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On episode 335 of the 40+ Fitness podcast, we meet Dr. Neil Baum and discuss his book, How’s It Hanging?: Expert Answers to the Questions Men Don’t Always Ask.
Allan (0:49): Our guest today is a professor of Clinical Urology at Tulane Medical School. He has written several books and many long-running columns for American Medical News and Urology Times, and more than 250 peer-reviewed articles on various urologic topics. He is Dr. Neil Baum. Dr. Baum, welcome to 40+ Fitness.
Dr. Baum (1:11): Good morning, Allan. Thank you for the invitation. I look forward to our discussion.
Allan (1:17): Absolutely. Now the book that you have here – I have a copy of it; I really enjoyed it – is called How’s It Hanging?, which is an apropos title. We’re going to talk a lot about men’s health, but I want to be clear because I do this when I talk about women in menopause and I’ve had a few experts on that. We’re talking about men’s health, but for anyone who has a man in their life, this is an episode worth listening to, because you’re going to learn a little bit and it’ll help you have the right conversations with him so he knows what’s going on. I just want to put that out there first because I think a lot of people will hear this is a men’s topic and think they can tune out. And the reality is, our health and the health of the people around us is really, really important, and this book can be a great resource for the men in your lives, if you don’t happen to be a man. Before we get into it, as I got into the book, one of the things that was really good about it was how you very carefully went through. Some of this is really complex medical information, but you’ve taken it down to, “Let’s just have a conversation, guys. Here are what the basics are.” Pretty scientific, pretty difficult, and really kind of dumb it down for the rest of us, for a lack of a better word.
Dr. Baum (2:25): That was very much intended, that I didn’t want to talk in medical language and be high-brow about it, but I wanted to make it something that everyone could understand, and then take that information, digest it and become more knowledgeable when they go and speak to their physician, so the patient, or the man, and the doctor are on the same page. That was what was intended.
Allan (2:55): I think that’s so important because it used to be a situation where the doctor said, “This is what you should do.” I think the medical practice is that people now are being given decisions, opportunities to choose different paths of how we deal with different medical things. Having a basis of understanding where you can go in and have that conversation with your doctor is really, really important because the doctor won’t necessarily tell you, “This is the treatment you’re going to do.” In many cases, they’re going to give you these different treatments with all the pros and cons, and then you personally have to make the decision that’s right for you.
Dr. Baum (3:38): This has been the shift in thinking in the last four decades of health care. In the past, the doctor had all the knowledge and the patient was at the mercy of the doctor to tell him or her what advice or what they needed to do. In 2018 any patient has as much information as the doctor has. Consequently, the patient can be in the driver’s seat and it can be shared decision making. I think that’s a much better way to have a doctor-patient relationship, when they’re a team working together to help the man or the woman achieve optimal health.
Allan (4:27): That’s why this book is so valuable, because this is going to give you the information so that you can be a valuable team member in your own decisions, so you’re not just going at this saying, “Okay, the doctor says this.” This book will actually give you an understanding of why the doctor’s saying what they’re saying, and as things continue to advance, this is a good primer for you to basically be in the driver’s seat as you’re going through making those decisions. I wanted to shift the conversation, because as you go through the book, you talk about various things that men may or can deal with, particularly as we’re getting older. One of those that I think strikes home for a lot of people is the prostate cancer. Can you tell us a little bit about what’s going on with prostate cancer, why it could be a big problem for us, and what we can do to know whether we have a problem or not?
Dr. Baum (5:14): Can I begin by telling the audience what is the prostate gland? Is that okay to start?
Allan (5:19): Sure, absolutely.
Dr. Baum (5:21): The prostate gland is unique to men; we’re the only ones that have it. It’s a small, walnut-size organ. It’s located at the base of the bladder and it surrounds the tube called the urethra that goes through the man’s penis. It is that gland that secretes fluid that nourishes sperm when a man is in his reproductive years. So, when a man is younger, it’s a gland of enjoyment and pleasure. However, as men age, for reasons not entirely known, the prostate gland grows. And when it grows, it compresses that tube, the urethra, making urination difficult. Most of the time when that prostate gland grows and compresses that tube, it’s benign and it can be treated usually with medication. However, for reasons not entirely known, sometimes the gland grows and develops a malignancy in the prostate gland that can spread locally to other organs in the pelvis, and it can spread to distant sites like bones and liver. These are examples of what we call “spreading” or “metastasis”. 250,000 men every year develop prostate cancer. That’s new cases every year. It usually begins around age 50 to 55, and then it gets more common as men age. By the time a man is 80, most men will have prostate cancer. However, in an older man it is usually not a major problem, and most men die with prostate cancer, not from it. However, if it develops in a younger man, 50-55, in his middle age, then it can be very problematic, and then it requires aggressive treatment. We’re not going to talk about treatment today, but I want to point out that about 35,000 men every year die from prostate cancer. Most of those deaths don’t need to occur, because if a man gets a diagnosis early, when the disease is confined to the prostate gland and it’s slow-growing, it can be cured. Have I explained everything so far?
