The Get Healthy Tampa Bay Podcast

E104: Understanding Immunodeficiency and PANDAS with Dr. Emma Westermann

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I’m joined by Dr. Emma Westerman, a clinical immunologist and founder of HealthSpan Immunology in Tampa, Florida. In this episode, we explore the fascinating world of immunodeficiency, uncovering the complexities of the immune system and the latest advancements in diagnosis and treatment. Dr. Westerman shares her expertise on conditions like CVID, PANDAS, and autoimmune disorders, offering insights into how personalized care and lifestyle medicine can support patients in their wellness journeys. Whether you’re curious about the science of immunity or seeking inspiration to advocate for your health, this episode is packed with practical advice and empowering stories!

Emma Westermann, MD, MA is a board certified, fellowship trained clinical immunologist in private practice in Tampa, Florida. She started Healthspan Immunology in November 2024 to serve complex patients who need more time with their physician. She sees both adults and children. She completed
residency in internal medicine and fellowship in allergy/immunology at the University of South Florida. She specializes in immune deficiency and immune dysregulation. She became interested in PANS/PANDAS when one of her children developed symptoms of OCD and Tourette syndrome.

00:28 - Introduction to Dr. Emma Westerman
01:02 - Dr. Westerman's Background and Practice
03:17 - What is Immunodeficiency?
08:43 - Recognizing Early Signs and Symptoms
11:57 - Diagnosing Immunodeficiency: Tests and Procedures
14:20 - Treatment Options for Immunodeficiency
20:11 - Understanding PANDAS and PANS
27:44 - The Direct Specialty Care Model
32:07 - Longevity Medicine and Future Goals
33:17 - Where to Find Dr. Westerman

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Kerry:

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a very special guest, Dr.. Emma Westerman. Welcome to the podcast.

Emma:

Thank you so much, Dr. Reller.

Kerry:

Yeah, I'm super excited to have you on today. Plus you know, I feel like I've gotten to know you over the time, bothering you with text messages and things. So I'm excited to hear all about you and your expertise today and what you've been doing lately. So why don't you tell us a little bit about who you are and what you do? And then we'll obviously go into more detail later.

Emma:

Well, I am a clinical immunologist. I have my own practice in Tampa. It's called HealthSpan Immunology that I actually just opened in November, 2024.

Kerry:

It's super exciting. Definitely different from what you were doing previously. So you, you trained in Tampa area as well, right?

Emma:

Yes. I did residency and fellowship in allergy immunology at the University of South Florida. And then I worked at USF for a while and then I decided to open my own practice.

Kerry:

Awesome. Okay. And you are expert in immunodeficiency. So I wanted to get, you know, all the knowledge from you today about that. So can you tell us what is immunodeficiency?

Emma:

Sure. So the immune system, as you know, cause you do quite a bit of allergy and immunology as well. It's very beautiful and complex and involves a lot of different cell types. So immune deficiency can result from problems with really any of those cell types. I like to think of it that way, rather than putting fancy labels on it, like Innate problems and humoral immune problems immune deficiency can result from issues with the B cells. Most commonly, those are the types of cells that. Primarily target bacterial infections. And then there's also T cells that primarily target viral and fungal infections. There's also neutrophils, which are part of your innate immune system. Those are kind of like your first line of defense. So a person with immune deficiency can have deficits in the number or function of any of those types of cells. And there are many more beyond that that I won't go into. So But the common types of immune deficiency that I see include common variable immune deficiency, which is a problem with antibody production. It's actually an umbrella term that encompasses a lot of different genetic disorders. So, I like to dig a little bit further and do genetic testing to see if we can find out exactly what's going on.

Kerry:

For our listeners, can you explain like what an antibody is? Why is that important?

Emma:

sure. So an antibody is produced by a B cell and it targets whatever infection is going on in your, in your body at that moment, but your body is also constantly producing kind of a random assortment of antibodies, some of which actually target self antigens. So you may produce antibodies that accidentally, you could say target your thyroid and then you could develop autoimmunity thyroid specific autoimmunity, or you could develop antibodies that target your platelets and then you would develop something called ITP or immune thrombocytopenia and that's actually very common in patients with. Immune deficiency, because the problems that lead to poor antibody production and immune deficiency also lead to autoimmunity.

