00:00 – Dr. Philippe Zimmern: Well, the success rate is around 60, 70 percent, but they can tell you the impact on quality of life and how people feel about it.
00:09 – They’re very, very happy and very grateful and they’ll let you know that.
00:24 – Melissa: We talked a bit about the fulguration work that you’ve been doing. So the last time we chatted on an interview,
00:29 – you were into a lot of detail about how fulguration works, how you diagnose someone with recurrent UTI that might be
00:34 – appropriate for fulguration. And so people can go back and watch those original videos, but I wanted to talk about the
00:40 – study that you published more recently, which is about the very long term outcomes of fulguration.
00:45 – So can you tell us a bit about that? What was the follow up timeframe for this study?
00:51 – Dr. Zimmern: I have the paper in front of me, but so I can tell you the follow up was 11 years.
00:56 – Melissa: Quite a long time.
00:58 – Dr. Zimmern: 71 out of 96 women were beyond 10 years.
01:01 – Melissa: Okay. That’s quite a long follow up.
01:04 – Dr. Zimmern: When I tell something important that you may not have realized is – that’s something new for me as well.
01:10 – When I search, look at my outcome, I realize that I had apples and oranges in my patients.
01:15 – I had women with very localized areas of infection which we call the trigone and the base of the bladder.
01:23 – And I had women who was very, very diffuse, the degree of extension of infection in the bladder turns out to be a critical
01:32 – factor for predicting the long term results. And there’s any disease if you tackle it at an early stage, you trust to do
01:41 – good or better than when you have a much larger volume of disease to take care of.
01:46 – So this report is specifically about what I sort of describe as stages one and two.
01:52 – I came up with a classification just for myself to be simple.
01:56 – The landmark on the bladder, we don’t have that many. So I took the trigone, which is
02:00 – a triangular area between the ureteric orifices and the bladder neck.
02:04 – They’re called trigonitis, that’s what we call it stage one. When we see lesion extending to the
02:09 – base of the bladder, just beyond that area, we call that a stage two.
02:14 – When they go laterally to – lateral to the ureteric orifices, we say it’s a three and
02:19 – when the whole bladder is developed, it’s a four. So nothing too complicated, anybody can relate to that.
02:25 – And then after that, there are other things that makes it more complex, which is the density of the lesion. Are they really
02:30 – close to each other or are they separate? Are there more good areas of the bladder or bad?
02:35 – We tend to work with the eye to try to figure this out. We got pictures.
02:39 – There are other things we’re trying to understand to stage the disease better.
02:45 – But right now, this report is only for the early stage. And the reason I did that,
02:49 – because I think that’s a group that stands the best chance to do well long term.
02:53 – And let’s see, because you start with a smaller involvement of disease.
02:57 – Why do some women have their whole bladder involved where they’re stage one
03:01 – before they became a four, whether a four from the get go? That I don’t know.
03:06 – But we studied the bacteria before and after. We see the bacteria in those two groups of women to sort out, you know,
03:13 – it’s really difficult because the data that we have is based on routine culture.
03:18 – We don’t have any sequencing that would characterize those bacteria very precisely. So again, or that we don’t know them.
03:26 – But we know unfortunately, but try to be more scientific and systematic.
03:30 – But what we’re reporting. So we’ve reported on stage fours.
03:34 – Melissa: Okay.
03:35 – Dr. Zimmern: We’ve reported on the simple classification.
03:38 – But that’s reported specifically for the early stage.
03:42 – Melissa: And how did you measure success amongst those patients?
03:45 – Dr. Zimmern: Well, we only had one option for that, which is the definition of recurrent UTI, which is, you know, three in a year.
03:52 – So we took cured – none, improve – one or two and failure – three or more.
03:59 – Melissa: Was that specific?
04:01 – Dr. Zimmern: You really can, really can figure that out. That’s not complicated. It’s just based on –
04:05 – Melissa: Was it compared to how many they experienced prior to the fulguration though, or just a general definition?
04:10 – Dr. Zimmern: No, that’s the general definition. So here you’re hitting a very crucial point and that’s very hard.
