 Welcome to resiliency radio with Dr. Jill, your go to podcast for the most cutting edge insights and functional and integrative medicine. I'm Dr. Jill, your host and with each episode we delve into the heart of healing and personal transformation. Today, we're here to explore the frontiers of health and intricate workings of microbiology and today, especially we're going to talk about radiology and gadolinium and heavy metal toxicity. Now, if you'd like this video, be sure to hit the like icon, share it. If you're listening on Stitcher or Spotify or anywhere you listen to podcast, leave a review. It helps us to reach more people. So without further ado, let me introduce my guest today. Dr. Semelka has been one of the major forces in radiology for three decades. He has been a leading researcher and practitioner in MRI, has pioneered and is leading author worldwide on abdominal MRI, and is the radiologist with the broadest research and publication record for on safety in radiology, having authored major works on informed consent, overuse of imaging, risk of cancer from CT and X-rays, nephrogenic system fibrosis, gadolinium deposition in the brain on MRI, and most recently has pioneered in the medical literature on the subject of gadolinium deposition disease or GDD. Today, we're going to talk about that. So stay tuned. And he's presently the leading author on the subject. GDD is essentially a severe persistent disease secondary to the use of gadolinium based contrast agents and individuals who have normal kidney function. Dr. Semelka has written over 350 peer reviewed articles of radiology and 17 textbooks, including healthcare reform and radiology. He's been one of the most accomplished authors on safety, especially regarding medical radiation, patient information and overuse, as we mentioned. I am so, so delighted to be here with you as an expert and author on this topic that just doesn't get enough attention. So welcome, welcome to the show. Thank you for having me on your program. I'm delighted to be here. You are welcome. And this is such an area of interest because as I could tell in your writings in your paper, and you sent me one of the most recent papers, we'll be sure and link for anyone listening to some of Dr. Semelka's papers and research. So stay tuned wherever you're listening. They're watching this in the notes. You'll have access to all the information we're talking about. Before we dive into gadolinium and heavy metals and maybe the overuse and some of the practices, I would just like to hear a little bit about your story. How did you get into the practice of medicine? How did you choose radiology and tell me just a little bit about your journey into where you've been? Okay, I'll try to make it as quick as possible. I'm actually from Winnipeg, Canada, and both of my parents were physicians. So being medical doctor was the thing that was most apparent to me. Now, I'd originally intended to do plastic surgery when I was going into medicine, but it's a funny way to say this, but my mother was a radiologist. So I was familiar with radiology. And just at the time in medical school trying to decide what I would do with my career, new things like CT had come out and radiology was changing and getting exciting. So it was no longer reading plain x-rays or doing ultrasound. It just came out was CT was on the horizon and then MRI also came onto the horizon and that sort of convinced me to go into radiology. So I did my original training in radiology in Winnipeg, Canada. And then through the course of my training, I became intrigued with the new thing, the new imaging kid in town, which was MRI. And, you know, my, my chief professor who I worked with in Winnipeg said, you know what? I went to UCSF in California was a fabulous time. Why don't you go there? So I ended up going to UCSF for specialized training in MRI of the body. And from there, I went to Germany for six months to work with the research team of Siemens and MR. And then as a Canadian, I went back to Canada for two years. But, you know, the problem is that once you leave a place that's very cold, like once you've left Siberia, and you've gone to, you know, the Mediterranean, it's kind of difficult to still live in Siberia. And I hate to say that to all the Canadians out there, but I just, it was just too cold. And it's funny how, you know, you just need a brief experience like two years in San Francisco, and I was ruined for minus 30 degrees in February in the wintertime. So I came to Chapel Hill, North Carolina, and I've been here essentially since then for 24 years working at UNC as a director of MR services for all of that time, director of Vice Chair of Quality and Safety for part of that time, and Vice Chair of Research for part of that time. And now I'm basically doing some radiology, still focusing on body MR, but I've happened upon, you know, looking after people with gadolinium deposition disease. And I'll tell you, and I'll try to be brief about this as well. How that happened as a director of MR services at UNC. It turned out that a patient who actually has become one of my favorite people and, and I work with her. She and her husband came to my house on a Sunday during the day. And she said, you know, I had an MRI at your facility. And after that, I had a feeling of burning like my entire body was on fire for months. And nobody knew what it was. And I think it was a gadolinium that I received. And, and I listened to this, and I said to her, you've come to the right person. So, you know, then, you know, turns out, senior physician, female physician at UNC also then approached me, not too long after that and said that she also had this disease. And based on that, and the fact that was maybe at the time, the leading author worldwide on the value of gadolinium. I thought, well, who better to write on limitations than me. Now, some of it you could argue maybe it's a feeling of penance and that's maybe true. But I think one of the things that's characterized me in my career is that I really care about the welfare of people. I really put myself in their position, you know, so I can feel what it must be like to go in, get an MR study with gadolinium being told everything is safe. Not to worry, it's the safest thing. Your kidneys are fine. Don't worry about it. Everything will be wonderful. And then end up with a horrific set of feelings that you feel you're going to die. I appreciate how that would feel like. So I've taken this on as a cause, my cause. And, you know, the good news is that it's kind of easy to diagnose and if caught