Allan (8:25): Yeah. One of the interesting things that I got out of the book was, this is not something where you’re going to have really any outward symptoms that you have a cancer. Some cancers, you can kind of sense that there’s a problem early on, but this is one that it can get all the way to the point where it’s spreading and you may not even know that you have a problem.
Dr. Baum (8:47): If there’s one thing I want to leave this program with, it’s that comment – that early prostate cancer has NO symptoms. It does not affect the urethra, it does not affect urination. It may have no symptoms, and that’s why men over the age of 50 need to talk to their doctor about getting screened for prostate cancer. That requires an annual blood test called PSA – Prostate-Specific Antigen. That’s a very simple blood test; the result is available in 24-48 hours. And they have to have a digital rectal exam, and that’s where the doctor inserts his finger into the rectum and feels the prostate gland because it sits right on top of the rectum. Now, what’s the doctor looking for? If I can ask you, Allan, and the audience – if you make a fist and you feel the soft part at the base of your thumb, that’s what the prostate gland normally feels like – kind of rubbery, movable, and soft. Move your finger to the top of the knuckle. Have you done that, Allan? I’m kind of watching you.
Allan (10:20): Yes. I’m here, I’m doing it.
Dr. Baum (10:23): Alright. If it feels like the top of the knuckle – that’s a nodule, and that’s suspicious and it needs to be evaluated. Now, there are certain men who are at a higher risk of prostate cancer. Those are African-American men, and any man who has a brother, uncle, cousin, father – a blood relative who has prostate cancer. Those men are at risk for prostate cancer, and they need to start being tested with that blood test and the digital rectal examination around age 40 to 45. If it is a man with no family history, not African-American, he can begin testing at age 50. And then I recommend at age 70 they stop getting tested. If you have prostate cancer at age 70-75, it’s a very slow-growing cancer, it’s not going to cause a significant problem, and it does not require treatment. But every man should have a discussion, have this communication with his doctor and decide should he agree to a screening or testing program, because if you wait until there are symptoms, like you said a few minutes ago – those cases where it produces symptoms, it’s going to be too late. Then it has spread to other organs in the pelvis, to the bladder, blocked the kidney and spread to bones and to the liver. Don’t wait for prostate cancer to develop symptoms before starting to proceed on a screening or treatment program.
Allan (12:34): I think “cancer” is one of those words for a lot of people, I know for myself, it’s just a scary word, because it seems like your body is going haywire and there are things that you can or can’t do about it, but there’s not a good cancer out there. But sometimes we go out and get these screens, and I understand we can get a positive PSA. That doesn’t mean we have cancer. It’s a marker that we then need to do additional diagnosis on, so I don’t want a person to go out and get their PSA tested, have an elevated PSA and freak out, because two things: One, you said it’s very slow-growing, and there are treatment options.
Dr. Baum (13:09): And also the majority of mild elevation of PSA in men is usually, most frequently not due to prostate cancer. It’s due to inflammation of the prostate, infection called “prostatitis” – easily treated with antibiotics, or it is due to that growth of the prostate gland that most men have after the age of 50. So it is really the trend of the PSA. The normal range is 0 to 4. If you have a PSA that is 3, that’s not alarming. The next year the prostate gland grows a little bit; it’s a little larger and the PSA is 3.5 – really not that alarming. Then if all of a sudden, four or five years later, the PSA is 6 or 7 – that becomes an issue. It’s the trend in the PSA. That’s why it’s good to get a baseline PSA. There are men I see who have a PSA less than 1.0. I don’t want to bog us down in numbers in this program, but they have a normal examination of a PSA less than 1. They can come back every two to three years for a test, if the PSA is that low. But if the PSA is in the 3 to 4 range, they probably ought to come back annually.
