Safe Pregnancy Tips (with Dr. Alan Lindemann)

Pregnant people have enough to worry about when it's time to head to the delivery room, but maternal mortality is still a huge concern for millions of Americans.  We talked to Obstetrician Dr. Alan Lindemann about what it takes to have a safe birth, why postpartum care is so important, and how US healthcare has made it even harder to have children.

Thanks to our Amazing Guest:
Dr. Alan Lindemann: Website
Buy Modern Medicine: What You're Dying to Know on Amazon
Buy Safe Pregnancy Explained: Three Steps to a Safer Pregnancy

Stuff We Talked About:
Maternal Mortality Rates
Rate is higher for Black woman and other minorities
Even more info 

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Transcript

0:45

Hey, everybody. I'm Brandon Fox. You're listening to another episode of Grandpa and Chill with our amazing producer. As always, Sierra, my good friend and co-host, Phines and my relative grandpa. Today we have an incredible special guest. If you could tell everybody your name, Doctor. Yes. I'm Alan Lindemann and I graduated medical school in 1977. Awesome. And cool. That's my intro. I don't want to interrupt the flow of conversation, but if you could just tell the audience a little bit about yourself before we dive in. Well, I graduated residency in 1981 from what is called Regents Hospital today. It was St Paul Ramsay Hospital, of course, in Saint Paul when I was there. And I have delivered about 6000 babies, no maternal mortality and not even any eclampsia. And that would be a seizure associated with preeclampsia. No, mother's in the nursing home, so we had a good, fun career, but it's taken every minute of my day to make sure that my patients do well. Yeah. And how rare is that? 6000 deliveries, No mortalities. Well, I think it's, you know, there's a lot of people that say yes, that's no big accomplishment. That's, you know, a lot of people do that. I have to say in my first month of private practice and this was back in 1989, I delivered 46 babies and that's like a three person practice. So and everybody did fine. I had no trouble with any anything. Mm hmm. And is a lot of that sort of negligence on your colleagues or what leads to a lot of these infant mortality or mother method mentality? Well. I can tell you a little bit, this is a story that I read on NPR. So it's public. The patient's name is Lauren, and she's a 33 year old, an ICU nurse, Nick nurse. She came in at term. Everything was supposed to be fine. She had hypertension. She delivered her baby vaginally. And 5 hours after she delivered, she stroked and 5 hours after that, she died. And if that had been my patient, I would have been there with her. Her doctor didn't come in to take care of her. He didn't come in to say, Oh, gee, we have to do this to get her blood pressure down so she doesn't sees in there was fragmented. He knew her doctor called a neurosurgeon who couldn't do anything because he had to wait for medications. Four or 5 hours. So this is the kind of thing that causes trouble. Doctors have to be there to take care of their patients. They have to care about it. What do you think that the sort of underlying mission of the United States health care system is overarching? Well, you know, that's pretty complicated. Right now, we are really fragmented. We have many of the systems that are supposed to be working that you would think would be working like Medicaid, Medicare are in. Influences. Malpractice. The American College of AUB began rather than opening access, in other words, letting patients get the care they need to get in an unlimited amount. They put barriers up so that it's difficult to take care of patients. One of the big problems we have today is we have we cut off her postpartum care at six weeks and we are the only nation in the world that does that. And unfortunately, one of the things we're seeing because of that is mental health issues. The main mental health issues there, too. One of them is suicide, and one of them is drug overdose. These things should be preventable. And I think if we could deliver postpartum care without barriers for one year and unlimited amounts, we would be dealing better with this problem than we are right now. How much is the right amount of time for? If you look at countries that do better than we do. For example, if you look at the scan, the Navy in countries, they have a maternal mortality rate between two and three per 100,000. You look at hours, you get between 20 and 55 per 100,000 based on the color of your skin. So I'm sorry. You know, just means that I miss the. So how long should you have time to like a one year? One one year, just like everybody else does. And that's what we should be doing, too. Because most of the people that make laws about just the. Cost of health. Care has gotten so high in the United States and the cost of of insurance for, you know, for people that aren't of a lot of means has as part of the reason for this problem is is it. When you say it, it's related to to the to whether you're a black person or a white person or whatever is it is it related to that or is it related more to their financial situation? Well, certainly socio economic conditions, deprivation, difficulty finding money, finding work, those are all barriers to the health care system we have today. And yes, the expense is awful. If you look at if you compare the United States and Canada, our prenatal care cost twice as much as theirs. And we have results that are twice as bad. That doesn't sound right. No, it's certainly we need. In short, we have a lot of work to do and we have to get started on it. Well, it sounds like we don't really care so much about our people, as you. Know. Well, as soon as we get started in, we have to think about how do we deliver medical care. And again, with when you're looking at prenatal care, I had an independent practice for many years and I saw my patients as much as they needed to be seen, whether I got paid for eight visits or whether the patient was seen 12 or 15 times, it didn't matter to me. I was the only boss. I was the only one. I had to argue with. There are no CEOs, no insurance companies. I just did it. Planning and it worked. How do you do it without insurance companies? Well, of course, they paid for eight visits, so that was fine. So that's what I had to be satisfied with was what they did pay. I had a lot of great nations in those days. You know, when I was first practicing, a delivery. Would be about 1500. Dollars. Of course, today it's much, much more than that. Yeah. You mentioned a figure of two mortalities per 100,000 in one of the Scandinavian countries. And something like I think you said 40 per 100,000 in the United States. I'm like my figures right. You. Are right. If you're looking at Native Americans and native Alaskans, if you're looking at Caucasians, you're looking about 23 per 100,000. If you're looking at people of color, you're looking at about 55 per 100,000. So there's a great disparity. Yeah, it's like 10 to 25 times the the rate of mortality. And is that due to their ability to get post care after that? A lot of it has to do with socioeconomic problems. And of course, it we do have a limit on our postpartum care. And we talked about the number one problem we have now with postpartum care is suicides and drug overdose. So if we looked at our patients for a year, I think we could do much better with our suicides and our drug overdose suicide as a result of depression. It's a result of untreated depression. So if we treated depression better or tried to avoid it, we would do a better job. And would that be handled by a by an OB doctor or by a cycle adjuster, psychiatrist or whatever? Well, you have hit on a really important point there. When I was working in Fargo, which is when I had my most my busiest practice, I would see my patients. I'd see all I see my dad, my moms and their children in their prenatal care. And I tried to avoid depression, but for the few that came in who said they were depressed, postpartum, I had a good psychiatry list I could