The Hidden Trauma Behind Surgery with Dr. Aimie Apigian

Dr. Amy's going to explain why this is such a big deal.

It causes the old trauma to come to the surface, and we find ourselves going crazy spinning all the stories, and one voice saying we should do it, another voice saying we shouldn't, and there's this inner war that happens. If you want connection, if you want love, if you want security, then you need to have big boobs. It sounds ridiculous when we say it like that, but that's exactly what this messaging gives us. That's exactly what Baywatch gives us. Why do I feel at war with myself? Why did I make this decision on Friday and it's Monday and I'm calling to cancel out of all of it because I've changed my mind? Am I crazy? Am I enough just as I am, even if that means I have Dr.

Amy, and she's been addressing my trauma, but now we're going to talk about the trauma that, um, and I was talking to Dr. Amy, like, everybody knows I take care of patients, um, who have a desire to explant. I don't explain this any other way than I, I help patients by educating and informing them so they can decide if if that's something they want to do, and I'll help them with it. I don't tell anybody they should or should not explant. That's a decision that everybody arrives on, on their own. I just try to educate and inform them because I know, and Dr. Amy is going to explain why this is such a big deal, it causes the old trauma to come to the surface.

These are insecurities that are right underneath the surface. They are always in our subconscious programming. And then something like this kind of decision makes it become conscious. And we find ourselves going crazy, spinning all the stories, and one voice saying we should do it, another voice saying we shouldn't. And there's this inner war that happens because of these beliefs that we have held that we don't even often know are there or where we got them from.

Dr. Amy, I was talking to you, and I've interviewed several patients, and their stories are fascinating in how they arrived at getting augmentation. And the— sometimes, uh, and I can recount the ones we were talking about. There was a patient who, for a job, was pressured by their employer, basically an agency, to get breast augmentation to be a better, uh, to get more jobs. Um, one was to fit into, like, the peer group. They saw that friends or their mom or the, the moms in the peer group had augmentations, so they felt that was the— they imprinted that, and that's, that's how they should do. And then, uh, folks who didn't develop as adolescents and were bullied or, or, uh, made fun of— that obviously is a terrible thing. And then the one I mentioned to you our patient from Europe who, because of Baywatch being exported to Europe, thought Pamela Anderson was the archetype of the body that they wanted. And so it's just all these, like, fascinating things that I never would have came up with in terms of, you know, why, you know, somebody pursued it. But when you— when I do an explant surgery and say I just do a standard explant surgery I'm reverting that back to that, taking them right back to that place or that time and that, that trauma or that cingulate cortex loop that they're in about what's going on, like you said.

Yeah. You know, we all at the end of the day are looking to be okay. We're looking for connection to know that we're okay. We're looking for safety in relationships and connection to be okay. And when we are exposed to these messages that if, if you want connection, if you want love, if you want security, then you need to have big boobs. It sounds ridiculous when we say it like that, but that's exactly what this messaging gives us. That's exactly what Baywatch gives us. You want to be attractive, you want to have a a partner that can't resist you, and so you feel secure in your relationship because you know they won't leave you, well then, honey, you got to have that kind of body because that's what it takes to be okay. And this programming runs so deep, and we've gotten messages as girls from very young that this is what it is to be pretty, that this is what boys like, this is what men want. So if this is not you, well, then you're going to have to deal with the, with the crumbs from the table of what's available, as opposed to having the connection, the love, and the security that you really want.

Yeah, that, um, It is, because I remember, like, at the magazines, you know, they had Marilyn Monroe during the '50s with Playboy, and '60s and '70s and, and '80s, and then, you know, you had the different models of the '90s. It's just a very— it's very different now than it was then because now you have the social media platforms. They're not helping this problem. There's all these unusual, um, techniques and filters and things that you can use to alter your appearance. Yeah, it's not— I always— obviously we should worry about the effect that's happening on young people because they're the, the most impressionable. And I don't want to say it's worse for boys or girls because they're both really susceptible populations to this and these, um, the pressures, uh, of it and the lack of— you said community, and I will say it's another C word, like communication. Like, they don't know how to communicate, right? And that's a huge problem because the, the, you know, the pandemic was not helpful, obviously, and people were becoming less, um, personal in communication and more digital in communication, if I can say that. So it seems like— it just seems like it gets worse, not better.

Absolutely. And so we really see what's happening is this pursuit for each of us to be enough.