Allan (14:43): Okay. Now, another cancer that I think scares a lot of men, because now we’re getting close to home, is testicular cancer. Can you go through the same exercise we just did with prostate cancer, talk about what this is, how we would potentially know that we have it?
Dr. Baum (15:00): The testicle is the organ that is located in the scrotum; there’s one on each side. Most men have two testicles, and the testicles have two functions. One – production of sperm, which is necessary to fertilize an egg and start the reproductive cycle. And the second is, the testicle is responsible for the male hormone, the testosterone, that is responsible for muscle mass, it’s responsible for libido or sex drive, it is helpful for erections, bone mass, wellbeing, controlling the red blood cell production from bones. It is a very important hormone that begins when a boy is in adolescence. Around the age of 12 to 14 a young boy develops pubic hair, hair underneath his arms, and by 16 he starts to grow a beard. That’s all due to testosterone; that’s the male hormone. The counterpart in a woman is called estrogen, and in a man it is testosterone. The testosterone unfortunately peaks around age 22 to 25. Around age 25, the testosterone slightly decreases about one percent a year. So a 25-year-old man, very sexually active and functional, and has good muscle mass – he’s not going to notice that one percent change at age 26. He won’t notice it at age 30. But by the time he reaches age 50 to 55 and his testosterone has gone down 10 to 15 percent, he may become symptomatic.
The symptoms of low testosterone are decrease in libido, a lethargy or a lack of energy, the erections are not as good or as strong as they were when the testosterone was normal. They may notice a decrease in muscle mass and strength. One of the common symptoms that’s often overlooked as a cause of low testosterone is falling asleep after meals. A man usually will report that he just runs out of gas at 4:00 or 5:00 in the afternoon. He has his dinner meal, and then he’s sitting in a chair watching TV and falls asleep. Often times that symptom is due to low testosterone. Also, I want to point out that testosterone increases the risk of obesity, it increases the risk of diabetes, and it also increases the risk of depression. This is a condition that is very common after the age of 50 to 55 in almost all men, because the normal aging process results in a decrease in testosterone one percent a year. It becomes symptomatic at age 50 to 55. That’s a beginning introduction, and let me turn it back to you and see what questions you have, and then I’ll go on and talk about the treatment, Allan.
Allan (18:50): Okay. Obviously we need our testis to make sure that we’re keeping the tee that our body can produce. And then here we are faced with the potential that we could get cancer. How are we going to recognize that we have a cancer, that we may have a problem there, so that we can know that we need to have a conversation? I’ll go to my doctor and they’ll ask me basic health questions about how I feel, but they’ve never specifically tested me to say, “You might have this problem.” So, I want to take it upon myself to understand what I need to do to, not self-diagnose, but to recognize there’s a problem.
Dr. Baum (19:28): I want to answer that question, and I want to backtrack, because I do want to talk about testicular cancer, but those are two entirely different conditions, because one part of the testicle makes sperm; another part of the testicle – different cells – make testosterone. So let’s talk about the two different conditions. What you have to do regarding testosterone – you say, “I’m in my early 50s and just not feeling quite as peppy as I used to. I’m having difficulty holding my erection. My interest in sexual intimacy has diminished.” You say to your doctor, “Would you please order a testosterone level on me?” I would request it for a middle age man who has symptoms. Now, if you don’t have any symptoms, you don’t screen for testosterone deficiency. If a man is sexually active, strong, energetic, no problem with the muscle mass or energy, not irritable or depressed – you don’t need to get a testosterone. It’s fine; that’s not a problem. But if you’re starting to feel the symptoms of decreased energy and decreased sex drive, falling asleep after meals – you need to ask the doctor for a testosterone level.
Shift gears now for a second. Let’s talk about testicle cancer. Testicle cancer is the most common cancer in men between the ages of 20 and 40. Again, like prostate cancer, early testicle cancer has no symptoms. Now, here’s the suggestion that I hope men get from this webinar. I want to mention again, there are no symptoms for early prostate cancer. There are no symptoms for early testicle cancer. Women are instructed every month, after their period, to do a breast self-examination. The health care profession is deficient in not instructing men between the ages of 20 and 40 to do a testicle self-exam every month. When they’re in the shower and the scrotum is relaxed, they need to feel their testicle and examine it. It feels very smooth and there are no lumps and bumps in the testicle. If they feel that nodule, like I showed you when you make a fist on the top of your knuckle – if you feel that in the testicle, you need to make an appointment with your doctor to get this examined. Often you will get a blood test and a testicle ultrasound examination, and that will make the diagnosis of testicle cancer.
