213. Nicole Bell: The Hidden Dangers of Lyme Disease—Brain Fog, Alzheimer's & Misdiagnosis

What if a negative Lyme disease test doesn't tell the whole story? And could an overlooked infection be contributing to symptoms like brain fog, chronic fatigue, or even cognitive decline? When Nicole Bell's husband began experiencing personality changes, memory loss, and confusion, doctors diagnosed him with early-onset Alzheimer's disease. But Nicole, an engineer with a background in medical diagnostics, couldn't shake the feeling that something was being missed. Despite initially testing negative for Lyme disease, her husband was later found to have evidence of Lyme and other infections, including Bartonella and Babesia. His decline and eventual passing transformed Nicole's life, inspiring her to become CEO of Galaxy Diagnostics and advocate for better testing for tick-borne diseases. In this episode, Nicole joins me to explore the often-overlooked world of Lyme disease, chronic symptoms, tick-borne infections, and their potential connections to brain health and inflammation. We discuss why Lyme disease can be difficult to diagnose, the limitations of traditional antibody testing, and emerging diagnostic approaches designed to detect infections more directly. In this episode, you'll learn: Why Lyme disease can be difficult to diagnose, especially in its early stages How Lyme disease and other tick-borne infections may affect the brain, joints, heart, and nervous system What researchers are investigating about infections, neuroinflammation, and Alzheimer's disease Why a negative Lyme disease test doesn't always rule out an infection The differences between antibody testing, PCR testing, and emerging urine antigen tests What Bartonella and Babesia are, and why identifying co-infections matters Why Lyme disease doesn't always cause the classic bullseye rash What to know about tick bites, early symptoms, and seeking prompt medical evaluation How to advocate for yourself when you're experiencing unexplained or persistent symptoms We also discuss the challenges of living with chronic illness, the importance of early detection, and Nicole's mission to make more accurate diagnostic tools accessible to patients and healthcare providers. Nicole shares the deeply personal story behind her book, What Lurks in the Woods, and the lessons she learned navigating her husband's illness while raising a family and searching for answers. The biggest takeaway? A negative test isn't always the end of the diagnostic process, especially when symptoms and exposure history suggest there's more to investigate. Understanding your symptoms, asking better questions, and working with knowledgeable healthcare professionals can make an enormous difference in identifying health problems earlier. Because longevity isn't just about treating disease once it appears. It's about recognizing warning signs, understanding potential causes, and giving ourselves the best opportunity to protect our long-term health. Learn more about Dr. Shah: Website: drshah.com https://drshah.com Clinic: next-health.com https://www.next-health.com/ Instagram: @darshanshahmd and @extend_podcast Learn more about Nicole Bell: Website: galaxydx.com https://www.galaxydx.com/ Instagram: @nicoledaniellebell and @galaxydiagnostics Book - What Lurks in the Woods: amazon.com/What-Lurks-Woods https://www.amazon.com/What-Lurks-Woods-Struggle-Chronic/dp/1955711011 Thank You to Our Sponsors! Next Health: Your destination for cutting-edge health optimization - from IV therapy to hormone balancing. Explore at next-health.com https://www.next-health.com/! Momentous: Head to livemomentous.com https://livemomentous.com and use my code DRSHAH at checkout for up to 35% off.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  Today on Extend, I am very excited to be joined by Nicole Bell, CEO of Galaxy Diagnostics. Nicole is an engineer with a background in medical devices and diagnostics, and she spent most of her career bringing new technologies through the FDA. Her work in Lyme disease began at home. Her husband, a brilliant electrical engineer and computer scientist, suddenly started showing mood changes and memory loss. He tested negative for Lyme and was eventually diagnosed with early onset Alzheimer's disease. Only later did they learn through better testing that not only did he have Lyme disease, but it came along with two common co-infections, Bartonella and Babesia. Nicole and I will be talking about why this very prevalent problem,

• 1:34Dr. Darshan Shah?

  Lyme disease, gets so little attention in traditional Western medicine. We're going to get into why standard blood tests so often miss it, and how the bacteria hides in tissue instead of the blood. We also talk about co-infections that the standard treatment doesn't touch, and the possible links between untreated infections and chronic and neurological conditions. Nicole will also explain Galaxy's newer approach of detecting the infection directly, including their Lyme urine antigen test. If you or someone you love has symptoms nobody can explain, this conversation is for you.

• 2:12Dr. Darshan Shah?

  Nicole, thanks so much for coming on Extend today.

• 2:14Speaker 01

  Yeah, thank you for having me.

• 2:16Dr. Darshan Shah?

  Really appreciate it. We're in Nashville, Tennessee, in this incredible studio. And where do you live again?

• 2:22Speaker 01

  I am in Raleigh-Durham, North Carolina.

• 2:23Dr. Darshan Shah?

  How far is that from here?

• 2:25Speaker 01

  Um, it's probably an eight-to-10-hour drive. I'm not sure, but it's a quick flight, which is great.

• 2:30Dr. Darshan Shah?

  I really appreciate you coming up. And we're in Nashville because we're doing our longevity summit tomorrow. And I use the opportunity to meet incredible people that are out there spreading the word of health, wellness, longevity. And I really appreciate you becoming part of the conversation.

• 2:46Speaker 01

  Oh, I'm honored to be here. Thank you.

• 2:48Dr. Darshan Shah?

  So this is something that I've really been wanting to talk about in the podcast for a long time, because it is very underappreciated, especially in like traditional Western medicine, and that is Lyme disease. And you have incredible body of knowledge of this that comes from a personal journey through this. And you know, before we dive into all the science and what you're doing, I'd love for you to talk about why, why you're so passionate about Lyme disease.

• 3:15Speaker 01

  Yeah, I mean, I came to it the way that a lot of people come to the space, when it hits your family, right? And so I'm an engineer, a science background, worked in medical devices and diagnostics, had a great career kind of leading new technologies through the FDA and doing things. And then I realized that my husband was starting to get sick. And at first, it was, it seemed more like we were headed for divorce because he was irritable, he was depressed. He just wasn't the man I married. And then I started realizing he was having cognitive issues. You know, he was forget, he was a brilliant man. He was an electrical engineer, computer scientist. And all of a sudden, he couldn't remember the time to pick up our kids from daycare.