04:15 – And I’d say, whenever you send us a patient, please have them collect the urine culture data before we see them.
04:23 – Because most of the time it’s, you know, very weak data.
04:29 – Some people say, yeah, I’ve had the infection for the last 10 years and you search the cultures and you can’t find anything.
04:35 – Either you find a plethora of culture and you say, oh my God, this is my – that’s a great day.
04:40 – But for many of them, they may have that symptom, they may have a treatment, they may have gone to an urgent care or
04:47 – called a doctor for an antibiotic but that doesn’t mean that you know what’s going on in the urine.
04:53 – So the culture documentation is a very weak part of our data set.
04:59 – We have a large data set with REDCap. I don’t know if you’remember with it. That’s a very good way to capture data.
05:06 – And I can tell you, we always struggle with what happened before.
05:10 – So, you know, if you ask me what’s the reduction, well, it’s obvious. People tell you, you know, it’s wonderful.
05:18 – Doctors we have not had an infection in years now and they used to have it all the time.
05:22 – So having it all the time means what? For some people it could be, you know, five a year,
05:25 – for others it could be five in three years. It’s just that that’s a notion it was recurring is coming back, but
05:32 – the severity of that recurrence that the documentation of that recurrence before we intervene varies a lot.
05:39 – So maybe a good message to your public is to, you know, capture this data
05:43 – because it’s useful for us to know what are the strains growing, what are the resistance patterns, how many you’ve had.
05:51 – And some people are doing great and come with very well reads and documents with everything.
05:58 – But some others it’s just, we just have a hard time figuring out, you know.
06:03 – Melissa: Yeah, it’s complicated for patients.
06:05 – Dr. Zimmern: To answer your question, how severe with the disease before we step in.
06:08 – Melissa: Yeah, and it’s complicated for patients too because they often find that going to get a culture doesn’t result in
06:13 – treatment that helps them. So they tend to stop going if they’re not getting helped.
06:17 – Dr. Zimmern: That’s true, but also some places don’t send the culture.
06:21 – Melissa: They don’t. It’s too –
06:22 – Dr. Zimmern: They just see the urine analysis, the symptom and they treat and they don’t send the culture and sometimes
06:26 – people say, but I don’t know if I had a culture done.
06:29 – Melissa: We see that as well.
06:30 – Dr. Zimmern: So yesterday we went through the whole phone because people have access to the phone and the story.
06:34 – And there was many treatments, but only a few urine analysis and only one culture which happened to be negative.
06:40 – Melissa: Yeah, the approach to care is very inconsistent and we find that globally.
06:46 – So it’s quite complicated to get patients who have a very well documented history if they’re entering a study.
06:53 – Dr. Zimmern: Very difficult, very difficult. But I think it’s because if we told the patient what is helpful to us, I think they
07:01 – can do a better job. We’ve never spoke up and say, you know, you can help us by bringing a good history.
07:07 – You know, same when someone comes, has a complication after surgery, it’s ideal to get an operate note.
07:14 – Otherwise, it’s a challenge to know exactly what was done, what happened in the surgery.
07:19 – It’s the same, you know, analogy. And people don’t know. I had some bladder suspension. I had some prolapse repair. I had,
07:26 – you know, it’s the same problem that we have is we have good historians and we have some less
07:33 – informed people. And so, the trajectory I’m offering in this paper is from the moment we did the fulguration forward.
07:42 – But comparing with before is difficult. We’ve done a cost study, which I don’t know if I sent to you to
07:47 – look at, but we look at one year before and one year after to see the impact of fulguration.
07:52 – And clearly, obviously, improves the cost because you don’t need to be getting cultures and antibiotics all the time.
07:58 – And so the impact of the fulguration was very noticeable. This is only one year before compared to one year after.
08:06 – Melissa: Right.
08:07 – Dr. Zimmern: That’s the timeline that we had.
08:09 – Melissa: So those in that keyword group, would they then not need antibiotics
08:12 – after a certain point after fulguration, or do they still sometimes get UTIs?