Kerry:

Yeah, like we were talking earlier we get lots of confusion around the whole immunodeficiency versus autoimmunity. So I think you kind of really helped to clear it up a little bit, but immune system is such a complicated thing.. And I think it was one of the harder things to learn in medical school. And I think most people would agree. You got all these different cell types, you have to know what they do and you know, how they interact with each other. And then obviously what we're focusing today is also like how they're, you know, fighting infection and disease. And like you just said, they can even somewhat cause this infection and disease too, right? So you mentioned the CBID or common variable immunodeficiency. What you were going to tell us some more about that and other types of immunodeficiency that you see in your practice.

Emma:

Yeah. So, just to tie that autoimmunity issue with the bow. There are many patients that will present 1st with autoimmunity and they'll be seen by rheumatology or hematology because they have a problem like, I mean, thermocytopenia and they'll kind of. Linger in those clinics for a while, and not until years later, are they discovered to actually have an underlying immune deficiency? So if autoimmunity is discovered especially in child teen young adults I suggest that people check at least immune globulins and lymphocyte subsets, which looks at, you know, how many white blood cells of various types does the person have absolute lymphocytes, you know, N K cells, et cetera just as a screen and if anything is abnormal on either of those, the patient should be referred to immunology.

Kerry:

Yeah, that's a really good point that I think, like you were saying, like some people can get missed or get delayed diagnosis like this is something that I think people spend a long time suffering and have no idea, but then obviously there's cases where it's picked up a little bit earlier to and kids I think, because something is definitely wrong. Yeah, so, so go ahead, you were still saying I hope I didn't cut you off, Mm hmm.

Emma:

not at all. Exactly. And they may have had a relatively mild infection history in childhood prior to developing auto immunity. Maybe they were an ENT frequent flyer. You know, maybe got ear tubes or adenoids out, but they don't have to have had, you know, recurrent pneumonia requiring hospitalization or what have you to have pretty serious underlying immune deficiency. It's not uncommon for it to be picked up in teen years and young adulthood. and that's what I love about this field is I get to help people who have been kind of bouncing around from doctor to doctor. They know something is wrong and they just don't know what and we can do that really in depth testing and genetic testing to help them. And it's important to, to catch them as early as possible. Because some of them will require a pretty intensive therapy and may even require a bone marrow transplant in some cases, and you really don't want to miss that window. Sorry, you had asked, I digress. You had asked about what types of immune deficiency I see when I talked about common variable immune deficiency, which is an umbrella term. There's also specific antibody deficiency, which is similar more mild in that they make enough antibodies, but those antibodies aren't aren't very good. They don't function all that well. The fight off infections. So we look for that, and then also there are chromosomal abnormalities, like partial detour syndrome and down syndrome that can lead to immune problems. There are certain immune deficiencies that involve not only the B cells, but also the T cells.

Kerry:

hmm.

Emma:

some of the more common ones that have historically fallen under the CVID umbrella are NF kappa B1 deficiency and CTLA 4 haploid deficiency. So when we do the genetic testing those are some of the ones that we might pick up. Oh,

Kerry:

Mm hmm. Mm hmm. So before all of the testing and stuff happens, there have to be some sort of early signs and symptoms that someone might suspect that you have an immunodeficiency. Can you kind of go over that a little bit for us so we can learn how to recognize it?

Emma:

sure. So anyone who has had an increased number of infections relative to their peers, Should be kind of on the radar. And like I said earlier, it doesn't have to be extremely severe, life threatening infections, just an increased number, you know, maybe they had 6 sinus infections requiring antibiotics, whereas their friends only have 1 or 2 per year. And so increased number of infections. Sometimes severe atopy, like more severely severe eczema can be an indicator of an underlying immune deficiency and then autoimmunity, as I mentioned, especially in young people but in older adults. You know, in their 50s, 60s it's not uncommon for them to have lived a relatively normal life. And then all of a sudden they're getting more infections and they can be diagnosed with CVID at that point require support with immune globulins and other treatments, which we'll talk about later.

Kerry:

Mm hmm.

Emma:

I've even diagnosed people in their 70s with. Monogenic disorders,

Kerry:

Wow. Where would type one diabetes fall in this class? Do you think, like, do they also present with some immunodeficiency problems? They already have deficient, you know, problems with that in general, but cause it's an autoimmune disease. Right.

