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Estrogen: a frienemy we all have

We long for estrogen balance: we feel scared by what estrogen can do in our bodies yet we cannot feel our best without it.  Many of us women have struggled with our hormones. Here are a few of the symptoms related to estrogen:

  • mood swings, 
  • sleepless nights,
  • bloating, 
  • migraines,
  • heavy periods, 
  • brain fog,
  • joint pain 
  • and some of us have even had hormonal related cancer. 

We then look at estrogen as a bad hormone. We heard about “estrogen dominance” over and over. But estrogen is also a feel good hormone; our brain makes estrogen to feel good. Other  reasons we need estrogen:

  • Joint health – estrogen keeps joints supple 
  • Cardiovascular health – estrogen protects our heart from cholesterol, 
  • Liver support – estrogen helps regulate cholesterol production. 

It’s important to note the issue with balancing our estrogen levels is not limited to women; men make and need estrogen too. For example, men need estrogen for sperm production and maintaining libido.

your brain makes estrogen
Benefits of estrogen

Estrogen is not the bad guy. The first problem is in how we each metabolize and clear out estrogen. This is a point worth stressing: estrogen can be unsafe if the body is not safely detoxing it from your body. Knowing how your body handles this process is essential to ensuring the estrogen in your body is safe. The second problem is that many of the chemicals in our environment mimic estrogens. This can confuse the body.  

There are 3 phases to your body clearing out estrogens efficiently. I am going to share how you can support detoxification at each phase. This process applies to all sexes. The tricky part is that you need to work backwards when supporting these pathways.  You have to start by cleaning up phase 3, then phase 2 and phase 1. The goal is to take estrogen, which is a fat soluble hormone, and turn it into a water soluble metabolite so it can be more easily excreted from the body.  

Phase 3

This is about the detox pathway: our gut.  Here, microbiome health and digestive function become important for clearing estrogen in this final phase. The estrobolome encompasses the part of the microbiome that interacts with estrogen. The big factors are making sure you do not have Leaky Gut.  Leaky Gut will allow estrogens metabolized by the liver to be reabsorbed back into your bloodstream, instead of being cleared out of your body via your stool.  Ask your doctor to check Zonulin levels in your stool to rule out Leaky Gut. 

Good gut bacteria are important for proper digestion but they are also key to effectively cleaning out estrogen. Estrogen needs to be processed in a specific way after the liver does its job in order to be excreted in your stool. When this does not happen, estrogens are reabsorbed back into the bloodstream – only to be processed again. The liver is not happy doing its job twice for no good reason. This is where opportunistic bacteria come into play. There are some bacteria that are only bad when they overgrow. This is because when they overgrow they produce an enzyme called glucuronidase. This enzyme undoes the work the liver did the first time around, in order to make your estrogen water soluble. 

This is why it is key to know you are having daily bowel movements, with good levels of healthy gut bacteria and no Leaky Gut.  All of this can be assessed in a stool test.  

Here are 3 tips to support your gut:

  1. Eat good sources of fiber daily.  Fiber rich foods such as whole fruits and vegetables, legumes, whole grains and seeds help clean out toxins, estrogens and cholesterol from your body. A 2007 study found that increasing dietary fiber from fruits and vegetables played a role in lowering estrogen levels and reducing the risk of hormone related disease, including breast cancer. 
  2. Make sure you’re having a daily bowel movement to clear out toxins and estrogens. 
  3. Take a probiotic with lactobacillus.  This is a good gut bacteria that helps to clear out excess estrogens. 

Phase 2

This liver detoxification of estrogen is about the Methylation Cycle.  This pathway relies on the COMT and MTHFR genes to take the metabolites from Phase 1 liver detoxification pathways and make them water soluble so they can be cleaned out easily. This phase, when effective, makes an estrogen metabolite that is calming to the brain and lowers cancer risk. 

Tips to support your phase 2 liver pathways:

  1. Make sure you have good levels of Magnesium and Zinc in your daily diet.  These minerals are needed as cofactors for your COMT gene pathways. Whole grains and dark-green, leafy vegetables are good sources of magnesium. Legumes like chickpeas, lentils, and beans all contain substantial amounts of zinc.
  2. Eat organic fruits and vegetables. Herbicides and pesticides are estrogenic toxins that can overwhelm your phase 2 detoxification pathways. 
  3. Clean out toxins in your home. Many chemicals like fire retardants, BPA and toxic metals activate estrogen receptors in a more toxic way because they are not actually a hormone meant for that receptor.
  4. You need good amounts of B12 and folate in their active forms (methylcobalamin and 5-MTHF, respectively) for liver detoxification. These nutrients become their active forms via your MTHFR genes through the methylation process. 