call. We could agree on a treatment plan with medications. She would see the patients the next week and nobody suicided. So a lot of the problem is with the depression, that postpartum depression. It certainly is. A double problem with. It. The other problem is if I were just going to send the average depressed patient to a psychiatrist, it would take three months to get them in and you could have a lot of suicide in that three months. Yeah. But they would. Also. Criticize me for managing the depression. What about statistically on on the child birth itself, you know, complications in childbirth or whatever? How do they have the statistics on those, you know, relative to the racial differences, the differences in countries and so forth? Yeah. Right now, I don't have the exact numbers, but I'd be willing to bet that we do have problems with our neonatal outcomes. I don't think that's quite as bad. I mean, naturally, the mortality rate for babies is per thousand, not per 100,000. So you can tell right away that there's going to be more mortality for babies than for moms. But I'd be willing to bet the same people who have the trouble with maternal mortality are also the ones who have trouble with neonatal mortality. And I read recently, again, this is Twitter. You can come up with $5 million bills for a baby in Non-icu that's at me or Nick you neonatal. No, no, no, no. I know what Nick means. But you said a $5,000 5 billion. $5. Oh, okay. As you were just saying, sorry. So it's. Expensive. Go ahead. Yeah, I'm sorry. What has your with regard to the mother mortality rates and things like that. Who who's on right now? Oh, Must be Ciara. Yeah. Hi. With regard to the motherhood mortality rates. Yeah. Can you hear it? You can't hear me. I can't hear you. Really? Well, thank you. All right. Okay. I hear. You. So what is your experience with medical racism? So, like, if you wanted to go into the practice of just now, how could you do that? What is greater area? Yes, that's one of the things that has happened. I have for the last several years just been in general medicine, because in the small town I live in, we don't do OB anymore. They have patients that go 85 mile. To. O.B. to get a week. So, Ciara, you had a question? Yes. It was about discrimination, is that correct? Yes. You know, I have done some reading on this, some investigation. And it turns out that doctors of color treat women of color as badly as these white doctors treat black women. So you're not going to get gain a whole lot of improvement by finding a doctor of color. Unfortunately, I think that's because we're all trained. The same way. Right. Mm hmm. Yeah. And Ciara, you're the only woman here. Can you hear me? Yeah. Yeah. Oh, yeah, I know. I'm. I'm the lone wolf here. I have a I actually have a fear of pregnancy, So this is all, like, really interesting to me. I sort of heard a little background noise, but. One of the things I would like to tell you sure is one of the things we talk about on our websites. Choose your doctor. Well, I know and you can doctor shop if you want to. I had a lot of patients who came to see me as a third or fourth choice. They would generally stay with me, but you can tell a lot if you can just sit down and talk with your doctor, if they'll give you a 15 minutes, you know, be two feet from you, look you in the eye and listen to what you have to say and try to answer your questions in a responsive and responsible way. Those are the things you need to try to look for. The other thing you can ask them is who's going to deliver my baby and how many doctors and nurses am I going to see in this process? Ideally, you'd like to see one doctor during every prenatal visit, and you'd like to have that doctor there for your delivery at the time you deliver. And I think that's one of the reasons I had no maternal mortality and we had some very good results is because I was there. Yeah. Mm hmm. Is there a a percentage difference in the in the situation prenatal or whatever, between the delivery made by a OB-GYN or a I guess it's called a midwife? Well, it depends on what country you look at. It depends on what kind of delivery you're getting. But again, if you go to the Scandinavian countries, where the maternal mortality is, where three per thousand, per 100,000, they have three choices. They can deliver with a midwife at home, they can deliver in a birthing center, or they can deliver with a doctor in the hospital. Here in this country, the American College of OB-GYN doesn't particularly like home births, and they also don't really like birthing center birth. But we don't really do a very good job even if we get our patients to the hospital. So if you look at the Scandinavian countries, they do a really good job of doing their deliveries at home with a midwife. MM. But you're saying, are you saying that that is not the case in the United States? It certainly isn't. We have, I would say, probably 3% of deliveries occur at home now. My wife's daughter in law has delivered eight children and six of them have been at home and she's had no trouble with her home birth. And one of them weighed over £4. Oh, wow. Now, just because you have a delivery and just because you deliver at home doesn't mean it's going to be carrying out badly. The ACOG does have recommendations for in-home delivery. If they see you should be 15 minutes from the hospital and you should be on the ground floor. In other words, they don't want to be paying to take you up and down stairs when you're trying to get on your way to a cesarean section in the hospital. That makes sense and makes sense. Right. I think I have some comments, just a couple of things. Like cool things that you were saying. What I'll say about black doctors and the training of our society and the treatment of black women in the medical field. You know, I still, you know, know pain as many people in color in those situations to change the system that that we're in and not that you were against it but decent general I think that it's like that was just my little tool for that. And it was something else. 6000 babies is amazing. Yes. I'm sorry. Go ahead. Yes. You were going to say you were talking about not enough black doctors, Right? They get diluted by the diluted by the white doctors. And yes, I think that in order if we're going to be get rid of our disparity, if we're going to treat everybody the same way, we have to have training that represents the amount, the percentage of people. Now that we're down. And that's I mean, teaching people that we have like we got extra muscles in our legs and that we don't process pain differently the same way. They're still telling people that. And this is a I'm sorry, I. Know. There's I believe, you know, today one of the if you talk to the people who are in kind of control of this, they say, well, our population is aging. Now there is the maternal mortality rate is up because we have old mothers now, you know, over with over 35 and because they're fat and because they smoke and because they drink too much and because they don't have their you know, they don't have enough money, I think the main thing is not enough money. Not good working circumstances. Not good living circumstances. No. If your family depends on your weight as a as a food server, for example, you probably don't get to play at home very often if you want to get paid. Definitely. Right. Okay. Yeah. And this is this is about I'm sorry, this is the question I'm wondering about. That is one just kind of got to know how many black women have you like? Like, have you like And they're 6000, you know, in like Ed was eight that I this is just me wondering because of that because of the high ratios of of issues. And I'm like, well maybe just do some white people the whole time. Like, yeah, you know, I have. To tell you that, you know, North Dakota is very homogeneous. We have a lot of Norwegians, we have a lot of German, we have some French, we have some English to maybe we don't have many people of color. I can tell you this. I have delivered many women of color and I have not