Emma:

Yeah. So there are certain immune deficiencies that are known to you know, they're characterized by auto antibodies against you know, the pancreatic cells that lead to diabetes or a few monogenic disorders like that. But in general, you know, because type 1 diabetes is relatively common, I wouldn't say that that alone would lead me to investigate for deficiency,

Kerry:

Okay. Yeah. I mean, they're already, you know, at like increased risks of infection and poor wound handling and all those things. It's hard to imagine that they could have something else on top of it. I feel like if that was even a case, it'd be very difficult to distinguish.

Emma:

but certainly it wouldn't hurt to just check immune globulins, lymphocyte subsets,

Kerry:

So you kind of touched it already, but any different signs of warning versus children and adults, or?

Emma:

So I think we pretty much covered that you know, adults. Who develop multi system autoimmunity that would be another, another clue. They've got colitis and I wrote in autoimmunity and ITP say. I want to check and also adults who develop leukemia or lymphoma in like, young adult.

Kerry:

Mm-hmm Yeah, I figured you had kind of said all the different warning signs, like you had mentioned, frequent ENT visits, frequent sinus infections in need of antibiotics and things like that would be one of the triggers for that. Obviously, pneumonia, hospitalization, sepsis, things like that would definitely be higher on your I guess higher for you want to test them. Okay. So we kind of already did a little bit of this, but how is it like diagnosed? There's a bunch of different blood tests and I know they're complicated, but can you simplify it a little bit?

Emma:

Yeah, so I, we look at the different branches of the immune system through kind of a standardized protocol. Shooting for the more common immune deficiencies 1st, looking at. You know, I mean, subsets as a screen. I also typically add on titers to different vaccines that most people will have had in childhood. Like most kids these days will have had Prevnar and Hib vaccines and so forth. So we check titers to those, also diphtheria and tetanus and look for a pattern if, if a person has. You know, low titers to those vaccines, then we can try re vaccinating and see how they respond. If they don't respond, then that indicates functional problem with their B cells. And then, you know, T cell disorders are less common and the testing is more expensive. So I reserved that for patients with. You know, clear history of viral and fungal infections. That are recurrent we can, we can do that T cell specialized testing or NK cell functional testing. Some of those labs are send outs to specialized labs like Cincinnati children's. So I would only do those in patients whose history kind of matches. So There's also, you know, tests to look at neutrophil function and so forth. There's many, many tests. And then genetic testing we can currently look at over 400 genetic immune deficiencies with one cheek, cheek swab or one blip.

Kerry:

Mm hmm. Mm hmm. Mm hmm. That's pretty amazing. The changes that have happened. And I think in this field over time, right. With all the testing available.

Emma:

2018, it was like 35 genes. That's amazing.

Kerry:

yeah, that's crazy. I think, I mean, I feel like I always am, you know, telling visions, you know, you're going to get a lot of blood drawn, but, you know, I think we'll, You know, get some answers and then be able to retest if needed and things like that. But like you're saying, some of them are more complicated and send outs and more expensive that we kind of reserve for, you know, different presentations and things like that. Good. So I guess once you have a positive screening test or test, how do you, or once they're diagnosed, what, what is available in treatment for these conditions?

Emma:

Well, for B cell conditions, we have many different immune globulin products. Which are basically pooled antibodies from 10, 000 healthy college students that replace the missing or dysfunctional antibodies that the patient you know, lacks. And so if we give them those replacement antibodies, then they're more able to fight off infections when they encounter them and that can be done. Through a monthly IV infusion called IVIG or a weekly or biweekly subcutaneous infusion, which patients can actually do at home after being trained by a nurse. And then for certain patients, they also require prophylactic antibiotics on an ongoing basis. And then, you know, we talked about the autoimmune issue for patients with autoimmunity and immune dysregulation, it's kind of counterintuitive because their immune system is quote unquote low, but we actually have to suppress their dysfunctional immune cells with immune suppressants, including, you know, sierra limus. Sometimes

Kerry:

Yeah.

Emma:

can produce autoimmunity.

Kerry:

Even like we were talking about progress in this field too, like it used to only be IVIG and now they have all these, you know, subcutaneous forms that can make patients life a little bit better. And, you know, they don't have to be spending hours at the infusion center every month. They can give it to themselves at home. I think those are, you know, big advancements as well in this field. I think that's pretty exciting. Like most of people, some of the reps that come in and say they have moved off of the, you know, IVIG and now are getting the subcutaneous, which I think is exciting as well. And. Yeah, and that these the immunosuppressant stuff that can be pretty hard to do as well. So how do you kind of support a patient who has to, you know, be on those kind of medications in like their journey of getting treatment for their disease?