early, it's also quite readily treatable, looking at all sort of comparable diseases. And I don't know, Jill, if at this point you want me to continue and talk about the diagnosis of GDD or if you have a question you'd like to add in at this point. I just want to comment, first of all, yes, we're going to go to so if you're listening, stay tuned, we're going to talk about diagnosis and treatment. And this is we're literally talking with a world's expert. I am so honored to be here with you, Dr. Simulka, and I just want to say like, on a human to human level, I have such a deep respect already getting to know you and you've told me because what I hear is so often we go to medical school and then after medical school, we think we've learned everything we need to know, right. And then many doctors don't continue learning or being curious. And the first thing that I hear is you were curious about, well, what if what if there was some problem here. And I think way back to the times when they were delivering babies after doing autopsy and not washing their hands right and that started this sepsis and the maternal mortality rate was so high because they were taking this bacteria from the cadavers and then delivering babies. And it was literally doctors causing harm. And you and I took the Hippocratic oath and said first, do you know harm and so part of that I think is remaining curious to could there be some things whether it's a drug work prescribing or procedure we're doing and just remaining open. And I just loved hearing your story because what it shows is this deeply compassionate human being that you are and you were open because it could mean that takes a lot of humility because here you are that world's expert on gadolinium and then to say well what if there could also be some harm. And I want to just publicly honor you for that heart that you have because there are people on all kinds of procedures and things that we do that can have harm because it's the spectrum people right. So let's dive in with that but I just want to honor you publicly for your work and for your humility, your compassion, and your curiosity because it takes a huge heart to do that and to say well what if. So then you did have obviously with these two patients kind of start to question and say what if. So tell us then about how did you determine that there could be possible toxicity. And then we'll talk about like how do you diagnose it in a patient who's having symptoms. You know, the other thing that's kind of, you know, a lot of this also comes with some sadness on many levels sadness of the illness of the patients. But also sadness in the unwillingness of many physicians to see what should be very obvious. And the way I sort of like to think of it is that if you were an eight year old child. And somebody told you, hey, I just had imaging study and they injected some fluid in me. And right afterwards, I felt really very sick. What could it be do you think it's maybe the presentation of lupus suddenly, or ALS suddenly, or is it what you just got put into your body, you know, and to me it's kind of so obvious that that, you know, if you have developed suddenly symptoms that you didn't have before and it came right on after the gallium injection. Why wouldn't it be this. And then the next thing is to figure out, you know, the features of the disease. So one of the things that I think it's very important and maybe it's worth repeating to your audience, a couple of times. But the symptoms that are sort of classical. Another thing that you have to remember is that gallium goes everywhere in your body. Yes. And as we're learning from the COVID virus, where we thought well just a lung thing but we're learning is going everywhere all the tissues yet. And gallium is going everywhere. So the symptoms can involve everywhere because it's going everywhere. But the classic symptoms are. And again, I think because it's given intravenous. One of the more distinctive symptoms that makes it different than many of the, what I would call it part of the group of immune mediated inflammatory diseases. What makes it different, I think, is that the extreme burning that people can can experience. So for me the five classic symptoms are skin burning. A bone pain. And it's not like, you know, what is that pain? It's like a screwdriver being rammed into your bone. And what's distinctive are rib bone pains because, you know, a lot of people have knee pain and so on. And I was like, just the knee pain I have or is it from gadolinium. So any of the bones and joints can can get very painful. Then the other feature is brain fog. So many people and and I know Dr. Jill dealing with the range of diseases that you deal with brain fog is a feature of them as well. So you also know how how how individuals will tell you, you know, I can't remember anything or, you know, I entered in a room I have no idea why I'm in this room and all sorts of cognitive impairments beyond just forgetfulness but confusion. So the and then the other feature is pins and needles sensations that can be anywhere. And the pins and needles, again, is a symptom that's classic for small fiber nerve disease. And the other feature that I like to focus on is fisculations. So muscle twitching that could be anywhere. So those are sort of the five classic symptoms but then beyond that, you know, we could talk just about all the different symptoms but the other second grouping that's very common are people will describe a head pain that they don't call like a headache it's a head pain. And I think the best description of it is that it's like having a swimming cap put on your head, but what is three times too small. So it's like a constrictive pain. Then vision is quite common hearing is very common cardiac arrhythmias and bowel bowel abdomen is usually stasis so alias type patterns, and then imbalance patients can experience incredible imbalance. So those are, I think the most important symptoms to to the people should know that they may have and unfortunately at this point in time, most of the patients with disease this disease, they've made their own diagnosis. Yes, because they've gone in to see their doctors, the doctors will say, hey, it can't be gadolinium because you have normal kidney function and the only people who have problems with gadolinium are patients with poor kidneys who get nephrogenic systemic fibrosis. So it's kind of tragic that most of the time the people who come to me, they've made their own diagnosis. Hey everybody, I just stopped by to let you know that my new book, Unexpected, Finding