had any problems with their pregnancies or their delivery or their babies. So I couldn't tell you, you know, of the 6000, I couldn't tell you exactly. It's not. I I have. To tell you, though, in Saint Paul, there's a lot of people of color and we had a lot of monks, we had a lot of diversity. And we had no trouble with our patients of color in Saint Paul. During my residency. I thought, yeah, not I would just one of my questions. I was kicking back and I was like, I just had it. I was trying to do what? You are absolutely. Right. We are homogeneous. So but again, I don't think there's anything intrinsically different about color. I think that your bodies are just as good. You know, the bodies of the black people are just as good or better than the bodies of the white people. I don't think there's anything to be said for, well, you know, you smoke more, you drink more. And I don't think that's true at all. I think we just wouldn't goes into like the stress, like you said, the socioeconomics of like the average, like patient of color that you may encounter in, you know. Dr. Lindemann. Yes. Unless Phines still has...Phines? Not obvious here. What's going Go ahead. Here. Okay. This is kind of a different subject, but I read years ago of. Grandpa Sierra wasn't done. I don't know if you're on a lag, but. Oh, he came here again. I don't know why, but if you go back to the thing that's so. We'll take Grandpa's question in a minute, okay? Okay. Go back to your question for. You Can't. Hear Sierra at all. Grandpa. No, There's. Something weird going on. There are still screens. That's. Yeah, I don't know. Okay, so I was just going to say you're right. You're. I think you're definitely, definitely right. My question. All right, Go ahead, Herman. Yes. I love. It. Go on. What's going on here? Years ago, I read in a paper where a young girl, she was of high school age, went into the ladies restroom, had a baby, came out and went dancing. And I've been around women, around my wives who had children. They suffered a lot of pain and discomfort for a long period of time. How is it that a person, a young woman, could have a child in a bathroom come out and and then go back into a dance? Well, I would say that would be extremely unusual because most women, they'd at least have an umbilical cord to hanging out or they'd have a placenta that they'd deliver on the dance floor or blood or something. So it would be very, very unusual. Now, one way that that could possibly work is if it were like her third or fourth child. But I did have one patient who had three children by the time she was 18. But that was just one. Yeah. And who knows what's real in the newspaper? You know. What? Some people are just he can't hear me. But some people are just nasty, you know? Some people, I'm sure. Erupted. Anybody? Sierra, I can't hear you at all. I'm just have a still. Tell him it's our grandpa. Sierra says it's okay if you if you try and refresh your page, maybe you'll hear. Oh, okay. All right. How do I do that? Cool. I'm muted myself. Um, I feel like you're committing timing was on point, Grandpa. I think he missed it. Oh, man. My. Oh, I guess I was funny on many levels. I love it's many levels. No, this is this. I'm going to say it while he's gone. I think you're absolutely right that the economics, that the socioeconomic status is like, I think, a huge factor. And I think like overall, with that in mind, like the the eating habits, the the all that stuff, I think the stress is like the biggest part of that, the different stressors that you have. Being someone that lives more paycheck to paycheck or having different struggles and like, like a constant. Some people have like a constant anxiety being a person of color in like predominantly white areas. It could be your workplace. It could be like your neighborhood where you live. You might be the only person of color like those kind of things can cause a lot of different long term stresses that I think affect our health a lot. Well, I think you're absolutely right. But we need really to work on socioeconomic problems. And in order to do that, I think this and we've talked I've talked about this before, the simplest thing would be to get unlimited prenatal care and unlimited postpartum care for up to a year. I think that would help, because then at least you wouldn't have to worry about going to work to pay for your medical bills. Right? Yeah, I can't imagine. I read stories all the time online, like on Reddit of these different. That's probably why that's part that's not helping my fear of pregnancy. But I read all these different stories. It's like I'm literally a different person. Every day is like this woman who's like, Yeah, So I just had a baby like three days ago and my husband is telling me that I really need to stop being so lazy and like, get up and like, you know, I'm still bleeding everywhere and I'm still doing this and this and this. And I do have to go to work on Monday. So I'm just wondering, what do you think? What do you guys think I should do? And they're like, you need to go to the hospital. I don't know. You need you just need help. You know, you sound like you've been reading Twitter because I read Twitter. Yeah. And those things. And, you know, I wanna give you another example. Years ago, and this is one of the things that I thought was fun about OB And one of the reasons that I decided to become an obstetrician, we could actually send our patients home when they were ready. We were one of the things we did on morning rounds. We listened to the nurses and they would tell us, Oh, this one is latching on, this one can breastfeed. This one knows what to do when she goes home. This one isn't having heavy bleeding. This one is. So when we sent them home, we knew what they what was going to be happening to them today. They get shoved out in a day. That is, if they have a vaginal birth. And as it turns out, women who say one day have twice as much failure to thrive in their babies at six months as do the ones the C-section moms have been there for three days. So getting moms ready to launch is a really important thing. And we have completely junked that. How about to say you paying all our money? I'm paying somebody to stand it for a couple more days and I come out worse? That's out of control right? Yeah, This out of control. There is something I was going to say earlier about something. Oh, yeah? Yeah. It just needs to be more, you know, Dr. Alan Lindemann is in every community. Um, and like, all going back to the difference in the races. Yeah, Yeah, there's no difference. I really think that, you know, there is very, very. There's no difference between me and you, but, you know, I don't know if I got a neighborhood, you know, Dr. Allen, in my neighborhood, like, but, you know. Let me say I'm a dinosaur. So I probably. Will be made into. Oil fairly soon. Find stuff of it and just we're made of the same thing and there's no difference. Me, too. Think that's one of the reasons I say try to find a doctor who at least you feel comfortable with. Yeah. Again, it's that's going to be more difficult than finding hands with teeth. And I don't know whether you have the experience you have with and I have 60 of them here, but none of them have teeth. So. Oh, see, for me I was like, Wow. Can I, can I ask you, doc, what is the best way of going about something like that when each, each visit can you hear me, Grandpa? Oh, poor grandpa. I ruined his. How do you go about going on three or four different doctor consultations when you know, for the uninsured or even with insurance and you haven't met your deductible, Each one is a few hundred dollars or excess of that over and over and over again. Well, you're absolutely right. You know, back when I was, well, 40 years ago, all of this stuff was simpler than they. So, you know, if somebody saw me and decided not to come back where they maybe they got a 20 or $30 bill, but it wasn't two or 300. So, yeah, that's a real big problem today. But I think it's probably worth it even if you have to pay for it out of your own pocket. If you can find somebody you're comfortable with, somebody who will see you and your family. And as many times as you need to be seen and not complain about it and see you every, you know, the same one, same doctor, the same provider sees you every time and comes for your delivery. Again, that's going to be pretty uncommon because we have what we call now the doctor on deck, the DA and the doc on deck there for 24 hours. They deliver whoever comes in in that time and then they leave. Know my daughter was she delivered about ten years ago. She was in the hospital for a day and a half. She had three different doctors taking care of what time. So that's fragmented care. It's not good for anybody. Yeah. Wow. Well.