DIY Diagnosis for Indigestion

Guest: Shivan Sarna

The contents of this presentation are for informational

purposes only and are not intended to be a substitute
for professional medical advice, diagnosis, or
treatment. This presentation does not provide medical
advice, diagnosis, or treatment. Always seek the
advice of your physician or other qualified health
provider with any questions you may have regarding a
medical condition.

Bridgit: Shivan Sarna, welcome to the DIY Detox

Summit.

Shivan: Thank you so much! What a wonderful project! I'm excited!

Bridgit: I'm excited to have you. We have a little bit of a different topic, you
and I, today that I'm excited about. It's kind of a DIY diagnosis, which I think
a lot of people are looking for, frankly, because it's expensive and you don't
know who to go see to get a diagnosis.

We're going to be talking especially about the gut. And basically everyone has
a gut problem, I think we can safely say. If you're attending and you want to
detox, as you learn from so many speakers here, your gut health has to be on
par. You can't be making gases and not breaking down food and all this stuff.
So tell us a little bit about your background. You have some personal and
professional history with gut stuff.

Shivan: Yea, I have had gut issues ever since I was probably five. And it turns
out that I have had IBS (irritable bowel syndrome) since then, and probably
SIBO (small intestine bacterial overgrowth), which are a couple of names of
conditions that I totally disavowed until it was so obvious that I had them. I
was just in deep denial. But I didn't know the names of those for decades.

And I knew something was off with me, but I didn't know how to give it
language. And I didn't know how to speak about it without feeling shame. I
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would mention it occasionally to my GP, and it just got blown off. I would even
go to specialists, and they hadn't even heard of SIBO.

This is a condition I really want everyone to be aware of, because if you bloat
after you eat, you have maybe a flat tummy in the morning and a poofy
tummy later on in the day after you've eaten, it's one of the signs, to talk
about self diagnosis. And there are a lot of doctors now and practitioners that
are learning in training, so you're not going to be isolated the way I was when I
was first figuring this out.

And so I had these conditions. I was going through life. I had this fancy TV
career where I have to look aspirational and pretty, high heels, and svelte and
all that. And, you know, occasionally people would write me these little emails.
"Oh Shivan, you're glowing. When is the baby due?"

Bridgit: Oh gosh! That's the worst.

Shivan: You know, lovingly, they were asking me lovingly. I'm not pregnant.
No, I was not. Anyway, so, just a lot of little stories like that, that are like,
yikes! But, the bottom line is that if anybody has ever had IBS, then you need
to understand what your underlying condition is, if you have it now. If you
bloat, I really want you to evaluate what your underlying condition might be.
And I'm going to explain how you can figure all of that out.

So in about 2015, I finally got a diagnosis after a false diagnosis for a year and
a half of being told I didn't have SIBO. Then I found out that I did have it. And
then I have been on an odyssey to teach other people about SIBO, so they
didn't have to go through what I went through, which was total confusion and
spending, I'll just say, thousands of dollars on trying to figure out what was
wrong with me.

As I aged, it got worse. And as I was going through certain stressful times, I
was just like falling apart. And I had a lot of co-conditions. Yay for Lyme and
EBV and—

Bridgit: I didn't know that. Wow!

Shivan: Yea. It's a party over here, and DNA structure that would give me the
proclivity not to have good liver pathways for cleansing and detoxing. So most
of my doctors call me the collector, because I was just like being exposed once
and it stays with me.

Bridgit: Party! You have a good attitude about it.

Shivan: Well, I feel a lot better. I absolutely feel a lot better.

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Bridgit: That's great!

Shivan: And I have a new appreciation for management of a chronic

condition. I always wanted to be just fixed and healed and done and negative
SIBO breath test, which I have had, but it's periodic. And so I have a new
respect for managing a long term condition, a chronic condition versus the all
or none thinking that I used to be stuck in.

Bridgit: Yea. If you've got mold and Lyme and EBV, yea, that is a tangle, as I
like to call it, all the things tangled together. Yea, that is often the kind of
emotional conclusion you have to reach. A lot of people are like, "Why can't I
just be like everyone else, and I can eat everything, and this will be easy?" But
I think it's getting more and more common to be like you and I where things
are complex. And our environment is complex now, so our conditions get more
complex. And it is a management issue.

