This week on ADVENTing Dr. Kandula and Dr. Handler discuss @Home Sleep Studies, Allergies, and a world without sports.
- Hey, it's Dr. Madan Kandula with ADVENT, and your host of ADVENTing, your show all about otolaryngology, which is otherwise known as ear, nose, and throat, snoring, sinus, sleep apnea related issues, we'll be talking about those things today. And kind of whatever else is going on in the world. So I am joined by your, my co-host, Dr. Ethan Handler. How you doing?
- You know, doing well, another week, another day, staying alive, looking forward.
- It's a sunny, sunny day and depends on when you all are watching or listening to this, but right now, it looks really nice outside. Spring is coming, flowers are blooming, right?
- It is. Golf courses are open. What else can we want, you know?
- Yeah, it's all good, it's all good. And we are, I mean, we kind of are giving people a little bit of a play by play, but we went dark at ADVENT for a bit just with the whole lockdown. And we've been kinda going gradually forward and what happened this week?
- Yeah, so I guess when we last touched base, you know, we had just started probably opening up for procedures, and so we have a full week under our belt. Huge volume of people wanna get back in, get their snoring, and sleep, and sinus problems under control. And so a lot of procedures last week went fine, went safely. Patients did well, no issues to report. It was just nice to kind of get back in the fold of things, you know, and have some routine, and obviously, we're taking slightly different precautions, obviously, in light of COVID than we did before as far as protection for ourselves, for patients, things like that. But it went as smooth as I could hope. And I think it's inspiring, looking forward to see how we can kind of get back up and running fully.
- Yeah, no, I agree. Yeah, it's a couple things going on there. One is, you know, closing things down, shutting things down, and not doing what we do for a while gets you a little out of your routine, and then the routine change when we came back up and running, which is also like, it's sort of two different things. I don't know that people think about this much, but, you know, well, we are surgeons, and so we need to perform. And in order to be at peak performance, you need to get your reps just like, you know, right now, you know, Major League is down and those guys are being challenged. But, you know, certainly they wouldn't go from zero to, you know, getting back in the batter's box and facing 90 mile per hour fastballs and curveballs and things. They're getting batting practice, but it's really hard to do that from a surgical standpoint. So, it does take a little bit of getting back in the swing of things. The nice thing is we are sort of pros in doing what we do. We do so many of, we do a select group of procedures, and we do those things often. And so coming into this we have had lots and lots of reps. So there's muscle memory involved. And then because we are very narrowly focused in the areas that we treat, it's kind of easy to get back on that bike and kind of ride it. And so I think there's kind of those things that, yeah, a part of the goal with this show and what we're doing here is to kind of get people a behind-the-scenes look into things. And I'd say that's one, that I don't mean, I don't know that people out in the normal or in the world think or know much about that, but it's true there and it'll be true on the playing fields. Have you caught any of the sort of spectatorless sports that have appeared?
- I haven't watched a lot on, you know, I haven't followed like that. I know South Korea got back up into baseball. And I've seen some pictures and still shots and like the cardboard cutouts and things like that. But, you know, and then the NBA. I would really love to see the NBA season getting back going, especially living in Milwaukee and obviously, being want to see the Bucks do well and Giannis get back on the court and what an awesome year he was having. And it'd be cool to kind of see them complete that in some way, shape, or form. So to hear the stars were all excited about getting back on the court and figuring out a way to move forward I think is good. When's the last time you've ever thought about a world without sports, being able to watch them in real time and like, it's never existed in my lifetime that I couldn't. And, you know, now that you don't watch, it's just so weird. I mean, it's so strange to not have that be part of your daily or weekly routine.