Resilience through Functional Medicine, Science and Faith is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein Bar and mold and biotoxin related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through functional medicine in finding resilience. So I noticed that in your bio as I read that in normal kidney function, which again for most physicians are worried about abnormal kidney function because if you're listening, you don't know all the medical technology here. Our kidneys are filtering these dyes and things that we put into our body. That's our natural way between liver kidney and that's one of the organs. So if your kidneys aren't functioning as a healthy filter, of course you could have more toxicity from something you put in intravenously. But what you're saying in your article and today is that many people are complaining of symptoms with totally normal kidney function, which again, for us medical professionals, if you're listening, you should be aware of this as well. What percentage would you say? And interestingly, I just want to say a little backstory. My interest in this, I wrote an article and I think that's how we connected and I am not the expert, but just like you, I saw a handful of people that came back and said, the day of my MRI, this is what happened. And it sounded just like what you described the burning, the brain fog, the neuropathic kind of neuropathy, numbness, tingling, a lot of those symptoms. And same as you, I said, well, huh, could it be connected? And I didn't assume anything. I just was open. And then I started reading more about some of your articles, the stuff you've published. So the same way that you came to this was as well for me when I heard patients complaining. So now that you've been writing, I'm sure you get contacted a lot, but say you have a thousand or 10,000 patients who get a gadolinium MRI. What percentage might have GDD? Have you do have any sort of statistics on this? Yeah, I'm glad you asked that because I think the next, the next question is who gets it and how frequent is that risk? Yeah. One of the things I think one of the reasons why radiologists don't want to accept the diagnosis is because they fear it will create a sense in the public that it's extremely toxic and nobody should get it. They don't want the gadolinium and they don't want to get MRIs and so on. And I think they have that sort of chicken little fear of running around and worrying that the sky is falling. But one of the first things I tell also to people who are going to get an MR and email me in our sort of panic about it. So one of the things that I say, first off, is it's relatively uncommon in the general public. About one in 10,000 people will get this disease. So that's one of the excuses that I have that radiologists and other physicians may not want to accept it because they may not have seen it. The other big problem of radiologists, which includes me and my former life, is that we never see patients. You're in the dark room, right in the basement of the hospital. And patients will guess what? You don't know if there's some lasting problem that they get. I mean, it just is that simple. So about one in 10,000 people can get it. So it's not that common. The people most likely to get it, Dr. Jill, as I look at you are people like yourself are white women, first off, but then you add onto it the areas that you have done a lot of work in. So anything that sets off your immune system, anything that I consider in the cluster of entities of T cell dysregulations, which includes regular autoimmune diseases like rheumatoid arthritis, but the whole grouping of conditions like chronic inflammatory syndrome or chronic fatigue syndrome, or even mole toxicity, fibromyalgia, chronic Lyme disease, chronic viral disease. These are all conditions that have set your immune system off. So it has a T cell dysregulation. And I'll give you a Latin quote that I'm very fond of that makes me think of all of these. And that is abyssum invocat. One hell calls forth another. Oh, so true. So once again, it's like it's primed, right? Your immune system is primed when you have a lot of these infectious toxic things that have triggered an immune response. Exactly. So another chemical can add to that load. Right. So many, many of the people come in, though they will have a history of what you could call multiple chemical sensitivity syndrome, or the other things that I mentioned in that sort of cluster of unusual immune mediated diseases. And once you have one of them, you're a setup for getting another. And that's why one of the things that I worry about, for instance, with the COVID long haul and the COVID vaccine long haul. So once you have one of these conditions, and what we do nowadays with everybody who has some sort of weird neural thing is they get an MR with gadolinium. Right, right. And if you look at that, you know, in a number of people, particularly if they get repeat gadolinium injections, then you have gadolinium deposition disease, and that then becomes your dominant inflammatory condition. Well, the good news is that we can actually treat that. But one of the things that I do want to emphasize, and this is a good point to do this, Dr. Jill, and that is if somebody is sick from gadolinium the first time through, before an MR, we have a check sheet that would give patients about things, you know, do you have like cardiac pacemaker clips in your brain and so on. You have to ask people, have you had a previous gadolinium injection? Yes. And did you have persistent symptoms afterwards? Because quite often what happens with the first onset of GDD, it may go away in a few months. So they will get this like burning and brain fog and then it goes away. Yeah. And then, you know, they're better. But with each successive MR scan, the disease becomes more ingrained and more difficult to remove, and you get progressively sicker and sicker. So a number of my individuals, they have this and they get neural symptoms and then, whoa, how are we going to investigate neural symptoms? We'll do another MR with gadolinium and the month later they're worse. Oh, maybe it's a progressive and neural condition like MS. Let's do another MR with gadolinium. So I have patients that have had maybe 15 gadolinium injections in a row, all of them to investigate what was started after the first. Wow. Wow. Yeah. So. Well, and I have that. Go ahead. I was just going to say, if you are a white female, but it's not only, you know, everybody can get it. I mean, white men are probably the next most common group, but