08:17 – Dr. Zimmern: Well, in that group, though, if they were cured, they were cured.
08:21 – Now, we don’t have 20 or 30 years. So, obviously the body changes.
08:26 – Some may have got menopause from then, since maybe some have developed diabetes or other risk factors, breast cancer.
08:34 – So, you know, we’re not saying this is a guarantee, nor are we saying that everybody will be well.
08:40 – The success rate is around 60, 70 percent.
08:43 – But they can tell you in terms of impact on quality of life and how people feel about it.
08:49 – They’re very, very happy and very grateful. And they let you know that.
08:52 – They’ll send you letters, they send comments, it’s been a turning point for many of them.
08:57 – And even when they have infection, they would say, most said that it’s easier to treat.
09:01 – The strains are usually much more sensitive. We’ve definitely changed their microbiome and their internal world.
09:09 – And we will know more with the upcoming NIH study that we’re doing on fulguration.
09:14 – We will be able to see that more scientifically.
09:16 – Just exactly what has changed from before and after.
09:19 – Melissa: That’s great. And you mentioned that it’s more effective if it’s earlier or it’s more restricted to a certain area of
09:27 – the bladder. Do you think that means that it should, that fulguration should be considered earlier in the recurrent UTI
09:31 – journey? Because most people that consider fulguration, they’re much further along.
09:35 – They’ve had many infections, possibly for years and multiple rounds of antibiotic treatment.
09:41 – Dr. Zimmern: You have to give me five years to answer that question because I need to know from that randomized trial if
09:46 – fulguration is proven through centuries and with science to be what my experience has been so far.
09:53 – So if that study showed that fulguration is a way to go, I would say yes to your question.
10:00 – And I hope it will show that, but I don’t know that. So I’m not going to say something that I don’t know.
10:06 – I think intellectually it makes sense. What I would suggest more practically speaking,
10:10 – increase people to have a cystoscopy in the office to determine whether they have chronic signs of infection or not.
10:20 – Because that’s the missing link. And the missing link comes from the fact that
10:24 – cystoscopy is not currently in the guidelines to evaluate women with bladder infection.
10:29 – And it’s not because people used to do cystoscopy to detect bladder tumors, which are exceedingly rare, fortunately, and
10:37 – not to stage how bad the infection is or whether they have any chronic areas of infection. Some women don’t.
10:45 – Some women don’t. But with that, we look at the role of flexible cystoscopy, women with recurrent UTIs.
10:51 – Some bladders are completely normal.
10:53 – Melissa: We hear that too.
10:54 – Dr. Zimmern: If you don’t have that level of information, you just don’t know.
10:58 – So right now when I had that situation, I will treat people according to guidelines,
11:02 – which is currently 6 to 12 months for long antibiotic therapy.
11:06 – I know there are countries in the world that’s not allowed in the UK, but you know, in the US, we’re allowed to do that.
11:12 – And then we re-scope them. I often time don’t wait 6 months. Sometimes I’m more like three or four months.
11:18 – to see, if we can really detect a change. And then we decide at that point, we continue with antibiotics
11:23 – if we see an improvement or do we switch to fulguration. So I am on the lookout for fulguration
11:29 – if that’s going to help people early on, but they still have to follow the current guidelines
11:33 – because fulguration is not a guideline approved treatment yet.
11:37 – Melissa: To attempt fulguration, do you need to be able to see areas of chronic infection on cystoscopy?
11:43 – Dr. Zimmern: For me, yes, because I don’t know why I would do that
11:46 – otherwise. This came from biopsy proven bacterial tissues of this woman.
11:52 – So my thought and maybe I will be proven wrong one day, but the most people
11:56 – understand that that’s what happens in the animal models. It’s in human looks to be the same.
12:03 – It took the work from Dr. De Nisco with a special preparation that she
12:09 – basically described to prove that they were bacteria in this tissue that were fulgurated.
12:15 – So currently we are biopsying people ahead of time to know their, you know, what happened to the tissue, the amount of
12:24 – immune reaction, immune cells, extent of infection, extent of formation, where are the bacteria,
12:31 – how deep they are – all this we’re studying right now. There will be some interesting data coming up.
