Jan's BloodTest April13/2007

[JanSz]

http://musc lechatroom.com/forum/showpost.php?p=122294&postcount=16

If Dr Hertoghe wrote that the synthesis of pregnenolone is fine, but the synthesis of progesterone is heavily downregulated, in males over 35, then he's plain wrong.

The synthesis reaction which slows down is the synthesis of pregnenolone from LDL cholesterol, and that is the fundmanemtal root cause explanation for why the vast majority of males have rising LDL cholesterol levels as they age.

If the conversion from LDL cholesterol to pregnenolone were working, then there would be no market for statin drugs to suppress LDL cholesterol levels.

The market for statin drugs is in the billions.

The only reason that pregnenolone supplementation isn't being used to keep LDL cholesterol in check is because big pharma would start world war 3 if someone were to go global with the info that pregnenolone is a low cost, bioidentical and extremely reliable alternative to statin drugs.

###

My guess is that Dr Hertoghe knows that if he spells out in black-and-white that the synthesis of pregnenolone is the problem, then a few doctors are going to learn very quickly that supplementing pregnenolone reduced their patient's LDL cholesterol levels. And once doctors start prescribing pregnenolone instead of statins, then that's when the first air strikes will be called in.

.

It is very easy to find out the real truth.


Lets keep taking pregnenolone
and check blood levels of

pregnenolone
and
progesterone

we will find out real answer very quickly.

--------
So far, for me, dr Hertoghes prediction panned out just the way he said.
But I do not really care if dr Hertoghe is right or wrong
or
if BigPharma makes a profit or not.

I just worry about my own health.

.............

All the theories still work as discussed, no need to change much.

Supplementing with progesterone creates all the desirable downstream metabolites of progesterone

AND

it raises pregnenolone

so

pregnenolone metaboloites (except for progesterone) are still being created.

--------

11/6/2010
I started supplementing with 100mg/day Prometrium (micronized progesterone)

had a chance to take a peek at my prog


11/18/2010
progesterone=1.7

more detailed testing I have now planned for a mid January.
I was trying to get it sooner but was not able to talk my doc into doing it.


////

It would be nice if you could post details on your own experience, it would increase our very small database.

If you are press for time I can help with organizing presentation of your data.

...............
============================
I first learned about the 35yo situation here, a week ago:

http://musc lechatroom.com/forum/showpost.php?p=121121&postcount=222
=================
For your convenience I will post the whole post:

===================

A small excerpt of an interview of Dr Hertoghe on Nutranews - march 2008

Et la prégnénolone, pourquoi une supplémentation ?

Dr Thierry Hertoghe : La prégnénolone
sert en fait à améliorer la mémoire, de
façon assez nette. J’en prends moi-même
50 mg chaque jour au matin. Il faut absolument,
et cela est très important, la prendre
le matin. Si on la prend le soir avant de
se coucher, cela semble ne pas fonctionner.
Par contre, une prise matinale de prégnénolone,
prise d’une certaine façon, avant
de l’utiliser, fonctionne très bien.
La prégnénolone est considérée comme un
précurseur de toute une série d’autres hormones.
Mais si l’on a plus de 35 ans, cette
transformation ne se passe pas très bien. Elle
devrait théoriquement se transformer en
hormones sexuelles, en hormones surrénaliennes,
en progestérone… mais en réalité,
cela ne se passe pas très bien chez une
majorité de patients après 35 ans. Il faut
donc plutôt la voir comme une hormone
typiquement pour la mémoire et, éventuellement,
dans certaines pathologies nerveuses.
Par exemple, lorsqu’on lèse certains
nerfs chez l’animal au niveau de la moelle
épinière, on a vu que la prégnénolone permettait
une réparation de ce nerf plus rapide
et plus efficace.

:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

Literal translation :

Dr H takes 50 mg of Preg in the morning ( oral ?). He insists that it should be taken in the morning - Why ?
He says that beyond 35 years , the conversion to downstream metabolites is far from perfect in the majority of his patients.

link : http://www.nutranews.org/article.php3?id_rubrique=24&id_article=915

Thank you, good info.

Now the mystery of why women's HRT doctors start with progesterone.
Apparently a route towars allo-pregnenolone still works (after 35yo).

Thank to Google Chrome here is translation to English.