Right, right.

Am I enough to just be liked for who I am? Am I enough to have someone's loyalty? Am I enough? And each of us, it may look different for one person, for another, but each of us, that's ultimately what we're seeking inside is answering this question, Am I enough as I am? And one of the key times in a woman's life that I've seen this play out as it relates to augmentation is the women that I worked with when I was in surgery residency who had breast cancer, right? And it was the common conversation of, we're doing a lumpectomy or we're doing a mastectomy, and what do you want? And I remember seeing these facial expressions that showed so much of the inner process that was happening in their brain of, am I enough without my breasts? We're doing a mastectomy. Am I still a woman? Am I still attractive? Am I still enough? And oftentimes that answer would come out to be no. No, I'm not enough. I want augmentation in order to fill that specific insecurity. Now, whether that was spoken or not, it was there in the air. The real question was, am I enough just as I am, even if that means without one of my breasts?

Yeah, and that dovetails onto— so I did, for everybody listening who doesn't know, I spent the better part of my career just doing oncologic reconstruction for sarcoma patients, patients with head and neck cancer, and then breast cancer reconstruction predominantly because it's the most prevalent form of cancer that we would be faced with. And my sister passed away last year, uh, after a long, long period of just battling with breast cancer, and she had had a reconstruction and had it taken down and It's a very— you know, I would only see a fraction of the patients who had breast cancer because they would have said to the breast surgeon, hey, I'm just interested in discussion about, uh, reconstruction. And so that was a small fraction. And then predominantly what I did was a D flap reconstruction, which was a more specialized operation involving microsurgery, which is basically taking the tissue of the tummy, preserving the blood vessels and the nerves, and then transferring that to the chest. So it's an autologous reconstruction. That was always my, like, principally what I was known for doing and wanted to do. And then, um, when I got faced with different implant-based reconstruction problems, I always had that as my out to take care of it. And I found, I found implant-based reconstructions on a whole to be challenging for patients. They don't feel natural. They can't, because patients had a mastectomy. It's not an augmentation, especially in a bilateral case. Of course, it's just— it's a very, um, like you said, it's obviously a mindset thing, body image thing. And we talked a little bit offline about body dysmorphia and how that contributes to some of these issues, but it's such a complex, uh, kind of situation. And, um, it was always hard to navigate with patients. I remember, Dr. Amy, they would show up to me on a Friday. They may have been diagnosed on Monday or Tuesday, and so I was last in line. It'd be like Friday afternoon in my clinic, gal would come in, usually alone, and just in a haze.

Yep.

And I would go through the— yeah, I would go through the discussion and, and I'd look at the nurse and go like, uh, well, do might as well just reschedule, you know, this for another— this person for another appointment because they didn't really hear anything. No, it's just like, you know, there's been so many things thrown at that poor person during the week about medical therapy or radiation therapy or, uh, mastectomy with or without reconstruction. And then they were pretty good about just kind of, if that was ever a discussion, that the patient wanted to have, they're, you know, very good about, you know, setting them up, you know, with us so I can see if I could help them. So that, uh, you know, for the better part of, I guess, until 2019, that was predominantly what we did. And then we transitioned to do more and more, you know, explant surgery, etc. Now we see like a whole range of other problems. But oddly enough, I have breast cancer patients reach out all the time to me to do or get advice about, you know, explant surgery and what would I do. And, you know, I'm not— I'm 56 now, I'm not 36, not 46. So back in those time periods, I would have just done a D flap reconstruction on those people who are most appropriate for that, because that would have solved the implant problem and done a natural autologous reconstruction with their own tissue, which would always heal and remain with them and be their own tissue. So I always go back to that because I— that seems the most holistic, natural way to do that. It's a complex operation, and I still do fat transfer for patients, which is also autologous. So I'm always aligned with those, and it just makes more sense to me.

You know, anytime that we're trying to go outside of ourselves for solutions is not going to be very effective. And whether we're talking now about, you know, autologous surgery, or we're talking about I'm needing to go to someone else for my sense of safety, I need to go to someone else for them to make me feel okay, rather than me being able to create that feeling for myself. And that's one of the first things that has to happen when someone decides, I'm ready to work on my trauma. We have to stop outsourcing our happiness, stop outsourcing our sense of safety, stop outsourcing our moments of joy, and say, I am so important to myself. I will learn how to create these feelings for myself. I deserve to feel safe. And I'm going to learn how to create that for myself. I feel like that's so much aligned with the principles of the body that you work with and in surgery, that when we're using the body's own tissues, it will always be better than bringing in something from the outside, right?