the combination of having a pre-existent something that you describe as the entities that I mentioned and the ones that you specialize in. You're a setup for getting this. It's so fascinating because women we know have four or more times the autoimmune risk, which is kind of in this realm. And that makes a lot of sense. One just thought personally that I think a lot of women may be facing. I'm a breast cancer survivor. I had breast cancer at 25. So of course, my follow up could involve MRIs as a young woman with dense breast tissue and I've had multiple with gadolinium. And of course, you know, as a radiologist, they really won't do for breast cancer screening or post treatment. It's pretty hard to do a non gadolinium MRI for the breast. Is that correct? So I've always been told the rule. Yeah, they, they would not want to do that. Now, not to say that it can't be done, but in part, I think, you know, we, for a number of reasons, we want to have the least likelihood of making a mistake. Yeah. There's good reason, like the best thing for the patient. And there's the other reasons that, you know, radiologists and absolutely. And that's what I want to say too. That's why we overuse. Yeah. Yeah. And I remember just in my early forties and some of the screening where I found a lump and it turned out to be nothing, but I had, I think two MRIs in the same year. And then it was, they were recommending a third. It was like every six months and they were all with gadolinium. Now I have not had any side effects or symptoms. Thank goodness from gadolinium. But intuitively on that third one, I thought, you know what, I'm not going to take a risk of one more gadolinium MRI. And again, I had multiple and I've had other ones as well. So this isn't something that I totally avoided, but it was interesting because even me personally, I thought, you know what, I don't think that's worth the extra risk of getting a third MRI within 18 months with gadolinium. And so I chose not to, and it turned out to be all benign and everything was okay. But there is this, I maybe talk about this because as a radiologist, you're trying to diagnose disease, help patients identify cancers, brain tumors, multiple sclerosis. And so with some of these things, the gadolinium is really, really important because it enhances certain tissues. Do you want to talk first to the patient, but also to the doctors about, because even as I'm an MD, but I'm not a radiologist. So sometimes I'll call someone like you and say, for this condition, do I want contrast or not contrast? Maybe just first mentioned to the public and to the doctors, why would we do a gadolinium enhanced MRI versus a non-enhanced MRI? What's the kinds of things we'd see differently? Well, as a general rule, with gadolinium is, if you think of sort of the broadest range of all organ systems, gadolinium allows you to see the presence of enhancement and the absence of enhancement better than anything else. So if we're looking for small tumors, so my particular area of expertise is the liver and pancreas and I guess the other organs in the upper abdomen. My, if you're looking for a small hepaticellar carcinoma to look for the pattern of enhancement that cancers have, you kind of don't want to miss them. Now the question is, how often should you do these studies and can you interleave other MRs without contrast? And I think a lot more thought has to be done in minimizing the number of times you may do the optimal study. So yes, it's by and large extremely helpful for looking for cancer, but can you use that enhancement template on a new study without contrast and then just transfer where you saw the enhancement and look at the morphology of that now. I think a lot more attention and focus and this may be something that artificial intelligence would readily be able to do. So I'm just, you know, in my earlier years, we were, we thought that gadolin was the safest water. So I would think, you know, with patients with chronic liver disease, let's do another MR in three months time. Now I spend a lot of time thinking about how soon I want to do it. Wait, right, exactly. Right. So there's that what we probably not that maybe Dr. Jewel have different discussions on different aspects of imaging the future. But for instance, you know, the, the reliance of other technology that we imaging wise that we don't inform of patients of the risk to me is hate to say it, but it's shameful. So there's a great enamor of pet and pet CT, but the radiation doses in pet CT are enormous and the new, the new radio traces that are coming out, they sound great. And some of them do wonderful things. But what is the dose and what is the risk to the patient. And that, I tell you a nuclear medicine pet and I hate to say that. So one group that really seems to avoid talking about safety and to me, it's unconscionable. Yeah. You know, again, just for those listening, you may not, you and I know about radiation and doses, but you want to just briefly talk about like a regular x-ray chest x-ray versus a CT versus a nuclear med test. And for the consumer who maybe doesn't know what they're getting kind of the numbers of how much more radiation they're getting with some of these studies compared to a regular chest x-ray. Okay. Well, now it's interesting before I got into the MR and the gadolinium safety, I was really focused on CT and radiation. And I like to think that that work because I would say that it was one of the first maybe the first university radiologists to write about this subject. Now there was a cardiologist who wrote in. It's funny. I wasn't aware of his work, but some months earlier, Eugenio Picano from Italy on the same subject of radiation doses. But at the time, most body CTs involved and I'll just have to use these units. Okay. Sure. 10 millisieverts of radiation. Now, if you look at the FDA website on radiation risk, 10 millisieverts in a 40 year old male is associated with a one in a thousand chance of cancer. Now, a lot of people will use that number and translate it to everybody else, but it's not the case too. Because, you know, you think you know about medical radiation, you think, well, 10 millisieverts is one in a thousand of cancer. Well, in a one year old female, 10 millisieverts of radiation is associated with something like one in a hundred or one in 200 chance of cancer. So an entirely different ball game. So what happened in the evolution of CT, which is one of the things, you know, that great things do happen in medicine. It was sort of, you know, 10 millisieverts and many children were done at