Why Pushing Through Can Make ME/CFS Worse
In today's episode, Haylie Pomroy welcomes back Dr. Melanie Hoppers of the Bateman Horne Center for a deep dive into post-exertional malaise, or PEM, the defining feature of ME/CFS that turns the conventional wisdom about exercise completely upside down.
Dr. Hoppers explains why pushing through fatigue can cause lasting and sometimes permanent damage in patients with ME/CFS and long COVID. She breaks down what PEM actually is at the physiological level, how mitochondrial exhaustion limits the body's ability to produce energy, and why willpower has nothing to do with it. She also shares practical, real-world pacing strategies, including resting heart rate tracking, scheduled rest breaks, and how to stay within what she calls the energy envelope to protect the body's potential for healing.
If you or someone you love has been told to just push through it, this episode will change how you think about energy, healing, and what your body actually needs. Tune in to Fast Metabolism Matters.
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Dr. Melanie Hoppers is a practicing physician, board-certified in internal medicine and pediatrics. Dr. Hoppers completed her Bachelor of Science degree in Biology at Union University in Jackson, TN, and attended medical school at the University of Tennessee College of Medicine. She completed a dual residency in Pediatrics and Internal Medicine at the University of Tennessee at Regional One Medical Center and LeBonheur Children’s Hospital in 1997.Prior to joining BHC in March 2024, Dr. Hoppers practiced at the Jackson Clinic until 2007, when she cofounded Physicians Quality Care, a multi-faceted clinic providing urgent care, primary care, occupational health, and physical therapy to patients in West Tennessee. The clinic now has two primary locations and several onsite occupational clinics as well as a mobile unit that provides occupational health onsite. Beyond her clinical practice, Dr. Hoppers is actively involved in numerous clinical research projects, furthering medical knowledge, and striving to improve patient outcomes. Her contributions to ongoing research initiatives underscore her dedication to advancing the field of medicine.
LinkedIn: https://www.linkedin.com/in/melanie-hoppers-939a00279/
Haylie Pomroy, Founder and CEO of The Haylie Pomroy Group, is a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience, she has worked with top medical institutions and high-profile clients, developing targeted programs and supplements rooted in the "Food is Medicine" philosophy. Inspired by her own autoimmune journey, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is a New York Times bestselling author of The Fast Metabolism Diet.
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Transcript:
Dr. Melanie Hoppers: Your baseline is the activity level that you can perform without feeling ill. That's your energy envelope. Well, I want you to stay in that energy envelope. No matter what you do, you can't make your mitochondria do what you want them to do. If you push past that envelope, you're gonna be much worse. But if you stay in the envelope, there is some potential that you could have some improvement.
Haylie Pomroy: I wanna welcome everybody to the Hope and Help podcast, where we talk about science and science-based tools for fatigue and chronic illness. I'm your host, Haylie Pomroy. I'm a #1 New York Times bestselling author of the Fast Metabolism Diet, a leading health and wellness expert, and I'm also a PhD student, guys, in neuroimmunology. That's right, I'm back in school again. I am a fierce advocate for those in need of a little bit of help and definitely some hope. Today, I have a super special guest.
You have met Dr. Hoppers in the past. We had such an incredible response from you guys, and there were so many questions that our community was asking us that I asked her and asked her to please come back and talk to you. Dr. Hoppers, thank you so much for being with us again today. It's just great to get a chance to monopolize your time a little bit on behalf of everybody.
Dr. Melanie Hoppers: Oh, thank you so much for having me. I'm really excited to be here and really excited to tell more people, talk about post-exertional malaise, and how it affects people. I think it's so important, and just having the opportunity is wonderful. Thank you.
Haylie Pomroy: Absolutely, and Dr. Hoppers, I know that you are practicing both in Tennessee and in Utah. Can you explain, just for everybody out there, we lean on you for advice and insight, but what have you been doing from a clinical perspective? Tell me a little bit about your practice.
Dr. Melanie Hoppers: Sure, so I started seeing patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), mast cell activation syndrome, orthostatic intolerance, POTS, long COVID, several years ago. But it was sort of like, it's never-ending in the fact that there's just not enough time, there are not enough slots for everyone who needs help. And I realized that I was chipping away at such a huge, monumental task and just not getting enough done. The Bateman Horne Center offered me a position there, and I realized I have a much bigger imprint when I work with them.
And so I worked for the Bateman Horne Center. Their mission is to provide clinical care for patients with these illness, but they also provide research and education opportunities. And what I especially love about the vision there is the educational portion is not just, it's great, it is toward patients, but it's also toward providers. And we try to think of it from a provider standpoint. We try to make it in bits and pieces that's digestible for the provider so that this chronic complex illness is not so overwhelming.
Haylie Pomroy: I'm just gonna really quick, the Bateman Horne Center, that's where you're practicing in Utah, correct?
Dr. Melanie Hoppers: Correct.
Haylie Pomroy: And what I just wanna bring up, so when I'm at NOVA at NSU we're part of a medical school. We're part of the osteopathic medical school. And whether it's with Dr. Klimas at the Institute for Neuro-Immune Medicine (INIM) or when we're engaging in education at the medical school, one of the biggest things and how we lean into you guys is educating the doctors that are coming up and rewriting clinical care standards for the doctors that are currently practicing. You kind of play in both of those roles, correct? You're advocating for patients, but you're also physically seeing patients and you're helping us get some of the medical curriculum just not archaic for these kinds of disorders.
Dr. Melanie Hoppers: Correct, correct. And that's one of our goals right now is we're trying to figure out how to get this into the medical school curriculum, because it's not. We have several projects in play right now where we're working on that.
But in addition, we have things like, for instance, we have what I call one-pagers that we've developed that we take several different topics like post-exertional malaise, or even low-dose naltrexone, we have one page. Every sentence is good information. But it's one page. Let's say you have a provider and you think you have orthostatic intolerance, but maybe your provider isn't well-versed in the fact that, oh, a person with long COVID should be checked for this. Well, you can take them to one-pager and say, hey here's something for you to look at that might be helpful for them. Or for providers that are actually looking for information, they can go to our website and find it.
Haylie Pomroy: Dr. Hoppers, you just said something, and it was one of the questions that our community wanted to talk about, which is how do we talk to our practitioners? How do we educate ourselves? There's just this hierarchy in medicine where a lot of people, I'm not. I've fired doctors that don't serve my family or serve us or are on the team that we can all be in collaborative service together a lot. But that's because of the struggles that I've been through and what I've come through from a successful health victory. But when I'm seeing these clients that are not well, that are struggling, that are stressed, they have a difficult time. Two things I wanna give people that are listening right away is, you talk about a one sheet. There are volumes, thousands and thousands of incredible papers that have been published with research with ME/CFS and now long COVID. But you guys have condensed that knowledge into very digestible stuff. Where can someone that's listening to this go to download that?
Dr. Melanie Hoppers: Our website is www.batemanhorncenter.org.
Haylie Pomroy: Will you spell that for me? My dyslexia; I'm not the only one in the world.
Dr. Melanie Hoppers: No problem. And let me make sure I spell it right. Okay, it's B-A-T-E-M-A-N-H-O-R-N-E-C-E-N-T-E-R.org.
Haylie Pomroy: Okay, thank you.
I wanted to get that out of the way because we're gonna talk about a lot of subjects today, and we're gonna fly through these fast because we were just peppered with interest and need after you were on last time. But I wanna make sure that people know that they can go and grab these resources really quickly so they can get up to speed, but also communicate with their physicians.
Your background, which has always been super fascinating to me, but you've got a lot of background in peds and pediatrics. And right now, I mean, it was just on the cover of National Geographic. It's been on the cover of Time Magazine. Our youth, our kids, our babies, right, are dealing with things like POTS and post-exertional malaise.
And can we just talk a little bit, and I think you're the right person for me to ask this to, what in the world is going on with our kids?
Dr. Melanie Hoppers: Well, I mean, it's numbers. Before the pandemic, there were maybe 1 to 300,000 children with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). These are typically post-viral or post-infectious cause or trigger. Not all.
Haylie Pomroy: Like mono?
Dr. Melanie Hoppers: Mono, giardia, and enteroviruses, whatever virus of the weak flu can do it. Even head trauma surgery can do it. It's not the only thing, but —
Haylie Pomroy: We saw a pediatric football player with a concussion. We've seen families that have mold in the house. There's some sort of negative hormetic event that triggers the immune system to go into this dysfunctional state. But kids were more resilient, or what's going on since COVID?
Dr. Melanie Hoppers: Well, COVID is just a lot of people got exposed to a virus they hadn't been exposed to before. So many people have gotten infected, including children, and children are not immune to long COVID.
About 10% to 20% of those that are infected get long COVID. The recent estimate I saw was 5.8 million children. Now, here's for perspective, and this is a trick question because why would you know the answer to this? But do you know how many people or how many children have asthma? The number is 4.9 million kids have asthma. And I can pretty much guarantee you that any provider who sees children, sees kids with asthma. If you're seeing kids with asthma, you're seeing kids with long COVID.
Haylie Pomroy: Wow, I never put it in that perspective. 10% to 20% of kids that got COVID are having long COVID or the population, but 5.8 million children. And every pediatrician, I hope to God, every pediatrician out there is super versed in pediatrics.
Dr. Melanie Hoppers: Oh, you are so hopeful.
Haylie Pomroy: Would you say that every pediatrician out there is super versed in pediatric ME/CFS?