Maybe we can circle back at the end to how you manage it and what you've
found. But let's get back into SIBO. Could you just define what is SIBO? You
mentioned the bloating as a clear sign. What are some other ways we might
know?

Shivan: Well, if you've ever had food poisoning, a lot of times if you've had
food poisoning, but it wasn't severe, you just had some diarrhea, you might
not consider that you had food poisoning. So there's something I'm going to
tell you about how you can get a test to find out if you have. But food
poisoning leads to something called post-infectious IBS in a lot of people. So it
doesn't happen a hundred percent of the time. But if you have certain other
conditions or a proclivity towards certain autoimmune scenarios, then it might
happen to you.

So the more food poisoning you have, the more likely you are to have post-
infectious IBS. So post-infectious IBS will make something called your
migrating motor complex malfunction. And what that is is the interior lining of
the small intestine helps to push out the crumbs of the food and bacteria after
you eat.

So the large intestine has the bulk of the microbiome. We've got tons of
microbiomes, our mouth, our skin, all that. The colon is the large intestine.
The rest of it is the small intestine. And the colon has trillions of bacteria
making up the microbiome. And then the small intestine has, by comparison,
it's almost sterile. There are bacteria in there, but it's almost sterile by
comparison.

So when bacteria aren't swept out of there, it ferments the food that you eat.
And it leads to bloating. So that's why you bloat, if you do have SIBO. And it
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produces different kinds of gases. Hydrogen, or methane, or hydrogen sulfide
are the most sort of famous ones that are well known. And if you have
methane producers, chances are you have either constipation or alternating
constipation/diarrhea. If you have hydrogen producers, chances are you have
diarrhea. So, if you combine this bloated belly after you eat, the changes in
your bowel habits, you may very well have SIBO.

And a lot of times doctors, depending on how knowledgeable they are, will
either have never heard of it, or they will give you the wrong test, or they'll just
simply treat you without testing. And this is where the DIY comes in. You have
to be your own advocate. I'm sure everybody has talked about that. I'm not
saying do it all yourself. But I am saying train your doctor or your practitioner.
And don't settle for anything less than a three hour lactulose breath test,
which I just happen to have right here. I keep one around.

Bridgit: On the black market?

Shivan: So this is where you drink lactulose, which is a sugar that feeds the
bacteria. And you do a prep diet beforehand. And then you blow into these
labeled test tubes every twenty minutes for three hours. And if you go to a
practitioner who says, "Oh, well just do an organic acids test to find out if you
have a SIBO," wrong! "Oh, we'll just go ahead and do a glucose test to find out
if you have SIBO." Wrong!

Well they could tell you if you have SIBO, but then you have to go and retest
to find out if you have methane or hydrogen. So my suggestion is to get a
really good reading and get a three-hour lactulose breath test. And do you
want me to talk about labs and brand names and stuff?

Bridgit: Oh, you're welcome to, yea.

Shivan: If it's DIY, I mean really, you can go to Aerodiagnostics Labs online.

Bridgit: You call it Aero?

Shivan: Aerodiagnostics.

Bridgit: I have not heard of that company.

Shivan: There you go. Hey man, there it is. It's a family run lab. And they're
out of Massachusetts. And they have amazing customer service. And they will
really help you through the process.

So they'll get you the paperwork where you can hand it to your doctor. They
will get the requisition, blah, blah, blah. They'll tell you who in your area does
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the tests. And you can do it at home. It's so cool. And then you can send it in.
The doctor gets the results, and then you'll get the results through the doctor.
If you don't totally understand, then you can call them and they will help you
figure it out and understand the test results.

Bridgit: Awesome, awesome! I'm good friends with the guys at Atrantil. I'm
sure you know them.

Shivan: Oh yea. They're so awesome!

Bridgit: They're so awesome. And I learned a lot from them about this whole
process you're describing, the gases. And I think a big learning point for me
through them was that you can have what you think is IBS. It probably is IBS
where you're having constipation or alternating constipation or diarrhea. But
the real root of it is the SIBO, because of these gases coming through. Would
you agree with that?

Shivan: SIBO is the leading cause of IBS.

Bridgit: Okay.

Shivan: So yes. And the product you were just talking about, Atrantil, was
developed by Ken Brown, who is a gastroenterologist. And his combination
helps to reduce methane producers. And it's fascinating, because I'm sure he
told you he found that idea from talking to someone who was studying cows,
wanting to reduce methane on the planet. And this is a similar formulation to
what they feed the cows to reduce their methane. And now we're benefiting
from it. I love that part.

