In this episode, Dr. Rigobert Kefferputz, ND joins us to discuss the connections that exist within our bodies between our mental health and our immune systems and what we can do to optimize both.
Episode 53: The Mental Connection to Immune Health
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[01:32] Cassy Price: Welcome back to Supplementing Health. The cold winter months often bring with them an emotional slump that seems to subside as spring rolls around. Often times, cold and flu season seems to follow in the same pattern. Today we have Dr. Rigo Kefferputz, naturopathic doctor, here to shed some light on this correlation along with other factors that connect our mental health and our immune system. Welcome Rigo.
[01:54] Dr. Rigo Kefferputz: Hi. Thanks for having me.
[01:56] Cassy Price: So, before we dive into our topic, I was wondering what got you passionate about our immune health and the tie to mental health?
[02:05] Dr. Rigo Kefferputz: That’s a great question. For the last seven years I spent a large part of my career in the cancer field. I always had this belief that cancer was a very important condition to be treated. I noticed that over the years as I was studying it, I got more and more interested in the quality of life. It is not that our lifespan isn’t important, but it really mattered to me that people when they are diagnosed with such a terminal condition that they continue to live and continue to live their life and put the living into their life. With time I started recognising that I started having more of an interest in the mental health aspect of cancer except I always had this mistaken, almost ignorant, belief that people that were diagnosed and living with a terminal condition like cancer required more mental health support than anyone else.
[03:00] Dr. Rigo Kefferputz: That is an absolute fallacy. That is not true. That is something that I have learned over the last three to four years where I started transitioning my practice from the cancer field more so into mental health. That is when I sort of made that tie between immunology and our mental health and the dynamic between the both of them. It is a highly interesting subject because we always live with our thoughts. Every day, every moment, and every relationship and everything that we do. There is much power to be given in how we perceive scenarios around us and how we react to them and how our environment influences how we think and very much so how our family dynamics and how we grew up. Our parents are our first teachers in our life. So, it is a really exciting topic for me to discuss and I am really happy that you’re having me on today to discuss it some more.
[03:58] Cassy Price: I can absolutely see how that connection would come up especially if you are working in the cancer field. We often hear when it is a terminal condition like that, or even a chronic condition, that your mindset plays a huge role in how long you have to live or if you recover and all of these pieces. When it comes to chronic conditions, what is it about the mind immunology connection that occurs?
[04:26] Dr. Rigo Kefferputz: Well, I mean it is a fair point you bring up. Just to backtrack a moment. When a person receives a diagnosis with a cancer condition there is a certain part of them that goes numb. They just stop listening. That is why I always recommend that when patients come visit that they have their partners come along because you need that second person there as that sound board so that they can filter that information that you are no longer listening to because there are so many questions that start coming up, right, about how long do I have? Especially then you start putting a lot of your attention and focus into numbers and into objective markers and into “this value is higher today and it is lower next week. What is the next treatment we have to do? Where do we have to travel to around the world to get the most state-of-the-art therapy?”
[05:20] That can create a lot of emotions. A lot of fear. A lot of uncertainty. It is interesting to note that when we feel stress acutely, there is a certainly a response in our immune system where we start releasing different cytokines which are sort of chemical messengers that have broad spanning influence on our immune system. If we look a little bit deeper, we notice that if we practice holistic care, I mean this in a very holism type of picture, then we need to understand that when we feel stress, when we feel worry or fear there is an endocrinological response, a hormone response, that takes place. Not just specifically from a medicine point. There is also an effect that takes place in our nervous system. Our whole body is tied together. We are like a spider’s web and all of the different anchors make us who we are. So, when we feel stress our nervous system goes through changes, our hormone system goes through changes and absolutely as a response you are going to have changes in your immune system as well that reflect that.
[06:32] Cassy Price: That makes sense. We hear all the time that stress has been tied to so many conditions. So, obviously people who already have those conditions adding stress into the mix is likely not a positive thing.
[06:45] Dr. Rigo Kefferputz: No. It becomes like a snowball effect. It starts compounding itself over and over. You know when you go down the rabbit hole and you don’t feel any better for it.
[06:57] Cassy Price: Yeah. True enough. So, what is the study of psychoneuroimmunology then and what are the aims of that field?