And pregnenolone, why supplements?

Dr. Thierry Hertoghe: Pregnenolone is really to improve memory, quite clear. I am myself 50 mg daily in the morning. It is imperative, and this is very important, take it in the morning. If taken at night before bed, it seems not to work.
By cons, a morning dose of pregnenolone, taken in a certain way, before use, works great.
Pregnenolone is considered a precursor of a whole series of other hormones. But if you have more than 35 years, this transformation does not happen very well. It should theoretically be turned into sex hormones, adrenal hormones, progesterone ... but in reality, this does not happen very well in a majority of patients after 35 years. It is therefore rather be seen as a hormone typically for memory and possibly in some nerve disorders. For example, when some injures nerves in animals the spinal cord, we saw that pregnenolone allow repair of the nerve faster and more efficient.

///////

http://musc lechatroom.com/forum/showpost.php?p=109770&postcount=499

----------------------------- =========

 

[JanSz]

http://www.mus clechatroom.com/forum/showthread.php?17267-What-tests-show-whether-you-are-primary-or-secondary&p=136227#post136227

hypogonadal primary = HCG test (with preg).
a) If the HCG (with preg) forces your testicles to increase testosterone production, you are not primary.
b) If the HCG (with preg) does not force your testicles to increase testosterone production, you are primary.

hypogonadal secondary = clomid challenge (with preg).
a) If the clomid (with preg) triggers your pituitary to increase LH enough to boost testicular testosterone, you are not seconday.
b) If the clomid (with preg) does not trigger your pituitary to increase LH much, resulting in very little testicular testosterone boost, you are secondary (provided you are not primary - see above)

hypoadrenal primary = ACTH stim test
a) If the ACTH triggers your adrenals to make more cortisol, then you are not primary.
b) If the ACTH does not trigger your adrenals to make much cortisol, then you are primary.

hypoadrenal secondary = CRH stim test (CRH is a hypothalamus hormone)
a) If the CRH triggers your pituitary to make sufficient ACTH to force your adrenals to make more cortisol, then you are not primary.
b) If the ACTH does not trigger your pituitary to make sufficient ACTH to force your adrenals to make much cortisol, then you are secondary (provided you are not primary - see above).

.

----------------------------- =========

 

[JanSz]

http://www.musc lechatroom.com/forum/showthread.php?17459-Hard-Flaccid-Syndrome.../page3

Hard Flaccid Syndrome...

Originally Posted by tierry

Post #41 is a first post in series on how to achieve high quality erection.

Combination of

alpha-blockers and PDE5

http://www.nature.com/ijir/journal/v14/n1/full/3900815a.html
=================================================

Yes I managed to use some alpha-blockers to help my sex life a lot.

Practical example:

FROM where:
PDE5is works only in high (double) dosages
the erection is obtained through stimulation
It needs to be constantly stimulated during an intercourse to be kept valid
the intercourse have not to last much cause the erection could fade
the standing posture or more difficult positions affect the erection quality
relaxing is not easy due to tension in the whole body and perineal muscles

TO where:
the erection is obtained only with arousal without need of stimulation
It last consistent without need to be continuosly stimulated
I can go for an hour without risk to loose the erection
relaxing is easy
the more I relax the more the erection get fuller
I can stand, lying or do difficult positions and the erection is unaffected


The alpha-receptors usually contract the smooth muscles when they are binded by noradrenaline. To have an erection We need the smooth muscles in the penis to be completely relaxed in 2 ways.

The first step is to lift the adrenergic tone keeping them in the flaccid state (contracted).
The second step it needs is an active relaxing stimuls by the neurotransmitter Nitric Oxide. PDE5is (viagra, cialis, levitra) works on this path.

If the first step is missing, the production of NO is poor and the relaxation will be never optimal even with intracavernosal injection therapy. That's why they mix the alpha-blocker phentolamine in some intracavernosal injection therapy.

There are 2 families of alpha receptors: alpha-1 and alpha-2

Alpha-1 are expressed in the corpora cavernosa muscles
Alpha-2 are expressed in the cavernosal artheries walls

If You block only one receptor the noradrenaline which not bind to the blocked receptor will bind to the unblocked receptor contracting the smooth muscle in that tissue.