Dr. Melanie Hoppers: Absolutely not. Sadly, tragically, no. I would say, I'm doing a Pediatric Echo in November, and I've spent a lot of time trying to listen to other people who've lectured, trying to listen or read all the papers I can, just to make sure I'm up to date on everything. And there just is nothing. There's very, very little. Even the lectures, some of them, there's nothing to do. There's not, here's the numbers, here's what's happening. We need research, and here's what we do now. And we've got to get the message out about post-exertional malaise. At least, that has to be talked about.
Post-exertional malaise, it's kind of like an upside-down world. All my career, exercise helps most everything. We want people to move.
Haylie Pomroy: Absolutely. Because I wanna jump into that juicy conversation, and I wanna dissect PEM, really for our community, because there's a lot of questions about that. I'm just gonna stick with the kids, because I have you for a minute. I love that people are talking about pediatric health in general right now. I think with the food coloring and the food dyes and the toxins and people going after Kellogg as a company, I think we should be going after our federal government as a company so that they don't allow those toxins in our foods.
But one thing that we talk about in our community is if you're not sure what toxins are in your foods and you're trying to seek out foods to have in a good example, go towards anything that's being marketed towards children right now, which puts the immune system in a more vulnerable state. I feel like there's kind of this massive pediatric need right now. And so we need to pull in all the assets that we can to get kids healthy or resilient again, but it's really shining a light on these toxins and specifically with ME/CFS, these neurotoxins that are bombarding kids.
I kind of feel like these two conversations are converging at once. Do you feel like pediatricians are starting to look at the children that are sick's ecosystem and say what's going on in their world? What are the stressors? Or are they just kind of saying, okay, oops, now we have a ton of ME/CFS kids or long COVID kids, how do we treat? Are they looking at why at all, do you think?
Dr. Melanie Hoppers: I guess it depends on who the pediatrician is. You know, I hope so. I hope so. I don't want to be negative. I don't want to come out of the gate negative. I hope so.
One of the things I get asked is, how do I approach my caregiver? How do I approach my pediatrician? And I hate the question. And the reason why I hate the question is I am embarrassed. I'm embarrassed to tell you the things that I think you need to do because it's just ridiculous.
You shouldn't have to figure out how to tiptoe around your provider and ask for what you want. And I hate the word provider. Collaborator is a better word because people don't know what I'm talking about. I think language is important. But the person who is working with you on your health needs to listen to you. You know yourself best, especially people with ME/CFS and long COVID who've been dealing with it for a while. If they tell you, this is not in my best interest, work with them. That's important.
Haylie Pomroy: Hi, it's Haylie Pomroy, your host. I've written six New York Times bestselling books on metabolic pathways. And my latest book, Toxic Overload, tells you exactly what to do when your body's overburdened.
If you go to hayliepomroy.com/book, for a limited time, you can download a digital copy of this book completely free. That's hayliepomroy.com/book. Grab your free copy while supplies last. Now back to our show.
And I just think of all the moms right now that are at least what we hear in our community that are being gaslit for lack of a better term about trying to seek care for their kids sometimes. It means the world to me that you would say what you just said about it's embarrassing that we have to tiptoe around our providers because it gives us permission.
And Dr. Klimas is really good about this with us. My daughter was in the hospital, and I called her. I have so many wonderful friends. I was at UCLA.
I love UCLA. And we just got a bad seed. I don't know what else to say.
And I called Klimas, and I'm in tears, and it's my baby, and she's in the hospital. Klimas says, fire her tomorrow, like now, do it now. Ask for another hospitalist.
And I know that. And I did. And we had the most amazing experience with the next practitioner that came in. But we, as people that are struggling or in crisis health situations, we need permission from exceptional physicians like yourself to say that we deserve and our kids deserve exceptional care. I appreciate that.
Dr. Melanie Hoppers: You absolutely do.
Haylie Pomroy: Our community, I got chills when you said that. I appreciate that. I just wanna thank you for being an incredible doctor, but also an educator because our community loves it.
Give me some of the insider practical tips that we can do walking in. Let's say a mom has a kid with long COVID or ME/CFS or the mom themselves or the dad themselves or the college kid themselves is dealing with this. I love your printouts. That's why I love your printouts because they're indisputable. They're backed by massive institutes and phenomenal research. What's somebody gonna say? That is empowering in writing. How do you prepare for a visit?
Dr. Melanie Hoppers: One of the things, I thought about this a lot. One of the things is I like to tell the provider, okay, here's what my function used to be or here's what my child's function used to be. They were active. They were in sports. They were in extracurricular activities. And now my child is unable to attend school every day of the week. When she's home, let me be clear, on the weekends she is unable or he is unable to attend social activities.
Be clear. It's not just, I don't wanna go to school. It's here's how my life has changed. Because there's always the whole, oh, maybe they're depressed.
Well, I'd be depressed if my doctor said that to me when I felt like that. But that's not the cause of this illness. Let me be very clear. And one of the ways you can distinguish that is what would you like to do? If you felt good today, what would you do? A person who is depressed doesn't wanna do anything. A person who's not has a list of things they'd like to do.
Kids of eight don't, and again, it goes back to the provider. If the provider would read and understand about the disease, they'd easily see this is very different from anything else. But that's what's hard about it is it's a phenomenon that doesn't occur in other illnesses. It's very different. We didn't learn about it in medical school. But again, I try to go into the room, I always believe my patient, always. Why would they make something up? Just believe them. And if you go in with that attitude, you're gonna come out learning a lot.
Haylie Pomroy: I love what you said. We were traveling and one of the other adults' parents was talking about their 12-year-old. And I mean, this kid is high-functioning, played every sport, did every musical instrument, and just tanked after COVID and spiked pseudo fevers. I mean, when they were telling me about it, I'm going, Mac's like a duck. It calls itself a duck. It eats duck food. You know what I mean? Like everything, boom, boom, it's a duck, yeah.
But the physician that they were with was talking about telling the mom she was a tiger mom, as she just pushed her Type A kid too far. She was type A. She now pushed her Type A kid. She needs antidepressants. They need to not let her play, have her phone; it's social media. I mean, the parents were like, fine, we'll do counseling. We'll do this, we'll do this. And I said, has she had any kind of a metabolic workup at all? Have they even pulled labs? Have they done orthostatic blood pressure testing? And the post-exertional malaise, which I want to jump into because it's such a judgment call for us adults, but it just breaks my heart with the peds. And we, fortunately, we were able to get her into a doc at INIM and I'm like, can you please see her? And they came down, and it was like every lab, like there wasn't a box that wasn't checked. And it doesn't mean that everybody's that way. But kids are sometimes more expressive in their symptom profiles. That's why kids get such big spiky fevers. And when they vomit, they projectile. Kids are more expressive. A lot of times adults, whether it's social, we hold back our symptoms, or it's just that our body, our immune system, is a little more mute as we get older.
But if you will, like the post-moves, we want kids, get them out, get them active. And that was the other thing is this was a female child. She was starting to also gain a little bit of weight, and the doc was harping on them to exercise.
And this is where it hit it for me, for the mom. And the mom was crying, and she said, look, when we go out and bike ride as a family, she is in bed for three days after. And swollen glands and achy joints. And they were telling the kid it was in her head. They were telling the mom it wasn't. The mom was projecting on them.
Dr. Melanie Hoppers: I would have probably wanted to projectile.
Haylie Pomroy: Yeah, you're right. You're absolutely right. Will you talk us through that post-exertional malaise? And again, I feel like in us successful Type A women, it's such a mind you know what? And in our peds, it's tragic. Explain to me what physiologically happens in the body. People tell me, you get tired after your exercise. I get it. I do too, push through it. What's the difference? Why is that not the case? And I know I probably just raised every hackle you've ever had.
Dr. Melanie Hoppers: No, so actually the definition of post-exertional malaise is a worsening of a patient's symptoms and level of functioning, following even small amounts of exertion or certain triggers, okay? And it can brain stress sometimes. Yeah, oh, absolutely. It can be physical.
I mean, here's the thing. Everything you do requires energy. If you write a paper, that requires a lot of energy. That uses a lot of glucose. When you do physical things, of course, and for some people, a physical stressor who has ME/CFS, it may be a walk around the block, but another person, it may be, I got up and walked to the bathroom, and that's enough of a stressor for them. But it's also like sensory input.
When you're in a room with bright lights, you're having to absorb that, and your brain is taking that information and processing it. The sounds that you hear, environmental stressors, like you said, toxins, or a busy environment can be a stressor. And I say stressor, but it's an energy consumer. And so everything takes up energy.
Well, a person with ME/CFS, long COVID, and not all people with long COVID have ME/CFS, but many of them do, okay?
Haylie Pomroy: And they're very similar symptoms, even if they're not false diagnosed.
Dr. Melanie Hoppers: It's kind of like the subset that's more severe are the ones who have ME/CFS, if you meet criteria. And one of the criteria is that you have to have post-exertional malaise. If you have post-exertional malaise, I would contend that most likely you're going to meet the criteria for ME/CFS.
So if you have this crash afterward, if you have this situation where everything gets worse, where all of your symptoms get worse, you may develop new symptoms, you're exhausted, fatigue is in there, but that's not the only thing. It's not just I'm tired, it's I'm tired, and my legs hurt, and my head is killing me. And I literally can only maybe crawl to the bathroom. If there was a fire, I don't know if I could get out of the house. Literally, their body has consumed all of the energy it can produce. The mitochondria cannot produce more. And so they're in an anaerobic state. They're unable to produce energy properly.
Haylie Pomroy: I love what you just said when you brought it back to energy. Because I think sometimes, at least in our community, I get a lot of feedback that energy sometimes is willpower. or thought.
Dr. Melanie Hoppers: Well, is it willpower if you're out of gas? It won't start if I just try harder. It's gonna start this time, no?