I mean, that's how I, you know, I— that has been a core principle for, you know, these are all the other things are all adjunctive and tools, and it's not to minimize their utility, like a hip implant or knee implant that allows somebody to walk. Like, these things are not going away. It's just, you know, utilizing them and making sure that we're doing our best, you know, uh, with each and every, you know, patient. And I always tell folks, Dr. Amy, that I'm not a psychologist, I'm not a psychiatrist, and I always just say, like, you have to start working on yourself. And obviously you're describing this, I try to use it in a very, um, it's not even— I'm just trying to get them to think about it. Like, you have to think about these things because I'm not solving them. I'm actually gonna— I'm gonna make all the ugliness, all the trauma, all the stuff come right back if you don't do something about it.

Right. And I think that's what most people don't understand. They're thinking that it will take it away. They're thinking that it will allow them to continue to avoid it and not realizing that no, like, it's just going to surface it.

Right. And with that surfacing, it's a lot of negative energy. A lot. Yeah. Because I am the number one generator of cortisol that's on this call. I cause a lot of cortisol. For all y'all who don't know what cortisol is, it's stress hormone. And I— Dr. Rob causes a lot of stress hormone release by operating on patients. So I spend my better part of my career, you know, now trying to make sure I help patients get out of that state as quickly as possible. But, uh, I think Dr. Amy's explaining, if you don't do some self-work, that's still going to be a problem.

It is. Stored trauma is your source of stress. And don't think that you can push it away, numb it away, stuff it down. That will, that will surface. And things like surgery makes those things surface. And so we look at the body as kind of like this container that can only hold so much stress. And then we reach a breaking point. And given the people who are landing on your table, they've already been through so much in their lifetime. Yeah. And have they done any work to resolve those experiences? If not, their body is still holding all of that. And now you as the surgeon are adding stress to that. That's what surgery is. Surgery is a stress. And it's intended to help the body heal, which it can when the body has the reserves to handle that new stress from the surgery. But for some people, like you've seen, it ends up being just that tipping point that they can't handle it. They can't handle any more stress. And so just this awareness around how do I best prepare for a surgery— it actually would be a really, really good idea to start to do some of this inner work so that I can unburden my body so so that I can actually be more resourced and resilient going into this, knowing that it will help my body be able to respond to it in a healing way rather than we've just crossed the line because we've been holding so much and this was just one more thing and we can't hold it.

Yeah, I'm glad you put it that way because I've seen some things recently that I mean, I've operated, uh, trained and operated in practice for almost 30 years now, which, it's a long time. Um, the, the things that you see over a career and how people react, especially when they wake up— like, adolescents wake up and are known for waking up violently from anesthesia. It's very standard, especially adolescent males. Young males. And we had a patient recently, a woman that we did a fat transfer for, wake up and was just out of control. And it was so uncharacteristic. I was already back at my office and just working, and they called me and said, you know, your patient woke up and they're complaining of pain out of proportion to exam, and they're, they're really wild, and it's uncharacteristic. And the nursing staff rightly started, you know, called me, and they're concerned. And then they called anesthesia, and anesthesia and I both basically showed up at the patient's bedside, and I said, okay, well, first of all, we have to make sure there's absolutely nothing wrong internally. So ultimately, you know, the— we had to have the patient, you know, get an imaging study, and everything's fine. And I, I tell the caregiver, everything's fine internally, you know, to me this is something else. And then I thought about it because I don't like to not understand what's going on. I'm super curious when I don't understand something. I think I've worked too long, I've paid too much attention, I've listened to my patients, but this one had not shared something very specific. And I typed a text message the following day to the provider, the anesthesia provider. I said, this is definitely PTSD. I don't know from what, but this is definitely— this reeks of this. So when someone's disinhibited because they've been blocking it, then it all comes out for everybody to see. Because when you're out of it You can't hide it anymore. And so 2 weeks later, 3 weeks later, it was divulged to my team that they were the victim of an assault, and that was what they were reliving, basically. And they told my, my team— they wouldn't tell me, they didn't want to say it in front of their caregiver, or, you know, we understand this. So this is the things that you know, Dr. Amy is acutely aware of. And personally, I make a point on every call that people like start working on and doing these things. I call it self-work for lack of a better way to explain it, but you're going to get yourself in a more complicated situation by not doing anything about that.