• 3:57Speaker 01

  He couldn't remember the house code for our security system. And that was when I realized that something was really wrong. And then I had to convince him to go to the doctor. And honestly, the first thing that I thought of when I started researching was Lyme disease. Because, yeah, and that's not typical. You hear a lot of people's stories with Lyme, and it takes them years to get to that answer. But I started Googling confusion, brain fog, and Lyme came up, and it immediately resonated because he was a hunter. He was always in the woods. He was, did the landscaping at our house, and he had many tick exposures. And so it fit. And, but we went to the doctor. He tested negative for Lyme, and we can talk about all the reasons why the current testing has issues.

• 4:40Speaker 01

  And then because most of his issues were either mood-based or cognitive, they referred us to a neurologist. And when we went there, after a series of cognitive tests, and then eventually a PET scan, he was given a diagnosis of early onset Alzheimer's.

• 4:55Dr. Darshan Shah?

  And it was showing on the PET scan?

• 4:57Speaker 01

  And to make matters worse, they told us that not only was it Alzheimer's disease, but he was in the late stages of Alzheimer's. So I was still trying to convince him that something was wrong.

• 5:06Dr. Darshan Shah?

  And how old was he at this point?

• 5:07Speaker 01

  He was 60 years old. 59, 60 was kind of the beginning of the journey. So he was older than I was, but still really young. And again, I'm an engineer. You're trained to find root causes. But I realized in medicine, that's not necessarily the way that it's built. And we kept going from neurologist to neurologist because it just didn't make sense. He had no genetic predisposition to Alzheimer's. He had no comorbidities, no other indications that would, you know, describe or explain why he was declining so rapidly and so young. And it took about another year, it was 15 months after our first doctor's appointment, when we returned to the possibility of tick-borne illness. Somebody else in my family had finally figured out after their health issues that they had Lyme.

• 5:53Speaker 01

  And at that point, we reassessed, and I found out that not only did he have Lyme disease, but he also had two common co-infections, specifically Bartonella and Babesia. But this was 15 months after he'd been given a late-stage diagnosis. And so we treated, saw some improvements, but really the cognitive piece, a lot of damage had been done. And so he ended up going into a memory care facility in 2019, and he passed in 2022.

• 6:18Dr. Darshan Shah?

  So sorry to hear that.

• 6:20Speaker 01

  Thank you.

• 6:20Dr. Darshan Shah?

  Yeah, and so do you think that the Alzheimer's disease occurring at an early age and rapidly progressing like this had a lot to do with just untreated Lyme and co-infections?

• 6:32Speaker 01

  Yeah, I mean, honestly, I think infection is a key missing piece in the Alzheimer's space and the longevity space in general, right? I think more and more people are starting to talk about inflammation as a key driver of aging and of decline. But what's one of the key things that causes inflammation, right? Infections.

• 6:50Dr. Darshan Shah?

  Infections, right.

• 6:50Speaker 01

  And these infections are kind of interesting. They're known as stealth pathogens. And so they can, they replicate slowly. They hide in tissues. They have the capability to cross the blood-brain barrier. And, you know, I think he had these infections on board for probably years, potentially even a decade. And it was slowly doing damage, but all of it was kind of subclinical. And then it got to a point where it was really an issue, but at that point, a lot of damage had been done.

• 7:16Dr. Darshan Shah?

  Right, right. And, you know, I think this is a couple of really important points we need to dive into here. One is the inability to diagnose these infections. I think that's a critical problem. And I think it's counterintuitive to a lot of people, and also the reason why a lot of doctors kind of shrug this away as a diagnosis, because doctors are very used to like, you know, I get a test for it, and if it comes back positive, it is positive. If it comes back negative, it is negative, right? And a lot of infections are like that. Like if you do a blood culture, if the blood culture is positive, you definitely have a bacterial infection, you know? And so, but Lyme disease doesn't work that way. Why is that?

• 7:58Speaker 01

  There's a lot of reasons. You know, if you look at the microbiology of the pathogen, it doesn't like to be in the blood, right? And what's one of the biggest things that we use for testing? We use blood samples, right? But Lyme likes to hide in tissues. And it's also in really low quantities. That's why I say it's called a stealth pathogen, because it replicates slowly and it hides. It actively evades the immune system. And there's been all sorts of research that shows, frankly, the kind of devious ways that it manipulates your immune response. And so it's been difficult. Like if you go and you want to know if you have COVID, right? You can get a blood test or an antigen test. And those are direct tests. They tell you whether or not the pathogen's on board. But in this space, it's just those techniques are not sensitive enough. And so as a result, the current standard of care

• 8:43Speaker 01

  is based upon antibody testing. That's really the only thing that's been available. But here, I just said that these pathogens actively evade and trick the immune system. And then what are you using as a way to measure it? You're using antibodies, which is a measure of your immune response. And so it's a fundamentally flawed testing approach, because the best time to treat these pathogens is early, right? As soon as you get bit, as soon as you figure it out. But antibodies take four to six weeks to peak. So you miss that early window. And then if you have somebody like my husband, Russ, he likely had these pathogens on board for, you know, years. And so his immune system was suppressed. His overall antibody titers, when we finally measured them, were low. And so, you know, there's a lot of people that are testing negative. We had him tested in that first doctor's appointment.

• 9:28Speaker 01

  And in order to be considered a clinical positive, according to CDC criteria, you need to have five antibody bands positive, right? Because antibodies are often cross-reactive and nonspecific. So they want to have multiples to ensure that that's really what's going on. He only had one. So he was far from a clinical diagnosis with the lab, far from a laboratory diagnosis. And that led us to a whole journey that wasted a lot of time.

• 9:53Dr. Darshan Shah?

  Yeah, yeah. How does Lyme disease lead to Alzheimer's?

• 9:57Speaker 01

  So again, these pathogens can cross the Blood brain barrier. And so if it gets into your brain tissue, it can drive inflammation. And there's been a lot of studies and a lot of case reports in the Alzheimer's literature that show the linkage with Lyme disease and actually case reports where people who are treated effectively reverse their cognitive decline. And so, and it's not just Lyme. It's again, these common co-infections, Bartonella and Babesia, they also cross the blood brain barrier. And ironically, I donated Russ's brain to an initiative called the Alzheimer's Pathobiome Initiative that's really studying the linkages between infections and Alzheimer's disease. And they found evidence of Borrelia in his

• 10:39Speaker 01

  brain. They found evidence of Babesia, a species of Babesia that until recently was only thought to infect deer. They found that in his brain. And that was what was driving this systemic inflammation that leads to neurocognitive decline. You know, I think the amyloid and the tau tangles, right? Those are byproducts of the problem. And it's, they've been the focus of the Alzheimer's community, but you have to look further upstream to really figure out what's that root cause.