12:37 – I don’t want to say too much. We’re working that field very well to understand better what’s in the tissues to start with.
12:45 – And I think if they’re a deep seated than everything that get there, the fulguration
12:49 – superficially helps basically open them up. They cannot hide anymore.
12:54 – And then a) the antibiotics can work, b) they are not buried in the tissue where you cannot get hold of them.
13:00 – And so you break the cycle of infection when you do that.
13:03 – So I think, intellectually, from the knowledge we have, fulguration does make sense until we will come up
13:09 – maybe with biofilm disruptors and ways to do things without cauterization, which would be ideal.
13:15 – Like placing a solution there that takes care of the problem. I’m all for that.
13:21 – Melissa: Yeah, me too. When you take the biopsies of the areas of chronic infection,
13:25 – do you take biopsies of seemingly healthy tissue so that you can see different microbiomes or organisms in those places?
13:32 – Dr. Zimmern: I did initially. And then the IRB rules changed at my institution. I’m no longer allowed to do that.
13:38 – Melissa: And when you did do that, did you see the differences?
13:41 – Dr. Zimmern: Yeah, there was. I’m so happy to have that chance to do that because we did find that they were bacteria
13:47 – that appear visibly normal and we reported that. So even when I do a scope and it looks normal, I know that they’re hiding.
13:55 – So, one of the grant we have right now with a brilliant chemist at UT Dallas is to
14:01 – use a special dye to try to identify what these bacteria are. And that’s another fascinating grant that’s advancing very quickly.
14:10 – So the dye works in the cell line. It works in animal tissues. We’re just waiting for the proof they work in those human
14:18 – biopsies. We have – we’re waiting for the IRB to give us permission to take
14:24 – a biopsy to prove that that I can identify what the bacteria are.
14:28 – Melissa: That would be interesting to see.
14:29 – Dr. Zimmern: That would be another turning point for us.
14:31 – Then we could get to this bacteria with other form of treatment than just fulguration.
14:36 – Melissa: Yeah, it sounds like there’s still many things that you’re hoping to discover,
14:39 – but you have been using fulguration for quite a long time now.
14:42 – And over those years, have you changed your approach to fulguration or the protocols that you use after fulguration?
14:49 – Dr. Zimmern: Always the same, simple one little scope, little tiny bugbee.
14:55 – I’ve heard people asking me about other ways of fulgurating with the resectoscope loops or laser.
15:04 – I don’t know any science behind that, but I’m concerned, we think they can penetrate deeper in the tissues.
15:11 – I want to stay just on the surface. So as you’ve seen in the movie, we just dealing with that surface layer.
15:17 – The resectoscope loops, I use to resect tumors, to resect tumors, to resect that can go deeper in tissues.
15:23 – I think it can damage the bladder wall. I’m not offering that to my patient. I don’t think that’s a good thing to do.
15:30 – Maybe some people do and have good results. I’m not, you know, disputing that,
15:34 – but it’s not something I want to even take a chance off. I don’t want to damage the deeper part of the bladder wall.
15:40 – And laser is the same problem. It’s harder to judge the depths of penetration.
15:44 – It’s more costly and not available everywhere.
15:47 – So the scope with the cauterization is a very simple thing that any urologist has done for bladder tumor or other.
15:58 – bladder ulcers, something like that. So it’s very readily available.
16:03 – It doesn’t require any sophisticated, you know, tools.
16:08 – Melissa: Okay.
16:10 – Dr. Zimmern: So I know, it’s always the same, always the same technique. Nothing has changed there. Sorry.
16:15 – Melissa: No, it’s fine. I mean, it’s good to know that you’ve been using a consistent approach. Yeah.
16:20 – What about after fulguration? Do patients usually have to take oral antibiotics for a certain amount of time?
16:27 – Dr. Zimmern: They don’t have to. We recommend for the first six weeks, the daily prevention.
16:32 – Melissa: Okay.