adults things and so on. But through the course from about 2005 to 2010 CT scanners were designed to deliver less radiation doses and protocols were designed to to also have less scanning. So nowadays, where where a typical abdomen CT was 10 millisieverts, maybe 15 years ago, now it's maybe three millisieverts. Wow. And the other thing that's important to keep in mind and it's, you know, it's it's difficult when to tell people when there's a risk. And there was a study that was done by the VA system, maybe 20 years ago published in New England Journal that described, you know, if the risk is something like one in 40,000, you should probably inform patients that there's that risk. So I think with, you know, a lower risk, I think patients should be aware of it, but aware that the risk is relatively low. Okay, and even though in the radiation literature, the sort of radiation biology literature that they have described there's no lower limit of risk. The lower limit I use is one millisievert. So right now one millisievert would be a brain CT to suggest that one brain CT done is probably not a huge thing. Now, in contrast, when you talked about chest X-rays, that's about 0.01 millisieverts. So about 1000, the amount 1000 is the amount of radiation. Now, PET CT combines both PET and CT. And traditionally that radiation dose is 20 millisieverts. So we'd have to go to the books and then calculate what is the risk. And again, not only and you as a female physician, you also know that most of the risks and so on have been determined for males, but it's different for females and not enough research has been done on females. But the risks are then much higher and you can't just simply do them every three months and say, well, there's going to be no problems. Particularly, I sort of in a dark humor think about if you're doing this every three months in a cancer patient and 10 millisieverts is a 1000 chance of cancer and 25 millisieverts is maybe 1 in 300 chance of cancer. You're given something that can cause cancer to people who already have shown you they can develop cancer. So it seems on the surface a little bit crazy. So that's why I recommend that you interleave them. So again, interleaving PET CT, which for many things is really the gold standard but interleave it with regular CT. Some things could be interleaved with ultrasound. Some things interleaved with MR and if it's not with gadolinium MR is extremely safe. So I just think that there has to be a lot more bot placed into these things, but it needs to be people like myself are interested in safety. And right now, you know, right now, my time is focused on this one area of gadolinium toxicity and by extension, actually heavy metals and general toxicity. Yeah, so hang on. If you're listening, we are going to get to treatment in just a moment, but this is so important because the other thing that I hear you saying is where I see clinical practice. Someone said, Oh, well, I really need a pet and a pet scan and I really need this or and patients are starting to demand and a lot of times physicians were trying to please the, you know, insurance and the patients and trying to balance all these needs. And sometimes when a patient comes and really, really request an imaging, you know, we disorder it and we don't think but I think that as if you're out there listening to your patient. I think it's your responsibility as well to know the risk and to not over ask for the things and again, we as physicians, number one, it's our responsibility informed consent, but I want patients to know to that there's no thing without a risk that you ask for, whether it's a drug or treatment or an image and just knowing and starting to understand that is important. So I want to be the first to say I want to educate physicians and patients about the benefits and the risk. So thank you for being on the forefront. Let's turn to treatment because obviously you have studied GDD. And it sounds like you've given us kind of the set of symptoms. Is there a diagnostic criteria? Is it mostly a clinical diagnosis? So let's go like, what is diagnosis really look like? And then what do we do for treatment? So the diagnosis really at this point is generally most people develop symptoms within 24 to 48 hours, but it can extend beyond that to at least a month. So I accept these new type of symptoms like I described new symptoms within a month period. GDD is is a likely entity and maybe the obvious entity. At this point in time, our first treatment is actually the best diagnostic tool to confirm that the patient has GDD. So I'll sort of interleave into treatment as we talk about diagnosis. The best treatment. And again, this actually applies to all heavy metals. And again, to me, it's kind of obvious, but people don't necessarily understand the obvious. But if you're trying to remove a metal from the body, you want to use a key later, which has the strongest adherence to whatever metal it is you're looking at. And one of the analogies I've used is the magnet crane game that used to be present in like grocery stores where you have a crane with a magnet on it and all these little stuffed nasty animals and plastic rings and so on. And then it sticks on that and it transports sometimes all the way through, but oftentimes read releases it, which with metal terms, we call redistribution. And then it will take it over and drop it into the shoot sometimes. So you want to have something that's really powerful that hangs on and stays hanging on and doesn't really release it. So, so we call that and we call that the stability constant. So, you have to know the stability constant. If you're going to use a key later now a number of people just randomly use key laders, but you have to know the stability constant with the metal that you're interested in. And it's knowable. It's a lab measurement, but it is knowable. And if it isn't, if the manufacturer hasn't determined it yet for that metal, then maybe you shouldn't do it because there's others where the stability constant is known. For instance, with with gadolinium, the most stable key later currently on the market is DTPA. Yep. So now I'm just using by memory numbers. So these aren't the exact numbers. But the key later that's oftentimes used is EDTA the stability constant and actually the log stability constant but stability constant is 17 for gadolinium with EDTA. For DTPA and gadolinium the stability constant is about 20. So in log terms, actually it's maybe 20, it's higher than that. It's actually around 22. Yeah. So 17 versus 22. So that actually by log scale is something like 300,000 times, and those are the right numbers. That's not, I'm not making a mistake. 