[07:06] Dr. Rigo Kefferputz: So, psychoneuroimmunology tries to tie together our genetics, our central nervous system, our endocrine system and our immune system. At the end of the day, it spans a wide array of different organ functions to make sense on how these different systems relate to each other and influence each other because we are recognising now that there is a little bit of mirroring that takes place, a little bit of interaction from both spectrums and that these are highly placid. That means they are dynamic. They can change. Toss out the window the old belief that you are seven stone, you are born with the genetics that you have and that’s that, you can’t change it. Then we have some really outdated ways of thinking. Back in the day when we thought that if such and such a person had this condition that means that all their children were going to have it.
[08:02] That mental health disorders were going to be acutely tied to the next of kin with no mention of epigenetics, with no mention of the environments, right? We have that common saying that the genetics are the gun, but the environment is the trigger, it is what pulls it. With psychoneuroimmunology, it even extends to psychoneuroendoimmunology, it ties all of those together. When you start assimilating all of these target organs and all of these different bio markers that is very difficult for a researcher to really control the different variables that are at play especially as it relates to human emotions which is so difficult to pinpoint, right? We can all see the same thing but respond extremely differently.
[09:03] Cassy Price: Yeah, for sure. Actually, back in February we were talking about mental health and how two twins and one could have a mental health condition and the other could be fine and it is partially how we take in our environment, right? So, one thing that I was thinking about there while you were explaining this field is toxic element exposure, it depends on which elements obviously, but it can result in certain mental health conditions and it is obviously taxing on your immune system. Are there other environmental factors like that that we already know for sure tie into both and can help this field advance?
[09:50] Dr. Rigo Kefferputz: That is a really good point. Ill give you one example. There is a study that noticed that there has been an age independent secular peak line in testosterone over the last 30 years. So, what does that mean? That means that men of the same age, whether they are in their 30s, 40s, 50s and 60s are noticing a drop in their testosterone levels every 10 years. This means that the men nowadays have lower testosterone levels than the men back then had. You ask yourself, what could be the influence of that? What is the factor? Is it environmental influences like what we eat or consume? Most definitely. What we breathe in? Perhaps. What we expose ourselves to in terms of our skin which is a sponge which absorbs everything? Most certainly.
[10:39] For example, one big environmental influencer would be plastics, xenoestrogens, BPA, faux folates, all the things that create the fake oestrogens in our bodies that have a huge downstream impact on the rest of our hormone production. Those hormones are very important for our health and wellbeing. We want to tie in together our hormones and our immunity, for example, then we know that progesterone, for example, is a highly calming antianxiety hormone. It is very important. It has many different biological and physiological aspects as does testosterone. We are noticing now, finally after decades, that there is a condition known as andropause where men similar to females experience a drop in their testosterone levels. We know that testosterone is acutely linked to moods. We know that it can be linked to depression. If you are experiencing lower hormone levels which are as a result creating a drop in your emotions, as in depression or anxiety or a lack of self-confidence, then certainly that will have impact on your immunity as well.
[11:59] Cassy Price: So, for the depression angle actually Seasonal Affective Disorder affects a lot of Canadians, right? We know it’s because we get less sun during our winter months, but I was wondering what else about those cold winter months trigger SAD and does that have any similar type effects that we see in other depressive conditions or other mental health conditions that would tie into the immune system?
[12:25] Dr. Rigo Kefferputz: I will give you right now some clinical feedback. Just this season alone I measured about 30 people’s Vitamin D levels. Not everyone wants to do it because sometimes people say “What if they are low, I’ll just take Vitamin D anyway so I’ll increase it.” Out of the 30 people, 29 people had low Vitamin D levels. Out of those 29 people I would say about 24 of them were taking Vitamin D. 24 of those, I would say half were taking three to four times the recommended daily intake which is usually one thousand or three hundred IUs of Vitamin D. That gives you a real impression of how the latitude of the world and where we live has a huge impact on our sunshine exposure. People forget that we in North America, specifically Canada, we are way North of the equator. We have much less sunshine exposure.