$20 for a doctor. That sounds very nice. What? Where do you think that sort of corruption or greed or you say that it's like a conflict hated system. Is that coming from the insurance companies? Is it the big hospital? Is it like where is the center of a lot of these sort of outrageous bills and financial problems coming from? Well, you see that well up there, it says modern medicine, right? You're dying for. No, we have five chapters that explain that now. We wrote that 30 years ago, but we were talking about the problems then that we have now. And of course, they're much worse today than they were then. But if you look at try to figure out a trail here, Medicare here sets the stage for many things. Whatever Medicare does, insurance companies do, and everybody tries to balance the ledger and depravation of care or denied access. And this is just fundamentally wrong because it's the thing that gets us our maternal mortality rate of 55 per 100,000 versus two per 100,000. So we need to have access to care, and that is insurance companies, Medicare, Medicaid, medical malpractice, the CEOs, ACOG. There's lots of people working against making affordable and accessible care for the public. Are you the norm or the exception amongst your colleagues? Oh. Well, in the first place and a big exception because I'm very offended by this. There are doctors who are also offended, and if you go to Twitter, you'll probably see them on Twitter. They're more now talking about doctor burnout. And there are two big factors for doctor burnout. One of them is having no control of your schedule. The other one is the electronic record. It's estimated now that an average 11 hour a day doctor see patients for 5 hours and they babysit the computer for 6 hours. That's totally, totally messed up. We should be seeing our patients for at least 80% of the day, which is what we did before, when we could write on charts. Mm hmm. That is actually have a piece of paper to write out. Okay. So you have to, like, log everything in. Place of account. Yeah, it's just remarkably complicated. It's under like, at work here. There are some days when the whole computer system doesn't work at all, So then. You're. You know, busy on Saturday, Sunday, trying to make the charts. That didn't work on Tuesday. You would think that the American Medical Association or and the doctors would get together and certainly would have the the power to change that. Well, the American Medical Association is very useless as better of. Doctor. Whereas not it's more than useless. It's in some ways harmful. There are many doctors now who don't even bother registering or paying for the AMA because the AMA like it. That is part of the problem. They make tons of money off of coding and the coding is one of the big problems we have with the electronic record. Now it does sound like you're kind of revolutionary in a sense of I'm sure that there are more doctors on Twitter. I'm not really on Twitter, but it sounds like what you're doing would fit that. It wasn't like you would have lots and it means lots of enemies, but you probably wouldn't be the most favorable person because you're you're kind of you're kind of blowing a hole through the whole bang of like, you know, it doesn't have to be this deep. You don't have to put this many hurdles in front of people to get care. And that doesn't seem like that would bode well for capitalism. Are you how you holding up? Are you say. How. So far I haven't been threatened. I haven't had anybody come in here with an M-16 or anything like that. No bombs, no car bombs. But I expect that sooner or later I'm going to have some crap from, you know, various organizations. But there are getting to be more and more doctors who object to the problems that we have with the relationship between patients and doctors. As a matter of fact, many times a day, I think there are only two groups that don't matter anymore in health care. One is patients, one is doctors. Whom. I can agree with. They sometimes you guys remind me of like cashiers at a restaurant, and I mean that. And like, that's the treatment. I don't mean that. But there is something else saying. Well, yes, it's getting to be more that way. One of the solutions that we see there are a few brave doctors who do direct primary care. So for 50 or $75 a month, you can have unlimited access to those doctors. You can call them as many times as you want, and you can come in for as many visits as you want. You get your medication that cost and you get your labs at cost. Naturally, insurance companies don't like that. They call us practicing insurance. But of course, insurance companies practice medicine. That's one of the problems with insurance companies. You know, they hire a doctor and the doctor says that does exactly what the insurance company tells them to do. So it's. Just. It's a it's a fake really. There's a whole stand up joke about doctors as being prostitutes. The insurance companies are sex workers are a better term. But it was about an important question. I want to ask you to bring this all around, because as grandpa and Sheila and as an age thing going on, at what age did you feel like you were ready to start being a rebel, liked to start putting like like I'm sure you've been doing this your whole career, but like, when did you really start feeling that, like, you didn't care as much? It was something that you had to do or. Or I have always been unpopular with the medical community because I have done these things with my patients. In other words, I saw them as many times they needed to be seen. I was there for their deliveries. I was there when I when they needed me and I have not participated in this dark on deck thing. So, yes, I've been unpopular. And yes, I think you know, the first time I wanted to be a doctor, I was 12 years old. And for years I thought, well, you know, I couldn't do math. So I flunked bone math. You know, the bone math is for the stupid people. So I flunked it twice. And finally I took it again and I passed it. I got the highest grade in the final test. But that was the thing that really stood between me and medical school. Of course, obviously I got in. I applied one time to one school and got in, so and I didn't think I was going to get in, but I did, obviously. And we're in. We're blessed that you did it. Yes. I'm happy with this career. I think I've done I've accomplished much of what I wanted to do. I am shifting gears now. I what I'd like to do is get us I'd like to fill the gap, in other words, where we are now and where we need to be. That's where I'm going to spend my time for the next ten, 20 or 30 years. Whatever God gives me to spend on this earth and to be able to talk and write. Wow, what a futurist. So tell us about this latest book, The Safe Pregnancy explained. You know. We do have it's a three chapter book. It's very yes, actually, it's a safe pregnancy advice. That's our faith group. And anyway. This flame is the Kindle. Safe Pregnancy Explained is the Kindle book. And like I said, it's just kind of a preview. But in there we talked about how to find a how to choose a doctor interviewing doctor. The question you should ask on an interview. We also talk about what to eat, how to eat, when to eat, for example. I've never had a mother who needed to have an energy tube or I.V. feeding. Every single one has