• 11:06Dr. Darshan Shah?

  Yeah. I've had Dale Bradison on this show a few times, you know, and he does talk about infections being one of the root causes of Alzheimer's. And sadly, like, you know, many neurologists are very dismissive of this. But I think what you mentioned there is extremely important for people to understand that the tau tangles and the amyloid plaques happen for a reason.

• 11:29Speaker 01

  Yes.

• 11:29Dr. Darshan Shah?

  They don't just happen spontaneously. And the reasons are infections, toxins, metabolic disease, et cetera. It's your body's attempt of trying to heal the neurons or fight off the problem.

• 11:41Speaker 01

  Yes.

• 11:41Dr. Darshan Shah?

  And that's why they're there. So I think the Alzheimer's pharmaceutical complex have looked at treating amyloid as the reason why people are getting Alzheimer's, but it's not treating the root cause. Once again, it's very, you know, looking at treating the symptom rather than the cause and the issue. And so if someone gets a diagnosis of Alzheimer's, the idea here is go look for the reason why. Why is that person getting amyloid and tau in their PET scan? And now we have great blood tests, P tau 217, amyloid ratios that you can do that would become positive way before a PET scan will become positive too. So that's an even earlier indicator to look for evidence of other causes of the disease.

• 12:23Speaker 01

  Yeah, no, you're spot on. I mean, there's been actually research out of Dr. Rudy Tanzi's work at Harvard. And they've shown that the amyloid beta is actually a response of our innate immune system. And so the question is, what is it responding to? Right? If you have somebody like Russ that has an early presentation, no comorbidities, no genetic predisposition, that's a prime candidate to start looking for infectious or toxins that are causing that issue. And, and if you're just taking the plaques out, you're a step away from the actual root cause.

• 12:53Dr. Darshan Shah?

  Yeah, absolutely. And the plaques will just keep coming back.

• 12:55Speaker 01

  Right.

• 12:56Dr. Darshan Shah?

  Yeah. So you talked about the brain, but Lyme can also cause other symptoms, right? I mean, your husband sadly had probably, you know, the brain symptoms dominated, but were there other symptoms? And what should other people be looking out for when they're considering Lyme as a diagnosis?

• 13:13Speaker 01

  Yeah, it's a great question. And I think when you first enter the Lyme space and you start reading, you're like, how can the same infection lead to so many multi-system problems? And it almost seems crazy, right? But when you think about the microbiology, it actually makes sense because the pathogen is like a little like corkscrew. It can get in anywhere and including immune privileged sites like the brain, the joints, the eyes, you know, these are places where it has kind of an all access path. And, and so when you, if it infects your joints, then you're going to develop arthritic symptoms. If it infects the tissue around your heart, then you're going to develop carditis. If it goes to your brain, then you may have mood based disorders or cognitive decline. And so it's

• 13:56Speaker 01

  very common for people to have multi-system issues. And in my husband's particular case, most of it started with the cognitive, but as he progressed, he absolutely had migrating joint pain. He had aches and pains and fatigue. And that's often what you see with these patients. And the problem is, is it's multi, you know, it's, it's not specific, right? When you go to the doctor and you say, I have joint pain, or I have fatigue, right? There's a lot of things that can cause that. But the patients that have multi-system issues, you know, brain fog or fatigue in combination with joint issues or card, you know, unexplained carditis in a really young patient, you know, idiopathic, you know, conditions, that's my favorite word in medicine is idiopathic. And, you know, these people that have multi-system

• 14:39Speaker 01

  failures or that aren't responding to traditional treatments, those are the people where you might want to think, hmm, maybe there's a driver and maybe there's an issue here.

• 14:47Dr. Darshan Shah?

  Right. You mentioned co-infections a couple of times.

• 14:49Speaker 01

  Yeah.

• 14:50Dr. Darshan Shah?

  Can you talk to us about what those are and why do these infections travel together?

• 14:54Speaker 01

  Yeah. And it's a, it's an important distinction because I think when people think about ticks, you know, they think about it more and more. People are starting to think about Lyme, but ticks are really nature's dirty needle. They carry all sorts of stuff.

• 15:05Dr. Darshan Shah?

  I like the way you described that is true.

• 15:08Speaker 01

  Yeah. And so you really want to be thinking beyond Lyme. So for example, Babesia is a very common co-infection, which is in a lot of ticks, particularly in the Northeast. It's in a high percentage of ticks in places like Pennsylvania. And that's a parasitic infection. It's actually more like malaria than it is like Lyme. And so the treatment is more like an anti-malarial. And so if you have that pathogen on board and you take doxycycline, which is the frontline treatment for Lyme disease, it's not going to touch the Babesia. And then Bartonella is another common co-infection. And there's a little debate about whether or not that's transmitted by ticks as the primary vector. Actually, the primary vector is fleas and lice. And it's one of those opportunistic pathogens where a lot of people

• 15:51Speaker 01

  have been exposed to it and a lot of people's immune system can keep it in check and fine. But then you get another pathogen. Maybe you get a tick bite and you get Lyme disease and you get Babesiosis. And all of a sudden, the Bartonella comes out and joins the party, right? And that becomes an issue where there's a lot of synergies between these pathogens. And they can lead to really complex neuropsychiatric issues. So Bartonella has been associated with schizophrenia. It's been associated with OCD, anxiety, Pan's Pandas in children. It really has an ability to go in and have some pretty dire consequences. And if you don't know that, then, you know, you're gonna, I mean, we've, we have many patients that have been in, in mental institutions, right? Not responding to treatment. And then we

• 16:36Speaker 01

  finally figure out that it's Bartonella. They get the appropriate antibiotics, again, different antibiotics and doxycycline, and they all of a sudden get their lives back, right? And so if you're not looking for these pathogens, then you're not gonna, you're gonna miss that root cause.

• 16:50Dr. Darshan Shah?

  What's the treatment for Bartonella?