Bridgit: Yea, so let's get into IBS. So IBS stands for irritable bowel syndrome.
And syndrome is sort of always like a catch phrase for like we don't why it's
happening; although we just listed one reason, SIBO. Tell us your opinion
about that IBS bucket and—

Shivan: Well, when I first got familiar with the term IBS, I finally went to a
gastroenterologist. So I've had these problems since I was five. I never went to
a gastro or GI doctor. I finally went. He was a nice guy, excellent scoping, but
wasn't really keeping up with the rest of the literature. And he was kind of like
on his way to retirement. And he could like see the door, right?

But he said, you know, really three miles of walking is the best laxative. And
he also gave me an antidepressant, which I now understand, but it wasn't
explained to me at the time. It was to see if some serotonin levels could be
helped out in my body. Most of the serotonin is in your gut. But it wasn't

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explained to me. So I just thought he thought I was nuts. It was terrible
communication. And I didn't ask the right questions.

But if you have diarrhea, if you have alternating constipation/diarrhea, if

you're fine and then you're not; you're like I ate the exact same thing, or I ate
an apple because it's supposed to be good for me. I ate garlic. Oh my gosh!
Everybody loves garlic, right? That's supposed to be like this wonder food. And
I feel terrible. Those are some signs that you might have IBS, because of the
way that the bacteria responds to those foods.

But if you've ever heard of the low FODMAP diet, that is a diet that is a way to
manage the symptoms of IBS and to reduce flares. And there are tons and
tons of websites and literature and food bloggers talking about it. And it's
definitely something that helps a lot of people. There's controversy--should
you not be on it for long term? Studies have been done. There are small
studies to show that actually being on it long term doesn't mess up your
microbiome the way people had said.

It's a reduced fiber diet, a reduced fermentable diet. So your food is going to be
less likely to be fermented by that bacteria. But what's cool is that Dr. Mark
Pimentel out of Cedar Sinai created a test called IBS-Smart. Now a lot of
people don't know about this, so that's why I'm showing it to you. IBS-Smart
is fairly new. It's by Gemelli Labs.

And Dr. Pimentel, I would say is the person who is probably going to find a
cure for SIBO in our lifetime, Dr. Mark Pimentel. He is working at a lab there
that he's the head of that has sixteen people working nonstop on trying to
figure this out, which is huge, because gut issues are one of the least funded
research projects. Anyway, that's a whole other conversation.

Bridgit: You held up that test. But if people who are listening are getting the
transcript, they might see it. It's called IBS-Smart. And what's the lab there?

Shivan: It's Gemelli. Here's the deal guys. You go to their website, and you
can have them send a requisition form to your doctor. They will also tell you
where doctors in your area are familiar with the test. Or you're going to
familiarize your doctor with the test. So you have to have a script. You have to
get your blood drawn. And depending on where you live, if you have like, for
example, Any Lab Test Now. Do you have that near you?

Bridgit: We do, yea.

Shivan: So they'll be able to process the lab. And then they'll send it off, back
to IBS-Smart laboratories, Gemelli Labs. And what's going to happen is you
get the results. And it shows if you have the antibodies that are the result of
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food poisoning. And those antibodies are the ones that are causing (I'm
simplifying it) this confusion in the inside of your small intestine that is
causing your migrating motor complex not to work.

Bridgit: That's great.

Shivan: It's great.

Bridgit: Very simple.

Shivan: And the reason why this is so important is because--hear me loud

and clear on this--you need to find out your underlying cause. SIBO mimics
the symptoms of ovarian cancer and other cancer. It is very rare. There's no
doubt about it, but it is rare. But, hey now, I don't want to be treating SIBO
and it turns out that I have cancer with the same symptom set.

And the other thing is, you can take the medication and the herbs to help
resolve SIBO, and the relapse rate is really high. Because if you don't know
your underlying cause, maybe it's adhesions and it's holding the intestines in
a way so that the migrating motor complex can't actually work, because that's
another reason why you might have SIBO. There's just a bunch of reasons
why you may have it, right?