been able to eat. After we talked about how, when, where and what to eat. So that's been very successful. So that's one of the chapters. The other one is how to take care of yourself when you're pregnant. I think I was successful managing my patients with hypertension because I got them to buy into their treatment in other words, they had their blood pressure cuffs at home. They could call me often with their blood pressures as they wanted to. We would talk about what they needed to do to keep their pressure down. For example, there are many women who like to work 12 hours a day. That's bad for blood pressure, very bad. So 312 hour days is not what you want, but it's much better for your blood pressure is five, six hour days. So there's a lot of ways to go about dealing with your blood pressure in ways that prevent a crisis, prevent strokes. Like I said, I've had no moms with strokes. How to be very popular. Yeah. Doctor, are there any organizations of physicians that think like you do? I think we're seeing more of that. And let's see, there's a doctor on Twitter. So if you go to that group, you'll be able to see he's in Montana. I think his name is Gabe Charbonneau. So look for him. There's going to be more and more because there are a lot of doctors who are tired of this rat race of being on the the squirrel cage. Definitely. Wow. It's going to be good here for it. Well, of course, most women here, they'll go to Bismarck, which is 85 miles away. We don't do obstetrics here. So I've just been doing general care. But I can tell you that North Dakota is extremely conservative. And, you know, I don't think we have any office in the state that's not Republican oriented. There was a doctor in Fargo who provided abortion services. However, Moorhead is just right across the Red River, so she's now moved to Moorhead. And of course, Minnesota is very liberal, very flexible when it comes to abortion services. So the people in Fargo don't have far to go. However, the people in the rest of North Dakota would have physical go. They would have to go to Minnesota. I don't think they're going to get very far growing to Montana. No. And what do you see as a path moving forward, especially, you know, for women, where transportation is tough, taking time off work is tough, but getting out of the state is tough. One of the problems, you know, and I'm sure that the Supreme Court didn't give this a thought, but we're going to see the maternal mortality rate go up, especially for people who are socioeconomically deprived lived. It's these are the people who are going to get hurt and hit the worst. So, yes, I expect to see that this 55 per 100,000 is just going to be going higher. Now, the long term outcome, I think, is going to be good for everybody. Like I said before, you know, if you look at the people who are coming out to vote, they are 21 to 25 year old females. Typically the group that does not come out to vote. So these these polls are going to be very heavily swayed by this pro-choice movement. Yeah, well. They had to be like that to get to that point. But again, looking at the you know, looking at everything in a positive. No, that's again, something about. Yes, the Supreme Court not thinking about it. Yeah. Hmm. I wonder why they didn't think about it. It was always my question. They didn't think about it. They just didn't factor in all of the poor white women that would also die, because right now the economy is actually terrible. One of the things about the Supreme Court is that they can have whatever opinion they want to have and you can justify almost any opinion at all. So these opinions are very personal. They do not represent the public. However, legislators should represent the public. I mean, they are voted in. They should be responsible for the needs of the voters. So I think we're going to see the composition of our legislatures changing a lot to pro-choice. Hopefully. I hope so. So it will happen, Sarah. It will happen. I know it will. Already saying that, but I'll be saying that. But I don't know every time I tell I've been so, so so Dr. Allen, I say this almost every day on this podcast. I say on this podcast every week, you know, every time I wake up, I look on my phone and I get embarrassed that I live here. I am really embarrassed. That I live here every day. Something dumb, it happens. Well, there's no doubt about that. We have it. All. Screwed up for a long I mean. And you came on here and you didn't make it any better. You're just like, still are. When you go in there and go, like, So you go in. Wait, it did say it again to me, but some people, if you're having a baby and you have a C-section and you're there for a short amount of time, which would cost less right then the person that stays there longer. Person stays there longer with the C-section, has a better has a more higher success rate with their baby at like the six month checkup. Right. Then a person who gives a regular safe like vaginal birth because they only get to stay in the hospital for one day. Right. The the three day people are more likely to be ready to go home. Then the people. Yeah, but. That makes it sound very. If they stay all that time, what are they going to feed their kids like the credit card debt or. You mean I think their kids. Get home. The bills are going to keep going up every day. Well, that would be one of the things that we need to work on here. And. You know, the shortening, the length of stay has done absolutely nothing to decrease. How about the thing? Yeah. Yeah. And, you know, for everybody, for all the boys back home listening, when you have a C-section, they are literally cutting it. Correct me if I'm wrong, please assuage my fear, but they are cutting into your whole stomach, moving around everything else that's in there until they get to the baby, popping the baby out of your stomach. And then they just so all that stuff back up and then you just sit, you have you have just a gaping hole in your stomach that is waiting to heal for months and months and months and months. But you get three days to stay in the hospital. Yes, I know it's not fair. Actually. I think going out of the hospital after three days is probably a benefit to the patient. But they do need to have support when they go home. Now, their words, they can't start vacuuming. And now. You can't do anything. And be, you know, up washing the breast pump at 2:00 in the morning. They can't be doing that stuff. They need to have a responsible significant other, whether it's their husband, whether it you know, whoever it is, they need help when they go home and a lot of it. And also understanding, like I said, I read Twitter quite a bit most of the questions that the moms have on their are questions they should be having. They should know these things before they go get out of the hospital. I would need to know all that before I even got pregnant. I'm like, I need a full binder. I need a I need honestly, I need like an associate's in pregnancy before I even before I would even start that. It's just no way. Oh, yes, There is such a thing as a dual. And the dual lives are very helpful during labor. Hey, when I was in Fargo, I. There were several what we call lay midwife. Then the lay midwife doesn't necessarily go to college for four or five or six years. They just learn by doing and a lot of them do a good job. And I never discriminate against those patients or those providers. And very often most of the time they would come into the delivery room or the labor room with their patients and I would welcome them. They would act as a Double-A that is a a friend of the mother who was in labor and doing the delivery. Yeah, I like that community, community. So scary. Yeah. Depth that they're good too in labor and delivery, especially if you get to know them before labor and delivery. If I always did. I saw on your page doc, that you avoid C-sections. Is that correct? Well, in my first practice, which was in Crookston, Minnesota, when I went there, the C-section rate was a whopping 15%. And I thought that was terrible. So I reviewed