Health for a Lifetime

Skin Disease For Adults

Three Angels Broadcasting Network

Program transcript

Participants: Don Mackintosh (Host), Jonh Chung

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Series Code: HFAL

Program Code: HFAL000214


00:01 The following program presents
00:03 principles designed to promote good health
00:04 and is not intended to take the place of
00:06 personalized professional care.
00:08 The opinions and ideas expressed
00:10 are those of the speaker.
00:12 Viewers are encouraged to draw their own
00:14 conclusions about the information presented.
00:49 Hello and welcome to Health for a Lifestyle
00:51 and I'm your host Don Mackintosh.
00:52 We're glad you join us today, we're gonna talk
00:54 about the skin today and we have a specialist
00:57 that deals with skin every day.
00:58 He is a dermatologist;
00:59 derm means skin and ologist
01:02 of course the study of the skin
01:03 and Dr. John Chung comes to us from Dalton,
01:06 Georgia, where he is practicing dermatology for
01:08 about ten years. You have a large practices
01:10 that deals not just with the common problems
01:13 of a, of you know children and adults skin problems.
01:16 But also more complicated things like
01:18 skin cancer and surgery, plastic surgeries
01:21 out there, all these different kind of things.
01:23 I think some of that, all that together
01:25 and so you're probably a pretty busy man there,
01:27 do you have other physicians that work
01:29 with you there, yes I do, do
01:31 you know Dr. Philip Mills? I know
01:33 Dr. Philip Mills, yes, yes he's my best of friend.
01:36 Yes, he's taking, he's my friend too,
01:38 he's your friend too good. Well, today
01:40 we're gonna talk about some common things that
01:42 afflict adults and their skin. First of all,
01:46 why is the skin important? I mean, it's, it helps
01:51 homeostasis of your body, and keeps balance,
01:54 so it keeps your temperature not too hot,
01:56 not too cold. That's absolutely right,
01:58 it controls your temperature and also helps
02:01 pathogens from coming into your body
02:05 as well as it helps you from the sun exposure,
02:10 the ultraviolet rays, if the body has a mechanism
02:13 to deal with harmful rays.
02:15 It also helps you loose prevention of the loss
02:19 of water from you as a barrier.
02:22 Isn't that well also helps you get vitamin D
02:25 what you need live? Absolutely, so the skin
02:28 is really important, it's also important in all
02:30 our relationships, we shake hands,
02:32 we give each other a kiss, we, all those different
02:34 things, that's right. Without skin that would
02:36 not be fun, that's right.
02:38 Okay, you know some of these skin problems,
02:42 I don't pronounce every day as a pastor,
02:44 I don't get up and preach the sermon on acne,
02:46 although maybe I should, but we're gonna talk
02:48 about several and you're gonna have to help me
02:51 with some of these rosacea, rosacea, rosacea
02:55 is the first thing then what is that
03:00 perioral dermatitis, psoriasis,
03:03 if we get time what are some of the
03:05 other ones here we have down that we might
03:06 talk about? Well, different like funguses
03:10 and something called like seborrheic dermatitis.
03:15 Okay, so we get time but we're gonna
03:17 working down through this and lets go back to
03:20 that first one, you're gonna
03:21 to say it for me again.
03:22 It's called rosacea that means, rosacea
03:24 like rose, that means like rose exactly,
03:25 so it look like a red, red head.
03:27 I mean not something in your hair
03:30 but right our red face. Right, okay,
03:32 so like rose that sort of means, okay so
03:34 what is this, how does it start, you know
03:37 what causes it and okay, all that.
03:39 It's a chronic like acne-like disorders but
03:43 it's not related to acne. And it has papules,
03:47 pustules and dilated blood vessels
03:50 and there's something called rhinophyma
03:54 which is you've seen WBC fields with
03:58 large lobulated nose. Okay, all those little,
04:02 right that's called rhinophyma that's
04:04 a result of rosacea. Okay, so what causes it?
04:10 You know, we don't know just happens,
04:14 is it genetic? We don't know, we don't know
04:16 what causes it at all, it may or may not
04:19 be genetic because we don't know what it cause.
04:21 But the onset is between 30 and 70
04:25 and it's slightly more common in females
04:28 mostly occurs in Caucasian,
04:31 but the rhinophyma occurs
04:35 almost exclusively in men.