Haylie Pomroy: Exactly. I love that you brought it back to the physiology of the body, that we actually generate energy. And you talked about mitochondrial exhaustion and mitochondrial fatigue, and this is measurable in these patients. And it can have degreeing levels. Sometimes it can be a person, it's so hard, I feel like, we were just talking to a disability attorney the other day, and he was saying part of the problem is that he was talking about this one client that was a super high power functioning attorney, and her 50% still runs circles around people, but she's at 50% of what she normally had the capacity to do before her immune system was out of balance or had dysautonomic or had the inability to kind of rebound.
Do you have a specific strategy when we're trying to build people up in this process? Like, I'm all about food. Before we started, you talked about downloading Nomato sauce, this non-tomato-based pasta sauce. Like, my thing is always like, okay, what's the problem? Let's find a solution. If you can't have tomatoes, let's make Nomato sauce. If you can't have gluten, let's make gluten-free. Yeah, amazing stuff. Let's find that. You guys are so good at helping patients. The diagnostic is so incredibly important. The validation is life-saving, in my opinion. But you also turn patients around, and that's what's really cool. How do you build a person or begin to build a person with post-exertional malaise?
Dr. Melanie Hoppers: Okay, well, so post-exertional malaise is, the more you're in post-exertional malaise, and a particularly severe episode of post-exertional malaise can cause lasting damage, permanent damage. And it can slowly cause you to lose your baseline. Remember, your baseline is the activity level that you can perform without feeling ill. Okay, that's your baseline. That's kind of your energy envelope. Well, I want you to stay in that energy envelope. I'm not trying to, no matter what you do, you can't make your mitochondria do what you want them to do. Now, you're gonna make it worse if you push past that envelope. You're gonna be much worse. But if you stay in the envelope, there is some potential that you could have some improvement.
It's not guaranteed, but it's possible. But you're not gonna be able to like, oh, let me exercise five minutes today. Tomorrow, I'm gonna exercise six.
Tomorrow, I'm gonna exercise seven.
Whatever your limit is, is probably going to stay at that limit. It's not like you can just keep willpowering yourself and pass. It's like me. I can lift so much weight. There's no way I'm ever going to be able to bench press 200 pounds. Even if I start with one pound and go up a pound a day, there's gonna be a limit where I can do no more.
Haylie Pomroy: And that's your personal best. That's your personal best. And so, if we as a community kind of set down with people that are dealing with this and we help them to define, I loved the way you said it, because I've heard the envelope. Stay within your envelope, and when you're in your envelope, that's the best potential for healing, too. When you're outside of your envelope, the body has to deal with that hormetic stress or that stressor that lives outside the envelope, heal from that, and heal from what puts you in an envelope in the first place. So, when you said create an activity level that you can perform at without feeling ill, do you guys do any, like we have a gentleman in our clinic that does testing to look at oxygen and mitochondrial activity. Is there a way to know, or do you do a symptom personally? Do you do that as a community , what kind of our symptom? Like what level do you do and feel good?
Dr. Melanie Hoppers: So, pacing to me is really individualized. You can do CPET testing. Most people don't have access to that. A CPET test can harm a patient. There's some modified protocols and this and that, but that's not something I order. And I'm not saying it should never be ordered. I'm just saying that's not something I do.
But we talk about pacing and we talk about staying within our energy envelope. There's different ways to do that depending on the person. Some people, like I have some patients that really like something to follow. They want a number. I had a patient who has a watch, and there's different ones; there are different apps and things like that. And I'm not gonna try to tell people which one to go to, but she had one that gave her activity points.
And this was actually a watch that they want you to get more points, but she learned if I get 30 points and I stay at 30, I'm fine. If I go over 30, I'm in trouble. She would watch that.
And she said, some days at 9 a.m., I was at 28 points, so I knew, and she was disciplined and she was lucky enough. I guess lucky is the word. I don't know what the right word is, but she was retired, and she had a very supportive family. When she was at 28 at 9 a.m., it was okay. She got to sit down, recline, put her feet up, and rest. Now, unfortunately, everyone can't get the disability that they need. Everyone doesn't have a supportive family. That's hard. When I say these things, I wanna put that out there so people hearing this, I don't want them to go, well, that's pie in the sky, cause I get that for some, you have to figure out some other things for other people.
But she used that. She used wearables. She had a number, an objective piece of information. We can also use heart rate. We can use your resting heart rate.
And what we do, the way we determine your resting heart rate, is every morning before you get out of bed, you check your heart rate. Do that on seven good days. Now, don't do it on a crash day. Don't do it on a bad day, but on seven good days, get that number. You wanna average it up. Let's just say it's 60. Your average heart rate is 60, and you know that. Now, every morning you check that heart rate.
If you're 10 above, so that would be 70 or more. If you're 70 or higher, or if you're 10 below, so again, that would be what I say, 60. That'd be 50. If you're below 50 or above 70, your average is 60, then that's a day where you better say, uh-oh, I need to back off. I need to take some rest time. I need to really watch what I'm doing so I don't go overboard. That's a signal for you.
Haylie Pomroy: That number is your resting heart rate. You take seven good days. You take that average, and you use that as kind of your template to say—
Dr. Melanie Hoppers: That's kind of your guide. That's right.
Haylie Pomroy: If I wake up and my resting heart rate is 78, then I go, I'm gonna have to be more gentle with myself.
Dr. Melanie Hoppers: Cautionary.
Haylie Pomroy: Cautionary, yeah. And also put things in place. Let my support world know. I love that. I'm a numbers girl. I appreciate that. My mind gets distracted in tasks.
Dr. Melanie Hoppers: I can do a little bit more.
Haylie Pomroy: Overwhelming. Yeah, to-do list that if I don't have something to measure, that's hard for me. When a person goes throughout the day, is there any indication that a person can preempt crashing? Like, is there any techniques that you can help us with that? Because so many of our clients or my clients will say, I'm crashed, I've tanked, I've crashed, I've hit a wall.
And I'm like, I wish we could have talked to you before then, hydrated you, given you some food, had you put your feet up, put compression stockings on, all of those things preemptively.
Dr. Melanie Hoppers: Well, there are a lot of things. One is, again everybody's different in what they're able to do, but scheduled rest breaks. That patient I told you about, she was really cool. We had done some things, and she had had improvement, and she was much better than when she started out, but she said I wanna feel a little bit better. And she decided to focus on pacing. I use her as an example a lot.
One thing she did is, and she was pretty much homebound, okay? She could do things around the house, piddle around the house. She really didn't do much outside of the house, okay? That was her baseline. And so she would, on Wednesdays, that was a rest day. Every Wednesday, rest day. Every other day, she'd have a morning break and afternoon break, and like an evening break. Like 20 minutes where she'd lay down, recline, put the the cold compress across her face, put some compression boots on and just breathe. Turn off the sound turn the lights down, all the things. She had scheduled rest breaks. She also, like I said, would take Wednesday off. That was one of the things that she did.
Now I've had other patients, again, and again, some people, the numbers will drive them bonkers. You have them like, okay, here's my heart rate. And now they're like constantly looking at it and they're always anticipating that alarm going off. Some people can't do this, and I completely understand that. But for some people, you can take that resting heart rate and WorkWell Foundation, which is a great resource, says to add 15 to it and use that as kind of a warning sign. That's hard, okay? Because if you're resting heart rate 60, at 75, that alarm's gonna go off and you're gonna say, okay, time to rest. Well, some people would never get out of their bed. They turn over, and they're up that much. That's kind of hard, but some people will use a heart rate of 120, but just something kind of limited, put an alarm on so that when that number goes off, you go, huh, let me be mindful here.
It's time to take a break. It just is kind of a reminder.
Haylie Pomroy: Hi, it's Haylie Pomroy, your host. When I was going through my health crisis, the worst part of it was feeling lost and alone. And I decided that I didn't want anybody else to feel as desperate as I did. That's why we set up a private membership group where you can come in, ask questions, get support, be connected with people that can actually help you on your health journey.
If you go to hayliepomroy.com/member, you can join me for 30 days for free. I'll see you there. We can jump in, and we can start to organize the path for your wellness. That's hayliepomroy.com/member. I will see you there. Now, back to our show.
Oh, I love it. I just to loop into that. We train fast metabolism coaches.
And one of the things that we talk to them about is data collection. Success leaves clues. And also, it's kind of like if you have a curve on a road where you're gonna come around the corner and there's deer, they put up a sign. That says deer crossing so that people are cautious or more aware or blind corner.
And so with our coaches, we talk a lot about measuring those changes in resting and active heart rate to give an indication of the resilience of a person's adaptability. And we do that in fitness.
Why we wouldn't do it in wellness, I'm not quite sure, but our coaches and I'm a huge advocate for it. In fitness, right, when we're taking people, and we're going longer and further in marathon-type settings, or when we're trying to do burn fat and we're looking at 135, 145 beats per minute for 45 minutes sustained, like we all wrap our heads around that.
Medically, professional football teams, like it's all accepted. It's super cool to see you and your practice in general looking at how the body adapts to life's stressors as an indicator of the medicinal approach to pacing. I think that's just genius. Like we do it in high-performance athletes. Why wouldn't we do it when the body has just as much demand to get well? Yeah, so I love numbers, but I also love that you're bringing that into helping the patient, like just leaning into what's going on in their body a little bit.
Dr. Melanie Hoppers: And see, they can also start to, a lot of it is paying attention. You hear the alarm go off and you go, how am I feeling? Oh, wait, I'm a little bit short of breath. Maybe my chest is a little heavy. Maybe I'm feeling a little brain foggy. Maybe it wasn't super obvious, because I mean, if you have brain fog, how do you know you have brain fog. It gives you that reminder, oh, wait, something's not right. Now you start to clue into those symptoms, and you don't necessarily have to wear the alarm.