Phase 1

This is the start of estrogen metabolism clean out. Phase 1 occurs in the liver and is run by the Cytochrome (CYP) genes. Fat soluble estrogens add hydrogen to make a more water soluble molecule. In this pathway we can often make a more potent toxin from our estrogens. 2-hydroxyestrone (2-OH-E1) metabolite is the cleanest and healthiest way to detox estrogen.

The next two metabolites are more toxic and have been shown to damage our DNA, which can lead to increased cancer risk:

● 4-hydroxyestrone (4-OH-E1) 

● 16-hydroxyestrone (16-OH-E1) 

All these Phase 1 detox metabolites are considered free radicals; we want to send them to Phase 2 as quickly as possible, so they don’t enter blood circulation and cause damage. 

And this is why we would not want to make Phase 1 work better if the next two phases are not working well: you could be increasing the toxicity of your estrogen metabolites. 

Tips to support Phase 1 liver pathways:

  1. Eat more cruciferous vegetables such as broccoli, brussel sprouts, cabbage, cauliflower, kale, and arugula. DIM is a molecule that your body makes when you eat cruciferous veggies and it helps to make healthy estrogen. 
  2. Eat more lipotropic amino acids like choline, methionine and inositol.  Foods high in these compounds include eggs, chicken, fish, nuts, cauliflower and broccoli. 
  3. Phase 1 activators are antioxidants (like vitamin C and silymarin in milk thistle). However, it’s good to add more antioxidants, especially polyphenols and flavonoids. If you eat 7-10 servings per day of a wide variety of fruits and vegetables, every day, you are probably covered. I take a functional food concentrate to fill in the gaps in my nutrition. Check out this link to learn more. 

Now that you know more about the process estrogen goes through in your body and have some tools to help your detox pathways work more efficiently, it might be time to test and see how your body is doing in these phases.  We use the Dutch Complete™ urine test to assess if your pathways are efficient.
If your doctor is unable to run this test for you, we invite you to consider Revolutionary Health‘s package “Are your hormones safe for you?” – get the Dutch Complete™ test and a written analysis report of your results. You even have the option to do a GI-Map test that tests for Zonulin. We believe in comprehensive testing for concrete answers to best serve our patients and clients.

get your hormones tested
Are your hormones safe for you? Click on the image and find out how to get tested.

Take action now: Don’t let AB 2098 pass

AB 2098 is California’s COVID-19 Vaccine Misinformation Bill and it defines “misinformation” as “false information that is contradicted by contemporary scientific consensus contrary to the standard of care.” The issue with this is that throughout the duration of the pandemic we have seen the “contemporary scientific consensus” change with high frequency.

If AB 2098 becomes law, doctors will no longer be able to make personalized recommendations to their patients. As Naturopathic Doctors we value personalized healthcare because we know that every body is different and has different needs. Doctors, who know their patients best, should be able to make recommendations, without fear of repercussions.

To learn more, we share Protecting the Future of Medicine: Why AB 2098 is Bad Medicine, an excellent post by Dr. Elisa Song, M.D.

TAKE ACTION TODAY and call or email Governor Newsom TODAY
ask him to veto AB 2098 BEFORE September 30, 2022

AB 2098 is on Governor Newsom’s desk now. Without his veto before September 30, AB 2098 will automatically become law.

Governor Newsom’s contact details:

By phone: (916) 445-2841

By Governor Newsom’s Email Form:

The Mounting Dangers of Glyphosate & What You Can Do About It

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Glyphosate is the world’s most widely produced herbicide (weed killer) and is the primary toxic chemical in Roundup™, as well as in many other herbicides that are commonly found at your local hardware store.  Glyphosate was introduced in the 1970’s to kill weeds by targeting the enzymes that produce the amino acids tyrosine, tryptophan, and phenylalanine. The enzymes of many bacteria are also susceptible to inhibition by this chemical, thus altering the microbiome of many animals.

Why is it so dangerous?