300,000 times more stable. So you would think, well, geez, if the whole basis of this is to hang on to the metal, shouldn't I use a thing that it's most likely to hang on to it? Because if you don't hang on to it, what happens is you re-release it back into the body and then it goes to somewhere else. Yeah. So the other critical thing about the diagnosis when I talked about chelation, so we will chelate with DTPA and the things that I look for to confirm the diagnosis is if you were sick from the gadolinium when it went in, and you're still sick from the gadolinium, when we remobilize it in your body and it goes into the circulation, should make you sick again, right? Yes. So we call that gadolinium removal flare. So you have to have gadolinium removal flare if you have gadolinium deposition disease, otherwise you have something else. And the other flare that's sort of very interesting that you also have to have is what I call gadolinium equilibration flare, and that comes on about three weeks later, because what happens with metals and heavy metals in general is that it's distributed in the body in various tissues at various strengths of adherence, and then in some repositories it's very durable. So using gadolinium and lead is very similar in this regard. The two largest areas that gadolinium goes to are the skin where it's easy for us to remove gad and the bone where it's difficult. So DTPA can remove gad directly from bone but doesn't do it that well. So what we then rely on is what's called Le Chatelier's principle, which is everything strives to be an equilibrium. So the gad removal flare occurs immediately. And at the same time, if you've used a porculator, you will get gadolinium redistribution flare. They both occur immediately. About three weeks later it becomes most noticeable of gad re-equilibration flare. And what that reflects is since a lot of the gadolinium you've removed has come from skin, some of it from brain and other soft organs, very little from bone, what happens if at one point you, you know, bone was here, skin was here. Well you've pulled it out from skin and now the difference is huge. So re-equilibration is now bone moves back to bring in gadolinium to skin. So that happens in force at about three weeks. So you will get a re-equilibration flare at three weeks time. And that has to occur as well. And that's very distinctive. And people will panic and think, oh my God, now I'm getting worse again and this didn't work, the circulation didn't work. No, this is what has to happen. And what's important for me to tell patients, and I think that's important for all patients, they want to know what they're going to feel. They don't want it to be a mystery. So I tell them you have to have a removal flare and you have to have a re-equilibration flare. If you don't, then you don't have the disease. Now, with time I've learned to manage that more. So we start by giving people lesser amounts of chelator to begin with and we give them IV steroids. And we generally then try to increase the amount of chelation with time and decrease the steroids to have a balance. So we basically treat it like an acute hypersensitivity reaction, the chelation process, because if you're sick from gadolinium and you remobilize it, yeah, you're going to get sick again. So we use the steroids as we use acute hypersensitivity reaction management and we also use the steroid taper, as you would with any sort of severe allergy. This makes so much sense because I'm in the world of I've done stuff with lead and metals chelation. So I know that EDT is better for lead. DMSA is better for mercury and we don't mix those two because, again, this coefficient of basically the Crane analogy, I love that, so Ablegol. And then I also deal with toxic mold in the environment and the accumulation in the fatty tissues. And so I know that as I'm detoxing a patient, same thing, they're mobilizing that from their tissues into the bloodstream with the liver and the kidneys are filtering. But if I mobilize quicker than they can excrete, which is exactly what you're talking about, then they get actually they're mobilizing their blood is actually almost like toxic for metals or or from, for my case, the mycotoxins and they get really sick. And I'm always as a doc have to really check in carefully because I know I can mobilize very quickly and make them very, very ill, but I don't want to because I have to make sure they're excreting that load. So I really love that you described it and can so relate to the patients that I've treated on a different level. And even like you said, framing the expectations because often I say, okay, this is what you should expect. If this XYZ happens, that's okay, but if it goes on to be this thing, you need to call me right away and we need to so really brilliant that you have discovered that and, you know, and also understand that it's going to be, we call it somebody's a herxheimer, the Jack's herxheimer reaction, which isn't very specific, but in a way it's just mobilizing and excreting and getting stuck in between. Now one thought is from my experience with metals is the kidneys are a big like that's where we do a lot of our metal detox through the urinary tract and the kidneys. Have you seen elevations in creatine or a kidney function disturbances during killing or during the process. And do you do anything specific besides hydration to support the kidneys. That's actually also very, that's a very interesting point as well. And I think after this I'd like to circle back to talk about how to manage toxicities. Yes. But so I'm telling you that so I don't forget myself. But you know, gathering was going everywhere so it's also going to the kidneys. And since we're removing gadolinium from soft tissues including the kidneys. My empirical thinking and it's sort of borne out the times that we've looked at it is a kidney function actually improves as you're getting you're pulling out of the prank him of the kidneys, the gadolinium to put it into the urinary system to have it removed. So in fact, if anything the renal function improves. And that's why, you know, I don't really use, although I'll, I'll get a measure of the renal function to begin with. I don't really use that too much to prevent me from from doing treatment because really in this disease, the only treatment is to get rid of metal. You have to go through that don't you that process. You know, so the thing that I think is also very important