And again, it depends on the person because some people are not aware of their symptoms. I'm aware of every single thing. I have a little, oh my goodness, this could be the end. I have a little bump on my finger. And then other people can walk around with a limb half off, and they don't notice. It just depends on the person. But the other thing, too is finding ways to conserve your energy. And I know I've said this a hundred times, and I don't wanna repeat things, but use a shower chair, ask your provider for a handicap, or I call them accessibility stickers, and then nobody knows what I'm talking about. But the placard that lets you park in front, okay? If you cook and you can freeze some meals for later, I'm trying to think of all the things. When people come to the doctor's office, I try to accommodate for them. When you go to the doctor, get a later appointment if possible. Ask if you can sit in the car till it's your turn.
Haylie Pomroy: We have reclining chairs. Our lighting, we're very sensitive to our lighting. Our goal with our patient, the time is so valuable that we have that face-to-face with them. We want to conserve, probably in a way selfishly, but on their behalf, we wanna conserve all the energy we can and for full stressors so that we can get a really good story and detailed intake of what's going on. And we can collect data to make appropriate shifts.
Dr. Melanie Hoppers: You don't want them to pay for coming to see you.
And pay with the crash. And I also want them to see, I find this extremely important for you to pace. I'm not just telling you something to do. I'm participating in it with you. And so I think that's really, really important.
Haylie Pomroy: I'm gonna circle it back to kids for a minute. We actually did two podcasts with attorneys that helped individual with disability where the cases are making an impact. The resolution isn't there and they're needing to figure out a way to put themselves in the envelope so that they can start to get as healthy as they can get. How do we deal with kids and development? There's so much science around exercise and activity for all of us as being the vehicle to getting well and being well.
How is that dichotomy of, but wait a minute, PEM is a major cornerstone of this syndrome. How do we reconcile that in the pediatric world? I mean do we tell our kids to lay down? What are you seeing? Because we're in a crisis over here, like clinically. We're going how do we support these kids? And we had a kid, the mom says I lay down and give them their iPad, and they watch YouTube. I go, no. Stimulus, stimulus, stimulus, stimulus. You know what I mean?
Dr. Melanie Hoppers: Exactly, exactly. I mean, it's really hard, but at the end of the day, if they're experiencing PEM, that's not good. I mean, that is detrimental to their health. And yes, sure, do I want our kids to exercise? Of course I do. But if they're in PEM, no, that's harming them. PEM supersedes the benefits of exercise.
Now, I was talking about this earlier with somebody, and again, I work with patients. I'm not the ultimate, here's what we're gonna do. It's the only way to do it thing. But I have a patient who it's very important for her to exercise some. And she said it's for her mental health. She needs it. And she will sacrifice other things so that she can have a 20-minute session once a week. And it's reclining exercise. She takes breaks in between, and I'm very nervous about it but she does that, and that's what she needs to do. And if that's what she needs to do, then that's certainly her prerogative. And so I try to guide her in a way to make it where it's not harmful to her as best I can.
With kids, it's hard because kids don't get to make decisions. I mean, it depends on what age they are. If they're 16, they're a little bit more independent. But when you're 10, and someone says to you, you need to get up and go to school, and their body is telling them, no, I don't need to get up and go to school. I need to stay home. And they say that, they verbalize, I don't feel well, whatever. And they get sent to school anyway. They're not in control of their pacing. I think we have to be really, really careful that, again, why we need to get the message out, because it's harder for kids to be autonomous. They're in a place every day for eight hours where other people are in charge of their schedule, in charge of them. And they don't even know that they're harming them. Just like that pediatrician you said, was telling them to exercise. She was harming them. I'm sorry.
Haylie Pomroy: No, no, I appreciate you saying that. And that brings me right back to where we started, which is the education. Because if you define bullying. I do believe that this pediatrician was doing the very best with the knowledge base that they had. I get upset and there's a responsibility. If you're going to care for kids, you need to learn what's going on with kids. And when you tell me that we've got 5.8 million children with ME/CFS or long COVID, it would be as derelict as a pediatrician not understanding asthma. Saying, well, gosh, I told him just hold your breath and do deep breathing, and that's going to cure your environmental-based asthma or whatever.
I do think like, now we know the science is there. You've got to get educated, and we've got to change the medical curriculum, period. Because this is what we're dealing with. There's no way around it. 5.8 million kids or 5.8 million people, are not suddenly going to some cure is going to fall out of the sky. Like if they're seeking medical care, the physicians have to be versed in the disease that warrants the medical care. I mean, again, we get in the community. I talk to the people, the moms that are just furious and frustrated, or we have right now a mom that was diagnosed with ME/CFS, and there's some genetic components that people talk about, not methylating it. There are all these theories. She had three incredibly robust children. One of them has just tanked after COVID. And genuinely, the pediatrician talked about do you think that because you've experienced this, maybe they're having mirroring behavior emotionally because they're trying to create a closeness with their mom that's struggling in their health?
Yeah, you're not surprised. You're not surprised because you live it. You live it. We always say we believe you. I love that you said that. How does one find doctors like you? Are you guys seeing patients in Tennessee and Utah? Do people fly in? How can they get this kind of care? Do you guys see pediatrics?
Dr. Melanie Hoppers: I do. And it's hard because everybody can't. Everybody can't travel. And we are working so, so hard at the Bateman Horne Center with Tahlia Ruschioni is our fearless leader on education. And we're trying our best to get this information out there. Just that's working nonstop to do that. And it's there. If the pediatricians will just look, there is information out there for them.
Haylie Pomroy: But moms and dads can go to your website and download it too. We'll post it. We'll post your guys' link and make sure. If your doctor isn't versed or educated in this—
Dr. Melanie Hoppers: If they're open, there's information.
Haylie Pomroy: Yeah, well, and you know what? If they're not open—
Dr. Melanie Hoppers: If they're not open, ditch them. But to be truthful, it's sometimes hard. There are sometimes people who are in situations where there's only two people in their town. If they are lucky enough to have it. You've got to figure out what it is. If you're lucky enough to be able to ditch them and get one who is willing to listen, fantastic. If not, there's resources. If not, God, this is horrible, but they have to read about PEM and learn how to pace themselves.
But it becomes difficult because with kids, see, here's one of the problems too, schools.
Haylie Pomroy: Yes. The most bullying P.E. Teacher is the one with the kids. You're soft, you're weak, get over it.
Just the peer pressure. The peer pressure from the adults, okay? I'm talking about peer pressure from kids. I'm talking about the peer pressure from adults. And even when given accommodations for the child, sometimes they're not followed. I wish I knew the answer to that. Maybe have somebody on who can give the answer to that. That makes me want to be —
Haylie Pomroy: The only reason we built our community, we have an online community, was because I just felt like, so we have this request for care, which is a letter that we help our community prepare before they go into a doctor's office. And it's how to lay it out, how to line it out, if you need to pull a white paper, if I need to pull resources from your clinic, how to pull it together so you present yourself with a package that you at least hedge your bets to get some decent aspect of care. And I also say, when you find a good doctor, and that doesn't mean that they can cure 5.8 children. It means that they're open, they're receptive, and then they're on your team. That is the definition. They have empathy. Shout them out.
We sign books and send hundreds of books to doctors all the time that are advocates for being healthy, using whole foods, falling in love with food, creating a healthy relationship. Like, when we find doctors that say, that's great, then we just say, thank you. Thank you, and we write notes. Thank you for being an advocate for this patient. And we do that, and we collect individuals like yourself that are out there breaking down barriers. We are in a crisis situation, in my opinion, with autoimmunity, ME/CFS, chronic fatigue, and chronic disease in general, and it's gonna take people like yourselves continuing to shout it out. And I just really appreciate you coming on our podcast because our community just loves what you give them permission to do, education to go forward with, and like a plan. They don't feel like they're without hope. I cannot thank you. We have a massive population at this point, and I know that you're making an impact one-on-one with every patient that has the privilege to see you, but I love that you're able to help our community because they need it really bad right now.
Hey, this is Haylie Pomroy. And right now we're gonna transition into our Q&A portion of the podcast. And you'll notice that we have live viewers asking us questions. They're my Fast Metabolism members, and they get all kinds of amazing benefits, like member discounts on my world-class supplements and shakes, every product, every day, personalized guidance and support from myself and my team, and even the ability to ask questions of our podcast guests. If you have questions and wanna get them answered, you should absolutely join my membership. And if you go to hayliepomroy.com/member, you can join for free for 30 days. Again, that's hayliepomroy.com/member and join for free for 30 days. I can't wait to see you there.
Dr. Hoppers, I know what's gonna happen. This is gonna go live. Everybody's gonna ask more questions. Please say you'll come back.
Dr. Melanie Hoppers: Absolutely. Thank you for having me.
Haylie Pomroy: Thank you for being here. And you guys, make sure you go to the website, download your information. I suggest going to Utah or Tennessee personally because people come to see us all the way in Florida, and there is just such a difference in outcome when you finally get the care you deserve, and you deserve it. Everybody's out there. You deserve to be treated with the utmost respect, the most forward-thinking science, and all the support that is possibly accessible. Dr. Hoppers, thank you for being here. We are all healthier because of you, so I really appreciate you.
Dr. Melanie Hoppers: Thanks for doing this.
Haylie Pomroy: We'll talk to you soon.
Dr. Melanie Hoppers: Okay, bye-bye.
In today's episode, Haylie Pomroy welcomes back Dr. Melanie Hoppers of the Bateman Horne Center for a deep dive into post-exertional malaise, or PEM, the defining feature of ME/CFS that turns the conventional wisdom about exercise completely upside down.