Emma:

So, if we do have to start an immune suppressant medication you know, as I said, it seems counterintuitive and like, wouldn't that lead to more infections? But it actually decreases the inflammation in the body and enables the immune system to kind of function optimally so that in the long run, they're going to get less infections. And we may also support them using immune globulin therapy at the same time.

Kerry:

Okay. Yeah, that makes sense. So you mentioned decreasing inflammation. So are there like lifestyle factors that they can do to support themselves on doing, you know, decrease of inflammation overall as well?

Emma:

Yes, I know that that's 1 of your areas of expertise. It's like wellness exercise supporting people on their, their wellness journey. So I am, you know, interested in that. I'm a foodie. So. I love to cook. I love to primarily vegetarian recipes, Mediterranean diet. So in that area, I'm not an expert in nutrition, but I certainly, you know, can support patients with recipes or what have you, if they're interested. I'm in discussions with various nutritionists in the area that I like to refer to. As far as exercise there's a personal trainer that I refer to and an excellent physical therapist who does things like dry needling. I think it's really important to help people get in the best shape that they can possibly be in to support their immune system, reduce the inflammation.

Kerry:

Yeah. Oh, it's funny you mentioned the dry needling because I had a doctor of physical therapy on a couple of episodes ago about dry needling. And it was just enlightening for me of what they can do and how they can help people. So you'll have to tell me who your person is. But yeah, I feel like when we have talked previously that you were, you know, wanting to help treat the whole patient, right. Even the name of your business, health span immunology, you're kind of, you know, wanting to help them without their whole whole health, health span vs lifespan. And I love that and we can talk more about that but i think supporting these lifestyle factors while they have to be on these treatments, is very very important, and i like that you have people that support you to treat them better like physical therapy, dietitian and personal trainer.

Emma:

it gives the patient a sense of control over their disease. They've spent so long being told that, you know, nobody knows what's wrong with them, not getting the support that they need. And then, you know, we can not only figure out what's going on, but also support them in those other ways and give them some control back. Yeah. I also am very passionate about mental health so I have kind of a cadre of mental health professionals locally that I refer to.

Kerry:

Yeah. I mean, that definitely has to play an important role too, like for, you know, quality of life and what they've been through to probably just to get the diagnosis in the first place. Right. They're definitely going to have some like trauma or micro trauma regarding that, that a mental health provider would really help out as well. Yeah.

Emma:

Yes.

Kerry:

Before I ask you another question, is there anything else about the immunodeficiency that you wanted to discuss? Sure.

Emma:

I don't think so.

Kerry:

Yeah, we got we kind of covered a lot of it, right? Yeah. I know it's complicated and really hard to explain, but I think you you've definitely made it more easy to understand for the listeners. So I appreciate that. One of the other things that I know you're very passionate about is PANDAS. And I think that is along the same, kind of thing here. But can you tell us what that is? What does the acronym stand for? And what is it? What does it mean?

Emma:

So PANDAS is pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection. Typically, you know, we think of abstract throat. As triggering this disorder, it was actually just in the past few months like formally recognized by the American Academy of Pediatrics as a disease. There are a lot of people over the past 20 years since it was discovered that even doubted its existence, which mystifies me, because if anyone has seen a case of it, it's impossible to ignore. But pandas happens, you know, After a child traditionally gets a strep infection and then shortly thereafter, they'll have overnight sudden behavioral change, whether that's increased aggression or OCD. Which can manifest in a variety of ways. It's not just hand washing all the time or worried about contamination fears that can manifest in other ways. Like you know, kids can have fears about their, their food being contaminated and not wanting to eat, or they can need to line things up in a very specific order, or maybe they need to touch things of a certain color. There's a variety of different fears that can arise that are, actually OCD. They may also have developed a tic disorder, so they'll have abnormal vocalizations like sniffing or even just coughing or abnormal movements that are called tics. And if they stick around long enough, they're called Tourette's syndrome. So it can manifest in a number of ways. But pandas develops, we think because strep infection triggers The development of autoantibodies that then attack part of the brain, the basal ganglia leading to this variety of manifestations, the behavior, the OCD, the tics and, I'm interested in it from an immunology perspective also because my younger child developed pandas. And I'm going to be starting a mentorship program in 2025, where I'll be interacting with experts in the field on a weekly basis, and I can present like, really challenging cases to them for mentorship, but I'm really excited to be getting into this field and I've already seen, you know, several patients with this diagnosis. So,

Kerry:

I think that's amazing. I mean, I have to admit I have not seen any, but I don't see too many kids. So is it mostly in children? Can it be in adults? Is it always with strep or is there another bug that can cause this?