and it's interesting how with different toxins, the emphasis is slightly different based on the nature of how, how treatment and recovery goes. So I think for all toxins. The first step is to not get it ever again. Right, the prevention is way more important right if we could just read. Yeah, the first treatment. I tell people with gadolinium deposition disease is don't ever get a gadolinium injection again so if your doctor tells you to get it, don't get it and I said, even if I tell you to get it. Yeah, don't get it. Because you have T cell dysregulation gadolinium and you will react to it. So that really works for everything. You know, if you're in a very healthy environment, right, get out of that. Exactly, let's not get that exposure. The first, the first rule of treatment. There's a whole big, big popular community out there of mold avoidance right so it's funny because it's almost like not made fun of because it's a very real thing but it's the same idea like everybody thought about that way why don't we just avoid it. So, then the next two forms of treatment are detoxification and removal. You know, I have found, and this is not an area that I'm an expert in and in the future. I think I'd be interested to pick your brains on different aspects of detoxification because I know that you're great expert in this. But for me, the most important thing about getting people healthy is to get their general diet healthy. And if you think about it, that's probably works for everyone in the population that's why we're such in such a bad. condition as a public, because we eat all these foods that are highly processed. So natural foods, limit the amount of sugar, as much as you can, you know, probably limit, you know, the amount of gluten you get. Limit somewhat the dairy and just and do physical activity and try to, you know, get fresh, clean air. And that kind of works for everything. Now there's nuances in different, you know, food groups and, you know, for instance, the food that I like to focus on from a heavy metal point of view is kale, which should be fundamentally the healthiest vegetables. But in the modern era, and that's what we have to always update our learning on. In the modern era, because of the nature of it being a cruciferous vegetable, that's very good at concentrating sulfur. Exactly. And it also concentrates thallium. Yes. And cesium. So when I look at the year, so I get urine's critical for evaluation is we get 24 hour urine. I always want to get them before and after chelation, because I want to know what their baseline is. I want to know how much I pull out of various metals. Yeah, which, which, and I don't just look at gadolinium so I get the panel. I use doctor's data, but you know, I think does the same. I get the panel of metals. Yes. And we also, it makes common sense that they also interact. Yes. It turns out that DTP as a great job of removing both lead and gadolinium and gadolinium. And you have to see what the other metals to what extent it removes others, because mercury is very variable, as you know, because there's inorganic and organic varieties of mercury. I'm now in the phase where I'm looking at, you know, I've sort of been forced into the phase of not only dealing with gadolinium where I started, but now I have to think about all these other metals, and also have to pay attention to what else they may have, which is mold, chronic Lyme and so on. So it's one of those things, right? Like I said, I'll say, same way, I was like, I'm never going to do Lyme or mold is complex. I don't understand it. And then you have to if you really want to help people because it's inevitable out there. These tick borne infections are creeping into the suburban environments and more and more common. One thing interesting, I love what you said about food, because one of the things I always say is just clean air, clean water, clean food. We start with those very, very basic principles, and that's like half of detox, and it sounds so simple. It's not always easy to do, but it's such a foundational principle, just like you said to start. You mentioned toxicity. So let's come back to like when you're treating a patient, what do you do to help them deal with the reactions in our last few minutes or so. Let's talk just a little bit about that. Okay, so I treated like they're going to have an acute hypersensitivity reaction. So I give them, and I prefer methylpregnase alone, which is solumedrol in IV form and then in pill form, because it's already methylated and a number of individuals, maybe a quarter or third, have an MTHFR gene variant. So I sort of take that out of the equation, assuming everybody has it. So I use methylated that and I used to use the methylated claretin. So claretin is methylated claretin and singular, which is a very nice combination. Dermatologists use it all the time. I now generally use adorax, which is also an antihistamine, but it's been used in PTSD patients. Because one of the things I find with all of my patients, and Jill, I'm sure you do in your patients, is that they're very anxious and very nervous. And I think, you know, one of the first things I tell them is you got to calm down. Yeah. And maybe do exercises, maybe tai chi or yoga or something to help you calm down because the cytokines involved in GDD are similar to the cytokines in stress. So they compound. So try to minimize the additional cytokine we see in depression anxiety. So it's no wonder, right? Because we're actually seeing the cytokine response on the brain and nervous system. So if anything, if you're out there listening, you're like, yeah, but I can't help it in a way you can't because your nervous system is creating the anxiety from the cytokines. But the truth is, like you said, we still have to deal with it, right? We still have to do whatever we can to calm that system down. Yeah. So so just to briefly touch on actually, I think one of the the works that I'm most proud of of all of my career is we did a small study looking at serial dynamic cytokine response to chelation. Yeah. And what what actually was an example of a normal. So I like you, Dr. Jill, I myself have received a number of gadolin injections. And I have like 13. I've had 13 injections. Wow. And for many of them, getting gadolin in a Louis Pasteur sort of way test for for reactions. So I didn't want to subject patients to it. And then, of course, did all this before realizing about gadolin deposition disease. I wouldn't have done that. Right. And I know about GDD at the time. But now, you know, the good news is that I'm now the perfect