices can be triggers. Like lack of sleep, dehydration, and then there's some more, you know, serious triggers, that can happen as well. So there's just so much about migraine and every individual is unique. So it's really a matter of being a detective and figuring out like, what are your particular triggers? Or how should you manage your migraines? Because no, no two people are the same in terms of how to manage their their symptoms.
The Crunchy Allergist 11:13
Do you have any kind of quick tips or things that would be helpful for someone who's dealing with headaches to think about as they're preparing for a visit with neurologist or neuro ophthalmologist or even their primary care doctor?
Dr. Rani Banik 11:29
Yeah, absolutely. I think the most important thing before you go see a doctor is to keep a headache diary, a diary of your symptoms. I shouldn't say headache diary, like more like migraine diary. And basically, you record for, you know, a few weeks or maybe even a full month, like, how many times a month do you get a headache? And what are those headaches like and what may the triggers be like? This is also really interesting. So a lot of people who have migraine because they're super sensitive to all kinds of stimuli. They're very sensitive to changes in weather, like barometric pressure changes. And, you know, maybe as an allergist, and immunologist, you may have some insights on this also, but definitely the weather affects our health. And people can sense like, I know when there's a storm coming on, I will be more inclined to have a migraine. So it's really important to track your symptoms. And there's a great app, actually, you can download for free. It's called migraine buddy. And you can download it to your phone and keep track of like what you're eating, how much sleep you're getting, what the weather's like, what the temperature is, like, what the humidity is like, and that way you can really figure out like, what are your specific triggers? And that way, that's like, the first step to really getting control of them is to figure out like, Okay, why is this happening to me? What do I have in my control that I can change? So consider doing that before you see your doctor.
The Crunchy Allergist 12:48
That's super helpful. And something that I talk about with patients with in other aspects of care, too, is having kind of that that journaling process can be really beneficial. It's nice to always know some of the tech tools that are out there now to and take advantage of these phones that we have on our side all the time. At least, you're pretty interested as well in how lifestyle can be really helpful in in our health. Do you have particular things that you like to suggest to patients to help with their everyday routines that are you know, beneficial for their eye health?
Dr. Rani Banik 13:35
Yeah, absolutely. So I actually I became so interested in this topic about how our nutrition and lifestyle affects our health that I actually got certification in it. So now I'm dual certified in functional medicine and integrative medicine as well, in addition to like traditional ophthalmology, so I just got that last two, I'm so super excited about it very, it was a long process, but worth it worth it.
Dr. Rani Banik 13:58
So I know a lot of approaches can be used for for overall health, but nutrition is really so like the foundation of our health. And you know, there's the saying that food is medicine, it dates back to you even though people attribute it to Hippocrates. It actually dates back to even before Hippocrates like millennia before him like ancient Mesopotamians and Chinese and Indian cultures used food as medicine. So the bottom line is if you eat the right types of foods that will provide your body with the nutrients it needs to stay healthy, to support your immune system to support your hormonal Health. To decrease your stress to be anti inflammatory, then you're less likely to get some of these chronic conditions and potentially even autoimmune conditions.
Dr. Rani Banik 14:51
And also if you eat other foods that are pro inflammatory, then you're more likely to get certain health issues down the road. And this is not something that happens overnight. This is cumulative. Like it's not, you know, just like, Oh, if you have like a McDonald's meal, the next day, you're going to develop this problem. No, it's not like that. It's like having a habit of eating in a particular way that may predispose you to certain health issues.
Dr. Rani Banik 15:15
So in terms of eye health, the eyes are just such specialized organs. They, they require a lot of energy. Like it's probably one of the most metabolically active next to the brain. The eye is the most metabolically active organ in our entire body. It's constantly processing light energy. So you really have to support your mitochondria. And if you think back to like, you know, biology class and mitochondria are the little energy powerhouses in all of our cells that provide us energy.