  • Glyphosate disrupts the microbiome in the intestine, causing a decrease in the ratio of beneficial to harmful bacteria. 
  • Highly pathogenic bacteria such as Salmonella and Clostridia are highly resistant to Glyphosate versus most beneficial bacteria such as Enterococcus, Bifidobacterium species, and Lactobacillus species which were found to be highly susceptible to being killed off by this chemical. 
  • Glyphosate acts as a mitochondrial toxin, impairing energy production which will cause fatigue.
  • Deactivates vitamin D3, which we know is of upmost importance in maintaining a healthy immune system and protecting us from cancer.
  • Impairs liver detoxification by interfering with liver pathways, which will increase the body’s overall toxicity.

What diseases is it associated with?

  • Psychiatric disorders: Autism, ADHD, Bipolar, Depression
  • Endocrine disorders:  Thyroid damage, Diabetes, Obesity
  • Cancer: Non-Hodgkin’s Lymphoma, Hairy Cell Leukemia
  • Energy Production:  Chronic Fatigue Syndrome, mitochondrial damage
  • Neurological disorders:  ALS, Parkinson’s disease, Multiple Sclerosis, Alzheimer’s Disease
  • Reproductive and Developmental issue:  Infertility, Low sperm count, Learning disabilities
  • Cardiovascular disorders: Hypertension, Stroke
  • Renal and Liver disorders
obesity deaths and glyphosate
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correlation between children with autism and glyphosate applications

What are sources of Glyphosate?

  • 90% of tobaccos in US are genetically modified (GMO) and full of pesticides including Glyphosate, which is sprayed on the tobacco as a desiccant. 
  • It is much easier for homeowners and gardeners to use Glyphosate products to kill weeds versus having to manually remove them. 
  • All Genetically Modified Foods (GMO’s) especially corn, soy, canola, rice, barley, sugar cane, sugar beets, beans, peas, and sweet potatoes.
  • Glyphosate is a primary drinking water contaminant that enters our water supply through ground water.
senile dementia deaths and glyphosate
Correlation between Senile Dementia deaths and Glyphosate Application

How do you get rid of it?

Initially, it is more important to prevent Glyphosate from entering the body first before working toward eliminating the stores that already reside in the body. 

female staff holding organic sign board


hand pouring a glass of water from filter tap, blue background
  • Be sure to use a high-quality water filter such as Multipure or Pure Effect filter for your drinking water and filters for your shower heads in order to prevent skin absorption.  If you would prefer a whole house water filter you can check out (
  • Avoid all Genetically Modified (GMO) foods.  Eat organic produce, grains, and animal products whenever possible.
  • Confirm that you or your gardener are not using glyphosate products on your yard and garden. 
  • Consider using a Tower Garden, which is an aeroponic garden, to grow your vegetables in or outdoors.  Even though you might have a traditional organic garden in your yard does not necessarily mean that chemicals are entering the roots from the ground water.


  • Many labs offer environmental chemical testing kits that only require a single urine sample.  The one that I frequently prescribe is Great Plains Laboratory GPL-Tox with the addition of Glyphosate.  This comprehensive testing allows us to assess levels of these dangerous chemicals in your body.


  • Glyphosate is water soluble so it can be eliminated faster if you drink ½ your body weight in ounces of filtered water per day.  This way it will be excreted in the urine more effectively.  The home water filter from Pure Effect Filters will also add minerals back to your water after filtration. 
  • S-Acetyl Glutathione or Liposomal Glutathione can be used to speed up the detoxification of glyphosate.  The dose is 100mg twice per day with a meal. 
  • Aerobic exercise can increase the excretion of glyphosate through perspiration.

If exposure has been chronic or severe you may need to consider using an infrared sauna, such as Sunlighten, for optimal detoxification of Glyphosate.

classic wooden infrarered finnish sauna cabin in bathroom interi
Infrared Sauna Cabin

Understanding Food Intolerances

Are you suffering from gas, bloating, irregular bowel movements, or gut pain?  Maybe you think it is food-related but cannot figure it out? Let us tell you, you are not alone.  Food intolerances can be tricky to figure out because a reaction can occur anywhere from within a few minutes to 3 days after eating the offending food.  Confusing, right?  

We are here to tell you it is not always about the food.  It is often due to inflammation in the gut (known as Leaky Gut), an overgrowth of bacteria in your microbiome, or stress reactions that shut down your digestive system. 