- Yeah, no, it's definitely, it's weird. I mean, I think I've, I mean, we've just all had to get used to it, I think at this point. But it does sound like, you know, in the States here, it sounds like there are plans with all the major sports to get back online at some point, you know. Like everything with COVID, it's like, you have a plan, and then there's reality and it's trying to mesh those two things. But it does sound like things going to back online. And, you know, I think before we dive into some of these medical topics, I would say, you know, here's my hypothesis on the sport, the lack of sport right now. NBA, I think is a prime example is, you know, Bucks were killing it, which is great. In a normal season, everything was going really well and then everything went dark. And then we're gonna come back online, sounds like not too, too far in the distant future, without fans, it'll be some weirdness involved. And I would say, if that's all true, and things get back online, then there is one team, or maybe two teams, right now in the NBA that are preparing for the new reality that's gonna exist whenever they get back on the court. And if that does happen, and they play the season out and they get to a champion, that champion is not gonna have an asterisk by their name. And so meaning that, like, the things that got the Bucks to the top of the NBA in a normal season probably won't be the same things to get them to a championship in this weird COVID world. But I hope that they are doing things right now mentally and physically to prepare for that, because somebody is. Somebody right now in the NBA better be, and it kinda, you know, it's interesting to think about that. And I think, again, when we come back online, it's gonna be go time and it'll be interesting to see how that plays, you know, how do you play without fans? You know, you can think about that, but they'd better be mentally preparing for that. It's just weird concepts, and this, I think, is where the excellent organizations and coaches are going to have the ability to stand out from the crowd versus those that are just, you know, stellar athletes without much mental game, I think they're gonna be challenged right now. Because I guarantee you, if you're used to being on the court, and used to hearing the cheers and the boos and all of a sudden those things are gone, and you're not consciously planning for that right now, when you get on that court, you're not gonna understand, your body is going to be completely, you're gonna feel like you're on Mars. And it'll be interesting. So we'll see how it plays.
- Yeah. I mean, the best athletes in any given sport, you know, and Giannis is certainly at the top right now. I mean, but if you think about ways to motivate oneself to compete, they'll find a way. They'll find motivation in something or somehow, and even if it's the player you're playing against, you know, across the, you know, guarding you, I mean, even if there's no fans, you know, the best players will find a way to excel and achieve what they need to.
- Yeah, well, I think hopefully one thing that they've all been doing is resting and recovering, the better. There's no excuse, you know, for all the injuries that happened during the season, there has been time to heal, there has been time to get the rest, take their naps, you know, get sort of recovered for the battle that's upcoming, and obviously, ADVENT, a big part of what we do is sleep and that part of things. And really, I think on the sleep front, one of the things we've been talking about here out in the public is sort of this concept of home sleep studies. What's the deal with that? I guess, for those that are uninitiated, let's assume everybody or let's assume nobody knows what we're talking about here. What's the sleep study? Why would you do such a thing? What's a home sleep study? What's the deal?
- Yeah, so I mean, a sleep study is supposed to... The concept is to record your sleep using various, I guess, parameters to measure sleep quality, but, you know, it can measure specifically, we look for, you know, snoring, spells of breath holding that actually decrease the oxygen saturation within your, within your blood. And there are lots of people that are walking around out there that get eight hours of sleep a night or six hours of sleep at night, but never feel rested when they wake up in the morning. Or they have other issues, high blood pressure, and things like that, that are they're having difficulty to control or other, you know, what we call comorbidities. And so, you know, sleep obviously is incredibly important. Good, quality sleep is important. So quantity matters, but arguably, quality is equally, if not, more important, right? So if you're only getting six hours of sleep, it better be darn good sleep, you know, and versus eight hours of really crappy sleep for every hour. And so, you know, initially when sleep studies came around, people had to go to labs and they get attached to these devices and it looked like the predator, you know, ropes, and strings off, and EEGs, which measure brainwave activity, and you just feel like you had to sleep in an environment that was nowhere near representative of your own bed, or your own normal night's sleep. And so with the ability for people to do sleep studies in their own bed was honestly a game changer. And so what was a barrier for patients to get sleep studies is because it's cumbersome, it's expensive, it's intrusive to be honest with you. Now, people can answer that question easily. Do I have a sleep problem or do I not? And get it done in their home. And so that can vary from being dispensed by a physician in their office and here, this is this device, take this home, wear this. Or what we've done at ADVENT is kind of shifted gears to an option where we try to make it as easy for patients as we can. And so if we feel like a patient needs a sleep study, there's now a company that we're working with and a service that can ship it directly to the patient's home. It's easy instructions, takes you step by step what to do, 24-hour support if needed, you wear the device, you put it back in the box, it's prepaid shipping label, you send it off and then that's it. And so it really has lowered the barrier again to just ask that question and get an answer. And we can dive into this more, I know we're focusing on the home sleep study part. And to all the patients out there, anybody who wants to know about their sleep, a CPAP machine is not the only option. So don't not get a sleep study because you're worried that someone's gonna push a CPAP machine on you, because we won't, we'll talk you through all options.