04:38 Thankfully, I mean the females are alright,
04:40 side released there. Okay, so 30 to 70 years old
04:43 that's the onset and you don't know the cause.
04:47 Well, we don't know the cause but there
04:50 are certain things that are making worse,
04:51 such as. Like changing weather, spicy foods,
04:56 hot foods, temperature hot foods,
05:00 certain medications and alcohol, alcohol,
05:04 alcohol and also the Sun. So, a lot of people
05:07 that drink alcohol you will see they have
05:08 that really red face and that's what this is,
05:10 right exactly. So, you said climate change,
05:14 so it's a better to live in a place where you
05:16 don't have the four seasons if you have
05:17 this, like Arizona, or, or else there is too
05:21 much, too much Sun there, too much Sun
05:23 there. Because the Sun can exacerbate dosage,
05:25 where would you live North Pole,
05:26 South Pole, what's the best climate for,
05:28 what is there? That was the best place,
05:30 it's okay, try and get away from that but
05:32 there is no favorable climate above others.
05:34 It's actually is the change in weather,
05:38 okay you know, it's not, it's not,
05:43 it's not so much the season. Exactly, it's
05:47 during the change, during the change okay.
05:49 So, what's the treatment for this?
05:51 Well, there are multiple treatments one is
05:55 topical, I like to use something called
05:59 matrigel and the other, other medication
06:02 is sulfa based medications, so matrigel
06:06 and sulfa topical preparation, right.
06:09 It's another that you rub all over,
06:10 exactly and also old medication that includes
06:14 tetracycline or minocycline or Doxycycline
06:19 and some times I use something called
06:22 Z-Pak, zithromax, yes okay. These medications
06:28 tend to work fairly well in most of the patients.
06:31 And again all those that you make sure the
06:33 patient is not pregnant, if it's a female and
06:35 be very careful with that. Right, exactly and
06:37 then what about tetracycline with the
06:38 little kid, this is not a little kid thing but
06:41 does that mess up your teeth somehow.
06:43 Yeah, it can, it can stain your teeth,
06:45 so what age is that. I would not use you know
06:48 they say 8, age 8 but I don't like to use
06:51 anywhere, anybody below age 12.
06:55 Because they still have teeth coming and
06:56 what not, but you know the literature say
07:00 and also I talked to a dentist who says it's
07:02 okay to give anybody above age 8.
07:05 Okay, but I will just wait till they're 12,
07:07 because if your wisdom teeth are stained
07:09 there in the back who cares right, right.
07:11 You're still wise, okay but that's still a good
07:14 role of thumb someone watching say hey
07:15 look watch before age 8 for sure as well.
07:21 Is that all we need to say about this one,
07:24 yes and also severe rosacea can also
07:28 treated with accutane just like severe acne?
07:32 Accutane, that's that thing that dries out
07:34 all the, all of the glands that have the oil
07:38 there, that are causing the problem with the
07:40 cap that's not going off and just kind of
07:42 dries it out right? Right, okay, good,
07:45 I'm trying to remember you know from what
07:47 we've learned. Okay, let's go on to perioral
07:52 dermatitis, right it's that around your mouth,
07:58 yes, okay. Peri means around, dermatitis
07:59 means skin, the inflammation of the skin
08:01 okay, perioral dermatitis is a, it's like
08:07 Acne-like eruption is micropapules and
08:11 micropustules around the mouth and usually
08:15 occurs in young females. And usually
08:18 spares vermilion borders right there between
08:20 the lip and, lip popper and the chin,
08:24 it usually spurs in that area. So, it doesn't
08:27 get right on the lip but it just right below it,
08:29 exactly and also you can have a very end
08:31 of it called periorbital dermatitis,
08:35 which is around the eyes. But you treated
08:38 the same way, I mean imagine these
08:42 things you know they're easy to talk about
08:44 but I mean someone gets that, the young
08:45 girl. Man, they come in and they you know
08:48 they probably feel embarrassed,
08:50 distressed, they don't wanna go to school,
08:52 they don't wanna do anything, wearing a hat
08:54 probably or something. No, I'm serious in the
08:56 emergency room I have people come in with
08:58 the ski mask on, they didn't want anybody
09:00 to see it. And you know, you feel bad for
09:02 them, right, and so what do you do to,
09:04 or what causes it first of all, do you know?