Dr. Rani Banik 15:15
So there are certain foods that I recommend to promote mitochondrial health to give you those nutrients you need, like all the B vitamins. You need antioxidants. You need certain minerals, certain co factors to promote your mitochondrial health. So that's usually what I recommend as an overall approach to eye health is to eat those types of foods. And the other just general tip I'll give you in terms of nutrition is that you know, a lot of people ask me, "Oh, should I be eating carrots? You know, if I eat carrots? I will I have 20-20 vision if it carries is that going to fix my eyesight?" The answer is yes, Carrots are important. And you do need those carrots for vitamin A, which is necessary for your retina did not have night blindness and help with dry eye. But there's so many other nutrients our eyes need. So don't just eat carrots, you have to have like a whole range of different colors and just different types of foods in your diet. Most of them are plants. So all different types of colorful fruits and veggies. But also you need to have our you should have some good sources of omega-3. For example, certain fish like salmon is a great source of Omega three. Eggs are also great for healthy fats, avocados. So there's just you know, you think about eye health, it's not just one thing, don't put all your eggs in one basket. When intended, you're gonna want to really have the whole spectrum and eat lots of colors. And that will provide your eyes with what you need.
The Crunchy Allergist 17:07
I'm going to play that back for my girls because they love carrots. And they actually have been known to say at dinner, because I worry, I'm the only one in the house that wears glasses, Mom, you need to eat more carrots. And I will share that with them. They're only six and three and a half. So they start learning.
Dr. Rani Banik 17:25
So one thing I'll just tell you in terms of like, especially with kids, one great tip you can tell them is eat the rainbow. So you want to have like the whole rainbow of colors in your in your diet throughout the week. Not all at once, but throughout the week. So I always tell my my patients who are parents, like Teach your kids to have a different color with every meal. And so like for example, most of us eat seven, sorry, three meals a day, seven days a week, that's 21 meals a week have 21 different colors in your diet. And that way you'll be giving your body and your eyes with what they really need in terms of nutrients.
The Crunchy Allergist 18:02
That's super fun. The other thing that we'll do on the weekends is I'll make like a snack tray essentially with like a lot of different cut up veggies and then all the leftovers are before dinner snacks for the week. So they have something to like snack on, that aren't just pretzels and goldfish. Those make their way into to help out.
Dr. Rani Banik 18:24
Yes, you can get rainbow goldfish. But that's not the type of rainbow we're talking about.
The Crunchy Allergist 18:28
They're full of all those different antioxidants, right? One of the other things that's really common, and I see kind of both in my practice, but also personally, is this interplay of like dry eye and allergic eye disease? Do you have kind of any like, quick tips or suggestions for people who may be dealing with kind of those itchy, irritated or gritty eyes symptoms?
Dr. Rani Banik 18:53
Yeah, they definitely do go hand in hand. I mean, absolutely, many people have dry eye and then on top of that, especially with seasonal allergies, many people have eye allergy symptoms. So dry eye symptoms can be redness burning, like a gritty sensation, like their sand or pebbles in your eye. And sometimes people tear. So people say "Oh, well, why do you why do you say I have dry eye because I'm tearing all the time." And the reason is actually because the surface of your eye the cornea gets dry and then the tear glands kick in the overproduced tears in response to the dryness so it's actually like a side effect of the dryness that you're tearing. So if you can stop the dryness, you can stop the tearing. That's one thing.
Dr. Rani Banik 19:33
And then in terms of allergy type symptoms, yes, you can get a lot of the same similar types of symptoms but also the itching and then discharge is very common with allergy. And usually the type of discharge is it can be clear could be watery and maybe mucousy like mucus trans. That's a very classic symptom of ocular allergy and there's so many things that can cause achiote allergy as you you must know, of course environmental triggers but even triggers within the home like just dust and pet dander and all kinds of things mites. So many things can trigger allergy types of items. And there is definitely overlap also in the types of ways you can treat both dry eye and ocular allergy. The mainstays drops and for dry, I obviously want to lubricate and treat the underlying cause of drying, we can talk a little bit more about that. For allergy, you want to calm down the allergic response. So there's very specific types of drops that can be used to calm that down and then also just for comfort, like cool compresses are great. Yeah, so many different things people can do.
The Crunchy Allergist 20:42
And I think the one thing that at least I was taught and please correct me if I'm wrong, but is to avoid the eyedrops that have like the the takeaway, the redness, because those can kind of essentially make make for more problems.