[13:31] Sunshine exposure helps us synthesise Vitamin D on our surface. Vitamin D we call it a vitamin but essentially it is a steroid. It is a hormone. There is a massive amount of research and data, current data even, that ties together the importance of Vitamin D and depression, Vitamin D and mood disorder, Vitamin D and immunity. Even with the recent Covid-19 outbreak there is already studies talking about lowered rates of mortality in countries or cities or areas that are below 25 degrees north of the latitude. We are noticing that Seasonal Affective Disorder, just to clarify in terms of its diagnosis, means that you have felt a drop in your emotions that you feel for example depression during particular seasons such as winter for at least two years. If you were counting ten years of your experience of that that you at least experienced more seasons of depression than not. I would say that most of us do experience Seasonal Affective Disorder in some way, level, shape or form. It is scientifically because of a drop in serotonin levels and an overproduction in melatonin.
[15:09] Cassy Price: Which is interesting too because some people they don’t always feel that they can sleep when they are depressed, right? Some people go to the extreme where they feel the need to sleep more but there is also some on the depressive spectrum that kind of go the other way and they sleep less. So, if its due to that over production of melatonin that is an interesting connection there that I assume there is probably other factors at play as to why they are not wanting to sleep more.
[15:39] Dr. Rigo Kefferputz: I find that depression and anxiety are intimately tied together. They are like two sides of a coin. One can lean in toward the other.
[15:53] Cassy Price: That makes sense. A lot of our emotions are closely tied. It is a fine line between excited and anxious, right? Between sad and angry for some people. Emotions are such a complex thing. The Vitamin D thing too, I think a lot of people forget here in Canada that between the months of, I think it’s October and March, the sun is at such an angle that even if you do get outside a lot you can’t process Vitamin D from the rays that you are getting. Even though you might be getting outdoors and doing outdoor activities you are still not getting those Vitamin D levels that you think you would get from the sun in the summer or even a more southern location.
[16:36] Dr. Rigo Kefferputz: You are absolutely right about that. There is actually a research study that measured that. I forget what it was. I think it was in Ontario or so. They noticed that people weren’t synthesising the Vitamin D even if they were outdoors. This is even more so for someone who for example is of African descent. Someone who is black and has more melanin because people that have darker skin tones have more of a resistance to absorbing sunlight as well. That is something to be tied together as well.
[17:12] Cassy Price: Then also for Seasonal Affective Disorder, it seems to come hand in hand with flu season too. Is there something about the cold months or Vitamin D that triggers these phenomena coming at the same seasons or is it just a timing coincidence?
[17:31] Dr. Rigo Kefferputz: That’s tough. There is no research out there that has actually acutely linked those two together. Taking a look at what we know from a Vitamin D standpoint and immunity or from our nervous system or moods and emotion and how they are tied into immunity, I do think that those really link together. It has always interested me that if we take a look at it and the historical context it is interesting to note that during the darker months, we as a society and culturally and even religiously in different religions have much more events take place during these dark winter months. Whether that is Sinterklaas in the Netherlands or Christmas or easter or Hanukkah, whatever it may be. Even if we think about Halloween there is all these things about people wanting to come together and celebrate and bring joy. I think from an ethnohistorical context I think it is very interesting and it might be tied together as well. We know we feel depressed during these months so that is why we create these events to help support us, even from a long historical context.
[18:59] Cassy Price: That is actually a super fascinating idea. It makes sense. Especially back in the day when they didn’t have science to explain why people would do certain things it makes sense that they would try and lighten the mood with these celebrations or community activities.
[19:18] Dr. Rigo Kefferputz: Yeah. I think even in British Columbia in February they created, because we didn’t have a ‘holiday’ we created, and because February had the highest rate of suicides annually, they created Family Day. A day off for everyone to spent time together with their families. I would say that trend even continues currently.
[19:45] Cassy Price: So, how does the connection with other people influence our immune system then? I know a lot of these blue zone areas; a lot of studies have shown that obviously community and connections to other people have a positive effect on our health. I assume that would also be emotional and immunological health.
[20:10] Dr. Rigo Kefferputz: Yeah, I would say so. We as humans are social creatures. We thrive on connection and there are studies out there that showcase that there is nothing worse than isolation. I think, I could almost say that we have had the largest sample size last year when Covid-19 happened, and you had a pandemic and we recognised how much social isolation and alienation influenced our mental wellbeing. Each one of us can attest to that. We also noticed the rates of certain substance use went up. Coping mechanisms went up. People are striving to find new ways and you are getting these Zoom style gatherings because people want to continue to keep that sort of community in their life. I think it definitely ties together and of course these positive impacts have an impact on our immune system.