100%. And this is what my work around the biology of trauma informs people, is that it doesn't just mess with your mind. It actually has an impact on your biology, right? It is contributing to your physical health issues. It will contribute to your diseases. It will contribute to your aging process. Trauma becomes our biology, not just psychology. And the more we try to pack it down, the more it impacts our biology because it doesn't have that valve to off-gas and to be able to go somewhere else. And so it's all trapped, creating so much tension and so much stress inside to try to keep that stuff down that it has an even greater impact on our biology.

Have you found a particular way— because this one sticks with me and bothers me quite a bit. And there's not a— that's not a question on an intake form you're going to be super excited to answer. Have you been the victim of an assault or something like that? And certainly there's different scores that, you know, from people's childhood, they get assessment, you know, scores for trauma, etc. Like, what do you think are the tools that, you know, someone like me should be using to better characterize that, you know, to help the patients, help the teams, you know, because I don't like being, uh, unaware. I don't want to be unaware. I certainly want to be aware and help where we can help or direct, you know, people to the correct resources like your book and your work. And I just want us to be doing the best we can do for each patient in their situations.

Absolutely. I'll share with you what I do, and then I've got a specific idea if I were still doing surgeries, what I would also add for that assessment. I am not looking at a person's past. That is a big difference between what I do and what another physician who is trauma-informed might do. We have these checklists. We even have adverse childhood experiences and people are calculating score. I do not find that helpful because I'm not concerned about resolved trauma. I'm looking at unresolved trauma. And unresolved trauma is going to show up in predictable ways in your life, in your relationships, and in your health today. So I'm not asking about your past. I'm asking, how overwhelmed do you feel in your life right now? And that's different for me than stress. So in my book, I make the distinction between stress and trauma, calling that trauma response overwhelm, where you're paralyzed, you're not able to think, you're not able to make decisions, you're not able to move forward. Because if you were, you'd still be in stress mode. So I make that clear distinction. But when I'm assessing someone, I'm asking those kinds of questions. How overwhelmed do you feel in your life right now. It's a good assessment for me to see their current burden that their body is under. But if I were the one still doing surgery, I would also be asking, is there anything from your past that might affect your body's ability to come out of or go into anesthesia and surgery that I should know about as your provider.

Okay. Yeah, I think that, that you gotta do that. You have to. Yeah.

Because as the physician, we are committing to safely getting them through this process. And if I don't have all the information that I need, then how can I safely get you through this process? If you had known that about this person, you likely would not have gone to your office. You would have stayed there. You would have just monitored a little longer. Why? Because of that possibility. And when we phrase it that way, is there anything that might impact your body's ability to go into or come out of anesthesia and surface old wounds? Old traumas that I should know about. It's phrasing it in a way that I'm here to safely guide you. I'm not here to ask questions just to know your history, because why would you trust me with those experiences? But when we phrase it as, I'm asking so that I can better help you, people with trauma histories are much more likely to say, yeah, I haven't been able to tell anyone else this. "But I realize that you should know so that when I'm completely unconscious and under the effect of anesthesia, disinhibited, you as my provider can know what's happening with my body and help me get through that process." Yeah.

That's, that's important.

Yeah. That disinhibition is scary. Scary.

Yeah, nobody likes— because they're looking at me like, what is going on here? And, you know, it's one of those things where he's operated for as long as I have, and you've seen, you know, whatever, hundreds of thousands of people wake up. Like, you know what you know, and when it's out of character, you're like, well, this is It's concerning, right? You want to know, you know, is there something else going on? Surgery is, you know, it's not a sport to be taken lightly.

No. And there's actually a lot of principles that are shared between surgery and trauma therapy. One would be that we don't open you up until it's safe to do so. And a big misconception in trauma work or self-work is this idea of you have to feel it to heal it. And so let's just rip off that Band-Aid. Let's jump in. And I'm looking at the principles of the body and what it needs to feel safe and be in the healing mode. And I'm saying, no, actually, before we start feeling, we need to make it safe to feel. Rather than putting the focus on, okay, I need to feel this grief. I need to feel this anger. I need to feel this. No, no, no. The question is, what do I need to do to create the safety to allow these feelings to be here and for me to be okay? That's a very different question. And now that gives us something else to do as opposed to just like, okay, I'm gonna feel my feelings now. I'm gonna feel my feelings now. And you don't get very far. As opposed to what do I need to do to make it safe? And then the feelings will come and I don't have to manage that process. I am managing the safety to allow the feelings to be here and me to be okay with those feelings.