Dr. Hoppers explains why pushing through fatigue can cause lasting and sometimes permanent damage in patients with ME/CFS and long COVID. She breaks down what PEM actually is at the physiological level, how mitochondrial exhaustion limits the body's ability to produce energy, and why willpower has nothing to do with it. She also shares practical, real-world pacing strategies, including resting heart rate tracking, scheduled rest breaks, and how to stay within what she calls the energy envelope to protect the body's potential for healing.
If you or someone you love has been told to just push through it, this episode will change how you think about energy, healing, and what your body actually needs. Tune in to Fast Metabolism Matters.
If your body feels like it's running on empty, overburdened, or just not responding the way it used to, Haylie's latest book, Toxic Overload, tells you exactly what to do. Download your free digital copy today and start understanding what your body is trying to tell you.
Free Download: Get Your Copy of Toxic Overload 👉 https://hayliepomroy.com/pages/toxic-overload
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Dr. Melanie Hoppers is a practicing physician, board-certified in internal medicine and pediatrics. Dr. Hoppers completed her Bachelor of Science degree in Biology at Union University in Jackson, TN, and attended medical school at the University of Tennessee College of Medicine. She completed a dual residency in Pediatrics and Internal Medicine at the University of Tennessee at Regional One Medical Center and LeBonheur Children’s Hospital in 1997.Prior to joining BHC in March 2024, Dr. Hoppers practiced at the Jackson Clinic until 2007, when she cofounded Physicians Quality Care, a multi-faceted clinic providing urgent care, primary care, occupational health, and physical therapy to patients in West Tennessee. The clinic now has two primary locations and several onsite occupational clinics as well as a mobile unit that provides occupational health onsite. Beyond her clinical practice, Dr. Hoppers is actively involved in numerous clinical research projects, furthering medical knowledge, and striving to improve patient outcomes. Her contributions to ongoing research initiatives underscore her dedication to advancing the field of medicine.
LinkedIn: https://www.linkedin.com/in/melanie-hoppers-939a00279/
Haylie Pomroy, Founder and CEO of The Haylie Pomroy Group, is a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience, she has worked with top medical institutions and high-profile clients, developing targeted programs and supplements rooted in the "Food is Medicine" philosophy. Inspired by her own autoimmune journey, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is a New York Times bestselling author of The Fast Metabolism Diet.
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Transcript:
Dr. Melanie Hoppers: Your baseline is the activity level that you can perform without feeling ill. That's your energy envelope. Well, I want you to stay in that energy envelope. No matter what you do, you can't make your mitochondria do what you want them to do. If you push past that envelope, you're gonna be much worse. But if you stay in the envelope, there is some potential that you could have some improvement.
Haylie Pomroy: I wanna welcome everybody to the Hope and Help podcast, where we talk about science and science-based tools for fatigue and chronic illness. I'm your host, Haylie Pomroy. I'm a #1 New York Times bestselling author of the Fast Metabolism Diet, a leading health and wellness expert, and I'm also a PhD student, guys, in neuroimmunology. That's right, I'm back in school again. I am a fierce advocate for those in need of a little bit of help and definitely some hope. Today, I have a super special guest.
You have met Dr. Hoppers in the past. We had such an incredible response from you guys, and there were so many questions that our community was asking us that I asked her and asked her to please come back and talk to you. Dr. Hoppers, thank you so much for being with us again today. It's just great to get a chance to monopolize your time a little bit on behalf of everybody.
Dr. Melanie Hoppers: Oh, thank you so much for having me. I'm really excited to be here and really excited to tell more people, talk about post-exertional malaise, and how it affects people. I think it's so important, and just having the opportunity is wonderful. Thank you.
Haylie Pomroy: Absolutely, and Dr. Hoppers, I know that you are practicing both in Tennessee and in Utah. Can you explain, just for everybody out there, we lean on you for advice and insight, but what have you been doing from a clinical perspective? Tell me a little bit about your practice.
Dr. Melanie Hoppers: Sure, so I started seeing patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), mast cell activation syndrome, orthostatic intolerance, POTS, long COVID, several years ago. But it was sort of like, it's never-ending in the fact that there's just not enough time, there are not enough slots for everyone who needs help. And I realized that I was chipping away at such a huge, monumental task and just not getting enough done. The Bateman Horne Center offered me a position there, and I realized I have a much bigger imprint when I work with them.
And so I worked for the Bateman Horne Center. Their mission is to provide clinical care for patients with these illness, but they also provide research and education opportunities. And what I especially love about the vision there is the educational portion is not just, it's great, it is toward patients, but it's also toward providers. And we try to think of it from a provider standpoint. We try to make it in bits and pieces that's digestible for the provider so that this chronic complex illness is not so overwhelming.
Haylie Pomroy: I'm just gonna really quick, the Bateman Horne Center, that's where you're practicing in Utah, correct?
Dr. Melanie Hoppers: Correct.
Haylie Pomroy: And what I just wanna bring up, so when I'm at NOVA at NSU we're part of a medical school. We're part of the osteopathic medical school. And whether it's with Dr. Klimas at the Institute for Neuro-Immune Medicine (INIM) or when we're engaging in education at the medical school, one of the biggest things and how we lean into you guys is educating the doctors that are coming up and rewriting clinical care standards for the doctors that are currently practicing. You kind of play in both of those roles, correct? You're advocating for patients, but you're also physically seeing patients and you're helping us get some of the medical curriculum just not archaic for these kinds of disorders.
Dr. Melanie Hoppers: Correct, correct. And that's one of our goals right now is we're trying to figure out how to get this into the medical school curriculum, because it's not. We have several projects in play right now where we're working on that.
But in addition, we have things like, for instance, we have what I call one-pagers that we've developed that we take several different topics like post-exertional malaise, or even low-dose naltrexone, we have one page. Every sentence is good information. But it's one page. Let's say you have a provider and you think you have orthostatic intolerance, but maybe your provider isn't well-versed in the fact that, oh, a person with long COVID should be checked for this. Well, you can take them to one-pager and say, hey here's something for you to look at that might be helpful for them. Or for providers that are actually looking for information, they can go to our website and find it.
Haylie Pomroy: Dr. Hoppers, you just said something, and it was one of the questions that our community wanted to talk about, which is how do we talk to our practitioners? How do we educate ourselves? There's just this hierarchy in medicine where a lot of people, I'm not. I've fired doctors that don't serve my family or serve us or are on the team that we can all be in collaborative service together a lot. But that's because of the struggles that I've been through and what I've come through from a successful health victory. But when I'm seeing these clients that are not well, that are struggling, that are stressed, they have a difficult time. Two things I wanna give people that are listening right away is, you talk about a one sheet. There are volumes, thousands and thousands of incredible papers that have been published with research with ME/CFS and now long COVID. But you guys have condensed that knowledge into very digestible stuff. Where can someone that's listening to this go to download that?
Dr. Melanie Hoppers: Our website is www.batemanhorncenter.org.
Haylie Pomroy: Will you spell that for me? My dyslexia; I'm not the only one in the world.
Dr. Melanie Hoppers: No problem. And let me make sure I spell it right. Okay, it's B-A-T-E-M-A-N-H-O-R-N-E-C-E-N-T-E-R.org.
Haylie Pomroy: Okay, thank you.
I wanted to get that out of the way because we're gonna talk about a lot of subjects today, and we're gonna fly through these fast because we were just peppered with interest and need after you were on last time. But I wanna make sure that people know that they can go and grab these resources really quickly so they can get up to speed, but also communicate with their physicians.
Your background, which has always been super fascinating to me, but you've got a lot of background in peds and pediatrics. And right now, I mean, it was just on the cover of National Geographic. It's been on the cover of Time Magazine. Our youth, our kids, our babies, right, are dealing with things like POTS and post-exertional malaise.
And can we just talk a little bit, and I think you're the right person for me to ask this to, what in the world is going on with our kids?
Dr. Melanie Hoppers: Well, I mean, it's numbers. Before the pandemic, there were maybe 1 to 300,000 children with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). These are typically post-viral or post-infectious cause or trigger. Not all.
Haylie Pomroy: Like mono?
Dr. Melanie Hoppers: Mono, giardia, and enteroviruses, whatever virus of the weak flu can do it. Even head trauma surgery can do it. It's not the only thing, but —
Haylie Pomroy: We saw a pediatric football player with a concussion. We've seen families that have mold in the house. There's some sort of negative hormetic event that triggers the immune system to go into this dysfunctional state. But kids were more resilient, or what's going on since COVID?
Dr. Melanie Hoppers: Well, COVID is just a lot of people got exposed to a virus they hadn't been exposed to before. So many people have gotten infected, including children, and children are not immune to long COVID.
About 10% to 20% of those that are infected get long COVID. The recent estimate I saw was 5.8 million children. Now, here's for perspective, and this is a trick question because why would you know the answer to this? But do you know how many people or how many children have asthma? The number is 4.9 million kids have asthma. And I can pretty much guarantee you that any provider who sees children, sees kids with asthma. If you're seeing kids with asthma, you're seeing kids with long COVID.
Haylie Pomroy: Wow, I never put it in that perspective. 10% to 20% of kids that got COVID are having long COVID or the population, but 5.8 million children. And every pediatrician, I hope to God, every pediatrician out there is super versed in pediatrics.
Dr. Melanie Hoppers: Oh, you are so hopeful.
Haylie Pomroy: Would you say that every pediatrician out there is super versed in pediatric ME/CFS?