If you don't know your underlying cause, when you take the first round of
antibiotics, which is a very special antibiotic that stays in the small intestine,
and studies have shown this to be true. It's called Xifaxan or rifaximin. And I
took that. And I felt, oh finally, a lifetime of struggle, I'm going to be well in
two weeks. No, I was not well in two weeks, because it only drops the amount
of bacteria a certain range of parts per million. So what that means is that you
might have to do multiple rounds.

So you might have to do four rounds. But it's proven to be safe. And it's
sometimes hard to get, sometime easy to get. It depends on your insurance.
But that's something, a big myth I wanted to bust for everybody, if you have
gotten into this. You think, oh this one round of antibiotics is going to do it.
Well, if you have a lot of methane producers or a lot of hydrogen producers,
you might have to do multiple rounds.

Bridgit: Okay. Do you ultimately recommend people do use antibiotics? Or do

you see people get results without it?

Shivan: So Dr. Jerry Mullen, he did a study showing that specific herbals
were as effective as the rifaximin; however, it took four weeks instead of two
weeks. For a lot of us, that's cool, that's fine. That would be great. You can go

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buy these herbals and treat your SIBO and maybe do multiple rounds. But
there are implications for the microbiome that way.

This is also the big myth, that rifaximin, this antibiotic that I'm referring to,
which is also the antibiotic for traveler's diarrhea. People tend to think,
understandably so, that antibiotics are going to be systemic and wipe out your
entire microbiome. Rifaximin has been shown not to do that. It stays in the
small intestine.

Bridgit: Oh, that's cool.

Shivan: It's fascinating. So that's why you can do multiple rounds. So it's not
your typical thinking around an antibiotic.

Bridgit: Okay, cool. Hey, you've really gone deep on that. So thanks for
sharing that, because I think a lot of people are just kind of spinning and like
don't know what to try next. Okay, so we've covered some tests for SIBO. What
else do you want to get into?

Shivan: So SIBO and IBS, remember that. If you have IBS, it's nice to know
what caused it. And one more thing about that, if you've been exposed to food
poisoning in the past; have you ever sat at a dinner table, gotten up, one
person gets food poisoning, everybody had the same food, and the other
people are fine? Like, "Was that fish funny?" "Oh no, I'm fine." But gosh,
Matilda over here was throwing up all night. That's because once you've had
exposure, your immune system is more prone to having a bad response the
more frequently you've had food poisoning exposure.

Bridgit: Oh, okay.

Shivan: This is where IBS becomes an autoimmune issue, and where SIBO is
part of the immunity, because it has to do with those antibodies, those
antibodies impacting the migrating motor complex.

Bridgit: Oh, that's really interesting. You're giving me something to think

about in my own health history, because I lived out of the country a good bit,
and I got sick like a number of times, like really sick, like high fever, and
diarrhea.

So I've definitely had some of those repeated food poisoning, or even kind of
water poisoning from Lebanon, a third world country.

Shivan: It's real. It's totally real.

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Bridgit: Yea, okay. So outside of like a food poisoning scenario, what are some
other underlying triggers or sources of IBS?

Shivan: Well, traumatic brain injury, impacting the vagal nerve, the vagus
nerve. The connection between the brain and the migrating motor complex is
the vagus nerve. Adhesions, which I mentioned. So adhesions are these little
collagen, strong, strong fibers that help build scar tissue. And when they
develop, they latch on to different parts of the body.

So let's say you have a hysterectomy. Then you have scar tissue, right? And so
the adhesions can form around that scar tissue and can literally pull organs
into different directions. So that's why a lot of women who have fertility issues,
when they get their adhesions addressed, all of sudden they're pregnant,
because their fallopian tube is not like being pulled out off to the side, so
things can flow better. I mean it's the physicality of the body. So when the
adhesions are there, it can literally move the small intestines in a way that
makes the migrating motor complex not work efficiently.

There's also ileocecal valve malfunction, which is the valve between the small
intestine and the large intestine. You can get backwash, and that bacteria can
go into the small intestine and overgrow. There's also diverticulitis. And in the
pockets of the intestines, bacteria can hang out there. And that can lead to
overgrowth. Opioid use, it slows everything, right? So sustained, even really
for major surgery, they say opioid medication can slow the migrating motor
complex. It goes on and one. Eating too frequently.

Bridgit: Go on. I want to hear them.