09:07 We don't know, you don't know,
09:08 God knows you keep saying that.
09:11 Okay, so what you do to for at least if
09:12 we don't know what it, what causes,
09:14 we know the treatment that's very effective.
09:16 Okay, what's the treatment, it's topical
09:17 erythromycin, okay or sometime metrogel
09:21 and or like tetracycline or minocycline or
09:26 Doxycycline, okay. They tend to be very
09:28 effective, alright and how long we have to take
09:31 those kinds of things? Usually for several weeks
09:34 and then it just goes away, yes, goes away
09:37 and what I find interesting about this is
09:39 that when it goes away, it kind of stays away.
09:43 Interesting, now look, you know all of these
09:45 different things we can have with the skin
09:46 is this the reflection of underlying maybe
09:49 immune system problem. Perhaps hormonal,
09:54 you just so, do you ever do test to figure out
09:56 what that is you look of course with that white
09:57 count and all that you know the white blood
09:59 cells in their system when they come in?
10:01 Not, not for this particular condition,
10:04 no but there are skin conditions where you
10:07 have to like for example acne fulminans you
10:11 need to get the blood work, right.
10:13 So, when there is that fulminating type of
10:14 acne, right okay, exactly. Alright, psoriasis,
10:18 right, okay what is it? What causes it?
10:22 What do we do for it?
10:24 Well, psoriasis comes from two Latin words
10:29 psor means itchy, okay riasis means condition,
10:38 okay. It means itchy condition but you know
10:42 usually people with psoriasis they don't itch,
10:45 so it doesn't itch but they called the itchy
10:47 condition, Right, it's more of a,
10:49 it's a miss number. Although there are several
10:51 significant number of patients who do have
10:54 itching, okay, so they call it psoriasis what
10:57 does it look like is it? I guess probably what,
11:01 flecked up skin, right it's, it has salmon
11:06 colored base with a silvery scale,
11:09 okay the problem with psoriasis.
11:12 First of all it affects about 2 percent of US
11:17 population, so 5 million bobs, about 5 million
11:20 people. And you know in normal skin it
11:24 takes about 53 days, it takes almost exactly
11:29 53 days for your top layer of the skin to
11:34 go from the base layer to the top layer.
11:37 So, in other words it's all, skin is always
11:39 sloughing off as it moves up, right and that
11:41 usually takes from the very base line to the
11:44 very top 53 days. Normally, normally but
11:46 what, how long does it take in psoriasis.
11:48 But in psoriasis it only takes seven days,
11:50 seven days so it turns over eight times
11:53 faster so that's why skin gets heaped up.
11:56 Is this dangerous? Not necessarily,
11:59 but there is certain form of psoriasis that
12:02 can be dangerous, okay. Now, there are
12:07 several forms of psoriasis, there are localized,
12:10 there is generalized and also there is something
12:13 called erruptive or guttate psoriasis, okay.
12:17 And there is a kind of an emergency type
12:20 of form alright, how generalized pustular
12:23 psoriasis of Von Zumbusch, well I don't
12:28 know if I could say that, yeah but it's a,
12:30 that you say it's a pustular type exactly.
12:32 So, there's pustules with it, it's a life
12:35 threatening condition and it has abrupt onset,
12:39 it starts with the burning redness and you
12:41 form lakes of pus all over the body.
12:44 And this could just be reasons life
12:46 threatening probably 'cause all the fluids
12:48 leaving, it's kind a like a burn patient.
12:49 Right, exactly you treated just like burn
12:51 patient, hospitalized them, have you ever had
12:54 the patient like that? No, I haven't,
12:56 probably don't want to have one yeah,
12:57 the fortunate one yeah, no, I haven't,
12:58 that's, that's one of the rare dermatologic
13:01 emergencies. And there is other form is a
13:06 localized form, a pustular psoriasis called
13:09 palmo-plantar pustulosis, okay, that you've pus
13:13 on your palm, on the palms and soles.