Dr. Rani Banik 20:56
Yes, so I'll say a brand name. Yeah. So you know, a lot of people will say, "Oh, my eyes look horrible, I need to get this right out." So they use the Visine and it works because it constricts the blood vessels. But what happens is, if you use it too often, your body gets used to that. And then as soon as you stop using it, it rebounds and you get this horrible worsening of your redness and your symptoms. So I usually tell my patients stay away from those types of drops that have the constriction like the vasoconstrictors in them.
The Crunchy Allergist 21:28
We have the same problem with Afrin. I'll name drop on that one, the same physiology, but in the knows that you can have that rebound.
Dr. Rani Banik 21:36
Yeah, so just be careful. I mean, it's okay to use maybe once in a while, like, if you have like some event that you're going to or you're taking photos or something like that, but don't please don't use them regularly. That's not a good thing.
The Crunchy Allergist 21:49
The other thing that I will see are patients and people away from our fragrance type things, too. Can be so irritating as you were talking about air quality. And I had a patient yesterday who he was not happy with his wife's use of like the plugins. And sure enough, it seemed like that was based on the story and the testing that that was contributing to his symptoms. And he's like, can I get that in writing? I was like, absolutely.
Dr. Rani Banik 22:16
Yeah, I mean, so many household things can trigger allergy type symptoms. Even detergents like you really have to kind of think about like, "Okay, what may my body be exposed to that it doesn't like?" And so one by one, you can eliminate all the possible triggers and figure out what it is, it's, again, being a detective in your own home. To try to figure out. Or maybe you're, you know, a lot of people, a lot of women, mainly women wear eye makeup. And sometimes that can be a trigger for ocular allergy. And what I sometimes tell them to do, and I know they don't like to do this is to take a holiday from their makeup, like don't wear mascara for like a week or two and see what happens. And then when you do go back to wearing it, get a fresh, you know, supply of bottle or whatever it is. Get something fresh, because whatever you were using before, first of all, you should probably throw it away, like every three months, because it collects bacteria in it. And then that can also be irritating to your eyes and you don't want to get infections, etc. But just start fresh, or maybe even just change your brand and see if that works. Lots of things you can consider trying for ocular allergy.
The Crunchy Allergist 23:24
And one resource that may be out there that folks may not be aware of. So there's kind of two types of allergy testing, the type that allergist do with the little scratch tests that look for like pollens and dust and pets. But then there's also something called patch testing that can be helpful for some of those other preservatives and ingredients that may be an eye drops or lotions and other things that we wear on us. That can be problematic. And that testing is sometimes done by allergist and sometimes done by dermatologists. But just to kind of realize that there are kind of different types and that might be helpful.
Dr. Rani Banik 24:03
That's so good to know. And thank you for sharing that because now I know like when I send my patients offer to figure out what it is. Yeah, there's systemic issues that they can ask for that.
The Crunchy Allergist 24:15
It's the one thing that's a little frustrating is patch testing is not quite as good at like picking up the reactions as like scratch testing is just an it's like ability as a modality but it's what we have.
Dr. Rani Banik 24:31
Yeah, and you mentioned earlier about preservative so you know when you're choosing eyedrops sometimes it's best to get preservative free. They're a little bit more expensive, but they come in like little single use vials that way you just like tear it off. You use it during the day and you throw it out and that way doesn't get contaminated. It doesn't you know and then there's a particular preservative in a lot of eyedrops called BAK benzalkonium chloride, I believe that's how you say it. And so that is many people that they just can't tolerate that they definitely develop a response to that. So check the ingredients on your eyedrops and just be a little bit more aware of what is in the eye draft that could also be propagating your symptoms.
The Crunchy Allergist 25:13
That ingredient is in some nose sprays, too. And it's like, ah, get out. I know they need preservative sometimes to keep them self stable and everything, but it is frustrating. Especially for those that are more sensitive to things in their environment. Do you have any other tips or tricks or things that you like to share with the world? Or maybe maybe any other like myths or misperceptions that come up in your field that people say, and you're like, oh, actually, that's not the case.