Shivan: Eating too frequently. I'm not saying that that's an underlying cause.
I'm just saying that you need to let your body digest, right? So the migrating
motor complex kicks in about every four or five hours. But it will only kick in
if you haven't eaten within that four or five hours. So that leads me to this.
Test, treat, test, pro-kinetic, get your results back. If you need to treat more,
treat more. If you don't test, you don't know. And there's a really tricky little
bit of timing that happens after you've finished treating your SIBO, to test
within a very specific window. So when you're done with that treatment, you
can actually tell whether or not you had SIBO.

If it's not SIBO, you won't know. So you won't know if the treatment really
worked or not. Does that make sense?

Bridgit: Yea, yea. You threw in a word there that I would love for you talk
more about, which is the pro-kinetics. I didn't know about those until not that
long ago. And I'm like, where have I been that I didn't know about it?

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Shivan: I didn't know about it either. But thank goodness, my doctor, Dr.
Allison Siebecker, taught me about them. She was one of the world's leading
SIBO experts.

Bridgit: Right.

Shivan: I've been really blessed to work with so many of these doctors and
practitioners and researchers. And it's an amazing group of people. I find very
little ego with them. They're just really devoted to helping the patients in the
world.

So, the pro-kinetic is something that coordinates the motion and mechanisms
of the digestive system. And one of the things that it does is it helps to
stimulate the migrating motor complex--ding, ding, ding--that's what we were
just talking about, right? So if you can stimulate that, it sweeps. It's not a
laxative, per se. But I do find people do well with it to help increase bowel
movements. But that's not the point.

And so if you're taking a pro-kinetic and it doesn't act like a laxative, it doesn't
mean that the pro-kinetic isn't working, because sometimes you aren't going
to be able to tell that that sweeping motion has happened from going to the
bathroom. The main thing is that you want pro-kinetics that will help the
sweeping motion so bacteria doesn't pile up in the small intestine and
overgrow.

What is a pro-kinetic? Okay, like giving some examples here. Ginger is one,
but we're not talking about a little slice of ginger. There are some supplements
like MotilPro. There are some drugs, pharmaceuticals. They find that low dose
erythromycin is helpful, and it doesn't act like a systemic antibiotic at that
level.

There is something called Resolor. Right now it's in Canada legally. It's coming
to the United States. So under a different name, it's called prucalopride. That's
the name of the drug. So look that up and see if you can get a hold of it. It's
obviously a prescription. And there are a couple of others. But those are the
most, I would say, famous.

Bridgit: Okay. This MotilPro, is that something that people can get their
hands on all on their own?

Shivan: Yes. The thing about ginger and MotilPro is that if you have GERD or
reflux or your valves aren't totally syncing, then it can often cause esophageal
burn.

Bridgit: Okay.
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Shivan: You know, you burp it up and you're like "oh my gosh!" It can burn.
Some people swear by it and love it. And other people are like me, I tried it
once, and I'm like oh my gosh, never again! That was painful!

Bridgit: Okay.

Shivan: It's intense.

Bridgit: Okay.

Shivan: But if you look up the medicinal properties of ginger, it causes like a
spasm-like motion in the stomach and in the digestive system. I'm not a
doctor. I'm just telling you my experience and my massive amount of research
and my communication with these incredible teachers and doctors. A lot of
the doctors that I've worked with have been teaching doctors. So it's really cool
to learn from the teachers and then the teachers' teachers.

Bridgit: It sounds like you said pro-kinetics is not the first step. It's like the
after treatment step. Is that right?

Shivan: Yea, a lot of people don't know it exists, like we didn't. And it is a
critical step in preventing relapse. So it's really, really important to research
that. And then also make sure that you take it very shortly, like within a
couple of days after finishing your SIBO treatment. Let's say you have
adhesions. And so your migrating motor complex isn't working the way it
should. And you've treated SIBO, but the migrating motor complex doesn't
kick in to clear out any new little crumbs of bacteria coming in. You'll
repopulate the small intestine.

Bridgit: Okay.

Shivan: Does that make sense?

Bridgit: Yea, definitely, definitely. I mean some people say gargling, singing. I
wonder, too, if like different, you know you mentioned the brain injury. I
wonder if different treatments, like physical treatments could help, like cranial
sacral.

Shivan: Of course. Oh my gosh, cranial sacral is like a miracle on the planet.