- Yeah, although, you know, back to the core concept there. So sleep study, when it was first introduced into the world, like in the '80s, roughly, the only option was to do it in a lab, in often, more often than not, those things are in hospitals. And more often than not, those things are, it's just a horrible situation to try to sleep in. It's a foreign environment. If you imagine trying to go into a hospital to get a good night sleep, just by definition, unlikely to happen. And then if you imagine you know getting hooked up to all sorts of wires and leads and blah blah blah, definitely not gonna get good and normal night's sleep. and then top that off by somebody who's going to be kind of creepily watching you, making sure that your leads are not coming off. It's just a lot of weird going on, and back in the day, it was the only option, and it was better than nothing. In the new day, like now, really about five to 10 years ago, technology came along where home sleep studies were an option and they've gotten better and better over time, and really at this point, there are times where in-a-lab studies are helpful, but most often they're not, they're not necessary. You can do a home sleep study, you can get the information that you need and we need to get the diagnosis and kind of get things moving forward, and that's just gonna continue on and on. And so it really, like a lot of things that we do and a lot of things that we offer for our patients, a home sleep study is basically, in my opinion, good for the patient, good for us to diagnose what's going on, good for the insurance company, the only person where that is, or only entity where it's bad for, is the hospital that has this sleep lab that they built out and they put a lot of dollars and cost into this thing that's a dinosaur, that it's not necessary these days. And so though, if you end up going through a hospital system, likely the only option you're gonna see or hear about is their in-labs study, not because it's better than at-home sleep study, because they've already bought that and so they want you to buy it, too. So it's a little, you know, and it's not all about that. But I would say it's not not about that either. And so I think there are a lot of things in medicine where I think people are unaware of kind of what's happening behind the scenes and the more you are aware of what's happening behind the scenes, it just makes you a better consumer, a consumer of medicine. I think that's where it's helpful to kinda have as much knowledge as you can. And that's really part of what we're trying to do here. I think, another topic, that's a different wavelength entirely, but it's another topic that I think there's a lot of misunderstanding about is pertinent to the time we're living in, in the moment right now, which are allergy issues. And so allergies, you know, and we can talk about this, but many people think about allergies and they think about the spring and pollen, and they think about what happens when they go outside in the spring and their eyes get itchy and they sneeze. And so, you know, I guess let's talk about that. I mean, is that, a lot of people would tell me, and they probably tell you, "Well, you know, I don't, "seasons don't bother me, I don't really have, "my nose doesn't work really well. "But you know, I don't get bothered in the spring, "so I can't have allergies." Is that true?
- That would be untrue. So part of it is that yes, there are seasonal allergies, but they're also allergies that you're exposed to year round, which might just keep your nose not working all the time, you know, as well as it could. So, you know, dust mites, dogs, cats, other things that are that are exposures. I mean, dust mites is a huge one. I mean, when you think about that, like that's everywhere, it's hard to protect against, and you're exposed to it all the time.
- Well, what's a dust mite? I bet you, like, I think here's my, you know, it's not a hypothesis, it's just, it's a guarantee is that--
- Yeah.
- Most people go through life and they hear things that they think everybody knows, and then they nod their head and they agree, and they don't know about them. So I'm gonna even stop you, I'll stop you before the dust mite, because that's kinda nuance and just an allergy. So like when somebody says, "Oh, I have allergies," what are they, you know, what does that mean? If somebody has allergies, what's happening?