the three years of C-sections and I to reduce the rate to 10%. I did it by doing this backs. In other words, moms got an opportunity to deliver a baby vaginally if they had had a previous cesarean section. I also delivered a second twins breech and I delivered vaginal breaches. And I have to say in Fargo, I had many doctors calling me to help me with their vaginal breaches. We never had any trouble. The thing you have to remember was a vaginal breach is first, you don't want to wear your pants at the. The second thing is you have to keep you have to deliver the arms. You have to make sure the baby's head is looking back. What is what is a vaginal breech. That is when the baby comes out. But first from the vagina. So anyway, when the main thing you have to do is keep the head flexed. So this if you do that, the baby will never deliver. So just remember. To do this and everything works out fine. So I think the art of vaginal breech delivery is gone. I think that there's a lot of young doctors today. If the second twin is breech, they won't deliver it. One time I delivered twins. They were both breech and we had no trouble at all with any of it. So breaches, you don't need to be afraid of them. But the problem today is I think that the people who are doing the teaching don't know how to do it themselves. Wow. That's so interesting, because I was a C-section. I guess I still am. But because of that, my two younger siblings had to be C-section as well. Well, you know, that style comes and goes. 40 years ago, feedback was very much in style. All I had to do was decide I want to do it, discuss it with the patient. And it was done. Never had any trouble. No ruptured uteruses, no blood transfusions, nothing. What's the feedback? That's a vaginal birth after cesarean. So it's matter of fact, I had one patient who withdrew practitioner. She had had four caesarean sections. She wanted to deliver her fifth baby badly. And we did it. No trouble. So there is really we like to say that you can deliver that If you have two C-sections, you can deliver the third one vaginally. But I've never had any trouble with the fourth or fifth baby, especially even after, you know, that birth before. So I'm not afraid of it. Never have been. Got a C-section. How are you doing here? Well. I didn't realize that multiple C-sections were thing. And now I'm. Said. That's another thing you have to understand when you. Choose your doctor. You know, are they willing to give you a vaginal birth after your C-section or are they not? What makes them just say no, I'm sorry. What would make your doctor just say, no, we're not even we're not going to try the vaginal birth. There's two problems. And one is that they don't know how or they're afraid. The other one is that from time to time, ACOG will raise its head and say, Oh, you're not going to do VAX anymore, or the insurance company company will come along and say, Oh, you're not going to do a vaginal birth after C-section in this hospital. So you've got a lot of people interfering with the care if you try to provide a patient. The insurance companies can make that decision. You have malpractice. Carriers can say you are not going to do a vaginal birth after C-section in. The hospital or. We're not going to deliver twins in. This guy's. Medical field. I mean, an insurance company is daddy cow. Cross Blue Shield just said, you know what? No, this vagina is mine. You can't. I'm saying now. How do we lock up these criminals and these assurance companies? Well, so. I would say the best thing to do is to do what you're doing. You know, the problem that we're having today, that is the destruction of the patient doctor relationship is really a big problem. And in order to repair that, we have to object and we can object by calling or writing to our legislators. That's the first thing. Also, visit Twitter once in a while, see Dr. Gabe Charbonneau. Also, you know, we're going to get another book out here pretty soon. We have a I do two podcast a week. Well, if you're interested in those. They're done with Neil Haley. And we talk about things that should make your pregnancy easier and safer, as well as to your delivery and your postpartum ego. So, yeah, I'm a fan. I'm a big fan. You know, you're not only walking the walk, know you're doing your best to wait. You talking to talking, walking the walk. There are lots of walkers you walk. No matter how unpopular. But I have to say, the patients have been good to me. I still get. I got an email a couple of days ago from somebody I delivered, delivered to of our children. They're now 36 and 32 years old. Wow. Wow. And I also delivered quads years ago, and they are now 23 years old. And we went to visit them and we have a video. And mom and dad talked for over an hour and we got the quads on video, all for a living. And that was pretty comical. You said he was in charge of the four babies when they got home. Mom went where he stayed and took care of the babies. He said he'd change 7000 diapers. The one. Hilarious. I bet. As it seems like you're very emotionally invested, Doc, and I'm curious if that's a rarity as well. Yes, I have. I really have cared, and I think that has made a big difference. Like I said, you know, we talked about Lauren, who died about 5 hours after she delivered. I, I was always there for my patients. And I always tried to figure out each one's risk. Probably one of the patients I was most worried about was an 18 year old girl. She had blood pressure of like 90 over 40 when she started her pregnancy, but she wound up with the 130 over 90. I think that that one scared me more than anything else. But she did not. CS And she did not stroke, but she did get it and she did do very well. And everything went okay. Yeah, everything. Baby's fine. Mom is fine. So it was the thing is that seems to be different today, at least in some parts and we've talked about this before today is fragmentation. I would never have asked a neurologist to come in to see to take care of one of my patients who I thought was high risk. We were taught to take care of them. There's another lady who this is a lady of color. She was a third year Pedes resident. Again, you'd think that if anybody would get good care, it would be a doctor. Well, she died three days after she delivered. She died from a ruptured liver. And their excuse was that. Oh, we didn't know she was going to have a ruptured liver. Well, that doesn't just happen overnight. However, once the liver capsule ruptures, it is a very serious problem. Slowing the liver is like slowing hamburger. It doesn't work. Well. Sometimes they put a sock around the spleen, and maybe they could have put a sock around the liver. But anyway, she died, and she died from a ruptured liver. So awful. I have a question, Doctor. Has there been any changes or improvements in the position that a woman takes when she has a vaginal delivery? Well, you're absolutely right for getting into that. Prior to about 1750, women were delivered by women and they were delivered in physiological conditions. For example, they could walk if they wanted to. My dad's aunt delivered five children at home. She actually one of them was a placenta previa. She talks about walking up and down the steps as part of her labor pain management. And many women used to do that. I always encourage my patients to walk. That means that I discouraged epidurals. I discouraged IVs that tied them up. I discouraged urinary catheters. I discouraged internal monitors. And I did it because the patients deserve to be able to have some autonomy. They need to get up and walk around if they want to and if it's safe. And 99% of the time it is safe. I'm here for that. I like that. So what did you enjoy the most about writing? About writing your book or books? Well, again, my goal and my wife is just really a big part of this. Our goal is bridge the gap. We need to get from where we are to where we need to be. And that's the fun part. That's one of the reasons I get up every day and read and write. And so and I get it. Right now I'm doing a chapter on