We created this easy Gut Quiz to help you root out the problem areas in your gut!

Let’s discuss the difference between Food Allergy and Food Intolerance.  Food Allergy is immunoglobulin E (IgE) mediated. This means much like your seasonal allergies, which are a result of IgE, the reaction happens within minutes of exposure. Symptoms range from hives, swelling, itching and you can have trouble breathing.  Food Intolerance is mediated by a different antibody, immunoglobulin G (IgG), which remains active in the body for 23 days. Food intolerance can also be non-immunological and have no antibody to test, meaning the reaction is not produced by, involved in, or related to an immune response or the immune system.  IgG Food Intolerance can be hard to uncover because the reactions can occur anywhere from a few hours after exposure to 3 days.  Yes, this means you can eat the food you are intolerant to and not have a reaction start until up to 3 days later. Here is another piece of information to muddy the water: You can test IgG antibodies to food in a blood test but the problem is some antibodies activate the intolerance reaction and some suppress reactions. In the Food Allergy blood test, there is no way to know the difference. How to make this distinction is through a food elimination challenge, which is an integral part of our 6-week Revolutionary Gut course. We show you an easy food elimination challenge to uncover which foods are causing symptoms and stoking your inflammation. 

You may have a food intolerance to foods for a range of reasons. These include but are not limited to:

  • Lack of the right enzymes to breakdown a certain food 
  • Reaction to additives or preservatives in the food like sulfites, food dyes, and MSG
  • You have a sensitivity to other agents in the food like caffeine or histamine 
  • Sensitivity to sugars or proteins found in foods like lactose in milk or Oligosaccharides in fruit

Symptoms of food sensitivity or intolerance can range from mild to severe.  Here are some ways it can show up:

  • Gas and bloating 
  • Change in stools – diarrhea or constipation
  • Heartburn
  • Cramping 
  • Nausea
  • Vomiting 
  • Joint pain 
  • Fatigue 
  • Itching 
  • Muscle pain 

If you feel you may be experiencing food reactions, it is important to know if you have Leaky Gut, an overgrowth of microorganisms, or a lack of digestive capacity. It is important to know before diving into food intolerance testing.  Why you might be asking?

The cells of the small intestine are responsible for filtering out your digested meals and absorbing into the bloodstream the broken down molecules of vitamins, minerals, proteins, fats, and carbohydrates, while not allowing larger, undigested molecules to pass through.

These cells are also responsible for moderating immune function in the gut and preventing microbial infections from creating disease. Your intestinal lining should act like a screen, which lets air and sun in while keeping insects, leaves, and critters out.  When there is damage to your screen, many things are allowed that should not be there. Just like with a screen, when there are holes in our intestinal lining (aka Leaky Gut), undigested food, proteins (dairy, gluten, etc), microbes, and toxins can have direct access to the bloodstream.  With this increased exposure to these substances, your immune system will produce an IgG antibody reaction to fight the invaders.  When you heal from Leaky Gut, many of these food reactions will disappear because you addressed the root of why they started.  This is the perfect example where the food was not the root cause.  

An overgrowth of microorganisms in your gut microbiome is another reason why you can have inflammation running through your gut that is not due to the food.  Your immune system has a job to fight invaders. When bacteria, fungus, or parasites overgrow, your inflammatory response increases and this can lead to an IgG response to food, causing confusion about what the reaction is due to. If you get the overgrowth under control and decrease the inflammatory response then you will find the food reaction will reduce also.

As for a lack of digestive capacity, when you do not properly digest either from 

  • eating food your body cannot break down easily, 
  • eating under stress so you don’t release enough digestive juices or 
  • not chewing properly 

then your microbiome will be overfed and thus overgrow, leading to leaky gut and/or Small Intestinal Bacterial Overgrowth (SIBO).

food intolerence blog visual
The cycle of an imbalanced microbiome

Testing (through a laboratory or an elimination challenge) for food reactions is useful.  Removing reactive foods can help you to heal faster.  The important things to know are:

  • You must get to the root cause of your digestive distress: leaky gut, low digestive capacity, or microbiome overgrowth (or a combination!)? Take our free Gut Quiz to learn which it is likely to be.
  • As you heal the root problem then many of the food intolerance may resolve
  • For long-term gut health, you need to find out which foods are healing and which are promoting your inflammation. 