- So, you know, and people, and just to run with that too, people say they have allergies when they actually are not actual allergies. You know, whether it's, I don't know, lactose intolerance or something else, right? Versus a true allergy, like to pollen and whatnot. And that is hardwired in your DNA, and that is the way that you react to the world around you, you know, and the way that your immune system reacts to the world around it. And so, you know, you see certain, let's use pollen, for example, let's use trees. Trees bloom and they dump a bunch of pollen in the air. And so your body gets hardwired to overreact to that pollen over time. And so the more exposure you get, the more severe your allergies can get. And that's, you know, it takes a little time for your body to build up that kind of reactivity. And so it's really something that's hardwired to them, which is, I guess, the best way, well, I'm sure we'll have a way of kind of piggybacking on that and kind of explaining it in that sense. But, you know, versus, you know, again, lactose intolerance, right? An intolerance or something that upsets your tummy when you eat it or drink or something like that.
- Yeah, all right, I'm gonna--
- I know you're gonna run with it. I'm waiting for it, let's do it.
- Your answer made me feel like you're one of the the crowd of people who are scratching their heads anywhere an allergy is around.
- That's why there's two of us.
- How about this one? Let's try this one for emphasis. Allergies are your body misidentifying something in the world as an enemy, and your body reacts to that misperceived enemy by trying to shut it down. And so it could be pollen, it could be dust, it could be, you know, many things in the world that usually they contact your nose, or the back of your throat, or your lungs even, or your eyes. And your body senses those things and it just wants to shut them out, and so to shut them out, it causes things to swell up, you know, so you get stuffy nose 'cause your nose swells up, causes your nose to run 'cause it wants to wash that stuff out of there, causes you to sneeze and to cough 'cause it wants to get it out of there. And it's so insane in some folks that the body completely shuts their airway down, and it kills people. So people do die from allergies in this world. And it's really the epitome of sort of the foolishness of allergies, meaning the body is identifying something stupid as an enemy and it wants to shut it down and it shuts somebody's airway down and they can't breathe, and then they die. Now, most people who have allergies don't die, but it could, obviously, it can run to that extreme. On the shorter side of that is just the annoyance factor. And so this time you're in the springtime, and things are changing. And so there's there's pollen, it's sort of just starting to come out in the air and so your body senses that, wants to shut it down, gives you all those symptoms. And so if somebody is bothered by allergy issues or maybe perceived allergy issues, that's a lining issue. So meaning that the lining in your nose, a lining in your eyes eyes, a lining in your skin, the lining of your body is reacting to what your body is contacting, and that's annoying. For folks who have nose issues that relate to allergies, almost always, it's a combination of a lining issue and an anatomy issue. So anatomy means that you have to have enough room to breathe, and if the are structures in your nose, for instance, are too big, then you don't have enough room. And so worst case scenario is you don't have enough room, that's annoying, and your lining is irritated, that's annoying. And you dovetail those things together and now you have not enough room, allergy is annoying, and then you're super annoyed. And so, you know, we can't get into all the details today about allergy treatment. But I'd say when you think about allergy treatment, it's really trying to impact those two areas. So we can we can either help the lining out. We can oftentimes do that with medications and other treatments and that's nice. Alternatively, we can help the anatomy out, so we can do procedures to get things more open, and that's nice. And so the reality is most folks who have allergy issues have been an anatomy issue and a lining issue. And most folks who have allergies that see anybody other than an EMT who deals with these issues, is only going to get half the story. So if you go to your primary care doc or an allergist, they'll tell you that they can treat the lining, but they can't treat the anatomy. And you know, the nice thing with our toolbox is we can treat all the above. And so it's just sort of a tailored approach for what somebody has got. And that's the right approach. You know, I do have allergies, and I've gone through allergy shots, and I've gone through procedures and I'm in a pretty good position right now, because of the dual approach of treat the anatomy, get things open, I'm open, and do what we need to do for the lining. If you do it in that order, what you'll find and what we find for our patients is that if you get the anatomy open, the lining is so much easier to treat and we don't tend to have to do so much. It tends not to be so annoying. If you don't have your anatomy open, you could throw every spray and pill in the world at your body and it's never going to be enough because things aren't open. So how's that explanation?