depression. We're going to do another. I don't know if it's if all the friends of Zane, Adam Zane's mom, committed suicide a month after her birth. So I'm going to be doing a podcast with her. Well, actually, it's a radio interview with her mother now, the grandmother of the baby. Mm hmm. And that's going to be on postpartum depression and preventing suicide. Exactly. What are the steps we use to prevent and deal with postpartum depression effectively? So we'll be talking about that. Wonder, is postpartum depression more of the norm or is it? What percentage of women have postpartum depression? If you look at maternal mortality and who dies, you're looking at now about 15 to 20% of those deaths. Occur. From some kind of mental illness, either suicide or drug overdose. Now, this is something that I didn't see much of 40 or 30 or 20 years ago. I never saw a mother commit suicide during pregnancy. I've never seen that. And as a matter of fact, I've never seen one commit suicide after pregnancy. But again, I think it takes commitment from the presiding doctor, from the whole health care system, the hospitals, the nurses, and in particular. The clinic. Treatment to ask whether these people really need to be followed is in the clinic. And. I think a lot of this information would also be good just to have as like part of like your common sense. Every student gets some kind of knowledge of how pregnancy just works. Like as part of your sex ed or your health class training, like not training, but health class education, because like some of this stuff, like you're saying is like should be common sense. Like to most people, like, everybody should. Know some of. It everybody should have some understanding of like how a C-section works so that they understand, like, how painful it is, how stressful it is, how much recovery there is. Everybody should know what postpartum depression is and how it can appear, because everybody knows someone who has a baby, you know? Hmm. Well, your point is well taken. And that's exactly another part of our audience. That is somebody who knows somebody. And incidentally, if you want to see how a C-section works, it's free on website. You can go to Lindemann, M.D. dot com and see it's it's not a video of a C-section but it is a diag a dramatic representation of a C-section. It's layer by layer in and out. When I look through, it's on YouTube. It's on YouTube. When I was doing these things, the nurses would say, I could do a C-section in 15 minutes and no blood on the floor. Mm hmm. So there's two ways you can do it that work well, and there are ways you could do it that work badly. But when if you want to go to YouTube and see my reputation, it's there. We talk about how to do it. I think. Well, okay. Yeah, yeah. I agree with what the Seer was saying. There's a lot of I was a big learning they did for me. I mean, even someone that worked in the medical field for eight years. There's a lot of little stuff that I did that was like, Oh, wow. I did not know that was a that was a thing. So you're right. More education would probably help things out quite a bit. And now would take the stress off of you guys. I education is really important. As a matter of fact, that's one of the ways that I got my patients to buy into their care. You talked about it, and I think that's one of the reasons we I had no maternal mortality is because when my patients after the first visit and throughout the pregnancy, they knew how to take care of themselves. Mm hmm. Dr. Lindemann, what did your parents do? Well, my mom never. She was a housewife. She was very depressed. And she spent most of her time in bed. I have two sisters who are younger. The youngest one is seven. I took care of her, so I was. I been taking care of people for a long time. My dad died. I. I turned 11 in February. He died in March. So, you know, we were very you know, we lived on it was about $200 a month. Our rent was about $15 a month. We spent about $60 a month on food. Wow. But, you know, we never we we certainly got $200 a month was enough to live on. I got $60 a month after I went to college, and that really helped me a lot.$60 today doesn't even buy you milk and eggs. Honestly. Wow. That's pretty. And that's that. That gives me a lot of context to. Have you considered being a Santa Claus? You know, I never I have been accused of looking like Santa Claus. I've also been accused of looking like Burl Ives and a few others. And of. Course, now I don't. Need padding anymore to look like Santa Claus. I have enough padding of my own. So, yeah, I've been there. A lot of. People don't. Realize. If I deliver, if I deliver babies, I'll be like, Don't ever call me Santa Claus. I bring more than just the gifts to people. Right? All right. Bring in life. I never do. Look like an angel. To me, that is a permanent gift. Eight years ago, I wore my white coat into the drugstore, and I had my beard. Was a little longer then, and the little boy was in the drugstore, and he looked up at me and he said, Are you Jesus? So that's the only time somebody thought I was Jesus. And I had no, I'm not. I'm his father. No, I didn't say that. I know. I said, thank you. Is there a much of a percentage difference in the mortality rate depending on what hospital a person goes to? Well, unfortunately, I think that's true. What I don't know is exactly which hospitals would be the most dangerous and which hospitals would be the least dangerous. But that's a good question. I need to know answer to it. I can tell you that years ago, it's what Consumer Reports. That's my wife talking with you. Yeah, that's a good. Place to go. Reports years ago. You know, now they're something we call group B and everybody, every woman who gets who has group B gets treated for it with penicillin. If she's not allergic in labor, well, that's only been treated now for maybe 20 years. But before that, we had a lot of deaths. Not mothers, but babies from Group B, because that's the problem is babies die from group B, So eventually the CDC thought of a way to deal with this. They thought of and then, of course, ACOG, the American College, endorse it. So now we have that treatment for everybody. I don't agree with the way they do it, because I had developed my own system 20 years earlier and that had always worked for my patients. Are any studies that show whether it's more beneficial to be delivering in a city, a big city or out in the country, that sort of. Thing? Well, unfortunately yes, you have to have a certain amount of deliveries per year. They say it's about 50. But again, 50 is not that many, considering I had almost that many in my first one month. So but there is that connection between less than 50, a higher neonatal mortality rate. That's an issue that should be addressed because it is not necessary. You can't be afraid of doing obstetrics and if you are, you. Sure can't. Let your patient know you're afraid of it. You know, no matter how worried I was, I tried to walk into that room calm and as dignified as I could. And that's the presentation I always wanted to make to my patients as there's no point in getting them worried. I mean, more worried for real. Yeah, right. What does it feel like walking away home after dealing with such a crazy and difficult process? You know, it's euphoric. One of the probably the biggest natural highs you could ever do is to make that delivery. And on the way home, you can feel tremendously satisfied. Do you do you miss the drug? Yeah, I do. I do miss it. And the things we're writing now are a good replacement. I get almost charged up doing these things, you know, talking with you, talking with the other people to do radio shows, TV shows, podcasts. It's fun and the message needs to go. I think I started saying a little while ago, this is really a grassroots thing right now. It's it has to start with consumers, just like not, you know, Mothers Against Drunk Driving in the early sixties, just like the anti-smoking in the early sixties, people used to say, oh, gee, why do you think we should quit smoking? You know, they thought it was a