Dr. Melanie Hoppers: Absolutely not. Sadly, tragically, no. I would say, I'm doing a Pediatric Echo in November, and I've spent a lot of time trying to listen to other people who've lectured, trying to listen or read all the papers I can, just to make sure I'm up to date on everything. And there just is nothing. There's very, very little. Even the lectures, some of them, there's nothing to do. There's not, here's the numbers, here's what's happening. We need research, and here's what we do now. And we've got to get the message out about post-exertional malaise. At least, that has to be talked about.
Post-exertional malaise, it's kind of like an upside-down world. All my career, exercise helps most everything. We want people to move.
Haylie Pomroy: Absolutely. Because I wanna jump into that juicy conversation, and I wanna dissect PEM, really for our community, because there's a lot of questions about that. I'm just gonna stick with the kids, because I have you for a minute. I love that people are talking about pediatric health in general right now. I think with the food coloring and the food dyes and the toxins and people going after Kellogg as a company, I think we should be going after our federal government as a company so that they don't allow those toxins in our foods.
But one thing that we talk about in our community is if you're not sure what toxins are in your foods and you're trying to seek out foods to have in a good example, go towards anything that's being marketed towards children right now, which puts the immune system in a more vulnerable state. I feel like there's kind of this massive pediatric need right now. And so we need to pull in all the assets that we can to get kids healthy or resilient again, but it's really shining a light on these toxins and specifically with ME/CFS, these neurotoxins that are bombarding kids.
I kind of feel like these two conversations are converging at once. Do you feel like pediatricians are starting to look at the children that are sick's ecosystem and say what's going on in their world? What are the stressors? Or are they just kind of saying, okay, oops, now we have a ton of ME/CFS kids or long COVID kids, how do we treat? Are they looking at why at all, do you think?
Dr. Melanie Hoppers: I guess it depends on who the pediatrician is. You know, I hope so. I hope so. I don't want to be negative. I don't want to come out of the gate negative. I hope so.
One of the things I get asked is, how do I approach my caregiver? How do I approach my pediatrician? And I hate the question. And the reason why I hate the question is I am embarrassed. I'm embarrassed to tell you the things that I think you need to do because it's just ridiculous.
You shouldn't have to figure out how to tiptoe around your provider and ask for what you want. And I hate the word provider. Collaborator is a better word because people don't know what I'm talking about. I think language is important. But the person who is working with you on your health needs to listen to you. You know yourself best, especially people with ME/CFS and long COVID who've been dealing with it for a while. If they tell you, this is not in my best interest, work with them. That's important.
Haylie Pomroy: Hi, it's Haylie Pomroy, your host. I've written six New York Times bestselling books on metabolic pathways. And my latest book, Toxic Overload, tells you exactly what to do when your body's overburdened.
If you go to hayliepomroy.com/book, for a limited time, you can download a digital copy of this book completely free. That's hayliepomroy.com/book. Grab your free copy while supplies last. Now back to our show.
And I just think of all the moms right now that are at least what we hear in our community that are being gaslit for lack of a better term about trying to seek care for their kids sometimes. It means the world to me that you would say what you just said about it's embarrassing that we have to tiptoe around our providers because it gives us permission.
And Dr. Klimas is really good about this with us. My daughter was in the hospital, and I called her. I have so many wonderful friends. I was at UCLA.
I love UCLA. And we just got a bad seed. I don't know what else to say.
And I called Klimas, and I'm in tears, and it's my baby, and she's in the hospital. Klimas says, fire her tomorrow, like now, do it now. Ask for another hospitalist.
And I know that. And I did. And we had the most amazing experience with the next practitioner that came in. But we, as people that are struggling or in crisis health situations, we need permission from exceptional physicians like yourself to say that we deserve and our kids deserve exceptional care. I appreciate that.
Dr. Melanie Hoppers: You absolutely do.
Haylie Pomroy: Our community, I got chills when you said that. I appreciate that. I just wanna thank you for being an incredible doctor, but also an educator because our community loves it.
Give me some of the insider practical tips that we can do walking in. Let's say a mom has a kid with long COVID or ME/CFS or the mom themselves or the dad themselves or the college kid themselves is dealing with this. I love your printouts. That's why I love your printouts because they're indisputable. They're backed by massive institutes and phenomenal research. What's somebody gonna say? That is empowering in writing. How do you prepare for a visit?
Dr. Melanie Hoppers: One of the things, I thought about this a lot. One of the things is I like to tell the provider, okay, here's what my function used to be or here's what my child's function used to be. They were active. They were in sports. They were in extracurricular activities. And now my child is unable to attend school every day of the week. When she's home, let me be clear, on the weekends she is unable or he is unable to attend social activities.
Be clear. It's not just, I don't wanna go to school. It's here's how my life has changed. Because there's always the whole, oh, maybe they're depressed.
Well, I'd be depressed if my doctor said that to me when I felt like that. But that's not the cause of this illness. Let me be very clear. And one of the ways you can distinguish that is what would you like to do? If you felt good today, what would you do? A person who is depressed doesn't wanna do anything. A person who's not has a list of things they'd like to do.
Kids of eight don't, and again, it goes back to the provider. If the provider would read and understand about the disease, they'd easily see this is very different from anything else. But that's what's hard about it is it's a phenomenon that doesn't occur in other illnesses. It's very different. We didn't learn about it in medical school. But again, I try to go into the room, I always believe my patient, always. Why would they make something up? Just believe them. And if you go in with that attitude, you're gonna come out learning a lot.
Haylie Pomroy: I love what you said. We were traveling and one of the other adults' parents was talking about their 12-year-old. And I mean, this kid is high-functioning, played every sport, did every musical instrument, and just tanked after COVID and spiked pseudo fevers. I mean, when they were telling me about it, I'm going, Mac's like a duck. It calls itself a duck. It eats duck food. You know what I mean? Like everything, boom, boom, it's a duck, yeah.
But the physician that they were with was talking about telling the mom she was a tiger mom, as she just pushed her Type A kid too far. She was type A. She now pushed her Type A kid. She needs antidepressants. They need to not let her play, have her phone; it's social media. I mean, the parents were like, fine, we'll do counseling. We'll do this, we'll do this. And I said, has she had any kind of a metabolic workup at all? Have they even pulled labs? Have they done orthostatic blood pressure testing? And the post-exertional malaise, which I want to jump into because it's such a judgment call for us adults, but it just breaks my heart with the peds. And we, fortunately, we were able to get her into a doc at INIM and I'm like, can you please see her? And they came down, and it was like every lab, like there wasn't a box that wasn't checked. And it doesn't mean that everybody's that way. But kids are sometimes more expressive in their symptom profiles. That's why kids get such big spiky fevers. And when they vomit, they projectile. Kids are more expressive. A lot of times adults, whether it's social, we hold back our symptoms, or it's just that our body, our immune system, is a little more mute as we get older.
But if you will, like the post-moves, we want kids, get them out, get them active. And that was the other thing is this was a female child. She was starting to also gain a little bit of weight, and the doc was harping on them to exercise.
And this is where it hit it for me, for the mom. And the mom was crying, and she said, look, when we go out and bike ride as a family, she is in bed for three days after. And swollen glands and achy joints. And they were telling the kid it was in her head. They were telling the mom it wasn't. The mom was projecting on them.
Dr. Melanie Hoppers: I would have probably wanted to projectile.
Haylie Pomroy: Yeah, you're right. You're absolutely right. Will you talk us through that post-exertional malaise? And again, I feel like in us successful Type A women, it's such a mind you know what? And in our peds, it's tragic. Explain to me what physiologically happens in the body. People tell me, you get tired after your exercise. I get it. I do too, push through it. What's the difference? Why is that not the case? And I know I probably just raised every hackle you've ever had.
Dr. Melanie Hoppers: No, so actually the definition of post-exertional malaise is a worsening of a patient's symptoms and level of functioning, following even small amounts of exertion or certain triggers, okay? And it can brain stress sometimes. Yeah, oh, absolutely. It can be physical.
I mean, here's the thing. Everything you do requires energy. If you write a paper, that requires a lot of energy. That uses a lot of glucose. When you do physical things, of course, and for some people, a physical stressor who has ME/CFS, it may be a walk around the block, but another person, it may be, I got up and walked to the bathroom, and that's enough of a stressor for them. But it's also like sensory input.
When you're in a room with bright lights, you're having to absorb that, and your brain is taking that information and processing it. The sounds that you hear, environmental stressors, like you said, toxins, or a busy environment can be a stressor. And I say stressor, but it's an energy consumer. And so everything takes up energy.
Well, a person with ME/CFS, long COVID, and not all people with long COVID have ME/CFS, but many of them do, okay?
Haylie Pomroy: And they're very similar symptoms, even if they're not false diagnosed.
Dr. Melanie Hoppers: It's kind of like the subset that's more severe are the ones who have ME/CFS, if you meet criteria. And one of the criteria is that you have to have post-exertional malaise. If you have post-exertional malaise, I would contend that most likely you're going to meet the criteria for ME/CFS.
So if you have this crash afterward, if you have this situation where everything gets worse, where all of your symptoms get worse, you may develop new symptoms, you're exhausted, fatigue is in there, but that's not the only thing. It's not just I'm tired, it's I'm tired, and my legs hurt, and my head is killing me. And I literally can only maybe crawl to the bathroom. If there was a fire, I don't know if I could get out of the house. Literally, their body has consumed all of the energy it can produce. The mitochondria cannot produce more. And so they're in an anaerobic state. They're unable to produce energy properly.
Haylie Pomroy: I love what you just said when you brought it back to energy. Because I think sometimes, at least in our community, I get a lot of feedback that energy sometimes is willpower. or thought.