[21:10] Then I would say there is also certainly an immunity component, more so physiologically or biochemically that is involved in being in a community of people. Our immune system thrives on experiences novelties and new things. Being in a community, I think our immune system definitely gets exposed to a variety of different, whether it is, pathogens or antigens that can train it just like a young born child is exposed to a variety of different things early on that test and trial the immune system to grow into adulthood let’s say.
[21:54] Cassy Price: Yeah, for sure. I think that is possibly something that we maybe haven’t even seen the full effects of yet from the pandemic. Like you were saying, we have seen some of the things from the social aspect, but people are still very much protecting their immune system and it makes sense as to why but down the road I wonder if that will have an impact on especially younger children. Children born during the pandemic or early toddler age when they haven’t had years of exposure already to build up that immune system.
[22:27] Dr. Rigo Kefferputz: Most definitely. It is interesting. Just going back to a question, you asked me about how the immune system and our moods are tied together. Have you ever heard of the sickness syndrome or the sickness behaviour?
[22:41] Cassy Price: No.
[22:43] Dr. Rigo Kefferputz: So, have you ever noticed Cassy that when you have a flu, you might not be at your social best? You might withdraw a little more and you might feel fatigued and tired and you might even feel a little depressed.
[22:58] Cassy Price: Yeah absolutely.
[22:59] Dr. Rigo Kefferputz: That is because when we have flu and when we have mounted an immunological response the body releases, again, these cytokinesisand they trigger our nervous system specifically across the sympathetic nervous system tract as well as of course our hypothalamic pituitary adrenal access and this can have a downstream or an upstream impact in terms of how we feel. Sometimes it is interesting to note that when a person feels ill you wonder to yourself “what came first the chicken or the egg? Is this person feeling sad because something happened to them circumstantially in their environment and therefore, they feel down or is it perhaps they are dealing with some sort of infection, dormant infection deficiency, and thereby there is more of an upstream impact that is causing them to feel like that.”
[24:00] We have noticed in research that inflammation is acutely tied to our immune system and we recognise that when people have higher levels of CRP which stands for C-Reactive Protein, a common marker of inflammation, that there is also a greater likelihood or an association to depression. It becomes again this double-sided coin of wondering what caused what and where did it start and what is the outcome and at the same time it makes it very difficult sometimes to pinpoint it because again it is in the eye of the beholder. The person who perceives the stress or perceives the scenario. This can even extend to post traumatic stress disorder. We recognise that people who experience PTSD have higher levels of CRP and struggle with their emotional faculties and experience re-traumatisation as well as some of the social outcomes of that like alienation or isolation. The list goes on.
[25:11] Cassy Price: So, then if you are diagnosing someone or working with someone who has received a mental health diagnosis do you do specific lab work as well to identify maybe some of these physical route causes that tie into those emotional effects?
[25:25] Dr. Rigo Kefferputz: Yeah. I definitely look at those. It wouldn’t always be my first instinct to go to because while it is sometimes great to get some objective markers, at the end of the day that is just one marker. It is just one thing that says, “could this be? Perhaps. Maybe not. Maybe it is actually something physiologically that is happening in your body.” I’m also a really big proponent of us dealing with ourselves or things and how we feel in our emotions and if we carry any regret or fear or worries or trauma from our past when we were children. A lot of that stuff carries forward. In one way it is a lot easier as a human being to want to take it, not just from a clinical but from a patient standpoint, to want to take a look at these objective markers and build some sort of attachment to it.
[26:19] For example, thinking to yourself “My markers look better and therefore I will feel better.” For some people that might be very true but sometimes, clinicians know this all too well, you have to throw all the biomarkers out the window because sometimes you have test that tell a person they are great and fine and the person across the room will look you blank in the face and straight in the eyes and tell you “But I don’t feel good. I don’t feel fine. I feel unwell.” That is where sometimes deeper digging is involved. Yes, my answer is nebulous. It’s a bit elusive but it is the truth. There is a two-sided thing that you have to address.
[27:03] Cassy Price: I think that is something that those of us who have been in the holistic health or naturopathic health area for a while have seen. Those situations where people, especially if they have gone down the conventional route and they come back with normal levels in all of their lab work and basically the conventional system has told them they are not diseased yet so they are fine, but that is where that idea of optimal health comes in as well, right? It is like yeah, those intrinsic numbers say one thing, but you know how you feel especially if you are tuned into you body.