• 16:51Speaker 01

  So the frontline antibiotics are like rifampin, rifibutin. And then a lot of people use herbal therapies. Those are very common and used pretty consistently across the vector borne disease community. If you know, then they're very treatable. But if you get to the point where, you know, like Alzheimer's disease, I kind of liken it to a forest fire, right? Like, once the entire forest is on fire, it's really difficult to get it under control. But if you get it early, like if we had screened Russ in his early 50s and figured out he'd had these pathogens on board, he could have easily gotten some treatment. And, you know, my story might have ended quite differently.

• 17:26Dr. Darshan Shah?

  Yeah.

• 17:32Dr. Darshan Shah?

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• 18:13Dr. Darshan Shah?

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• 18:30Dr. Darshan Shah?

  How does one diagnose Babesiosis or Bartonella?

• 18:33Speaker 01

  Yeah, so that's what we do at Galaxy, right? And so I think, again, those are also stealth pathogens. And so a lot of frontline treatment is still antibodies. And that is, again, complicated because a lot of people have been exposed, especially to Bartonella. So Bartonella is a common vector for Bartonella, or a common reservoir, sorry, for Bartonella is household cats. Actually, a pretty high percentage of cats have Bartonella on board. And if you Google Bartonella, what comes up is cat scratch fever.

• 19:03Dr. Darshan Shah?

  Yeah.

• 19:03Speaker 01

  Right? That's the acute form of the disease. But what Galaxy's founder has found in the research is that there's a lot of chronic conditions that are also, just like in Lyme, where some people have a really strong acute reaction and get the big rash and the flu like symptoms. Other people don't. And when they don't, that doesn't mean that it's not going to cause a problem, right? It festers and it can manifest in other ways, like neuropsychiatric diseases and like arthritis and other conditions. And so a lot of frontline testing is still antibody based, but just because you have positive antibodies, I mean, I have COVID antibodies, but I don't have COVID.

• 19:37Dr. Darshan Shah?

  Right.

• 19:37Speaker 01

  Right? And so it's, it's complicated.

• 19:39Dr. Darshan Shah?

  Yeah.

• 19:40Speaker 01

  So what we do at Galaxy is we focus on that direct detection. How do you do, you know, either a PCR test or an antigen test? But because these are low abundance pathogens, that's not that simple. You can't just use standard techniques because you'll miss it. So we use enrichment methodologies. We understand the microbiology of the pathogens because we work really closely with the researchers. So for Bartonella and Babesia and, and relapsing fever Borrelia. So Borrelia has kind of the Lyme Borrelia, and it also has the relapsing fever Borrelia. Those are in the blood. And so if you use the proper enrichment and high sensitivity PCR techniques, you can use a blood based test. And that's what we do. We have a multiplex test for all three of those pathogens.

• 20:20Dr. Darshan Shah?

  Okay.

• 20:21Speaker 01

  But Lyme just does not like to be in the blood.

• 20:23Dr. Darshan Shah?

  Right.

• 20:24Speaker 01

  So there, we use a different technique and actually take advantage of the microbiology where It likes to shed pieces of its cell wall.

• 20:33Dr. Darshan Shah?

  Okay.

• 20:33Speaker 01

  Right? So either structural components or surface proteins. It sheds them as part of its life cycle and also as part of its immune evasion. You know, if you think about it, it's like, oh, I'm going to take all these, these proteins and shed them. And so now the immune system is going to attack those free surface proteins instead of the bacteria itself. It's kind of genius.

• 20:52Dr. Darshan Shah?

  Yeah.

• 20:52Speaker 01

  And but those free surface proteins, those free biomarkers basically get filtered out by the kidneys and get excreted in urine. So urine is actually a fantastic matrix for diagnosing Lyme and we use a Lyme urine antigen test. Which is great for early stage disease because you don't need that antibody response. But it's also good in the later stages of disease because you have a lot of people, especially if you live in an endemic area. You get an antibody test for Lyme, maybe you know that you had Lyme in your twenties. And so it's not unusual for you to be antibody positive. And going back to what you said, that's part of what makes it difficult with doctors is because they look at it and they say, well, yeah, you, you had it in your twenties, so you're going to be antibody positive. But that doesn't mean that the infection didn't resurge or that you didn't get reinfected.

• 21:37Speaker 01

  And so if you have antigen markers, that's a direct evidence that the pathogen is present. And that gives you more clinical, you know, real clinical support that something's on board.

• 21:49Dr. Darshan Shah?

  Yeah, that's, first of all, it's so incredible that the science has advanced to where we have much better testing. Because we've been using antibody testing for everything, you know? And it's like, it doesn't tell you how severe the infection is. It's sometimes very low resolution to your point, especially with these stealth infections that like to hide. And it doesn't tell you when the infection has occurred or even if it's current, right? You can get some, some kind of indication with IgG versus Ig and those kinds of things. But it's, it's difficult. It was very difficult with COVID when it first came out because all we had was the antibody tests, right? And it was such a huge question mark. So antigen testing is definitely where you get a lot better clarity about is this a current,

• 22:34Dr. Darshan Shah?

  the occurring phenomenon versus something that was in the past?

• 22:37Speaker 01

  Yeah, and we see a lot of chronic patients, right? Because the causes, when it gets misdiagnosed, it leads to really complex chronic symptoms. And what we see with these patients is some of them have hyperactive immune systems. And so if you're testing them for antibodies, they have antibodies to everything. And so then it's like, well, okay, fine, you're, you're testing positive for all, you know, six to 10 infections. Co-infections are common, but is it more likely that you're just, your hyper immune system, your immune system is hyperactive? And the key is, is okay, well, which infections are actually driving the bus, right? And that's where direct detection comes in.

• 23:10Dr. Darshan Shah?

  Got it. Would you say if someone is symptomatic and they want to figure out whether or not they have Lyme disease or not, is it better to do the antigen testing first instead of doing the antibody? Is it a replacement for antibody testing?

• 23:22Speaker 01

  I think we would love to get it to the point where it's a replacement, you know? But the science is really still evolving. And so at this point, we always encourage people to do both and kind of see. And you still have to do a clinical diagnosis. Does it make sense with the picture?

• 23:37Dr. Darshan Shah?

  Yeah.