16:33 – Dr. Zimmern: We recognize that the tissues are more bare and some are, you know, and then we have exposed bacteria.
16:37 – So if you have a bad infection and when you start to heal your bladder, it’s obviously not great.
16:43 – It’s going to create another cycle of inflammation. So we recommend the six weeks.
16:48 – Melissa: Okay.
16:49 – Dr. Zimmern: Antibiotic prophylaxis – whichever they can tolerate. And then some people wish to continue.
16:54 – Some actually happen to stop and monitor them with symptoms and culture if needed.
16:59 – It’s a recommendation. It’s not mandatory. If people have had a long list of allergies
17:05 – and resistance and we have no antibiotics to use, then we use nothing. That’s okay.
17:11 – But it makes sense to at least just after the fulguration to protect them from another infection soon after.
17:19 – Melissa: Okay. And what can someone expect in terms of pain after fulguration and how would you manage that pain?
17:26 – Dr. Zimmern: So we are gathering the data on that. Two of my medical students
17:29 – are looking back at our history of how people did after a fulguration. So I don’t have the final overview of that.
17:36 – Melissa: Okay.
17:37 – Dr. Zimmern: From my overall personal impression, which may turn out to be wrong.
17:41 – That’s why we have to look at data before we have their impression.
17:45 – I cannot predict very well who will and will not have pain. And the thing I mentioned that before the depths of penetration of
17:53 – these infections, the sensory nerves where they are, how people send signals to the brain,
17:59 – in terms of pain, that’s also a very complicated story.
18:02 – So I tell my patient to expect some discomfort for a few days. Like when you burn yourself on the skin.
18:10 – There are things to probably avoid. Nobody should do horse riding or drive, you know,
18:17 – hours and hours in the car and have their bladder go up and down like crazy.
18:21 – Or have intercourse intensely for a while just because it’s just – all of the bladder. So you have to let the tissue heal.
18:29 – It’s a burn. If you burn your hand, you don’t want to touch it 25 times a day to hurt more.
18:34 – Melissa: Yeah.
18:35 – Dr. Zimmern: Or put it in water or do something with it. So it’s same. You have to protect your bladder a little bit.
18:40 – The urinary environment is very acid and very toxic. So you know that it can create burning.
18:46 – And I don’t know that there’s any really way to predict who will. And if they have pain, what I know is pain pills don’t work.
18:54 – Melissa: Okay.
18:55 – Dr. Zimmern: They don’t work. They work on some things. They work on muscles, but they can take any pain medication
19:00 – you want, including, you know, strong pain medication or anything – codeine, morphine – anything like that
19:05 – which may help to sleep, but it won’t do anything for your pain.
19:08 – Melissa: Interesting.
19:09 – Dr. Zimmern: So what we use the most are things that people can take over the counter like Azo or pyridium or different
19:18 – limited, you know, analgesics that can help. Maybe anti-inflammatory agents work for those who can tolerate them.
19:24 – But, you know, that’s very poorly studied.
19:30 – Melissa: Okay.
19:31 – Dr. Zimmern: We don’t know because we don’t have to measure
19:33 – that other by their symptoms and the symptoms come and go.
19:36 – One thing that I need to mention that’s important is if your bladder hurts, please don’t drink five gallons of water.
19:44 – Just limit your fluid to rest your bladder.
19:48 – Because, you know, your bladder doesn’t have to be stretched 20 times a day.
19:53 – Because some people go home and drink thinking, oh, I’m going to clear up all this infection.
19:57 – And they call the next day. They’ve been up all night and have been miserable and have bladder cramps everywhere.
20:02 – So that’s a no-no.
20:04 – Melissa: Okay. Make sense.
20:07 – Dr. Zimmern: Make sure your bowels move because, you know, if you get constipation, that also can affect your bladder
20:11 – function. And after that, it’s just – even those who have pain or discomfort because people really use the term pain.
20:19 – They use discomfort or pressure or discomfort when they’re urinating.
20:23 – They realize it’s going away. They call you the first week, but the second week,
20:27 – they’re really better and by four weeks, it’s all gone.