When I began my career as a urologist in the 1970s, testicle cancer took the lives of a lot of young men. Today, the treatment is so effective that very few men will succumb or die to testicle cancer. But they must make the diagnosis, and it is the responsibility of the health care profession to explain to young men. Men in high school and young boys should get health classes and learn how to do a testicle self-exam. There is nothing wrong with men doing it. It is good. Women do it for breast self-exams; there’s a lot of publicity around this. It’s kind of amazing to me, Allan, that every October, the National Football League goes pink. You know what I’m talking about? The breast cancer awareness month. Are you aware of that?
Allan (23:55): Yeah, absolutely.
Dr. Baum (23:57): What happened to the National Football League telling men to check for prostate and testicle cancer? It just boggles my mind that the women, who are much more aggressive about the marketing and promoting of breast cancer awareness, got a boys’ game to put the pink on and get the word out. I think the month of September or November ought to be men’s health awareness month and talk about prostate and testicle cancer.
Allan (24:35): Before we get off that, there actually is a movement to do something exactly like that. It’s called Movember, and it’s an organization I participated in last year that basically you try to grow a mustache for the month of November. You donate money and you’re trying to raise money, so all of us are doing fundraising. We did it at our company; there was a big group of us that got together and we all grew a mustache. The basic thing is, someone is going to comment if you start growing a mustache out of nowhere. If you’ve never had one and you start to grow one, you actually start getting comments on it, and that’s the opportunity to have that initial conversation about men’s health issues that include these two cancers. So, it is happening.
Dr. Baum (25:19): That was a genius idea. I believe it started in Australia. I’m not sure. Does that sound familiar?
Allan (25:25): I’m not sure of the exact origins of it. I just know it was interesting around the office, because people were talking about men’s health issues like they never had before. It was a very interesting opportunity and I’m glad I went through it. I think it’s a growing movement and I hope it does continue to grow, because this is one of those big things. It kind of goes down to that whole point – women seem to be the caregivers in the home, and men want to be these macho tough guys. It’s how we were brought up – we’re here to take care of other people. The women tend to look on the health side. You wanted me to ask you the question why do men live shorter lives, why do women live longer than men? And I do think that’s a big part of it, that there’s much more awareness by women of their health issues.
Dr. Baum (26:08): Women start into the health care arena right after they graduate from high school and college, when they are in their reproductive years. They frequently see their obstetrician and gynecologist, and they are programmed into annual health by getting a pap smear and a mammogram at a very early age. Men, on the other hand, have a void. After they graduate high school, they will seldom see a physician until they’re in their mid-50s, and consequently they’re not programmed to take care of themselves. In the South we have a saying here, “If it ain’t broke, don’t fix it”, but men apply that not only to their cars and their fishing boats, but they apply it to their bodies. Unless they’re having a symptom, they don’t have to go in to see the doctor, so consequently they can go years with hypertension, diabetes, high cholesterol, because early on they don’t have any symptoms. So if it ain’t broke, they don’t fix it, and by the time they go in, when it becomes symptomatic and they have full-blown diabetes and they’re overweight and hypertensive and they have high cholesterol, they end up being on four to six medicines a day. The average man, after the age of 50 – middle age – is taking four to six pills a day. He wouldn’t have to do that if he went to see his physician early on, got his blood pressure checked, got his weight down, got an annual examination, and practiced good health habits. Men take on risky lifestyles – they smoke more than women, they consume more alcohol than women, most of the drug abusers are men more than women; and as a result, it’s impacting their longevity, and they die five to seven years earlier than women. I think the playing field is equal when we’re born. We all have two kidneys, one heart, one brain. And what happens, I think, women take much better care of themselves than men do. Men often take better care of their cars and their fishing boats and spend more time planning a vacation than they do taking care of their health. So programs like Movember are absolutely phenomenal in increasing awareness towards men’s health.