Yeah, my clients, my patients, my staff, predominantly female, obviously, and they're very good at stashing things and ignoring them or, or compa— whatever, compartmentalize, or however you want to describe it, like just kind of pushing it away and like not dealing with it. And then until it's a real, real problem that's, you know, in, in this instance, it's a scary problem because the, um You know, say for instance, Dr. Amy, we go from a surgery center to an urgent care with a CAT scanner, and now you got a whole group of people going like, what in the hell is going on here? And so oddly enough, the ER doctor on duty at that particular center knew me. And so I went back, and, um, while the patient was getting, you know, a study done, I looked at it and I Obviously, I looked at it, it was fine, and, and they waited for the radiologist, you know, to read it, making, and confirm it was fine. But I had told the caregiver, I was like, it's, it's fine, there's not a problem with what we did for, you know, the patient. And then, you know, there's only a certain amount of solace you take as a provider when you do that because you still don't understand what the heck is going on. But at this point, I know enough to know that that is the problem.

It's just like trying to get someone to do something about it is the larger problem, which is fascinating because we all have this understanding that women are the better feelers. That women feel their feelings. And I'm going to say, actually, what women do, they hold it all together. They have learned to push through holding everything together until they simply can't anymore. But they don't stop trying, which means that they're getting to the very end of their capacity, and then everything falls apart. Because they've pushed through for so long to hold everything together.

Right. Right. That's— yeah. And the other thing is the rush factor. Like, everything's a rush, right? The world has become, I want it done yesterday, and then I need to be back into my life. And I try to give like this very— it's measured. I say, look, we've constructed a healing environment with a lot of support. You're not going to get this when you go home. You can't because there's The staffing, the team is always paramount. Like, you build the team out, the team takes care of everybody. And then the specific modalities like hyperbaric oxygen or lymphatic massage devices from New Zealand, or the Human Regenerator to help reset the parasympathetic nervous system from Germany that I have, or whatever else I have. Like, you just don't have all these things. This is not what you go find at your local wellness clinic or gym. So I try to get everybody to understand, like, the minimum entry point in our ecosystem is about a week. Not because we're trying to, uh, make you captive. We're trying to get you to care about and take care of yourself and recover and embrace, like, self-care. Those are things that are super important for healing.

Well, exactly, because what we know as physicians, especially surgeons, is that when the body has everything that it needs, it will heal itself. It's when it doesn't have the nutrition that it needs that that skin incision is not going to heal well. It's when the body doesn't have the support that it needs that that mesh is going to fall apart or the infection is going to settle in. So, Our job then is to give our body everything that it needs so it can do the healing process. And that's exactly what you've created. You've created a space, an environment for someone to support their body with everything that it needs to heal well. That's huge. That's not what they're finding in other places that they go to.

I feel like we can do a bit better and we're always trying to improve it, but trying to get folks to slow down enough to take care of themselves is probably, you know, the larger portion of the battle that's the most difficult. Once they're here in the ecosystem, it's fine. Everybody kind of gets it and it's the trusting that that's something they should actually do. That's something that they've, how do you want to say, earned?

We're back to the trauma conversation that we started with. Am I enough? Or do I need to be productive in order to be worth something? So much of the messaging has been, no, I've got to get stuff done. I need to accomplish things. I need to be productive. I can't slow down. This this self-care stuff. I mean, I'll do it if I have to, when I have to, but I'm going to push myself to the limit. I'm going to live on that edge because my sense of worth is wrapped up in my productivity.

Right, right. Yeah, basically, you know, that's the problem. Yeah, that's the problem. Trying to break that is incredibly hard.

Yes. Because it goes back to our early childhood and attachment. And actually, this is what I go into in chapter 11 of my book, how those early years that you don't even remember formed the foundation of your lens and your beliefs about yourself. So no, those beliefs are not just a decision that you can make to change those. I will not believe this about myself anymore. I will not attach my productivity and my sense of worth. No, because this has become your very fibers, the very felt sensation. This is, this is so much of your programming that you don't even have access to because it's in your subconscious. It is not something that you can make a logical decision about and expect the rest to follow. And that is why this is not an overnight job. This is, for me, Rob, like, I see it as this is the The work of the rest of our life is how much of a sense of worth can I gain to feel like I'm enough just as I am? That is the work for the rest of our life because there's no end to my ability to feel more and more worthy.