example of somebody who has a lot of gadolin in them. And the other thing is that, you know, people, you know, physicians so doubtful that gadolin, you know, stays in there. Yeah. Well, what I find is many people have that medieval thinking of the four, the four humors. Yes. Yes. But don't actually look into it. So it's very easy. If you don't think that gadolin is still there. And I know you're wrong. Yeah, the way that you can look at it is do chelation with DTPA. And you can get gadolin out of anybody who's received, even if it's many years in the past, particularly if they've had a number. So I, my cytokine response, and this is the thing. So we did very short duration, like one minute, five minute, 10 minute, 20 minute, 30 minute, an hour and 24 hours. And I did this work with the Stanford immunology center. So I wanted to work with, with a group that you could not question their, you know, ability. I didn't want to use just some local group of characters. So we came up with the cytokine response that they'd never seen before because they'd never have done dynamic cytokines. And chelation, but it would be the same with vaccines is the ideal setting because you're suddenly getting an impact on your immune system. So you can test exactly. So we saw patterns of cytokines peaking at different times. Now the problem is, you know, there was four normals and 10 patients. And as, as a physician yourself has done a lot of research, you realize, you know, to get truly meaningful data to separate, you need in the neighborhood of hundreds of thousands. If you look at the research that's done on asthma where they have all these different panels of cytokines that they've shown with the different types of asthma. Those are probably thousands of patients in each of these groups. And guess what, you know, studies of that nature are in the multi millions of dollars. So we self funded it. So I wanted to fund because I wanted to get the work going. I didn't, you know, for the sake of patients, I didn't want to wait, you know, I'm going to apply for a grant and right a year. They'll say, well, you could get it, but you need to do this. And then, you know, next thing it's three years down the road and you haven't treated people. So I wanted to treat people right away as soon as I could. So very interesting stuff. I'd love to do larger studies, but it's a lot of money. So I think the answer would be with cytokines. But what I was struck by is that I've had 13 GPC as we did a number of people who had pretty bad GDD with just one injection and we studied them at three months so they would get tremendous flares from doing sterilization. And at the time, because I wanted to see a pure flair, we didn't give steroids to them. We just did, you know, did flair steroids after the fact a day later, but not at the time. So they had tremendous flares. But this is a thing that I found fascinating at the time. Their overall cytokine amounts being released were not that high. The highest in all of all of the people, the highest was me by far. The highest highest was a patient with disease who had four GBCAs. But this is the fascinating thing about cytokines is that, and this is one of the things that I tell people, you know, maybe you don't like the diagnosis of GDD and you're thinking whatever it's ruining everybody's lives by talking about it. But looking at the normals like myself, to figure out what we are doing that is not causing reaction to gadolinium, maybe the answer to many autoimmune diseases, what cytokines am I releasing to prevent me from getting sick? Because my cytokines were like 10 times anybody else's and yet no symptoms. So the thing is that most of the cytokines are regulatory cytokines are suppressing cytokines. Well, like IL-10 we know, right? Like IL-10 is effective. I haven't had a genetic deficiency in that. And I've had a lot of inflammatory issues because I have maybe half a quarter production of IL-10. And IL-10 is a cytokine. But what it does is it calms that response. So fascinating with your study. You're putting yourself out there for science like you said. That's amazing. Well, I'm gonna, if you're listening, if you're a doc, if you're anyone who wants to know the research, wherever the notes are for where you're listening, I will be sure and include Dr. Zemalka's research. I could talk to you for hours. This is so fascinating. And I really want to go back to just thank you for being the kind of person that you are, the kind of doctor that you are with curiosity and compassion and that combination I think makes the greatest people who discover, like really this is a discovery that's going to change the way we practice medicine in a good way because there is a place and there has been a lot of things, a lot of life saved with gadolinium MRIs and imaging. But now that we know, it's always like I say, once we know what we know, we can't go back, right? Now that we know that you've brought this to the forefront, we have to be stewards of this wonderful technology. What? And if you could go back to your younger self, you know that you're telling us about in Canada and then realizing this new technology and the power there and obviously you've done an amazing thing with your career. But what would you go back to tell your younger self knowing what you know now? Anything that any advice you give or encouragement or things that you would say to your younger self? You know what, Jill, you're asking me something that I was hoping I would have time to mention, but in a different way. But I would tell my younger self the words of Sir William Osler, patients listened, or sorry, doctors, listen to your patients. They're telling you the diagnosis. I would tell my younger self, listen to what patients are telling you at all times. Oh my goodness. That's where like the mic dropped. But the truth is like that is where we as healers need to go. I've often said that heard that and continue to need to be reminded if we can just be present with our patients and really listen. We have everything that we need there in that encounter, right? If we just listen and remain curious. Well, Dr. Samalka, I am truly honored to have this time with you and to learn more about you and your work. I hope we have another chance to talk. And I'm just so grateful for you going to that deep level and making the discoveries and then bringing this information because I as a physician need it to help my patients and you've laid the foundation. So just a huge thank you from me and all the other docs out there and the patients for all of your work.