they thought it was funny. And I can remember all of that stuff. So that's where we are right now. We we're still like in 1960 and the No Smoking campaign people are asking, why are you doing this? Mm hmm. I don't know if you already answered this question, but why did you stop your career as a obstetrician? Why did you stop doing deliveries? Well, you know, I got to 6000 and I thought, well, maybe I just need a little bit of a change. I did actually go to a small town to revitalize the OB program. And so that's one of the reasons I left Fargo, was to bring obstetric practice to a small town. I was there for six years and they eventually decided to close the program. So then I thought, okay, fine, I be done with this. So I went on to just being a general practitioner. I would've had fun doing that too, and I really like to work with people who are socio economically disadvantaged because they're very needy and they have a hard getting care. So it's fun to deliver care. Almost as much fun. As doing the C section, going home. I have to tell you a story. In about two decades I lived in Fargo. I never got a speeding ticket except on my way home. So I had one speaking pick that was on the way home. I'll tell you another story. I was on my way to a delivery and I was trying to ditch the cops. I knew they were following me. And they follow you for why? Because They said, Well, I jumped out of my car. I went to the police car and I said, Give me a ticket if you want. Just let me get to my delivery. And they said. Yes, but you were doing 65 and a 25. Zone. And they say, Oh, I'm giving you the ticket. I didn't get a ticket. Oh, my gosh. You should have said that. When you're on the way home to. Right. Just people like I'm going back to back. I've got I'm busy and busy, man. Yeah. Yeah. What's the the sort of best outlook in your field in, like the next 2040 years And what's the worst outlook like? Where do you see all this going? It's going to take a long time and it's going to take a lot of work and it's going to have to be generated from the public. None of the people involved with making this problem are interested in fixing it. As a matter of fact, they're really interested in making it worse. One of the huge problems we have today is the proliferation of CEOs. That is chief executive officers. They have in the last 20 years increased by 30 to 100%, whereas the physician community has increased 150%. So we have had a big. Proliferation of. People who do absolutely nothing good for health. Care. Wow. They're making the most money, right? Well, I'm make millions. Millions a year. Is it is it because they're in the politicians pockets? Is it is this the lobbyists? Is this big pharma? Is this. Well, certainly Big pharma is their real big problem. I'm going to give you an example of that. We have something called see this? And they as far as I'm concerned, they're basically bandits. But they bought out, you know, the insurance company. Mm hmm. And the price. In coupons. And who you read between 68 and $75 billion. Now, where does that money come from? It comes. From you. It comes from the people who buy their insurance, buy their their medication. And Aetna. Oh, yeah. Well, now you would see these. Now shoot even worse. Now. Wow. Doctors can't tell in hospital. Well, yeah, my wife is reminding me one of the big problems we have is doctors can't own hospitals. So that would be something that would be easily repairable by talking to your legislators, because that's something that was legislated in, I'd say about 25 or 30 years ago. It could be legislated out. I really do think that the majority of doctors, if they have a choice, will do things that are best for the patients. Yeah, this should be like a wizard thing so they don't so they can free themselves. Doctors. What artists have? What is that thing that they were doing for a while? Poverty. They were trying to go away now? Yes, yes, yes. Sure. But not when they were trying to make money by themselves. Like there are selling figures like no fees. Yes, doctors, you know, the free themselves from the insurance pimp. There you go ahead. And just it would be nice to get rid of the insurance pimp. Yes. Very, very. Really happy to do that. And again, I think this has to be we have to have people objecting to it like we have women objecting to the overturn Roe v Wade. All I feel like that would make a beautiful. Go ahead. I'm sorry. Oh, no. Just your face saying we have to get rid of the insurance pimp. Would I think a viable stop right there. I want to. Get to Dr. Lindeman doing like like a doctor exams on the corner to play a. Sick if you want to go. Viral. I'd really like. Sorry, Grandpa rented. It while Dr. Lindemann and the crew. I'm going to say good night. My. My bird has been operating on the back of my neck. Rosie said, Get off the phone. I can't take much more of it, but continue without me. And. No, no, no. We're we're all saying, you know, we're at 830, but give us your last thought. Oh, well, Dr. Lindemann, you're a very interesting guest, and I've learned some things that I did not know before. And it was very nice meeting you and talking with you. Well, thank you for the opportunity so. We're all part of the solution now. Let's do it. Grassroot. What what are your final thoughts here? This was so scary and informative and I. I appreciate you coming on and I'm glad we got to make it work this week. I'm going to. Sorry about the problem we had getting signed in. We're not used to Riverside so it took me took us a while to figure it out. So now Riverside is not used to us either. You saw Brandon and Phines kept popping in and out I'm like, or Grandpa Barton. Brandon kept popping in and out. Two stars for them. Two stars today. Riverside disappointing there. But but thank you so much. All right.

Phines: 1:22:21

final thoughts. Yeah, and I'm starting to sound like grandpa, but these every guess it comes on but very like just good examples. I'm just really very feeling very lucky to be in the presence of you and hearing your thoughts and what you what you have to say. I think it was well needed and I'm glad I got to hear it and got to talk to you. So thank you so much. And what about you, doctor? What's your final thought? Well, I want to learn once again, I want to thank you for this opportunity. We we the people can fix this if we cannot. Rely on the people would. Like to think could fix. It because they will only make it work. So we the people have to make this better. Amazing. My final thought is you said that the high that you feel from delivering babies, you know, bringing life into the world, nothing is comparable until you started going on these podcasts and so on our website now post as good of a high as delivering life into the world. And yes. Thank so much. Yes, I do appreciate it. I know you have many more interesting people to talk with, but I thank you for the opportunity where. Can people find you, Doc? Well, the best place is Lindemann, M.D. dot com. We also have safe pregnancy advice on Facebook. Amazing. And one more time if you could promote all the titles of your book so people can go and pay to buy them. Well, of course we have the 30 year old book which is modern medicine What You're Dying to Know. We should have named it something different because people thought it was a comic book and not funny at all. It's the story of what happens when when you interfere a lot with patient provider and ship. And the other one we're going to be doing is pregnancy your way. And so that's not out yet, but it is it'll be on our website, it'll be available. And we have. Safe pregnancy. Ours and we have seen the Kindle book, The Safe Pregnancy explained. That's just a few chapters. Jack Canfield has called it brilliant, whether it's because he figured we would pay him for that or not. But anyway, it was something that we were happy to get from him. Beautiful. Well, I want to thank you so much again for coming on. Grandpa is gone. But I do love him. I love all you guys, and I'm very grateful. So have a great night, everybody. Thank.