• 23:38Speaker 01

  Right? And so our goal and what we're working towards is FDA approval for our urine antigen test and really have that be focused in early stage disease. I think for late stage disease, there's a lot of opportunity there too. It may take multiple markers to make sure you're capturing all manifestations, right? Because if you think about Lyme, as I mentioned, depending on where it is, you can have different manifestations. So there's neuroberliosis when it's in the brain, there's carditis, there's arthritis. And so making sure you're capturing all those cases is really something that we're still working on.

• 24:11Dr. Darshan Shah?

  Got it. Can we go back a little bit, just for the audience's sake? Can you talk a little bit about tick bites and Lyme infection, where it occurs in the country and what to look out for? How does it look? When to, when to get treated if you, if you've gotten a tick bite? And what you should do? Just kind of give people like a lay of the land on this.

• 24:31Speaker 01

  Yeah, and I think when you say Lyme disease, right? The first thing that shows up in people's mind is a fever and a rash, right? The rash, that typical bullseye rash is the first manifestation. And I don't, what I think a lot of people and doctors don't realize is that that bullseye rash, kind of the EM rash with the central clearing is actually rare. So about 14% of patients get that classic EM rash.

• 24:56Dr. Darshan Shah?

  Right.

• 24:56Speaker 01

  And about 30% of patients don't get any rash at all. Right? So there's no indication that might say from a physical, you know, perspective that you have Lyme disease. Because the other fever, the other symptoms may be fever, maybe fatigue, right? That could be COVID, that could be a whole host of things. And so, and a lot of people, about 60% of the people do get rashes, but they're different, right? I just, I had a friend that reached out to me and his daughter was misdiagnosed with shingles. Because the rash looked exactly like shingles.

• 25:27Dr. Darshan Shah?

  And was it painful too?

• 25:28Speaker 01

  It was very, it was, it was painful, it was irritable. And there's been papers and case reports in the literature that actually show that this vesicular rash is actually associated with Lyme disease. But she went to three different doctors and they diagnosed it as shingles. And she's a nurse, very smart person, and she was like, this doesn't seem to fit. And then she finally, after a conversation, you know, that I had with her dad, she insisted that they test her for Lyme and sure enough, that's what it was. And within 24 hours, the rash went away. And so a lot of these rashes come in different forms and they get misdiagnosed. You know, the other types of rashes, the non-bullseye rashes are misdiagnosed 36% of the time, according to studies. And so when you put together the fact that some people don't have rashes, the misdiagnosis rates,

• 26:12Speaker 01

  rash diagnosis is about 50% accurate. And so a lot of people get told by their doctor, well, you don't have Lyme disease. Or back to your other question, what regions? You know, Lyme isn't in your, in our state, right? And that's just not true. I think it's definitely expanding. The hotspots are definitely the, you know, New England and the Upper Midwest. But it's been documented in California and the Southeast. I mean, there was just a study that was published recently that showed the black-legged ticks in Ohio. And, you know, 2010, they tested a bunch of the black-legged ticks in one of the counties there for Lyme disease and only 2% were positive. They redid that study 10 years later and it was almost half.

• 26:53Dr. Darshan Shah?

  Oh, wow.

• 26:54Speaker 01

  Right? So the endemic areas are growing.

• 26:56Dr. Darshan Shah?

  Right.

• 26:57Speaker 01

  And then people travel, right? A lot of people go different places, they, you know, they get exposed to things and that's an issue. And so it really needs to be something that people have on their radar screen. And if their doctor is not supporting them, they need to be their own advocate and help figure out if that could be leading to their symptoms.

• 27:16Dr. Darshan Shah?

  Absolutely. So if someone gets a tick bite and they, let's just say they have a rash, should they get immediately treated?

• 27:23Speaker 01

  I would absolutely say yes.

• 27:24Dr. Darshan Shah?

  I would say yes as well.

• 27:25Speaker 01

  Yeah, so I mean, the, the sooner you get on a treatment, you know, doxycycline, herbal therapies, whatever your approach is, doxycycline is the frontline treatment, the more effective the treatment is. And there's been studies that have shown even a 30-day delay to diagnosis can over double your risk of having complex chronic symptoms. Because what happens is these, these pathogens, when you get bit, right? It starts in your tissues and it expands. That's the, there are them on migrans rash or the EM rash, that's why it expands, right? It's spreading within your tissue.

• 27:56Dr. Darshan Shah?

  Got it.

• 27:56Speaker 01

  But it starts going throughout the body, right? And it starts, and it can go to places like your joints and the brain and other locations. And once it's disseminated, it becomes a lot harder to treat, right? It also can form, you know, biofilms and protect itself. And so the longer you go, the harder it is to, to get that treatment.

• 28:16Dr. Darshan Shah?

  Yeah. What if someone gets a tick bite and they don't have a rash? Do they still get a prophylactic antibiotics?

• 28:22Speaker 01

  If they're having symptoms, absolutely. I think I'm a big fan, I always tell people, please do not flush the tick down the toilet, right? Take the tick and get it tested. Because again, it might not just be Lyme, it could be other infections. And so you want to know what you were exposed to. It doesn't mean you have it because the tick may or may not have transmitted that pathogen to you. But at least you know you've been exposed because if that tick had babesia, right? Doxycycline is not going to help you.

• 28:50Dr. Darshan Shah?

  Sure.

• 28:50Speaker 01

  And you may end up getting fatigue and, and other issues months after that initial bite. And, and some people don't associate it with that, right? If you get bitten in May and then all of a sudden in October, you start feeling fatigue. Not a lot of people make those connections. But if you take the tick, you save it, you can send it out for testing, then you know, and you just have it in the back of your mind, okay, if I have any symptoms, this is something that I need to assess.

• 29:16Dr. Darshan Shah?

  Yeah. So, you know, I think a lot of people, they go to a physician or an emergency room or urgent care and they have all these nonspecific kind of symptoms. After they hear this podcast, how can they like advocate for themselves?

• 29:30Speaker 01

  Yeah, I mean, one, get, get tested. And, and the problem is, is a lot of people are going to test you for antibodies and, and that's very inaccurate. So studies from Bay Area Lyme has shown that it's over 70% of early stage cases are missed by antibody testing. And that just makes sense with the immunology, right? Again, IgG takes four to six weeks to peak. So if you get tested two weeks or a week after your tick bite, you're not going to necessarily test positive. We're providing better solutions. I'm a huge fan of the urine antigen testing. And so, and we're available, you know, in 49 states.

• 30:04Dr. Darshan Shah?