Allan (28:59): I agree. I don’t take that same mindset of, “Wait until it’s broke to fix it”, because I’ve seen how bad broke we can get before we actually recognize we have a problem. We hear a screech in our car and it’s in the shop the next day. We get a little sore here or there and we think, “I’ll just work this out and I’ll figure it out”, and then it becomes a bigger and bigger problem as it gets worse. You’re right, Movember is a very good movement, but I really believe that men and women should make a point of what I call “wellness visits”. The doctor is so used to seeing people that are already sick or already in bad shape and need a lot of help. If you make a practice of wellness visits – which I do anywhere between three to four a year, where I’ll go get a blood test and talk to my doctor about it, just to see if there’s anything out there that alarms him or that should alarm me – then we can have those conversations as a part of a wellness visit, not as a part of a care visit.
Dr. Baum (29:56): I would like to see the time come when the doctor would be paid to keep you well, and if you got sick, he didn’t get paid. I think we need to shift gears.
Allan (30:09): I don’t think you’re going to get a single doctor to sign on for that.
Dr. Baum (30:12): I know that’s unlikely to happen. That’s the pie in the sky.
Allan (30:18): That’s where the man, we have to step up and realize our importance in this health team. We have to be the instigator; we have to be the one that manages the situation and drives the car, so to speak, to say, “I am going to have these wellness visits because I want to know that I’m in good health. If my health habits are working, I should see my numbers trending better. And if it’s not working, then I need to maybe readjust and do something because I don’t want to be the guy on four to six medications per day. I’d rather not go through the expense of a surgery or having a foot cut off or whatnot because I have diabetes.” So, I make a point of the wellness visit and I think that’s what we should all do, as men and women, is step forward and say, “How do we become more empowered?” And that’s just by doing, by saying, “I’m going to get the blood tests, and then I’m going to make an appointment with my doctor and we’re going to talk about this.”
Dr. Baum (31:10): You made a good point when we started, right from the get go, when you said women should be listening to this program. And the reason is, even in my own household – I’m a physician – my wife takes responsibility upon herself for my health care. On my birthday every year, an appointment is made for me to go in and get screened and treated on a regular basic. In the Western world, but particularly in America, culturally, women are in charge of men’s health. Consequently it behooves women to be as responsible and as forthright, and maybe even read the book How’s It Hanging?, so they can be on the same language and the same page as the men, and get the men to the health care provider at a much earlier age. I think that’s really important. Our society seems to work that way, and I think women should take part of the responsibility. Ultimately it’s the man; we are in charge of ourselves. We have no excuse. But I think in our society, women control the health care of the children, and it is often that they become responsible for the health care of their spouses or their significant other.
Allan (32:41): And to make your job easier, let’s go in for those wellness visits and we’ll find these things like prostate cancer, testicular cancer early. And he’ll have the discussion with his doctor about fatigue levels, his energy levels, his libido. All those conversations that he would be having with his doctor are going to help him get the treatment so he stays well and he stays energetic and he stays the guy that you may have married 20 some odd years ago, because he’s taking care of his health and he’s keeping his body from aging faster than it needs to.
Dr. Baum (33:15): These men who take testosterone replacement therapy – their lives are like a light switch has been turned on. They just have been living in the dark, and are suffering in silence and not having the quality of life that they should have when it can be treated. I also want to point out about the abuse of testosterone. Let’s talk a little bit about that. Can we do that, Allan?
Allan (33:41): Yeah, absolutely.
Dr. Baum (33:43): For men who have everything, they’re firing on all cylinders – they don’t need a testosterone level, that’s not necessary for screening, and they should not take extra testosterone to make them extra strong or build more muscle mass. This is a dangerous thing to do, and to increase the testosterone beyond physiologic normal can have repercussions. The repercussions are that it tells the testicles you’ve got extra testosterone on board; the testicles will stop producing testosterone for people who are taking testosterone when they don’t need it, and the testicles shrink and they don’t come back. Consequently they’re stuck being on testosterone forever. That is something that should be avoided in normal men. The way to build up muscle mass is get into the gym, work out, lift weights, and not take creatinine and supplements and testosterone when you don’t need it.
Allan (34:58): Actually testosterone is one of those interesting hormones that if you’re in the gym lifting heavy weights, your body is naturally going to want to produce more. So there are things you can do in a natural sense. If you’re eating well and you’re exercising, and particularly lifting heavy things, you’re signaling to your body that you need more muscle mass, and your body will often respond by producing more testosterone.