And that's probably the biggest tug of war, right? So it's not so much like there's always the standard And you can see it too when I talk to somebody and they're like, they're locked in, they're gonna, you know, do it versus the, am I enough, can I do this, that tug of war. And then you get the people who commit and decommit, or you get the people who commit and come up with excuses. I mean, there's just like the standard litany of like, am I enough? I mean, that's a great statement about that and that kind of overcoming that, if you will.

Right. Yeah. And this is why in the trauma work that I lead people through, I have found parts work to be essential. And it's this idea of there's a part of you, there's a part of you that says, I have to be productive in order to be okay. And it will panic when you go to relax because it says, "Well, you can't relax too long because we have to go back to being productive. No one can catch me relaxing because we have to be productive." But there is this other part of you that says, "Can we just fucking take a break? We are tired. We are exhausted." And so we do have these different parts of us that have competing desires, have competing beliefs. And this is what creates the tug-of-war. This is what self-sabotage actually is, or excuses that come up. It's just another part of us that has surfaced and said, we have a different opinion here than the part of us that made that first decision.

Right. That's— yeah. And surgery is such a— and this one in particular is such a complex emotional experience. Surgery is difficult. Regardless, right? So the, you know, the— I treat it with a lot of respect, and I, I tell everybody the same things. Like, I don't say, oh, you need to explant to get feeling better. I say, this is what we've seen in several thousand cases. These are the contributing factors, the best I can explain right now, whether they're from bacterial contamination, whether from immunologic responses. And then you're, you're saying the quiet part out loud, like your own traumatic experiences. And they all play a role. And I never know, like, what role everything is playing. Like, I can't know that. But in this instance I brought up, that was certainly playing a big role that we had no idea about. And, you know, it's not that we always want to be first and foremost as safe and protective of everybody as possible. So we need to know what's going on, you know, in everybody's atmosphere, if you will, to better care for them.

100%. And as I look at these, like the emotional aspect of making these decisions, for people to even just have the language and the understanding of why do I feel at war with myself? Why did I make this decision on Friday and it's Monday and I'm calling to cancel out of all of it because I've changed my mind? Am I crazy? Am I, you know, this unpredictable? And now we're bringing on shame and guilt and all of this other stuff. And so it's just this ability to understand why we do these certain things, why my body reacts, why my body would go through this process, and this is the response. The understanding really helps a person be able to navigate all of this experience without the added shame of embarrassing things that they don't like about themselves.

Yeah, I mean, that's what it comes down to. And you're We'll kind of end it on what you said, am I enough? Because I try to impart to everybody they are, and it has nothing to do with these devices because they are enough. And then I get the usual problems with caregivers or loved ones, and if they are not aligned with what you want, then need to have a chat about that, right?

And then we're back to that question around safety. Is it safe to even have a conversation about that? Right.

Absolutely.

For most people, the answer is no. I don't actually have a person in my life that I feel safe enough to be this honest and real and authentic with, which is why we then just say, well, I guess I just keep holding it all and pushing through. And we're back in the same vicious cycle.

Right. Um, I have found this to be both enlightening and fascinating, and I want everybody to be able to go get your book. So can you let everybody know the title again and where to go get it so they can access it?

Yeah. So my book is The Biology of Trauma: How the Body Experiences and Holds Fear, Pain, and Overwhelm, and How to Heal It. And it's very science-based and will help them understand why they paralyze, why they freeze, why they come into your office in a daze and didn't actually hear anything that you said. They're in a trauma response, and it's in their biology, not just psychology. So anyone wanting to understand themselves on that deeper level, you will get so much out of this book. You can buy it on Amazon, and then I have some resources that go with the book that they can find on my website for free, and that's biologyoftrauma.com/book. I have a nervous system journal that they can use to start tracking their— how much time am I actually spending in survival mode as opposed to healing mode? Going into surgery, I would want them to know that so that they can shift and be spending more time in that healing mode since that's what their body needs to heal from the surgery.

Absolutely. Um, we're going to put that in the show notes as well so everybody can access that. Thank you again, Dr. Amy. I appreciate it.

Well, thank you for the work that you're doing in the world. It's very unique, and I hope that people See that.