Ex: if You use an alpha-1 only blocking agent, You get the positive effect on the corpora cavernosa but You get some degree of negative effect on the cavernosal artheries walls, and vice versa.

Anyway using an alpha-1 only or an alpha-2 only blocking agent can give partial results, especially if combined with a PDE5is.

Using agents which effectively block both alpha-1 and alpha-2 receptors gives the best results.

To my knowledge there are commercially available only 2 effective agents which block both alpha-1 and alpha-2 adrenergic receptors.

These are Phentolamine mesylate and Phenoxybenzamine. They are not available in all countries. I'm not sure but I think Phenoxybenzamine is available in the USA.

Phentolamine have an effective action of around 5 hours.
Phenoxybenzamine have a prolonged action of around 24 hours.

I use Phentolamine from 10 to 40 mg around 1 hour before intercourse and every day or
Phenoxybenzamine from 3 to 5mg each day.

The dosage have to be cared particularly because alpha blockers do have sedation effect on the Central Nervous System and they lower blood pressure.

If You get too much of an alpha blocker, for erection enhancing purpose, the sedation of the CNS will impair the libido, dopamine and neurogenic stimulus to get an erection.

The dosage used of this drugs for BPH or for lowering an high blood pressure may be too much for the purpose of erection enhancing thus many may not see the benefits of lower dosages. Yes they have a bi-phasic effect.

If You lower too much the blood pressure the erection will not be full. The erection pressure is almost the same of the systolic blood pressure.

The dosages have to be tailored to relief the excessive adrenergic tone but not impair blood pressure or sedate the CNS (sleepyness, fatigue, etc)

The most common side effect is that the orgasm is delayed much since It is a sympathetic event and these agents are anti-sympathetic.

All this get rid effectively of my excessive adrenergic tone in the penis.

This said You need to have a functioning Nitric Oxide pathway to make the second step of the erection.

If You manage to make the first step relieving an excessive adrenergic tone also the Nitric Oxide production will be enhanced.
These two steps are a cascade, the second poorly works without the first.

The most effective agents which enhance also the second step are the PDE5is (viagra, cialis, levitra).

I usually combine Phenoxybenzamine 3-5mg once per day with cialis 20mg or Viagra 50mg /day.

Note that this regimen worked perfectly also when not on TRT.

The alpha-blocker Phentolamine mesylate is an approved oral therapy for ED in South America where It's sold at pharmacies in 40mg tablets. I heard many positive reports by the users and they often combine this medication with PDE5is.

=================================================

 

[JanSz]

http://www.mus clechatroom.com/forum/showthread.php?13628-My-Green-Laser-Prostate-surgery/page8

http://www.mus clechatroom.com/forum/showthread.php?13628-My-Green-Laser-Prostate-surgery&p=98129#post98129

Important when someone is insulin resistant.
Insulin resistant=high fasting insulin (almost anything above detectable limit.

Magnesium, serum is poor indicator.
Serum contains only about 1% of overall mg in the body.

GNOLLS.ORG OPENS THE DOOR TO OBESITY FIGHT - Jack Kruse
depletion of Magnesium always predates insulin resistance

------------------------------------------------------
One newer know, lets keep this in mind.


Magnesium Per Rectum
From DoctorMyhill
[/URL]Magnesium Per Rectum - DoctorMyhill


Giving magnesium by injection is the quickest way of restoring normal blood and tissue levels of magnesium. However, for some patients the injections, whilst giving benefit, are too painful to be considered long term.

At a conference in Australia in 1999 I spoke to a doctor who had been trying magnesium sulphate given PR (per rectum - ie up the backside! - like a suppository) with some success. If this technique works, then it would be a cheap, safe, do-it-yourself at home technique which could replace uncomfortable injections. I have now tried magnesium PR with quite a few of my patients and it has been as effective as the injections in some of them.

To try this at home, you need some Epsom salts and an enema syringe. Epsom salts are virtually pure magnesium sulphate and are available from chemists. You can buy an enema syringe from the chemist and this can be re-used so long as sensible hygienic precautions are taken between doses.

Dissolve 250g of Epsom salts in 1 litre of warm water. This provides 5 grams in 20 ml, equivalent to 600mgs of elemental magnesium. This solution can be stored in the fridge for six months, but do not forget to warm up before use.

Small bottles of spring water are 8fl oz=236ml
0.236*250g=59g Epsom Salt.