13:16 Yes, and then also there is another kind of
13:19 a almost a life threatening it can be
13:21 form called erythrodermic type
13:23 when your entire body is red, and if you have
13:28 a poor heart you can have, you can
13:32 develop a heart failure. So, you have to control
13:35 that, so the blood, the heart doesn't have
13:37 to work that hard to supply the redness
13:40 to your skin. Alright is there any, are there
13:42 any other types of psoriasis we wanna
13:44 mention here before we start talking about
13:46 treatment. Yeah, you know, we didn't,
13:49 we just briefly mention about eruptive type
13:52 or guttate psoriasis, okay and it has
13:54 abrupt on-setting, it's like the rash that
13:57 comes suddenly and many times it's proceeded
14:00 by struck throat, okay, and many times
14:04 just resolves on his own. But some patients
14:09 go on to have chronic type of psoriasis,
14:12 okay so we've given our overview of the
14:14 common types of problem but there also
14:16 talked about some of the unusual things.
14:18 We're talking with Dr. John Chung,
14:21 we're talking about dermatological problems
14:23 and when we come back we're gonna look at
14:25 some treatments, join us when we come back.
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15:28 Welcome back we're talking with Dr. John
15:30 Chung, we're talking about psoriasis and
15:32 dermatological problems and now we're
15:34 gonna talk about some solutions to
15:36 psoriasis, alright, very common form of
15:40 dermatological problem, you said about 2
15:41 percent or 5 million people in America have
15:43 this and they all come to your office on
15:45 Wednesday. Maybe not Wednesday,
15:47 maybe they come to our Bible study after
15:53 that okay, good. Right, so you know by
15:54 the way speaking of that, what type of
15:55 problem you think Naaman had, I guess it
15:56 was leprosy, right. Have you ever seen
15:58 leprosy? Yes, I have. In your practice in
16:01 adults. Yes, yes and 2 patients,
16:03 2 patients, interesting, well that's not we're
16:05 talking about right. So, let's go back to
16:07 psoriasis, how do we treat psoriasis?
16:09 Well, there are many, many ways to treat
16:11 psoriasis and give me the top ten
16:16 Alright, one of the best things for psoriasis is
16:21 ultraviolet light that means Sun really helps.
16:25 That's why a lot of times you see psoriasis
16:27 in Sun covered areas, so you don't see
16:30 much on the face. Okay, because it's always
16:33 exposed to the Sun and so, and related to that
16:36 you have something PUVA, PUVA, PUVA
16:39 which is Psoralen added to ultraviolet A.
16:43 And that is very, very effective treatment.
16:46 Excuse me, one more time that is what
16:49 added to ultraviolet ray? Key part is called
16:51 Psoralen, right added to ultraviolet ray.
16:55 What you have in that UVA, that's why PUVA.
16:57 Alright, it's a specific type of the lamp,
17:01 right exactly, you take a pill and then you go
17:04 into the light, and you have this in your
17:07 office. No, we don't, you don't because we
17:10 have many other treatments, if it's just
17:12 localized you can treat with like type of the
17:15 steroids, okay if it's more extensive.
17:18 I like to use something a methotrexate,
17:21 methotrexate. Methotrexate is, it has a little
17:26 bit of, it may have a problem with the liver
17:28 and also it can cause problem with blood.
17:33 But not usually so you can use it for a lot
17:35 of people, right, yes okay. One, one draw back
17:38 with this is that, it cause you have to do a
17:42 liver biopsy, when you use that, yes.
17:45 But not, not everyday, not everyday,
17:48 even once is enough. But you mean the
17:50 simple treatment is to go out in the Sun how
17:52 long? Well, we'll talk about that later okay,
17:56 because the Sun can have beneficial effects
18:00 but also it has harmful effects as well.
18:03 Okay, so what are some other treatments?
18:05 Well, there's something cyclosporin,
18:07 we use it for immunoseparation, okay.
18:10 But you have to worry about developing like
18:12 when you're on the developing other skin
18:14 cancers and also Lymphoma. And, you
18:20 mean all your treatments you're talking me
18:21 out of here, is there something that I
18:23 gonna want. Well, there is another
18:25 treatment that which maybe effective called
18:28 soriatane which is a retinoid. And what's a
18:33 retinoid again? A retinoid is, is retinoid is a
18:38 vitamin A derivative, a vitamin A derivative.
18:41 It works well for acne, okay but you can
18:45 use for psoriasis, okay in a, in a oral form.