[27:36] You can tell when you are not your 100%, right? I think too for some people if their norm has been that subpar, they might not actually know what feeling good feels like because it has been so long since they’ve felt good which is maybe partially why that placebo effect can happen as well. I don’t know. I’m obviously speculating here because each case is unique in their own situation. I can see how both sides of that coin can be beneficial. It depends on the person too, right? Some people are more spiritual than others. Some are more of that scientific mindset and want to have those markers or that map laid out for them, right? They believe that if they get to the end of that map things will be better. Maybe it will, maybe it won’t depending on that person.
[28:30] Dr. Rigo Kefferputz: I think you hit the nail on the head with that. It is one thing I regularly 100% do. My first visit with patients is to figure out what I call their modus operando. How do you operate? Are you the type of individual that needs these tests to validate something to help you be compliant with whatever our treatment plan is? Do you have faith and can draw from the knowledge that I am sharing with you to make some well-informed decisions and trust me along this process? So, it is really important. You are right, every person is different. Some people are very analytical. Some people really want to talk things through and have an emotional perspective. Giving what you said about the conventional healthcare system I think there is an inherent Achilles Heel there and that is especially true in the public health sector, as in with Canada, because we have a publicly funded healthcare system, we need to recognise that when we do certain blood tests that there is a bell curve.
[29:43] This bell curve takes in together thousands and thousands and thousands and thousands of individuals with no cause or concern for what their emotional changes are or what their upbringing is or what trauma they have experienced or perhaps what some of their biological parameters might be different about them. We make this generalised curve about it where we put these two markers down and we say, “If you are below this you have disease and if you are above this you also have disease.” That is where pathology begins. The reason these curves are so large is because if you really wanted to personalise a patients health profile, you really wanted to be like “Yes, you know what this is where you are okay, but we really want to see you at your best.” If we wanted to do that, we would have to take that bell curve and shrink it down to like half its size.
[30:39] If you do that and you shrink it down half it’s size that means that probably two times as many or five times as many or 10 times as many individuals will fall outside of that curve which then means that 10 times more doctors visits, 10 times more referrals, 10 times more hospital admittances and I guarantee you that in three months the whole healthcare system would come crashing down. That is that gift and the curse of a publicly funded healthcare system. So, there has to be room for some patients to understand that this is the best-case scenario that we have right now and it takes off a lot of the financial troubles for patients but it is not perfect and you can’t blame it for that.
[31:33] Cassy Price: Yeah, I think too people need to realise that it is impossible for one person to know everything. As much as you want to be able to rely on and trust your family physician or your doctor, they are also human too, right? They can’t spend all their time learning all the new evolving facts of science because that is changing minute by minute as it is such a dynamic industry and keep up with their patients. There has to be some give and take there as well that obviously we are moving in the right direction as well because patients are becoming more educated and knowledgeable and being an advocate for their own situation which I think is great. It is not necessarily being dictated so much anymore as it maybe once was and now there is more of that relationship between the patient and their entire healthcare team because I think that is the other thing they have lot of different types of practitioners out there that all specialise in different areas and by having a team working with you, you can actually address far more than having that one professional that has their own limitations as we all do.
[32:44] Dr. Rigo Kefferputz: Yeah, especially as it comes to specialties. You expect the specialist to be the expert in this particular field but when we try to apply something like psychoneuroendoimmunology, well then you got to bring four different specialists into the field. You might have to bring a psychiatrist, you will have to bring a neurologist, you will have to bring a endocrinologist and an immunologist and probably it still wouldn’t be enough. You are right, you want to bring a healthcare team together to take a look at the different sides of the patient and the different parameters. The way I like to approach a patient’s care is like a game of chess. The reason I call it that is that you can’t win a game of chess with a single piece. It doesn’t matter if it is the queen or not. You have to build a strategy where you have different parts that play a role in a patient’s wellness. Sometimes there may be sacrifices involved in order to create a better position for the patient. Other times you might move several pieces to have the same end result. That is the beauty of naturopathic medicine.