  What's the name of your test again?

• 30:06Speaker 01

  It's, it's our Lyme urine antigen test.

• 30:08Dr. Darshan Shah?

  By Galaxy.

• 30:09Speaker 01

  By Galaxy Diagnostics.

• 30:10Dr. Darshan Shah?

  Okay. And is this available like through Quest Labs or to LabCorp? Or is it a special?

• 30:15Speaker 01

  Not yet.

• 30:16Dr. Darshan Shah?

  Okay, got it.

• 30:16Speaker 01

  Not yet.

• 30:16Dr. Darshan Shah?

  So they have to ask, they have to look up your company and say, I want to get this antigen test because it's more specific.

• 30:22Speaker 01

  Yes, they can order it directly through the company. It's very easy to set up an account. We have scientific advisory board members from both LabCorp and Quest, you know, helping us. And I think that's our goal, is to get it in the hands of the big diagnostic players, but that's still a work in progress.

• 30:37Dr. Darshan Shah?

  Right. And is it as effective at helping people diagnose chronic versus like an acute?

• 30:43Speaker 01

  Yeah, we diagnose chronic patients quite a bit. And I think that's something that we really adds a lot of value. Because again, if you have somebody that you know has had a past exposure to Lyme, but then they're having symptoms, and actually we've seen several cases where women come in in perimenopause phases, they go to a functional medicine doctor and they're like, hey, I just, I feel like I'm going through a hormonal transition and so forth. And then the doctors that we work with have a really good eye for kind of looking at vector borne disease. And in several cases, they've tested and then their, their urine antigen comes back positive.

• 31:20Speaker 01

  The research out of Johns Hopkins shows that these hormonal transitions, right, the symptomology often changes. So a pre-menopausal woman is gonna have a woman is gonna have a lot less symptoms than a post-menopausal woman. And actually, women's symptoms are less than men's. And so, just like in everything else, your immune system can respond in a certain way, but then you go through a trauma or hormonal transition, a stressful event. And then all of a sudden, the infection picture changes.

• 31:45Dr. Darshan Shah?

  Sure.

• 31:46Speaker 01

  And so, we've had a lot of people that have gone in and think it's something else. And then we test them and it ends up being Lyme.

• 31:52Dr. Darshan Shah?

  Yeah. I think what's really important there to highlight that is this infection could live with you for years and be asymptomatic. And then something like a hormonal transition, or maybe even like getting COVID and it depresses your immune system for a while, can reactivate this infection.

• 32:07Speaker 01

  Yes.

• 32:07Dr. Darshan Shah?

  And then it could really take hold by, like you said, like spreading throughout your body, hiding and causing this chronic inflammatory type of reactions.

• 32:16Speaker 01

  Absolutely. And that's why I think this is the key missing piece in the longevity discussion, right? Because like I said, my husband had a perfect, you know, I think he had these infections on board for probably a decade.

• 32:28Dr. Darshan Shah?

  A decade, yeah.

• 32:29Speaker 01

  And so, you know, because he was healthy, he had a good immune, you know, support. But then all of a sudden, it started cascading, right? And so, if we're looking at these things as part of a screening protocol, understanding who has exposures, understanding who has a past history, not just of a tick bite, but cats. Have you had a, have you have a flea infestation in your house? Have you had a lice infestation, right? A lot of, millions of Americans have had exposures in that way. And then, you know, does that lead to the onset of symptoms? And start looking at that in the differential and then testing. Because if you catch it early, it's absolutely treatable. But if you wait until that whole forest is on fire, then it becomes a much more challenging endeavor.

• 33:07Dr. Darshan Shah?

  Absolutely. Does the Galaxy test also simultaneously test antigens for the co-infections as well?

• 33:13Speaker 01

  Not yet. That's something that's been shown in the literature. And the urine test is actually, can be a really good vehicle to look at co-infections. But right now, if you're looking for broads coverage, we do the urine antigen test for Lyme and then the blood-based test for co-infections.

• 33:27Dr. Darshan Shah?

  Got it, got it.

• 33:28Speaker 01

  And that's a good way to do kind of a broads approach of what vector borne infections might be, you know, affecting you.

• 33:35Dr. Darshan Shah?

  Sure.

• 33:39Dr. Darshan Shah?

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• 34:22Dr. Darshan Shah?

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• 34:30Dr. Darshan Shah?

  So, you know, what we're really talking about here is creating more awareness in patients, but also the medical community.

• 34:36Speaker 01

  Yeah.

• 34:37Dr. Darshan Shah?

  That needs to happen. And there needs to be just like a fundamental rethinking of how do we address symptoms? By looking for the causes and not just treating the symptoms. And that's probably across all diseases, right? But specifically related to Lyme, how do you kind of see the future of this awareness going? How do, how does the community advocate for this? How do patients advocate for it? How do we re-educate the medical establishment?

• 35:02Speaker 01

  I mean, I think that the functional medicine movement has been a fantastic one.

• 35:06Dr. Darshan Shah?

  Yep.

• 35:06Speaker 01

  And it's really helped a lot of people get well. But there's also, you know, always those patients that fail therapies, right? You go in for the gut protocol and then all of a sudden, the therapy's not working. Or you're doing the hormonal treatment and it's not working. And so, for people that aren't entrenched in the vector borne disease space, you know, one of the things we like to say is look for the multi-symptom, multi-system type patients. Look for the people that are not responding to your core therapies. And those are the people that you really want to take a step back and say, am I missing something? Why are they not responding? You know, and, and it can be a chronic based symptom, but it can also be acute. I mean, one of the things, we talked about Bartonella and the neuropsychiatric link.

• 35:49Dr. Darshan Shah?

  Yes.

• 35:49Speaker 01

  Like we had, there's a case study that's been published by our founder. There was a young boy that was 14 years old and all of a sudden had sudden onset psychosis. He was homicidal, he was suicidal, his parents had to basically sleep split. And one parent would sleep with him, the other would sleep with the younger sibling because they were literally worried about him assaulting. I mean, it was awful. And he was placed in a mental institution, non-responsive to therapy, spent over $400,000 in psychiatric care. And fortunately, an acute, an astute nurse noticed these striae. So there's this skin condition, they kind of look like stretch marks.

• 36:26Dr. Darshan Shah?

  Yeah.

• 36:27Speaker 01

  That are often associated with Bartonella.