1 US cup = 8 oz=236.588237 cc
I make my 10 oz coffee using round (measuring) tablespoon of Maxwell House Instant Coffee.
Coffee enemas are done with full strenght coffee.
For 20cc enema I would need 1 tablespoon coffee.
Lets try first half strenght.

236ml/20=11.8 portions=11.8/2=6 tablespoons(to get half strenght)
I am not giving up to purists who would insist on organic coffee.

Wonder if sleeping is going to be affected by "taking" 5oz of full strength coffee in the rear.

No, sleep is not disturbed.




To load the syringe dip the tip into the magnesium solution, and draw 20ml back into the syringe. Some patients find it easier to hold the magnesium in by starting with a very tiny amount of the liquid and slowly increasing the dose, thus giving the back passage time to get used to the experience! Magnesium is well absorbed through the colon and 600mgs is a good dose. All electrolytes have potential toxicity, so do not use more than 20ml in 24 hours.

Insert the tip of the enema syringe into your bottom (perhaps using some KY jelly as a lubricant). Once the tip is in position, slowly squeeze the bulb and the contents will pass into the rectum. It is sensible to lie down for several minutes after! Hold on to the magnesium for as long as possible.

If the magnesium is being absorbed, then I would expect patients to get the same response as from a magnesium injection, but of course without the pain. It does work for a useful proportion of CFS patients so is well worth trying if you get benefit from the magnesium injections.

====================
Mentor Red Rubber Urethral Catheter - 14 Fr. Price: $1.00
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Catheter Tip 60 CC Syringe Price: $0.72

Amazon.com: Catheter Tip 60 CC Syringe: Pet Supplies

Fast Weigh M-500 Digital Pocket Scale, 500 by 0.1 G Price: $5.70
Amazon.com: Fast Weigh MS-500-BLK Digital Pocket Scale, 500 by 0.1 G: Kitchen & Dining

Rite Aid Epsom Salt 64 oz (1.8 kg) Price: $6.99
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----------
Magnesium - treating a deficiency - DoctorMyhill
Can you hang on to magnesium?

For magnesium to be retained inside cells you need good cell membranes. The two important facets of cell membranes are:
Have good antioxidant status - see Antioxidants. (I take them a lots for A1c management and other)
Have good levels of fats and Essential Fatty Acids in the diet. See GOOD FATS AND BAD FATS. (I take them)
Boron is necessary for normal calcium and magnesium metabolism.

I take 3mg of Boron with each Only Trace Minerals pill, I take 3 pills. Total 9mg of Boron
Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong - DoctorMyhill
Myhill's Magic Minerals would have me use 6*2=12mg of boron
...

 

[JanSz]

http://www.marksdailyapple.com/forum/thread32345-1176.html#post644345


quelsen
you are insulin resistant
we have to change that




---------------------
GNOLLS.ORG OPENS THE DOOR TO OBESITY FIGHT - Jack Kruse
depletion of Magnesium always predates insulin resistance


eat Mg malate until you have runs
to slow down runs, hold runs, eat lecithin, couple tablespoons/day,
http://www.lef.org/prod_desc/images/large_product_images/img_00020_big.jpg

test your fasting insulin
if that does not lower your fasting insulin
do epsom salt enenas using my contraption (and details)


If you can't locate my contraption I will look for it if you decide to use it.


short blood test (saving $$$)
insulin
steroid hormones panel
hemoglobin


If malate does not do the job, go for enemas, mg oil is waste of time.
Mg injections hurt.
================================




couple days ago dr K mentioned


Magnesium Test: Intracellular Analysis for Heart Disease, A Fib, Arrhythmia, Stroke: EXA Test


JanSz Labs & Tests - Page 25


but you already know that you are low Mg






//////////


http://jackkruse.com/what-can-you-find-about-your-own-health/#comments
Jack Says:
December 2nd, 2011 at 4:25 pm
@ MM Losing blood sugar control fast can be a sign of many things. There is no way to get to the bottom of it without testing and your doc. Thinking out loud, low intracellular Mg levels (exatest), LR, High 06/3 content on tissue and serum, a leaky gut, hepatic disease undiagnosed, environmental toxin exposure, unknown MSG exposure from foods are some off the top of my head for you and your doc to consider.

http://www.marksdailyapple.com/forum/thread32345-1176.html#post644527

also watch your iron and transferrin levels as you are changing from a sugar burner to a fat furnace.