20:29 – So you’re not going to live with that forever. It’s not a permanent handicap. It should clear out.
20:36 – Unless you really have done something wrong technically or you’ve been much deeper than you should have been.
20:41 – But if you’re just at the surface, you know, it’s – the healing process should be good.
20:47 – We use the same cautery, the same low voltage on the cautery.
20:51 – So you can’t use high levels that could burn and damage the tissues.
20:56 – I think you have to be gentle and careful how you do it.
21:00 – Melissa: Okay. Yeah, it’s good to reiterate that because I think we covered that in our first interview too.
21:05 – So if you can go watch those videos for more information about fulguration itself and what it looks like afterwards.
21:12 – And earlier in this interview, you mentioned bladder removal and we did get a question from the community
21:17 – about that as well. Like at what point would bladder removal be considered an option?
21:21 – And is that something that is done very often for recurrent and chronic UTI patients?
21:26 – Dr. Zimmern: No, it’s done rarely, fortunately. I think the answer to the question is when your life is on the line.
21:32 – If you’re at the point where you have no more oral antibiotics to treat your infection,
21:37 – you have been hospitalized several times and been septic.
21:41 – And you have to choose between losing your life or losing your bladder, I think, you know, you should do so.
21:47 – So you can imagine this is not frequent, but it does happen in the specialty practice that we have.
21:52 – So we’ve published our experience with that. The blessing
21:56 – though is that the bladder removal can be done robotically, at least in the US.
22:00 – And so the operating challenges that we used to have with open surgery are very less.
22:09 – The pain is much less, but you’re sort of left with a bag for the rest of your life, like someone had bladder cancer.
22:16 – But it’s a better life. I mean, you talk to people after this. I just got a letter from someone who had that three years ago
22:23 – and she said, you know, I really wanted to let you know that this decision has changed my life for the better.
22:29 – So not to say that’s true for everybody, but it does, you know, when you think, you know, I can’t do anything.
22:35 – I have only one or two IV drugs left that was super resistant strain.
22:40 – My bladder has not responded to multiple rounds of fulguration, which is oftentimes what we’re trying to do here.
22:46 – But we fight to keep patient’s bladder, Melissa, we do fight, but there are times where I say, you know, time out.
22:54 – You’re going to get sick or been sick. We don’t have the luxury of taking that risk,
23:01 – you know. I have people coming with very poor, they’ve had countless big lines, infectious disease
23:07 – people have struggled to keep them alive. So, I think, you know, there’s a time where you have to make that call.
23:14 – But fortunately, it’s rare. It’s a very last resort. Oftentimes that was called stage four.
23:19 – Those are women was very bad infection to start with, it’s in the whole bladder.
23:23 – They’re resistant type of strains. You look at their resistance pattern and you see it.
23:28 – Every where, you know, with maybe one or two as sensitive for,
23:34 – you know, an IV drug like atropine or meropenem or any case.
23:38 – And so you’re realizing that you’re narrowing down on the options you have to take care of them.
23:44 – Melissa: In these types of situations where the resistance is quite high, do you still recommend
23:49 – fulguration first before moving on to something like bladder removal?
23:53 – Dr. Zimmern: No, I give them the choice.
23:54 – But I can tell you, and you probably would relate to that. People want to keep their bladders.
23:58 – So if there’s any hope that we can do that and they can get better and a lot of them will,
24:04 – so I think it’s worth fighting for that.
24:08 – But it’s usually on average, I would say, three to four fulguration. One to really get rid of the majority of the infection.
24:16 – And then when you come back six months later, whatever is left,
24:19 – you go back after and we even had them third and fourth fulguration. And we’ve published all that.
24:25 – So, yeah, I will not give up. But there’s a time I will say, I think, you know, it’s not working. You have –
24:34 – and they can just be their comorbidities, maybe their age, their diabetes,
24:39 – they are on immunosuppression drugs because of transplant, whatever that makes
24:44 – that fight between the host and the bacteria, leaning more to the bacteria winning that we just can’t change the host.