Dr. Rani Banik 25:50
There's so many myths, actually about eye health. Things like sitting too close to the TV is going to damage your eyes. No, that's that doesn't happen. You know, you're I may be chained especially young people there I may be changing and maybe growing. So they may be developing something like myopia, but sitting too close to the TV is not going to make that worse, necessarily. That's a process that's happening. And a lot of people also feel like you know, as they get older, their eyesight gets worse. That does happen in certain respects. But a lot of that worsening is age related in terms of something we call presbyopia, which is basically not being able to read up close when we get to a certain age. And most people, it happens in their 40s. Some people it happens in their 50s. Some can be people in their late 30s. But basically, like you're trying to read something, and then you kind of have to like hold it out here because it's just not clear anymore. So that's presbyopia. And that's like a natural part of I don't want to say the aging process. But it's a natural change that happens in the lens when the lens becomes less flexible and just can't focus as well, up close. So a lot of people come to me in that age group saying, "Oh, my goodness, my vision is getting worse. I just can't see anymore." And the truth is, they just need reading glasses. It's something correctable, so a lot of the things people think, Oh, my eyesight is really going downhill after 40. It, it may have changed, but it's correctable, that's the most important thing to keep in mind is that you can fix it.
Dr. Rani Banik 27:13
And then a lot of the other changes that happen as people get older, or the eye diseases that older people may get into their 60s 70s 80s, for example, like cataracts or glaucoma or macular degeneration, a lot of that can be prevented using proper nutrition. Just so important. This is what people just don't realize is that eye health is like something you need to start early like start it when you're young. So you develop good habits through your young adult life into your later years to prevent some of these diseases. So I'm actually I'm just about done with my first book, which is Best Foods for Eye Health A to Z. And in that book I go through, like everything that you need are different foods that will give you the nutrients you need. So not just carrots, but all the other things you need to keep your eyes healthy as we all are getting older. So so hopefully that book will be coming out soon.
The Crunchy Allergist 28:03
Oh, awesome. I can't wait. I love learning. Well, first of all, I love food in general. I love cooking and all those things, but factoring in the science and how we can like use food to help improve our health is so much fun to learn about. So I look forward to reading.
Dr. Rani Banik 28:18
Oh, yeah, thank you. Thank you.
The Crunchy Allergist 28:21
Where can people find you and follow you and kind of get updates about your book or continue to learn from you?
Dr. Rani Banik 28:28
Yeah, so I'm, I'm my website as probably a good place. But I'm also on social media. Instagram is probably my biggest platform. I'm on there pretty often. So I'm @dr.ranibanik. And then I'm also on Facebook. So if any of you on Facebook, I have two different Facebook actually three different Facebook groups.
Dr. Rani Banik 28:47
One is called Envision health. So I talked about just general eye health in that group and I give lots of tips.
Dr. Rani Banik 28:51
The other group is Eye on Migraine. So if you suffer from migraines, if you know someone who suffers from migraines, I have a separate group for those people. And I get again give a lot of tips like natural tips on how to prevent migraine and manage it.
Dr. Rani Banik 29:03
And then I have a new group on Macular Degeneration. So if anyone's interested in macular degeneration, I have a group focusing on diet and lifestyle for macular degeneration. So So those are some ways to find me. I'm also on YouTube. So I put some of my videos, I should put more of my videos on YouTube, but I post some of the videos from Instagram on to YouTube. So you can find me on YouTube as well.
The Crunchy Allergist 29:22
Oh, fantastic. I'm going to make sure to add your headache group to my I have some patient education information on headaches, I will add that end because it's always great to have good reliable resources to send patients to to get to get good quality information.
Dr. Rani Banik 29:41
Thank you. I'd appreciate that.
The Crunchy Allergist 29:43
Thank you so much for joining us today. I really appreciate it and I hope we're able to maybe do this again soon.
Dr. Rani Banik 29:50
Yeah, absolutely. I'm actually today I thought we were going to talk a little bit more about Sjogren's Syndrome. But maybe next time we can talk about it. I actually was thinking like okay, what am I share about sjogrens but next time maybe we can talk about shared grunts a little bit more.
The Crunchy Allergist 30:04
I would really appreciate it and I'm sure all of our listeners would too. Absolutely, thank you so much.