Dr. Baum (35:20): Exactly. You can’t short circuit it or speed it up. It does happen when you do that, but at a risk. And the risk is that your testicles will stop making testosterone and you’ll be deficient forever. The second thing I want to point out is, testosterone is what fuels prostate cancer. So, if a man has a prostate cancer and he takes testosterone, he is going to fuel the prostate cancer and it’s absolutely contraindicated in men who are getting treatment for prostate cancer. So, before a man who is symptomatic, he has all the symptoms we’ve just discussed, he should have a testosterone level to show it’s low and a PSA to show it’s normal – then he can proceed with testosterone replacement therapy. No man should receive testosterone if they haven’t had a PSA and a digital rectal exam to make sure he doesn’t have prostate cancer. The extra testosterone or replacement therapy can accelerate the growth of prostate cancer.
Allan (36:39): I think the core of this, and the cool thing about this book is that you talk about a lot more than just what we went over today. You really go from one side to the other of men’s general health issues that we’re going to deal with, particularly as we age, and that awareness of what you should be looking for, what it means. And of course you get a little bit into what are some of the current things we can actually do about it. The book is How’s It Hanging? Dr. Baum, if someone wanted to get in touch with you, learn more about the book, where would you like for me to send them?
Allan (37:39): This is a book that I think every man should read, and most women should probably read as well, particularly if you are the head of health at your house. You should know about some of these issues, and this is a really good book to have available so you can help understand them and be a driver in your own health and fitness. Dr. Baum, thank you so much for being a part of 40+ Fitness podcast. I really appreciate you.
Dr. Baum (38:02): Thank you, Allan. I enjoyed chatting with you, and hope we’ve brought some light onto the topic of men’s health.
Allan (38:11): Absolutely.
I hope you enjoyed that conversation with Dr. Baum. Men, we do need to be more proactive in looking out for our own health. I know a lot of us like to let the women in our lives be the ones that nag at us to do those things, but really, we need to be doing that for ourselves. So I hope you got something valuable from today’s session, and if you did, would you please go out and give us a rating and review? You can do that through the app that you’re listening to this podcast on, or you can go to 40PlusFitnessPodcast.com/Review and leave a review today. I read each and every one of those and I really do appreciate hearing what you’re getting from the podcast, what you’re learning and how it’s changing and working for you. So please, go to 40PlusFitnessPodcast.com/Review, or leave a rating and review on your app of choice.
As you’re listening to this podcast, if you’re listening to it the first couple of days it’s come out, I’m either in Belize or I’m on my way back. You’ve probably wondered, I’ve talked about taking a couple of trips here and there. I guess I’ll go ahead and somewhat spill the beans. My wife and I are looking to further downsize, further down-stress our lives. It’s no secret that stress has been something top of mind for me for over the past year as I’ve looked at what it’s doing to my health and wellness and seeing it as my next big rock, the next big thing that I need to take care of to get my health and wellness exactly where I need it to be, because my stress level tends to be the one thing that really foils and stumbles up everything else. When I’ve got my stress under control, everything else seems to just fall in place, and that’s what I’m working on doing. So my wife and I may actually move outside the country to find a lower stress, lower cost, lower maintenance level; minimalize some things and get ourselves into a better place. And so, we are checking these places out. If you are living abroad, if you are an expat and you’ve tried different places, I’d love to hear from you, really. You can contact me – email@example.com, and I’d love to hear your stories, love to hear what kind of guidance you can give me on that, because we are looking to do this type of thing in the near future. I’ll still do the podcast, I’ll still work with clients. That is a big part of what makes me happy and where I find joy, so I’m not letting that leave my life just for the sake of living in a smaller, quieter, less stressful location. But I do want to do something like this and I will keep doing this podcast and I will keep doing the training, and God willing, I will get this book out.
As I talk about the book, I wanted to remind you, you can go to WellnessRoadmapBook.com to learn more about The Wellness Roadmap book. It’s due to come out at the end of November, but there are still a lot of things that need to happen between now and then to include getting a launch team together. And I’d really appreciate if you would join me on the launch team. You can go to WellnessRoadmapBook.com, and there on the bottom of that page you’ll find an opportunity where you can go ahead and give me your email address and your name. I am not going to use this email address for anything else other than to give you updates on the book and to ask for your help as a part of The Wellness Roadmap book launch team. So I hope you will go out there today – WellnessRoadmapBook.com. Thank you.