 

[JanSz]

http://www.mus clechatroom.com/forum/showthread.php?15433-JanSz-Labs-amp-Tests&p=164845#post164845


http://jackkruse.com/what-can-you-find-about-your-own-health/#comments

90
Jack Says:
December 2nd, 2011 at 4:25 pm
@ MM Losing blood sugar control fast can be a sign of many things. There is no way to get to the bottom of it without testing and your doc. Thinking out loud, low intracellular Mg levels (exatest), LR, High 06/3 content on tissue and serum, a leaky gut, hepatic disease undiagnosed, environmental toxin exposure, unknown MSG exposure from foods are some off the top of my head for you and your doc to consider.

http://www.exatest.com/

Anybody knows how to have this test done?
Do the have good range for this test?



IntraCellular Diagnostics, Inc. is: CLIA approved; California and Oregon State Licensed; an Independent Clinical laboratory and a Specialty Reference Laboratory; Eligible for Medicare and Private Insurance Coverage. We accept assignment.


http://www.exatest.com/PDF Files/1. Correlation ofTissue Magnesium with Cardiac Levels Using a Non-invasive Testing Method (full paper)..PDF

Noninvasive Measurement of
Tissue Magnesium and
Correlation With Cardiac Levels


Conclusions
Sublingual epithelial cell [Mg]i
correlates well with atrial [Mg]i
but not with
serum magnesium. [Mg]i
levels are low in patients undergoing cardiac surgery and those
with AMI. Intravenous magnesium sulfate corrects low [Mg]i
levels in AMI patients.
Energy-dispersive x-ray analysis determination of sublingual cell [Mg]i
may expedite the
investigation of the role of magnesium deficiency in heart disease.


.
http://www.exatest.com/physicians.htm

Exa Test™ was developed as an assay for difficult to detect intracellular mineral electrolyte deficiencies or imbalance. Exa Test provides information not available through blood tests.Using direct tissue analysis Exa Test™ provides results that correlate with heart, muscle and deep organ tissue not with blood.Exa Test™provides an analysis of tissue where 99% of essential mineral electrolytes are found. For example, 99% of magnesium is found in soft tissue and less than 1% of magnesium is found in blood.​

Through clinical practice and extensive research, this noninvasive test has proven to assist the healthcare provider in managing heart disease and other physiological dysfunctions where mineral electrolytes are compromised.​

Exa results assist the healthcare provider in establishing treatment protocols that improve the patient's intracellular status, manage symptoms, improve stamina and quality of life.​

The Exa Test™, tissue mineral electrolyte analysis, includes all ions and ratios for
the following essential light elements:​

Magnesium Magnesium/Calcium
Calcium Phosphorus/Calcium
Potassium Potassium/Magnesium
Phosphorus Potassium/Calcium
Sodium Potassium/Sodium
Chloride Phosphorus/Magnesium​

​

OFFICE BASED 60 SECOND SPECIMEN COLLECTION

1. A epithelial cell scraping is easily obtained from the sublingual area. The healthcare professional scrapes the soft tissue on the floor of the mouth to the side of the frenulum.

2. The non-cornified sublingual epithelial cell samples are deposited and fixed on specially prepared slides and sent to IntraCellular Diagnostics.

3. Results are rapidly returned with evaluation of the patient's current intracellular mineral electrolyte status.

4. Exa Test™ results correlate with heart, muscle and deep organ tissue not with blood.

5. The information provided is not available through blood tests.
* IntraCellular Diagnostics, Inc.™ is CLIA approved; California and Oregon State Licensed; an Independent Clinical laboratory and a Specialty Reference Laboratory; Eligible for Medicare and Private Insurance Coverage. We accept assignment.​

 

[JanSz]

Leptin Reset Experiment starts today - Jack Kruse style | Mark's Daily Apple Health and Fitness Forum page 1183

Soooo, does easy bruising tie into anything LR or quilt oriented? I just started that again, after a long hiatus. I've never tested anemic. Hemoglobin & B12 levels are solid; ferritin is nearly off the top end of the range.

I am still behind in understanding vit A.
If there is a good writeup, I would appreciate link.