Dr. Melanie Hoppers: Well, is it willpower if you're out of gas? It won't start if I just try harder. It's gonna start this time, no?
Haylie Pomroy: Exactly. I love that you brought it back to the physiology of the body, that we actually generate energy. And you talked about mitochondrial exhaustion and mitochondrial fatigue, and this is measurable in these patients. And it can have degreeing levels. Sometimes it can be a person, it's so hard, I feel like, we were just talking to a disability attorney the other day, and he was saying part of the problem is that he was talking about this one client that was a super high power functioning attorney, and her 50% still runs circles around people, but she's at 50% of what she normally had the capacity to do before her immune system was out of balance or had dysautonomic or had the inability to kind of rebound.
Do you have a specific strategy when we're trying to build people up in this process? Like, I'm all about food. Before we started, you talked about downloading Nomato sauce, this non-tomato-based pasta sauce. Like, my thing is always like, okay, what's the problem? Let's find a solution. If you can't have tomatoes, let's make Nomato sauce. If you can't have gluten, let's make gluten-free. Yeah, amazing stuff. Let's find that. You guys are so good at helping patients. The diagnostic is so incredibly important. The validation is life-saving, in my opinion. But you also turn patients around, and that's what's really cool. How do you build a person or begin to build a person with post-exertional malaise?
Dr. Melanie Hoppers: Okay, well, so post-exertional malaise is, the more you're in post-exertional malaise, and a particularly severe episode of post-exertional malaise can cause lasting damage, permanent damage. And it can slowly cause you to lose your baseline. Remember, your baseline is the activity level that you can perform without feeling ill. Okay, that's your baseline. That's kind of your energy envelope. Well, I want you to stay in that energy envelope. I'm not trying to, no matter what you do, you can't make your mitochondria do what you want them to do. Now, you're gonna make it worse if you push past that envelope. You're gonna be much worse. But if you stay in the envelope, there is some potential that you could have some improvement.
It's not guaranteed, but it's possible. But you're not gonna be able to like, oh, let me exercise five minutes today. Tomorrow, I'm gonna exercise six.
Tomorrow, I'm gonna exercise seven.
Whatever your limit is, is probably going to stay at that limit. It's not like you can just keep willpowering yourself and pass. It's like me. I can lift so much weight. There's no way I'm ever going to be able to bench press 200 pounds. Even if I start with one pound and go up a pound a day, there's gonna be a limit where I can do no more.
Haylie Pomroy: And that's your personal best. That's your personal best. And so, if we as a community kind of set down with people that are dealing with this and we help them to define, I loved the way you said it, because I've heard the envelope. Stay within your envelope, and when you're in your envelope, that's the best potential for healing, too. When you're outside of your envelope, the body has to deal with that hormetic stress or that stressor that lives outside the envelope, heal from that, and heal from what puts you in an envelope in the first place. So, when you said create an activity level that you can perform at without feeling ill, do you guys do any, like we have a gentleman in our clinic that does testing to look at oxygen and mitochondrial activity. Is there a way to know, or do you do a symptom personally? Do you do that as a community , what kind of our symptom? Like what level do you do and feel good?
Dr. Melanie Hoppers: So, pacing to me is really individualized. You can do CPET testing. Most people don't have access to that. A CPET test can harm a patient. There's some modified protocols and this and that, but that's not something I order. And I'm not saying it should never be ordered. I'm just saying that's not something I do.
But we talk about pacing and we talk about staying within our energy envelope. There's different ways to do that depending on the person. Some people, like I have some patients that really like something to follow. They want a number. I had a patient who has a watch, and there's different ones; there are different apps and things like that. And I'm not gonna try to tell people which one to go to, but she had one that gave her activity points.
And this was actually a watch that they want you to get more points, but she learned if I get 30 points and I stay at 30, I'm fine. If I go over 30, I'm in trouble. She would watch that.
And she said, some days at 9 a.m., I was at 28 points, so I knew, and she was disciplined and she was lucky enough. I guess lucky is the word. I don't know what the right word is, but she was retired, and she had a very supportive family. When she was at 28 at 9 a.m., it was okay. She got to sit down, recline, put her feet up, and rest. Now, unfortunately, everyone can't get the disability that they need. Everyone doesn't have a supportive family. That's hard. When I say these things, I wanna put that out there so people hearing this, I don't want them to go, well, that's pie in the sky, cause I get that for some, you have to figure out some other things for other people.
But she used that. She used wearables. She had a number, an objective piece of information. We can also use heart rate. We can use your resting heart rate.
And what we do, the way we determine your resting heart rate, is every morning before you get out of bed, you check your heart rate. Do that on seven good days. Now, don't do it on a crash day. Don't do it on a bad day, but on seven good days, get that number. You wanna average it up. Let's just say it's 60. Your average heart rate is 60, and you know that. Now, every morning you check that heart rate.
If you're 10 above, so that would be 70 or more. If you're 70 or higher, or if you're 10 below, so again, that would be what I say, 60. That'd be 50. If you're below 50 or above 70, your average is 60, then that's a day where you better say, uh-oh, I need to back off. I need to take some rest time. I need to really watch what I'm doing so I don't go overboard. That's a signal for you.
Haylie Pomroy: That number is your resting heart rate. You take seven good days. You take that average, and you use that as kind of your template to say—
Dr. Melanie Hoppers: That's kind of your guide. That's right.
Haylie Pomroy: If I wake up and my resting heart rate is 78, then I go, I'm gonna have to be more gentle with myself.
Dr. Melanie Hoppers: Cautionary.
Haylie Pomroy: Cautionary, yeah. And also put things in place. Let my support world know. I love that. I'm a numbers girl. I appreciate that. My mind gets distracted in tasks.
Dr. Melanie Hoppers: I can do a little bit more.
Haylie Pomroy: Overwhelming. Yeah, to-do list that if I don't have something to measure, that's hard for me. When a person goes throughout the day, is there any indication that a person can preempt crashing? Like, is there any techniques that you can help us with that? Because so many of our clients or my clients will say, I'm crashed, I've tanked, I've crashed, I've hit a wall.
And I'm like, I wish we could have talked to you before then, hydrated you, given you some food, had you put your feet up, put compression stockings on, all of those things preemptively.
Dr. Melanie Hoppers: Well, there are a lot of things. One is, again everybody's different in what they're able to do, but scheduled rest breaks. That patient I told you about, she was really cool. We had done some things, and she had had improvement, and she was much better than when she started out, but she said I wanna feel a little bit better. And she decided to focus on pacing. I use her as an example a lot.
One thing she did is, and she was pretty much homebound, okay? She could do things around the house, piddle around the house. She really didn't do much outside of the house, okay? That was her baseline. And so she would, on Wednesdays, that was a rest day. Every Wednesday, rest day. Every other day, she'd have a morning break and afternoon break, and like an evening break. Like 20 minutes where she'd lay down, recline, put the the cold compress across her face, put some compression boots on and just breathe. Turn off the sound turn the lights down, all the things. She had scheduled rest breaks. She also, like I said, would take Wednesday off. That was one of the things that she did.
Now I've had other patients, again, and again, some people, the numbers will drive them bonkers. You have them like, okay, here's my heart rate. And now they're like constantly looking at it and they're always anticipating that alarm going off. Some people can't do this, and I completely understand that. But for some people, you can take that resting heart rate and WorkWell Foundation, which is a great resource, says to add 15 to it and use that as kind of a warning sign. That's hard, okay? Because if you're resting heart rate 60, at 75, that alarm's gonna go off and you're gonna say, okay, time to rest. Well, some people would never get out of their bed. They turn over, and they're up that much. That's kind of hard, but some people will use a heart rate of 120, but just something kind of limited, put an alarm on so that when that number goes off, you go, huh, let me be mindful here.
It's time to take a break. It just is kind of a reminder.
Haylie Pomroy: Hi, it's Haylie Pomroy, your host. When I was going through my health crisis, the worst part of it was feeling lost and alone. And I decided that I didn't want anybody else to feel as desperate as I did. That's why we set up a private membership group where you can come in, ask questions, get support, be connected with people that can actually help you on your health journey.
If you go to hayliepomroy.com/member, you can join me for 30 days for free. I'll see you there. We can jump in, and we can start to organize the path for your wellness. That's hayliepomroy.com/member. I will see you there. Now, back to our show.
Oh, I love it. I just to loop into that. We train fast metabolism coaches.
And one of the things that we talk to them about is data collection. Success leaves clues. And also, it's kind of like if you have a curve on a road where you're gonna come around the corner and there's deer, they put up a sign. That says deer crossing so that people are cautious or more aware or blind corner.
And so with our coaches, we talk a lot about measuring those changes in resting and active heart rate to give an indication of the resilience of a person's adaptability. And we do that in fitness.
Why we wouldn't do it in wellness, I'm not quite sure, but our coaches and I'm a huge advocate for it. In fitness, right, when we're taking people, and we're going longer and further in marathon-type settings, or when we're trying to do burn fat and we're looking at 135, 145 beats per minute for 45 minutes sustained, like we all wrap our heads around that.
Medically, professional football teams, like it's all accepted. It's super cool to see you and your practice in general looking at how the body adapts to life's stressors as an indicator of the medicinal approach to pacing. I think that's just genius. Like we do it in high-performance athletes. Why wouldn't we do it when the body has just as much demand to get well? Yeah, so I love numbers, but I also love that you're bringing that into helping the patient, like just leaning into what's going on in their body a little bit.