There are many things everyone can do, for free, from the comfort of their own home to heal their gut. That’s why we are holding a Free Masterclass – 3 Secrets to a Happy Gut – on Wednesday, April 27 at 6pm Pacific Time, to teach you these secrets.

Once you understand how the gut functions and what it needs to optimally function, limiting certain trigger foods or adapting some minor lifestyle changes will be less daunting. Also, once these changes become a habit, they’re no sweat – even though the benefits are monumental: Imagine NOT feeling bloated or always wondering if there will be a bathroom nearby!

And if you are ready to finally put an end to the discomfort of bloating, IBS and/or constipation and get you back to living the life you deserve, consider our 6-week Revolutionary Gut Masterclass. Click here to learn more. If you have questions, email

Clinic Holiday Wishes and Schedule

CNM holiday wishes
xmas closure sched

From the Cypress Natural Medicine Team, we wish you all good health and a joyous holiday season!

Holiday closure schedule: December 24, 2021 to January 9, 2021 inclusive) We re-open at 9am on January 10, 2022.

If you would like to get in touch, please email us at This will ensure the fastest response once we re-open. If you need to schedule an appointment, please use our online scheduler by clicking here and follow the instructions at the top of the page.

Thank you!

FREE MASTERCLASS: Biohacking Secrets for Spontaneous Healing

Our next event is this Thursday, December 2 at 6pm Pacific Time.*

What we think, the beliefs we hold, and past experiences can hold us back from living the full lives we truly want (and deserve!). Join Dr. Destia as she explores the mind-body connection and offers ways to strengthen the nervous system and options to dig deeper.

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Hear what some previous clients have said about working with Dr. Destia:

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This event is part of Revolutionary Health, LLC.

*This event will be recorded and made available to registered participants.

Thanksgiving Gratitude

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Happy Thanksgiving!

Please note Cypress Natural Medicine will be closed on Thursday and Friday, November 25-26, 2021. We will reopen at 9am on Monday, November 29, 2021.

The Vagus Nerve

vagus nerve vector illustration. labeled anatomical structure and location.
How the vagus nerve connects to the GI tract and other relevant digestive organs.

Could the root of your digestive distress like gas, bloating, heartburn and irritable bowel syndrome be in your nervous system?

How is the gut connected to the brain? Through the vagus nerve.

The vagus nerve functions as the body’s two-way, highway carrying information from the brain to the organs of the body and back. In particular, the heart, adrenal glands, gut, pancreas, and lungs. And they all react to chronic stress and trauma through this connection. 

The vagus nerve stimulates these gut functions:

  • The micromovements in your gut that move food through is called peristalsis 
  • The pancreas stimulation to release enzymes for digestion 
  • The release of stomach acid, hydrochloric acid (HCl) 
  • Intestinal permeability (when there is high permeability, it is known as Leaky Gut)
  • The regulation of inflammation

This is important because research has found one of the key controls of inflammation is the vagus nerve.  This means the vagus nerve is part of the process for switching inflammation on and off. It is well known that inflammation is at the root of the majority of chronic diseases. 

The health of your gut depends highly on what kind of bacteria live in your gut. This is called your microbiome. A healthy microbiome will send a happy signal to your brain via this vagus nerve. Alternatively, an unhealthy population of bacteria will send distress signals to your brain. If we pay attention to our mood, we are listening to our microbiome literally speaking to us through the megaphone that is your vagus nerve. We can’t ignore these signals. This is why we cannot ignore the patient’s mood. 

Here are some specific things that you can do daily  for your gut-brain connection:

cute baby with freckles on her face breathes spring fresh air.
You don’t have to stick your nose into nature – but you get the point. Soak in the sights, sounds, smells and feel – activate your senses!
  1. Get outside and start Forest Bathing! Soak up the sights, smells and sounds of a natural setting. Scientific evidence demonstrates that forest bathing reduces our stress response and inflammation. It improves sleep quality and mood, increases energy, accelerates recovery from surgery or illness, lowers heart rate and blood pressure and even reduces stress hormones production.  With these far reaching effects it should be on every treatment plan.
  2. Start every meal breathing!  A  series of 5 slow gentle breaths  activate your vagus nerve and parasympathetic nervous system to stimulate the release and flow of digestive juices like enzymes and HCl. 
  3. Gargle and hum every day!  Your vagus nerve is toned and stimulated by these actions. Remember the vagus nerve can have a big impact on inflammation. We want to keep it happy and toned.
  4. Cold showers: cold therapy is shown to increase vagus response. A simple way to incorporate this into daily life is finishing every shower with a cold flush to the neck and chest before getting out of the shower. 
  5. Meditation: This is shown to support vagal tone and activate your parasympathetic nervous system. My favorite easy way is HeartMath’s Quick Coherence Technique.  I also like the Insight Timer App for the wide range of mediations available. 
woman face with water drop
Just a few seconds of cold water can do the trick!

Remember how we said the vagus nerve is a two-way street? This means your mood affects your gut and your gut affects your mood.

There is so much more I want to say about gut health that is outside the scope of this blog entry.

I want to direct you to our Gut Quiz – uncover the true state of your gut health! 

This quiz is important because we don’t know what we don’t know about the far-reaching implications your gut has on your current and future health. 

Consider that even your mood could be a symptom of your gut health. Get an early start with Gut Health by exploring the root imbalances in your gut. 74% of the population are struggling with digestive issues but how many are getting the help they need?

You are invited to the Lifestyle Medicine Summit

lms largest global gathering lifestyle medicine health coaching

Patients suffer from an array of chronic diseases like obesity, diabetes, pain, heart disease, cancer, anxiety, or depression. They are equally frustrated because they often find themselves going down a rabbit hole of managing their disease that never seems to end.

Fortunately, there’s a scientific solution that benefits practitioners and helps clients not just stop but even reverse chronic disease.

  • It’s evidence-based
  • Proven to be effective
  • Personalized
  • Empowering healthcare professionals and patients alike

This new promising field of practice has been extensively researched and has actually been practiced by thousands of doctors and allied health professionals for years.

If our lifestyle habits cause lifestyle disease, then shouldn’t we use lifestyle improvement to resolve them?

Experts agree that Lifestyle Medicine needs to play a vital part in healthcare.

But the big question is HOW:

  • How can we make Lifestyle Medicine and Health Coaching accessible to everyone?
  • How can practitioners integrate Lifestyle Medicine and get paid well, without the need to change workflow or hire expensive staff?

All these questions and many more will be answered by our 50+ speakers, researchers, and experts during the non-profit Lifestyle Medicine Online Summit Oct. 27 – 31, 2021. This summit is for anyone interested in preventive care and reversing chronic diseases – from patients to practitioners and health coaches.

Register here for FREE!

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As an additional bonus, we are giving away a limited number of premium ticket upgrades for FREE. All you have to do to get your chance to win one of these premium tickets is share a short 1-minute video on social media about why you are excited to see me and the many other incredible professionals speaking at this summit.

Don’t miss this chance! Premium access is valued at $3,315. Yes – you read that right: $3,315 value for FREE.

To qualify to win the FREE Premium Ticket, your video post must be set to public on your view privacy settings and you must tag @drskinnersonline for Instagram or Destia Skinner on Facebook. Don’t miss out on this once-a-year opportunity. Hear Dr. Destia speak at the Summit on Oct 31 on neuro-emotional health, the gut-brain connection and empathy!

See you there!

UPDATE: Revolutionary Gut Masterclass

business woman's hand is writing on a notebook with a pen.

Due to various requests, the Revolutionary Gut Masterclass will now be a self-study course, available to start at the end of October 2021! We truly appreciate the feedback from our webinar participants and those that have taken our Gut Quiz. Our main goal is to make improving people’s health more accessible and hearing that the preferred method for this course was as self-study, is extremely valuable to us. Thank you!

This change in format also means a huge reduction in cost. You can now gain access to the Revolutionary Gut Masterclass for $397 (previously $997!). And if you are one of the next twenty to sign up, you will receive $50 off.

The option to do a GI-Map test is still available to you and now you also have the option to sign up for a 4-session series of Rapid Reprogramming of Emotional Stress Technique (rREST®) with Dr Destia Skinner.

As a cornerstone objective of the Masterclass is to break bad habits and form new and healthy ones, the course is still 6 weeks and each module is released on a weekly basis.

If you have any questions, please email

Thank you,

Drs. Bryan and Destia Skinner

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