Anybody who is taking Vitamin D3 supplements, concerned/interested about Vitamins A and K2 - read this blog by Chris Masterjohn on the balance of Vitamins D, K2 and A in the diet. Imbalances can cause kidney stones and calcification, aches and pains and anxiety. Be sure to read the comments as well The Daily Lipid: Tufts University Confirms That Vitamin A Protects Against Vitamin D Toxicity by Curbing Excess Production of Vitamin K-Dependent Proteins

Also read this, especially the Comments for discussion of aches and pain related to Vitamin D supplementation:Is Vitamin D Safe? Still Depends on Vitamins A and K! Testimonials and a Human Study | Weston A Price Blogs - Weston A Price Foundation

ok back to 4 grams of mag daily for me.


sigh this is truly a grind

Q if I recall, you take very high doses of Vitamin D3; you should check this out from the Comments section in this blog by Chris Masterjohn Is Vitamin D Safe? Still Depends on Vitamins A and K! Testimonials and a Human Study | Weston A Price Blogs - Weston A Price Foundation

There is also quite a bit of evidence that Vitamin D depletes magnesium, and so I find these symptoms are an ‘induced’ magnesium deficiency in those who are already ‘borderline’ magnesium deficient.

[h=1]TEDxIowaCity - Dr. Terry Wahls - Minding Your Mitochondria[/h]

http://www.youtube.com/watch?v=KLjgBLwH3Wc&feature=youtube_gdata_player

 

[JanSz]

This post is a place maker,

I will not answer any questions here.


thank you.


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[JanSz]

This post is a place maker,


I will not answer any questions here.




thank you.




---tttttttttttttttttttt----------55555555555---------------- =========

 

[JanSz]

This post is a place maker,


I will not answer any questions here.




thank you.




---tttttttttttttttttttt----------55555555555---------------- =========​

​

http://anabolicminds.com/forum/newreply.php?do=newreply&p=3119167​

 

[JanSz]

This post is a place maker,


I will not answer any questions here.




thank you.




---tttttttttttttttttttt----------55555555555---------------- =========

 

[JanSz]

This post is a place maker,


I will not answer any questions here.




thank you.




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[FlyingElvis]

Still trying to find a Dr. that will prescribe test. THis is as TRT not for body building. I am an older male and produce little to no test. Also, I do not have the money to spend $200/month for this. Any help? Please?

 

[FlyingElvis]

Odd, I did not try to post here, but in the other thread in which others were posting also.

 

[JanSz]

1. physically hard working people live shorter life
2. we are made by Sunlight, follow Circadian Rhythm or die
3. we all came from Africa from around Lake Victoria, then spread around the world.
Those transitions changed us. Check your haplotype on mothers side (23andme).
find out (latitude) where your great grandmother was located, 5000-10000 years ago.
You will be better off moving to that lattitude or closer to equator.

Food that we eat fights us back.
Think about it when eating.
Follow this two guys.
Forget that one of them is talking Alzheimer's, it applies to everybody.


The Plant Paradox: The Hidden Dangers in "Healthy" Foods That Cause Disease and Weight Gain Hardcover – April 25, 2017
by Steven R., M.D. Gundry (Author)

https://www.amazon.com/gp/product/006242713X/ref=oh_aui_detailpage_o07_s00?ie=UTF8&psc=1
=========================================================================================


The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline Hardcover – August 22, 2017
by Dale Bredesen (Author)

https://www.amazon.com/gp/product/0735216207/ref=oh_aui_detailpage_o01_s00?ie=UTF8&psc=1
============================================================================================

 

[The Matrix]

Holy Sh!t, the old goat is still kicking or should I say dancing lol

 

[JanSz]

Not only kicking but also figuring ways to raise your cholesterol.
But likely you have that covered.

.

 

[kenpoengineer]

Not only kicking but also figuring ways to raise your cholesterol.
But likely you have that covered.

.

How's your TRT/Supplementation program treating you all these years? Would you mind sharing what TRT protocol and also what your supplement protocol is now?

 

[The Matrix]

Commonly seen in mold exposure. When addressing this with clients it helps their cholesterol levels. Look at NRF2 and how mold impacts it by alterinh bile conjugation.
I have advanced my clinically knowledge through collaborations with top clinics internationally.