Dr. Melanie Hoppers: And see, they can also start to, a lot of it is paying attention. You hear the alarm go off and you go, how am I feeling? Oh, wait, I'm a little bit short of breath. Maybe my chest is a little heavy. Maybe I'm feeling a little brain foggy. Maybe it wasn't super obvious, because I mean, if you have brain fog, how do you know you have brain fog. It gives you that reminder, oh, wait, something's not right. Now you start to clue into those symptoms, and you don't necessarily have to wear the alarm.
And again, it depends on the person because some people are not aware of their symptoms. I'm aware of every single thing. I have a little, oh my goodness, this could be the end. I have a little bump on my finger. And then other people can walk around with a limb half off, and they don't notice. It just depends on the person. But the other thing, too is finding ways to conserve your energy. And I know I've said this a hundred times, and I don't wanna repeat things, but use a shower chair, ask your provider for a handicap, or I call them accessibility stickers, and then nobody knows what I'm talking about. But the placard that lets you park in front, okay? If you cook and you can freeze some meals for later, I'm trying to think of all the things. When people come to the doctor's office, I try to accommodate for them. When you go to the doctor, get a later appointment if possible. Ask if you can sit in the car till it's your turn.
Haylie Pomroy: We have reclining chairs. Our lighting, we're very sensitive to our lighting. Our goal with our patient, the time is so valuable that we have that face-to-face with them. We want to conserve, probably in a way selfishly, but on their behalf, we wanna conserve all the energy we can and for full stressors so that we can get a really good story and detailed intake of what's going on. And we can collect data to make appropriate shifts.
Dr. Melanie Hoppers: You don't want them to pay for coming to see you.
And pay with the crash. And I also want them to see, I find this extremely important for you to pace. I'm not just telling you something to do. I'm participating in it with you. And so I think that's really, really important.
Haylie Pomroy: I'm gonna circle it back to kids for a minute. We actually did two podcasts with attorneys that helped individual with disability where the cases are making an impact. The resolution isn't there and they're needing to figure out a way to put themselves in the envelope so that they can start to get as healthy as they can get. How do we deal with kids and development? There's so much science around exercise and activity for all of us as being the vehicle to getting well and being well.
How is that dichotomy of, but wait a minute, PEM is a major cornerstone of this syndrome. How do we reconcile that in the pediatric world? I mean do we tell our kids to lay down? What are you seeing? Because we're in a crisis over here, like clinically. We're going how do we support these kids? And we had a kid, the mom says I lay down and give them their iPad, and they watch YouTube. I go, no. Stimulus, stimulus, stimulus, stimulus. You know what I mean?
Dr. Melanie Hoppers: Exactly, exactly. I mean, it's really hard, but at the end of the day, if they're experiencing PEM, that's not good. I mean, that is detrimental to their health. And yes, sure, do I want our kids to exercise? Of course I do. But if they're in PEM, no, that's harming them. PEM supersedes the benefits of exercise.
Now, I was talking about this earlier with somebody, and again, I work with patients. I'm not the ultimate, here's what we're gonna do. It's the only way to do it thing. But I have a patient who it's very important for her to exercise some. And she said it's for her mental health. She needs it. And she will sacrifice other things so that she can have a 20-minute session once a week. And it's reclining exercise. She takes breaks in between, and I'm very nervous about it but she does that, and that's what she needs to do. And if that's what she needs to do, then that's certainly her prerogative. And so I try to guide her in a way to make it where it's not harmful to her as best I can.
With kids, it's hard because kids don't get to make decisions. I mean, it depends on what age they are. If they're 16, they're a little bit more independent. But when you're 10, and someone says to you, you need to get up and go to school, and their body is telling them, no, I don't need to get up and go to school. I need to stay home. And they say that, they verbalize, I don't feel well, whatever. And they get sent to school anyway. They're not in control of their pacing. I think we have to be really, really careful that, again, why we need to get the message out, because it's harder for kids to be autonomous. They're in a place every day for eight hours where other people are in charge of their schedule, in charge of them. And they don't even know that they're harming them. Just like that pediatrician you said, was telling them to exercise. She was harming them. I'm sorry.
Haylie Pomroy: No, no, I appreciate you saying that. And that brings me right back to where we started, which is the education. Because if you define bullying. I do believe that this pediatrician was doing the very best with the knowledge base that they had. I get upset and there's a responsibility. If you're going to care for kids, you need to learn what's going on with kids. And when you tell me that we've got 5.8 million children with ME/CFS or long COVID, it would be as derelict as a pediatrician not understanding asthma. Saying, well, gosh, I told him just hold your breath and do deep breathing, and that's going to cure your environmental-based asthma or whatever.
I do think like, now we know the science is there. You've got to get educated, and we've got to change the medical curriculum, period. Because this is what we're dealing with. There's no way around it. 5.8 million kids or 5.8 million people, are not suddenly going to some cure is going to fall out of the sky. Like if they're seeking medical care, the physicians have to be versed in the disease that warrants the medical care. I mean, again, we get in the community. I talk to the people, the moms that are just furious and frustrated, or we have right now a mom that was diagnosed with ME/CFS, and there's some genetic components that people talk about, not methylating it. There are all these theories. She had three incredibly robust children. One of them has just tanked after COVID. And genuinely, the pediatrician talked about do you think that because you've experienced this, maybe they're having mirroring behavior emotionally because they're trying to create a closeness with their mom that's struggling in their health?
Yeah, you're not surprised. You're not surprised because you live it. You live it. We always say we believe you. I love that you said that. How does one find doctors like you? Are you guys seeing patients in Tennessee and Utah? Do people fly in? How can they get this kind of care? Do you guys see pediatrics?
Dr. Melanie Hoppers: I do. And it's hard because everybody can't. Everybody can't travel. And we are working so, so hard at the Bateman Horne Center with Tahlia Ruschioni is our fearless leader on education. And we're trying our best to get this information out there. Just that's working nonstop to do that. And it's there. If the pediatricians will just look, there is information out there for them.
Haylie Pomroy: But moms and dads can go to your website and download it too. We'll post it. We'll post your guys' link and make sure. If your doctor isn't versed or educated in this—
Dr. Melanie Hoppers: If they're open, there's information.
Haylie Pomroy: Yeah, well, and you know what? If they're not open—
Dr. Melanie Hoppers: If they're not open, ditch them. But to be truthful, it's sometimes hard. There are sometimes people who are in situations where there's only two people in their town. If they are lucky enough to have it. You've got to figure out what it is. If you're lucky enough to be able to ditch them and get one who is willing to listen, fantastic. If not, there's resources. If not, God, this is horrible, but they have to read about PEM and learn how to pace themselves.
But it becomes difficult because with kids, see, here's one of the problems too, schools.
Haylie Pomroy: Yes. The most bullying P.E. Teacher is the one with the kids. You're soft, you're weak, get over it.
Just the peer pressure. The peer pressure from the adults, okay? I'm talking about peer pressure from kids. I'm talking about the peer pressure from adults. And even when given accommodations for the child, sometimes they're not followed. I wish I knew the answer to that. Maybe have somebody on who can give the answer to that. That makes me want to be —
Haylie Pomroy: The only reason we built our community, we have an online community, was because I just felt like, so we have this request for care, which is a letter that we help our community prepare before they go into a doctor's office. And it's how to lay it out, how to line it out, if you need to pull a white paper, if I need to pull resources from your clinic, how to pull it together so you present yourself with a package that you at least hedge your bets to get some decent aspect of care. And I also say, when you find a good doctor, and that doesn't mean that they can cure 5.8 children. It means that they're open, they're receptive, and then they're on your team. That is the definition. They have empathy. Shout them out.
We sign books and send hundreds of books to doctors all the time that are advocates for being healthy, using whole foods, falling in love with food, creating a healthy relationship. Like, when we find doctors that say, that's great, then we just say, thank you. Thank you, and we write notes. Thank you for being an advocate for this patient. And we do that, and we collect individuals like yourself that are out there breaking down barriers. We are in a crisis situation, in my opinion, with autoimmunity, ME/CFS, chronic fatigue, and chronic disease in general, and it's gonna take people like yourselves continuing to shout it out. And I just really appreciate you coming on our podcast because our community just loves what you give them permission to do, education to go forward with, and like a plan. They don't feel like they're without hope. I cannot thank you. We have a massive population at this point, and I know that you're making an impact one-on-one with every patient that has the privilege to see you, but I love that you're able to help our community because they need it really bad right now.
Hey, this is Haylie Pomroy. And right now we're gonna transition into our Q&A portion of the podcast. And you'll notice that we have live viewers asking us questions. They're my Fast Metabolism members, and they get all kinds of amazing benefits, like member discounts on my world-class supplements and shakes, every product, every day, personalized guidance and support from myself and my team, and even the ability to ask questions of our podcast guests. If you have questions and wanna get them answered, you should absolutely join my membership. And if you go to hayliepomroy.com/member, you can join for free for 30 days. Again, that's hayliepomroy.com/member and join for free for 30 days. I can't wait to see you there.
Dr. Hoppers, I know what's gonna happen. This is gonna go live. Everybody's gonna ask more questions. Please say you'll come back.
Dr. Melanie Hoppers: Absolutely. Thank you for having me.
Haylie Pomroy: Thank you for being here. And you guys, make sure you go to the website, download your information. I suggest going to Utah or Tennessee personally because people come to see us all the way in Florida, and there is just such a difference in outcome when you finally get the care you deserve, and you deserve it. Everybody's out there. You deserve to be treated with the utmost respect, the most forward-thinking science, and all the support that is possibly accessible. Dr. Hoppers, thank you for being here. We are all healthier because of you, so I really appreciate you.
Dr. Melanie Hoppers: Thanks for doing this.
Haylie Pomroy: We'll talk to you soon.
Dr. Melanie Hoppers: Okay, bye-bye.