• 36:29Dr. Darshan Shah?

  Really?

• 36:29Speaker 01

  And so, she noticed this on his torso and then connected him with our founder, tested him for Bartonella, turned out he was positive. Within a few months of being treated with the appropriate antibiotics of rifampin, rifabutin, he got his life back, right? He went back to high school, he graduated valedictorian of his class.

• 36:47Dr. Darshan Shah?

  What?

• 36:48Speaker 01

  All, and yeah, he went on to study at Ohio State University. And so, you know, this is what happens, the people that are not responding to treatment, right? These are the key. And all of that happened right after they adopted a cat, right? And I don't mean to anti-cat bash, it's just like, it's, that's something that you need to think about. That's an exposure. If you have a new dog or cat or something, you have a flea infestation, that's an exposure. It's really not, it's bigger than ticks.

• 37:12Dr. Darshan Shah?

  Yeah. Yeah, the conversation does go beyond Lyme disease to all, to the other co-infections. And is, you're right, the functional medicine movement has brought more awareness to this because I think people get frustrated when they get kind of gaslit or they get ignored by the medical establishment. And they see more of a functional provider who then can then order some of this testing. But even in the functional medicine space, I don't think there's a lot of awareness about the different types of testing. So I appreciate you coming on the podcast. And I know a lot of the people that listen to this are functional medicine providers. So for them to know that better testing is out there is huge, right? So if you were to like wave a magic wand and create a new standard of care for Lyme disease, or even just, you know, some of the other ones, how would you see it playing out?

• 37:58Speaker 01

  There's different answers to that. I think in the acute space, I would love, when you have that acute exposure, to get, you know, our urine antigen test or something that actually is designed for early detection, right? Because that's the most effective window. It's just like Alzheimer's disease, you don't want to wait until somebody's into the late stages of cognitive decline. You want to get it early and start thinking about it in your 40s and 50s and as early as possible. And with these infections, that's absolutely the case, the earlier the better. But not all cases are gonna be found because a lot of people don't have a rash, a lot of people don't have strong symptoms. And so, I would like to wave the magic wand and have it be part of a longevity screening protocol, particularly for people that live in endemic areas. Or for, particularly for people that fit certain protocols, like, or, or themes, like,

• 38:43Speaker 01

  again, multi-system issues, non responding to treatment. Those are the types of people where I think, you know, screen for pathogens and really understand. And that becomes a critical piece of really understanding how your immune system is responding and how to keep it healthy. Because again, my husband was doing all the right things, but he declined. And I watched him age in front of my eyes. When he passed, he was 65, but he looked like he was in his late 80s, right? It was, it was the most tragic thing and I'll never forget it. But I don't think it has to be that way.

• 39:15Dr. Darshan Shah?

  Yeah, no, it's so true. So earlier testing.

• 39:18Speaker 01

  Yes.

• 39:19Dr. Darshan Shah?

  And more awareness that when you need to get tested. Is there a direct to consumer version of this test that, that might be happening?

• 39:27Speaker 01

  Not just yet. I think that's a dream of mine, especially for our urine test, because it's really easy. You can collect it at home. Right now, we're establishing some telehealth options that make it really easy so that you can, you know, very quickly get an assessment and a test. And we'll be expanding that as we go forward. But I think it's absolutely coming and I would love to be able to have kits sold on Amazon and Walgreens and make it really accessible because that's what it needs. You know, as a person who had to advocate for my husband, I, I really love putting the power in the hands of the caregiver or the patient. Because you know what's wrong with you. You might not be a medical expert. You might not be the, you know, expert on the science, but you are an expert in you. And you know when something's wrong.

• 40:12Speaker 01

  And giving people more tools to help figure that out is something that I believe firmly in.

• 40:16Dr. Darshan Shah?

  Yeah, I think everyone should have access to making the decision about whether they get tested for something or not.

• 40:22Speaker 01

  Yeah.

• 40:22Dr. Darshan Shah?

  There's no reason to gatekeep that. It's your own body, it's your own data. And you see more of that happening with like standard blood tests. And hopefully, it can keep expanding as time goes on. And then of course, you know, there has to be really good education out there and what to do if it's positive and also really good support. But I think all that can be built.

• 40:42Speaker 01

  Yeah, absolutely. I mean, the, the literature is there. There's treatments that are out there that are frontline. We need to do better. I think some of the treatments have shown that multi antibiotic therapies are more effective for later stage disease. A lot of that research is coming, but you know, if you don't know what pathogens you have on board, you don't know what you're fighting, it's really hard to get well.

• 41:02Dr. Darshan Shah?

  Absolutely.

• 41:03Speaker 01

  Right? So you need to know first and foremost, what are the pathogens? Because a babesia treatment is different from a Bartonella treatment, which is different from a Borrelia or Lyme treatment. And so, if you don't know what you're fighting, you're never gonna win.

• 41:15Dr. Darshan Shah?

  Yeah, absolutely. You know, I see on, online, there's a lot of communities that have developed. Are there any ones that you can refer people to that you find particularly helpful? If people think they might have Lyme disease or are struggling with the treatment or the symptoms of it?

• 41:31Speaker 01

  Yeah, I mean, I think that's one thing that's been great about the Lyme community is a lot of people that have experienced this personally have helped to build solutions. So, you know, Project Lyme is a really great resource, which is there for, as a source of community and as a source of curated information. The Center for Lyme Action is, is really lobbying for more support within the government to make this a priority. And I think there's been a lot of awareness and there's been a lot of change in the, in the government's position on Lyme disease. You know, if you look back when Russ was first diagnosed, the CDC said chronic Lyme didn't exist. And they've pulled back from that position. And a lot of that has happened because of the advocacy that's gone on there.

• 42:13Speaker 01

  And then there's companies like Galaxy where we have a lot of, if you look on our website, we have a lot of information for providers, for patients. Because part of the understanding in, you know, if you don't, diagnostic isn't really good if people don't know when to use it.

• 42:29Dr. Darshan Shah?

  Right.

• 42:29Speaker 01

  Right? So you have to educate. What does it look like? How does it work? Where do you go? And so we really take that seriously because if it's not on their differential, then it's never going to have the impact that it needs to. And so we have a lot of information on our website that allows people to go and learn and really figure out how to implement it, either for themselves or for their patient population.

• 42:49Dr. Darshan Shah?