[33:51] I find that because we have such a large toolbox you know it is like all roads lead to Rome. There are many ways in which we can approach something, and it becomes then a question on; is the patient onboard with some of these modalities? There are certain modalities that I can understand a patient might say “I am afraid of needles so any acupuncture or IV therapies are out” or “I don’t believe in homeopathy” so we take energetic medicine out or “I think the pharmacy is the devil” so that we might take out. Still there is so much more room for different therapies that are available. One thing that I wanted to mention just going back to personalities and understanding who the patient is that is in front of you. You know there has been research done over the last20 or 30 or 40 years that talks about the big five personalities and how they tie in together with our immune parameters. The big five for anyone who might forget is a short acronym called OCEAN.
[34:51] The first one is openness so being in touch with your feelings and your actions and your ideas. Conscientiousness, so confidence, self-discipline, thoughtfulness and being goal driven. Extrovertist, so are you sociable? Are you assertive? What is your emotional expression like? Agreeableness. What is your level of cooperativity? Are you trustworthy? Are you good natured? The last one is Neuroticism, but it is also emotional stability as in like, do you tend toward unstable emotions and anxiety and depression or are you more evenly tempered? It is interesting to note that over all those decades of research, especially in regard to that big five and our immune system, over and over and over again they reveal that conscientiousness was associated with lowered inflammatory markers. So, is that a causality? Maybe. Probably not. It is definitely an association where we can say that if you are conscientious you have lower levels of CRP which is the marker that that measure, C-Reactive Protein again, and that is really interesting but again research like that can be easily flawed because who decides that you are conscientious?
[36:11] Half of the studies are that your teacher decided on that. Well, how well does your teacher know you? Or your parents decided on that or you yourself gave yourself a scale rating of what conscientious means. The thing is a lot of these emotions and these personality types they overlap. They totally do. Whether it is extraversion and openness or conscientiousness and agreeableness. Being hard disciplined and goal oriented is also like saying “He’s a good lad. He does what he is supposed to do, and he checks in on his grandmother and he does his homework.” We have all these different perceptions of what a good-natured working person is. I think that has even changed culturally. I think it has even changed through generations. There are things I hear my parents, or my grandparents say that I don’t agree with or that I would never think of.
[37:14] We have these different chasms of what was important back in the day and what is important now. What does hardworking mean nowadays? To be honest too often to I talk to people that feel like if you are getting eight hours of sleep you are lazy, you should do more work, right? It’s becoming this world of fast, quick, fast-working pace that we are going. What does conscientious really mean and how does that fall into? For me is it interesting? Yes. Can we speculate on it? Most certainly. Why not? Again, I feel there is always going to be this Achilles Heel on how can we really truly test for it? Is it valid and important? I think so because we feel emotions every day, and they have a huge impact on our mental wellbeing, and I believe it impacts on our physiological wellbeing and wouldn’t that be worthwhile looking deeper into?
[38:16] Cassy Price: Yeah, this is a fascinating topic and field of study and I can see how it is very challenging for those who are researching it. Like you said, there is a lot of bias even when you are trying to create controls. You can’t really tell someone how they are feeling, right? You have to allow for some self-reporting which takes away some of that control and the ability to compare because when I think I feel sad might not be how you think you feel sad, right? We might rate ourselves the same sadness, but one is exhibiting more symptoms of depression than the other or all of those kinds of pieces. I do think it is a very interesting field and one that has a lot of potential for opening new avenues of medicine and treatment and ability for people to improve and optimise their wellbeing.
[39:15] Dr. Rigo Kefferputz: Yeah. I don’t think there is any downside to doing that and digging deeper as to who we are and how we are and how we can feel our best.
[39:26] Cassy Price: So, if our listeners wanted to work with you and get a hold of you, how could they go about doing that?
[39:31] Dr. Rigo Kefferputz: I would say probably the easiest way is just to go on my website drkefferputz.com. You can find me on Instagram as well. Honestly, I find sometimes a picture, or a video, speaks a thousand words so find me on my YouTube channel. I only have one video on there, but I think it really gives a good perspective on who I am and how I am because to me there is nothing more enjoyable than working together with people that I enjoy and love working together with. I have learned that over the years that you’re for some people and not for others and that is a good thing.
[40:11] Cassy Price: Awesome. Thank you so much for taking the time to chat with me today. That has been an absolutely enlightening conversation and I have really enjoyed conversing with you.
[40:20] Dr. Rigo Kefferputz: I appreciate it. Likewise. Thanks for having me.
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