Emma:

So there's pretty good evidence that mycoplasma, which causes walking pneumonia can trigger this disorder as well. There's a related disorder called pediatric acute neuropsychiatric syndrome or pans which includes pandas, but can be triggered by any number of infections, viral infections. So really anything in theory could trigger it. And so I'm interested in seeing any kids that have that type of symptoms, whether or not they've had stroke infections.

Kerry:

And so does, is there anything that can present in adulthood or is this mostly in kids?

Emma:

Yeah, that's a question that comes up a lot and I think needs more research. I think there are probably plenty of adults who, had pandas in childhood, developed OCD in childhood and just were never diagnosed. And may persist with OCD or Trout syndrome in adulthood and going back and reconstructing that at this point can be difficult. But I certainly have some young adults who you know, have parents who are kind of on their radar and they've been tracking over time, you know, the kid had a history of of what sounded like pandas in childhood and may benefit from antibiotic therapy, even at this point.

Kerry:

Which leads to the next question. How do you treat it? Right.

Emma:

So we often start with ibuprofen or another NSAID at a little bit higher doses than what you would give just for a routine fever. And then we do that twice daily, just as a trial, 5 days, 5 days and then antibiotics, depending on which infection is thought to be, triggering uh, source after checking various antibodies and autoantibodies. We might try Augmentin if we think that it is triggered by a strep infection, or Azithromycin if we're leaning towards mycoplasma. Just depends on what we think might be the trigger. And then the child may or may not need kind of a prolonged course of antibiotics. And then some kids actually need the IVHG or subcutaneous immune globulin, like we were talking about earlier. And I investigate their immune system before starting those products because I want to know, how is their antibody function before replacing the antibodies?

Kerry:

so question for that. if the function is good, do you still try to treat with the, like the immunoglobulin or does insurance cover it? It's good. That's kind of my question there.

Emma:

That's a great question. You know, some people code for autoimmune encephalitis in order to get the immune globulins covered. As an immunologist kind of entering this field, you know, we'll see I'm hoping, you know, I have relationships with some of the companies that offer these products when they are great at working with me to get them approved. So I'm hoping that it will be kind of easier for me, it's certainly easier for me to get immune globulins approved than it is for a hematologist or a practitioner, just in general. So I'm hoping that it will be the case for Panda's kids as well.

Kerry:

Yeah, I hope so. I feel like There are a lot of conditions that we use immunoglobulin for, and I often forget that I'm always thinking immunodeficiency, but even off label use, like, we've tried to use it for a long COVID for a couple of patients and very difficult getting anything like that approved. So I feel like. I think you're on the right path and hopefully that will that will work, especially for the way that you describe the nature of everything happening. So I feel like it should be covered. But I guess more time will tell right? I don't know the answer there.

Emma:

And certainly doing the immune evaluation may uncover that some of these kids actually have an immune deficiency. Certainly that was the case for my son. He has specific antibody deficiency and he's going to probably end up on immune globulin replacement. So

Kerry:

So what is if like that didn't happen? What is the long term management or what a long term effects if you don't treat it?

Emma:

the effects are myriad, you know, just the child's suffering with severe mental health complications. The family, it's really hard on families, siblings struggle because they get less attention. It can be really hard on marriages. And then, there are certain kids that do have underlying immune deficiencies and increased infections in general. So you want to get them on therapy to prevent not only infections, but exacerbations of pandas.

Kerry:

So you can actually have an exacerbation even though you've been treated.

Emma:

Yes, it can be a waxing and waning kind of presentation.

Kerry:

Okay. Wow. A lot, a lot, I think, to be researched in that field. Like you said, it's newer and it just got called a, you said a disease, right? Was it by FDA or who? CDC?

Emma:

it was the AAP that

Kerry:

Okay. Sorry.

Emma:

said, okay, we agree. This is a thing. Yes.