  Yeah. Wow. Lots of great information is out there. This podcast would definitely help drive awareness.

• 42:56Speaker 01

  Yeah.

• 42:56Dr. Darshan Shah?

  Which is fantastic. And I really appreciate you coming on the podcast and talking about your journey. And, you know, I'm curious, like, you're a single mom.

• 43:05Speaker 01

  Yeah.

• 43:06Dr. Darshan Shah?

  You're leading a movement. You're also working in this space. Like, you're directly involved with Galaxy now, right? You're their

• 43:14Speaker 01

  CEO.

• 43:14Dr. Darshan Shah?

  CEO of Galaxy now. Wow. You know, it's a mission for you. And I'm just curious, like, what's the future for you?

• 43:22Speaker 01

  Yeah, I mean, on the other side of my journey with Russ, right? It's one of those experiences you just can't walk away from.

• 43:29Dr. Darshan Shah?

  Right, of course.

• 43:29Speaker 01

  Right? I had worked in medical devices. I had worked in medical diagnostics. I've taken several products through the FDA. And I kept coming back to that first doctor's appointment. When I knew that Lyme was a high risk for him. And he was tested and he tested negative. And I had to, you know, I kept coming back to that. How would my life be different if we had gotten a better answer? If somebody had told us to use this test? Or if somebody had told us to test for co-infections? And so I kind of started diving in on the research. And so there has to be better solutions out there. And that was how I came across Galaxy. Because they had really strong peer-reviewed science. Our founders have over 450 peer-reviewed publications on the science. And so that was when I literally just called up the founders and said,

• 44:14Speaker 01

  "Hi, my name's Nicole. I love what you're doing. I want to figure out how I can help." And my background in commercialization and getting through the FDA was really what they needed to try and take the company to the next level. So about two years ago, I took over as CEO. And we've been growing the team and the business. And so for me, the future looks like changing the standard of care.

• 44:36Dr. Darshan Shah?

  Right.

• 44:36Speaker 01

  Right? Everybody acknowledges that the standard of care is broken. Right? The CDC, HHS, they've basically said, "The current tests aren't working, but we need a better answer." Right? And so that's what Galaxy's working on. And there's been a lot of great innovations that have happened in the universities. Right? But it's a, it's a long way to go from working in a university lab to working at LabCorp and Quest.

• 45:00Dr. Darshan Shah?

  Right.

• 45:00Speaker 01

  And that's really where I see Galaxy bridging that gap. Right? Taking this new innovative technology, building it into something that scales at high volume, and then feeding it to these larger laboratories so that they can make it accessible to everybody with reimbursement and with all the things that it takes to make something mainstream.

• 45:18Dr. Darshan Shah?

  Yeah.

• 45:18Speaker 01

  So that's our mission, to change the standard of care. And also, not just for Lyme, but for all these other co-infections, because they're just as nasty. And they're called co-infections, but it's important to know that, like, you can have Babesia and not have Lyme. You can have Bartonella and not have any. So they're, they're important in and of their own right. And so, I mean, that story of the young boy that I told, that was Bartonella. There was no Lyme. There was no Babesia. It was Bartonella. And so we really need to raise awareness and provide better testing tools so that people can get their answers.

• 45:48Dr. Darshan Shah?

  Yeah, so true. How does someone find out about Galaxy? What's the website? And is there any information that, other information you can point people to? Maybe even your information, if they can learn more from you somewhere?

• 46:02Speaker 01

  Yeah.

• 46:02Dr. Darshan Shah?

  Yep.

• 46:02Speaker 01

  So our website is galaxydx.com.

• 46:05Dr. Darshan Shah?

  Okay.

• 46:05Speaker 01

  And as I said, we have a lot of information for providers and also for patients to really understand and learn about these pathogens. And to understand what the different testing, you know, options are and why what we're doing is something that needs to be part of the equation. We're on Instagram and Facebook as Galaxy Diagnostics. I am also, you can find me under Nicole Danielle Bell. And if you want to read more about my story, I have, I basically, as part of my healing journey, I started journaling. Right? Because in my mess of chaos, one thing people don't realize is how devastating chronic illness can be. It really can take a high-functioning individual like myself and bring you to your knees.

• 46:48Speaker 01

  I mean, I have done a lot of really hard things in my life, but being a caregiver was by far the hardest one. And so I'm a, I'm a ruminator. And so I like to solve problems by thinking them in my head, over and over. But I couldn't solve that problem. Right? That serves me well in engineering, but in caregiving, it didn't. And so I started journaling as a way to get it out. I found that, like, writing it down helped give it an outlet. And so I took all my journal entries and I turned it into a book called What Lurks in the Woods. And it's a pretty raw and honest view of what it's like to live with these devastating diseases and to be gaslit by the medical community and to figure out how to advocate for yourself while you're still raising two young children and trying to work

• 47:33Speaker 01

  and care for, at that point, a full-blown dementia patient. I mean, as you can imagine, it was chaos.

• 47:38Dr. Darshan Shah?

  Yeah.

• 47:38Speaker 01

  And so that's another vehicle, I think, that I encourage people. If you're dealing with chronic illness, you know, it's, it's a good resource because you can feel, like, one of the things you're going through is you feel so isolated. And it's a good way to know that there's other people that are suffering in the same way. And then I also tell people, if you're sick, you know, maybe my story's not the one for you because it doesn't end well and you want the happy ending. And, you know, spoiler alert, that's not the way my story ended. But it's good to give to your family members and the people around you so that they have some empathy for what you're going through. Because that community and that support network is a huge piece of getting well. And if you don't have people that understand the journey, it can be really hard. So, so that was something that I did for healing.

• 48:23Speaker 01

  But now I, you know, try and get that out there so that other people can really connect and learn from the things I did well and the things I didn't do so well.

• 48:32Dr. Darshan Shah?

  Yeah. What lurks in the woods?

• 48:34Speaker 01

  What lurks in the woods?

• 48:36Dr. Darshan Shah?

  I really want to thank you sincerely for coming on the podcast. Thank you so much for doing this. And I look forward to having you again on one of these days, when these tests are more available, maybe direct to consumer, and we could talk even more about it.

• 48:49Speaker 01

  That would be fantastic. And thank you for having me.

• 48:51Dr. Darshan Shah?

  Thank you.

• 48:54Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best. And it's always important to seek their guidance.