18:49 Alright, so go ahead there is a very exciting
18:54 and new breakthroughs in psoriatic treatment,
18:57 it's called biologics, biologics that's sounds,
19:00 sounds like something that John Harvey
19:01 Kellogg would talk about. Well, it's something
19:03 that your body produces naturally okay and
19:06 it's mass produced and usually given by IV
19:09 or subcutaneous injection. It's very,
19:13 it's painless and it works very well and
19:18 this is many patients are going through this
19:21 route. Biologics, what are they exact,
19:23 so what part of your biological system are
19:25 they? Well, it's things found in your blood I
19:31 see that, that can fight the, the disease of
19:39 psoriasis and so actually you know mass
19:44 produce that and inject it to yourself.
19:47 And where would you inject it, let's say
19:48 I have psoriasis on my knee caps.
19:50 A lot of times on the, even if it's on my
19:52 knee caps I put it in the abdomen.
19:53 Because it's systemic, systemic, goes around
19:55 the system. Right, exactly but you have to
19:57 you know makes sure you get a TB scan
19:59 test before you do this. Because if you have
20:01 tuberculosis you don't wanna exacerbate it,
20:03 oh I see, if you can get a, if you get a
20:05 severe infection you stop that too.
20:08 And the problem right now what that is it's
20:13 very, very expensive, it's several thousand
20:15 dollars a month, wow! To treat it.
20:18 So, probably does your, do peoples insurance
20:21 in this country cover it? Many, many insurances
20:24 do, but that's a very, but it's promising because
20:27 it's doesn't have the side effects of the
20:30 others. Exactly, okay so those are the ways to
20:33 treats psoriasis. Right, alright are we ready
20:36 to move on to the next P, yes alright and
20:39 let me see if I say this right, peterius
20:43 rosacea, peterius rosacea that's correct,
20:45 okay so that's it's sounds like it's pitiful.
20:49 What does peterius mean? Pete is like bran
20:55 like, that's what it means. Okay,
20:57 looks like a piece of bran flakes,
20:59 right exactly or bran cereal right.
21:01 Okay, you don't want them alright, so
21:03 basically what it is, is a acute, acute
21:06 eruptive rash occur mainly on the trunk.
21:12 And it has something called Christmas tree
21:14 distribution, oh that's sounds festive,
21:17 yeah look at, look at somebody's back and
21:19 looks like a Christmas tree. Yeah, it has a,
21:21 if you use your imagination it can look
21:23 like Christmas tree. But it's certainly not a
21:25 present, right, okay so you know not to
21:28 make a lie of it all because you know it
21:30 probably very painful. No, it's not painful,
21:32 it's not painful, it's almost asymptomatic okay.
21:36 Sometimes it itches a little bit, alright,
21:38 but it lasts about 6 to 8 weeks and usually
21:43 before one to two weeks prior to getting this
21:48 eruption you have something called herald
21:50 patch, usually what that it is a patch usually
21:54 on the trunk, that almost looks like a fungus.
21:57 People treat that for fungus and they come
21:59 in and it's, it's funny when some, some
22:03 people come in with just that and you have
22:06 to scrape it, make sure there is no fungus
22:07 there and a lot of times you can recognize
22:10 that and you tell this person in one or two
22:13 weeks, you may get a lot worse than this,
22:16 you may get another rash and when it comes
22:18 they're very surprised you know,
22:20 but you know they know that it only lasts
22:22 about one, six to eight weeks. So, what
22:28 does it happens, is that a little spot that just
22:31 kind of multiplies, is that what's happening.
22:34 I don't know if it's multiplies but it just kind
22:36 of appears almost overnight and we don't
22:41 know the cause again but it maybe associated
22:44 with something called herpes seven virus,
22:47 herpes seven, yeah there are many types
22:49 of herpes and we don't know and the best
22:53 treatment for this is ultraviolet B,
22:55 ultraviolet B like, another like a sunlamp thing
22:58 or something. Sunlamp or sunlight, especially
23:01 if you started within the first week,
23:04 it helps with the resolution, quicker also
23:08 helps with the symptoms. So, maybe it
23:10 sounds like people in the United States aren't
23:12 getting enough sunlight. Well, I think they're
23:14 getting too much but in this case are not.
23:17 So is this all we about peterius rosacea,
23:20 did I say that right? Peterius rosacea,
23:22 peterius rosacea, right, okay well lets move
23:25 unto well I think the fancy word let you say,
23:28 but to dandruff, seborrheic dermatitis,
23:32 okay seborrheic dermatitis let's talk about
23:33 that we got about four minutes you think
23:35 we can cover it in four minutes?