Kerry:

I mean, some of these things are, you know, just we're discovering and it is, you know, they're kind of crazy to think about how they occur, but like when, you know, the research is done and everything, it's just very interesting and good that it's being brought to light so that these people can get better treatment. And better outcomes. So the other thing I wanted to ask you about, so we hear a lot about direct primary care and here you are like an allergist immunologist and you're starting what I would say is a direct specialty care model. So what inspired you to do this kind of model, the direct specialty model?

Emma:

So direct care means that the doctor aims to develop a very personalized relationship with the patient. They want to be able to spend as much time with as possible with the patient. You know, many of my patients come with, you know, 4 inches thick folder of records and I want to have the time to go through those records and really address the many, many years often that patients have been searching for answers and really spend the time that they need. In order to do that I have to use the direct model, which means that I don't take insurance for my consultation. I do bill insurance for medications, for lab work, for radiology, the other things, referrals that the patients need but to give myself the time to really spend with the patients that I want that makes me feel like I'm doing a good job and giving them what they need. I don't take insurance. Some of the patients you know, typically the direct primary care model is a subscription model where the patient will pay a certain fee monthly. You know, I think the average is like, 75 dollars a month for direct primary care. And 20 to 30 dollars for each child, something like that which is a great option for some families that either have high deductibles or don't have insurance or you know, just want greater access to their physician. Some of my patients would benefit from a subscription model, you know, those that have more severe disease, those that really need a lot of coordination with other specialists. Got an immune deficiency, the immune deficiency has led to, you know, I'm having a giant spleen for which I have to refer them to a hematologist or what have you. They may have liver disease, I have to refer them to a hepatologist doing all that coordination care requires an extraordinary amount of time outside the office, you know, when the patient's not even before me. So I recommend that they Join the subscription model some even will require I have both. Yes. So they can come and be seen for just a consultation fee once or twice or whatever they need or they can sign up for a few months of subscription services or whatever their preference is. But yes, I can do just a consult for you as well.

Kerry:

Yeah, I think in your field, like, like you said, they bring stacks and stack of records and to really understand what has happened before what's, you know, what's going on with them. Like, it would be very helpful to have time to review them. And, you know, in a 15, 30 minute appointment and an insurance model, that's really not going to happen very easily. So I think, you know, this really makes a lot of sense for your, for immunology with these More advanced cases too. So I commend you for getting out there and creating your own practice its amazing. So is there anything else you'd like to add to for anything that we've discussed today?

Emma:

So you mentioned the name health span, which I did choose because I like to follow people, you know, through through the lifespan and increase their health and wellness. Which I think of as health span. My goal is to eventually get certified in like longevity medicine so that I can offer longevity services because I think it's really exciting what we're learning about inflammation and how you know, certain patients are already using serolimus, also known as rapamycin because there's decent animal data saying that Using that medication increases lifespan difficult to do those studies in humans. But I think the data is pretty exciting and I'd like to be able to offer those services eventually.

Kerry:

Yeah. I'm glad you brought that up. Like explaining why you named the business, what you did. And I mean, I think that makes a lot of sense. It certainly goes along with your model there. The longevity practice, I think rapamycin does have some side effects. I think from what I hear, like, it's more like an on again, off again, kind of drug, but some people do have, you know, I guess we don't even know if they're having success with it really. Cause like you said, you can't study it so well, but longevity medicine is pretty exciting. So I think that would be a great plus for your HealthSpan immunology practice. So I'm glad you mentioned that. anything else we forgot?

Emma:

My ideal would be to be able to partner with someone to be able to prescribe rapamycin on a research basis as part of an official research study.

Kerry:

Yeah, very nice. So where can people find you if they want to work with you?

Emma:

Well I have a website www dot healthspan immunology.com or they can email me at healthspan immunology all one word@gmail.com. Or call the clinic. It's(813) 869-7111. And I'd love to hear from people.

Kerry:

And I think you have a Facebook page too, right?

Emma:

Yes, I do. I have a Facebook page and I just started an Instagram page,

Kerry:

Okay. All right. So we will put all that information in the show notes and please, you know, let me update me on the Instagram thing. So we can add that as well. And I just want to thank you so much for coming on the podcast today. And this was an awesome discussion and I wish you best of luck in your practice and I think you're going to do great.

Emma:

Thank you so much, Dr. Reller. Thank you for the opportunity.

Kerry:

You're welcome.

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Dr. Kerry Reller

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