24:53 – Melissa: Yeah, I think it’s good for patients to understand the escalation of treatment options too
24:57 – which is why we do these interviews so that we can ask questions about that.
25:00 – So it’s helpful to have that insight shared.
25:03 – Dr. Zimmern: And I think, you know, people always ask me what’s my thought process.
25:06 – So in the paper, I think I’sent you titled Gaps in Knowledge in rUTI. I tried to look at all the gaps in knowledge
25:13 – for the thing we don’t know, but this one particular table I made, I was asked
25:18 – to do that to kind of show my progression from the time to present the scope findings,
25:24 – the decision we made, the fulguration result.
25:27 – So that’s kind of the flow that we’re following right now.
25:30 – Melissa: Okay.
25:31 – Dr. Zimmern: And I have not changed that. It’s been kind of my way of thinking and processing over the years. Obviously,
25:36 – you know, everybody has different severity of UTIs and that’s something we’re trying to put also into a,
25:43 – to qualify that better. We work with infectious disease. We work with,
25:50 – you know, our partners in gyn, in colorectal, to try to improve everything we can about their gut health and across the gyn sphere.
26:01 – It’s a multi-prong approach.
26:03 – Melissa: Yeah, I think that’s probably a helpful paper for us to include in the video description
26:07 – along with the others that we’ve discussed in this interview. But since we’ve had it last time.
26:11 – Dr. Zimmern: It’s humbling because it shows you all the things we’ve gone through,
26:14 – but at least it summarizes everything that we know.
26:17 – Melissa: And it’s sometimes a bit frustrating and depressing to read a paper like that because there are so many gaps in the
26:21 – knowledge, but that is why you’re doing the work that you do as are all the other researchers that we talk to you for this
26:26 – channel. And it’s encouraging to see the work being done, even if we don’t have all the answers yet.
26:32 – Dr. Zimmern: Thank you. Yeah, we do. So as you mentioned, we have been blessed with a center. It was a gift from the Cain
26:39 – Foundation to me to be able to help as many women as I could and train the new generation of people in the field and fellows.
26:46 – So that center has international members, local members, emails, so we happen to help people within the limitation of
26:55 – time and resources. But we have ongoing solid clinical trials that have submission to the NIH for different
27:05 – level of grants. We call R01 which are five-year grants or 21 which are more short grants of two years.
27:14 – We love donation to help us with our research. It’s huge when people can do that
27:19 – because we can then move on to fund a primary data project.
27:24 – We have labs with brilliant young people doing their PhD program that just needs that type of support to get moving, so.
27:35 – Melissa: Yeah, it’s really important.
27:36 – Dr. Zimmern: I know you’ve been very supportive and I have been immensely grateful to
27:39 – you for all the work you’done in your own area. But that’s so – kudos to you. Thank you.
27:44 – Melissa: Oh, thanks. We’ll also have to get an updated list of any trials you have running so that people based in Texas can
27:49 – reach out to us for that information. And I’ll put a link to the new center in
27:53 – the video description so people can find you more easily.
27:55 – Dr. Zimmern: Absolutely. We have website and newsletters and happy to help. That’s what we’re trying to do.
28:02 – Melissa: Well, this has being very insightful again and our community really appreciates the work that you and your team
28:07 – are doing in this space. So I wanted to thank you for sharing your time with me.
28:11 – Dr. Zimmern: I hope I have something interesting for you before another three years. So let’s hope I can get that to you.
28:15 – Melissa: I think it will be faster this time.
28:17 – Dr. Zimmern: Yes, it’s I mean, a lot of people are motivated and we have built a good group of people and I think the NIH is to
28:25 – recognize that we have a strong center with many facets and different level of expertise from the metabolomics to
28:31 – microbiology, etc. So I hope they will continue to help us, you know,
28:37 – move this project along both on the scientific side and the clinical side, so.
28:41 – Melissa: Yeah, that would be great to see.
28:43 – Dr. Zimmern: It’s partnering with people like you that makes it fun too. So thank you.
28:47 – Melissa: You’re welcome.
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29:08 – Thanks again fo