23:36 Yes, lets do it. It's very common and what
23:39 it is basically redness and scaling that occurs
23:42 on the scalp and center part of the face,
23:45 and presternal area are right here and also
23:49 the folds okay, and you've heard of cradle
23:52 cap, cradle cap when the kids are born with
23:54 that, yes, right. And, this they think is maybe
23:59 due to a yeast called pityrosporum ovale,
24:05 pityrosporum ovale and this you know maybe
24:09 associated with that and so you treat a
24:12 lot of times with antifungal and it helps.
24:16 But initial treatment for this is over the
24:19 corner shampoos that you can use like T/gel
24:23 or Selsun Blue type, that type of shampoo
24:27 that can help with this condition and prescription
24:30 shampoo you have like Loprox or you know,
24:35 nizoral shampoos and stuff like that and so you
24:37 just prescribe this, they take it and how long
24:40 does it take, what's that, what does the
24:41 prescription do, does it just like make sure it
24:43 doesn't flack off too soon or does it treat in
24:45 one one. It slows, it, I mean you can't really
24:49 treat the underlying cause because it's causes
24:51 always, we don't know what the cause,
24:53 I mean we know the cause that's ovale but it
24:55 doesn't actually, it keeps on producing
24:57 because a lot of, a lot of people actually
25:01 carry this on their skin. And so,
25:05 what you're gonna do I mean it's there,
25:06 you can get rid of it, exactly you can't scrub
25:08 it off, something like that. Right, but you
25:10 know when they come into the office for a
25:12 very quick resolution we give them topical
25:16 steroids and as well as topical antifungal and
25:23 some type of a sulfur type of a wash.
25:27 So, you can help rapidly, if someone wants
25:29 to go in and not be seen. Okay, and the next
25:31 thing we can talk about, yeah, we can go to
25:33 the next one, yes, okay let see it.
25:35 Tinea versicolor, tinea versicolor,
25:39 tinea versicolor, tinea versicolor is again is
25:42 caused by the same organism. And what is it
25:44 exactly? Tinea versicolor, is it like a little
25:46 worm? No, it's a rash that you get in humid
25:52 climates usually, okay on the trunk okay and
25:56 on the upper part of your arms a lot of times
25:59 and its usually white scales or fawn colored
26:03 scales, fawned colored, you know like the
26:05 deer fawn like the spots they have.
26:08 Right, exactly okay and it may also be due
26:11 to pityrosporum ovale, same thing is causing
26:18 it but it's now in a different kind of a part
26:19 of your body, right. And same kind of treatment
26:22 then? What I like to use is something called
26:26 Nizoral shampoo you put on for 5 minutes,
26:29 5 minutes since, that's it, and then,
26:32 I do that for about three days.
26:33 And people must come in to you and you
26:34 would say well that's the problem and then
26:36 they get they say man, just went in,
26:37 it this took that long and you feel almost
26:40 guilty. You helped them so quickly,
26:42 don't did you get a little tense of guilt?
26:45 That's why I have to give them Revelation
26:47 seminar during the same time, okay well
26:51 actually you know, it sounds kind of funny
26:53 but you do make sort of a spiritual connection
26:55 with people when you're helping them.
26:56 Right, and just that, that little touch
27:00 you know like that song the touch of the
27:01 master's hand and then the following in his
27:03 footsteps, you have mastered a lot of these
27:06 diseases and your help, it's very helpful for
27:08 people to come see you. Now, you know the
27:11 other thing I wanna just point out as I listen
27:12 to you, as I reflect on it, there's a lot of
27:15 things that we often just put up with that if
27:17 we just went to get help they can be taken
27:19 care of rapidly, very easily. I had one,
27:23 one patient one time had a fungus wasn't
27:27 treated for, he had a rash on his back part
27:32 for over ten years, he was suffering with it and
27:36 within two weeks he was come completely cured.
27:38 Wow! I mean that's a spiritual lesson in itself
27:41 isn't it, many times we just go on and we
27:44 should go to the healer, the master healer
27:48 and he can just in a moment deal with things
27:52 that we shouldn't be struggling with.
27:55 Thank you so much for being with us,
27:56 and thank you for being with us.
27:58 We hope you have health that lasts for a lifetime.


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Revised 2014-12-17