It's one of my very favorite, most profound methods of healing. I wish I had
found it sooner. Yes, Dr. Datis Kharrazian, a genius, amazing, is doing so
much breakthrough research. And one of the things that he definitely has
helped a lot of people get turned on to is the vagal nerve and the stimulation of
it through gargling, loud singing. If you tear up, it means that you've really

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sort of activated that nerve. And that nerve is responsible for a lot of the action
of the migrating motor complex. Yea, I've gone through all angles, everybody.

Bridgit: Yea. So, Shivan, people are listening, and they're like, okay, what's
my step one? Would you say that's doing some testing, either like kits you can
order or finding the right person and encouraging them to get certain tests?

Shivan: Yea. Come over to sibosos.com. We've got tons of information. My

doctor, Allison Siebecker, at siboinfo.com, has tons of information. But
basically, get a hold of a doctor who is SIBO literate.

Bridgit: Okay.

Shivan: If you already have a GI doctor who is dialed in, then walk in with the
studies, which is what I did. Walk in with a protocol. You can go to
Aerodiagnostics Labs and get the requisition form. You can have
Aerodiagnostics contact the doctor. You get the same thing here with IBS-
Smart. So you can walk in as a prepared patient. But if you're on your own
and you don't have that doctor--this is a lot of DIY, right?--go, reach out to
these companies and have them tell you who in your area does work with
them as a lab.

The other thing that was really a big shift for me was to embrace telemedicine.
So I thought a Skype consultation, a video discussion about my condition,
would not be nearly as effective as being in the same room with them. Well, I
was totally wrong. Look, if you're talking with a person who knows what
they're doing, then I don't care if you're on an airplane or next to them or
you're doing Skype, that is the information that you need.

So there are people around the country in the U.S., and certainly, I would
imagine, in the world. But I think the education on SIBO and IBS is very
strong here and in Australia. And get a consultation on the phone of on Skype
with them, and you can really move forward.

Bridgit: Yea, thank you for mentioning that. I think it's still like a bit of a
mindset shift. Like our company is all online now. And people will contact me
like, "How can I find a doctor in my area?" And I'm like, why are you
contacting me to ask me to see someone else? I think there's still like that
hurdle to get over. And we can shift kits wherever we do the SIBO test. You're
just introducing me to the IBS-Smart test. And usually that's the thing that
slows things down the most. It's like waiting for labs to come in.

Other than that, there is usually less inconvenience with an online person,
because you don't drive and have people driving three hours to see their
doctor. And yea, I mean I think it's fine to have a mix. And I love, like you
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said, cranial sacral. I love modalities that involve touch. And I think that's
really great. But, yea, I'm glad you brought that up. You know, just find the
brain that you want to connect with or the person you want to connect with.
And if it has to be online, then it can be a great connection.

Shivan: You don't have to fly. I mean it's amazing. Embrace it. The internet is
great when it's great; it's not when it's not. But that's one of the best things
about the internet and things like this.

Bridgit: Connecting us. So you said your main site is sibosos.com? Is that
right?

Shivan: Yep, sibosos.com, where we do master classes. They're like a medical

conference level class that the practitioner delivers on power point, just like
you were going to a medical conference for patients and doctors and
practitioners, and then followed by a two-hour super-duper intensive Q&A. So
being a TV show host, I know how to handle like the law of activity and
questions and how to manage my time on air, so to speak. So I really get to, I
would say, ninety-nine percent of the questions that are asked. And we really
go deep on these topics. So it's really cool.

Bridgit: That sounds like a lot of fun, yea. What a great idea, awesome. Well
thank you for like turning your journalistic brain towards health and the
intestines. Like it's so valuable. I can tell you've really like synthesized these
different skills you have. And it's so amazing.

Shivan: Well, you're very sweet. Thank you so much for all the good work
you're doing. And chronic conditions can be managed. And you can feel a
hundred percent better than you did when that condition was not managed.
So don't give up. And know that you might need a little inspiration on the way.
So be sure to be your biggest cheerleader.

Bridgit: Amen! And this talk right here might be a good reason to buy the
upgraded package and get the transcripts so you can see all this in writing.
There are some details here, and you'll get a bunch of other gifts from our
speakers as well. So you can see the website for that. But thanks again,
Shivan. We really appreciate it.

Shivan: Thank you so much!

© 2019. All rights reserved. 13

© 2019. All rights reserved. 14