- That's good. And I'm gonna I'm gonna piggyback on that and just say, you know, there are questions posed to us as clinicians, even after doing procedures, and we've touched base on this before, and I believed you called me, said I had a dumb answer, so I'm gonna improve upon it at this time. But, you know, a patient said, "Hey, I was told, "my allergist told me or my, you know, whoever told me "that after this procedure, my allergies have gotten "a lot worse, because I'm breathing more through my nose." And I think a good answer is, "Well, you could not breathe "or you could breathe, and why would you ever "not want to breathe?" So it's a matter of let's get that nose open. It's a lot easier to treat it on the back end versus having just a stuffy nose all the time.
- Yeah, absolutely.
- And then one other question I had for you, so when patients say, "Well, why do I have allergies "and my, you know, neighbor doesn't or, you know, "my daughter doesn't?" You know, why do some people have allergies and others don't? Why do they perceive that that pollen is the enemy.
- Generally, it's something bad they've done in the past. Is that the right answer? No, that's not the right answer, is it?
- No.
- No, the right answer is if you truly have allergies, it's oftentimes genetic, and it's really just a misidentification of common things. And, again, we don't have time to go really deep. I mean, allergy is a huge topic. But it's even that like, if you think about it, and most people don't, but if you think about it, our ancestors didn't have these allergy issues. These allergy issues are really sort of post industrial man. So last couple hundred years is where we've been suffering with allergies and asthma and many, many things, and it's actually becoming more and more prominent. Nobody knows for sure, but we think it's some combination of our environment getting cleaner and cleaner over time, which sounds good, but it's not. Because the less things that your body is interacting with, when all of a sudden it sees something a little bit strange, it wants to go crazy versus if you grew up on a farm and you're eating dirt and you're rolling in dirt, and you know what I mean? Like you get stuffy all the time, your body is sort of used to seeing some strange things, and it's not so spooked. And so now you have people who live in bubbles, and, you know, the world is sort of shocking to their system that tends to be allergies. And then they're likely as some other component, which is some combination of kind of what's in the air these days as far as pollution and, you know, nobody knows all the the nuances, but our bodies are becoming more and more sensitive over time to the environment around us, which is, you know, not a good thing. But it is what it is. But, yeah, I mean allergies, we could go on and on and on, and we will at some point, because it's actually kind of interesting multiple levels, frustrating for so many people. I guess, the short answer right now just for those that are listening and watching is that there are answers. And so if you're suffering with those sorts of issues, it's really trying to get to the root cause of what's going on and kind of knocking through a game plan that's specific to you and with a goal line in mind, like, "Hey, we wanna get you here, and this is how we're gonna do it, that kind of thing.
- I think we are coming near the end. I'm gonna give you a shout out this week. You and Dr. Schmidt, you are the ADVENT's representatives to the Milwaukee Magazine's Top Docs of 2020. So does this mean you're a better doctor than I am?
- It absolutely does not mean that. Many thanks to any of those who, who, you know, I feel honored to even you know, be mentioned in that light. So, you know, obviously we're here for patients and serve, you know.
- No, it's a good thing, it's a good thing. I mean, just like everything else, I'd say is that some that's probably a whole other topic we can cover some days is sort of the kind of these doctor ranking kind of things. It's sorta interesting, you know, and there's there's a lot of stuff we don't know. So I think sometimes sometimes talking through things that we don't have all the answers to sometimes might help those that maybe think that they do. But that is a good thing, and it's not to be taken lightly. And I think when you look at lists like that, I think one thing for those out there to pay attention to is when you look at those lists, and you look at the docs, pay attention to the docs that are part of independent medical practices like ADVENT, and pay attention to the docs that aren't. And those lists, like the medical community, are made almost entirely of docs that are part of the big hospital systems. It's very unusual to have independent doctors on that list. Well, number one, because there's not many of us. And number two is a lot of those lists are voted on by other physicians, and if your physicians are all part of the same big mega group, it's a lot easier to find yourself on that list. But so it's a notable thing, you know, for you guys to be on that list and just, I'm just sort of pointing that out for those that don't kind of follow the ball there, but that's a big deal. So any shout outs from you? Yeah, I'm just, you know, we're coming up on what is it? May 26th, there's a kind of a shelter in place, hopefully, will be lifted and just wanna give a shout out to all those continents, you know, and say, "Hey, you guys "have, everybody's rocked it," and, you know, people are itching to get back out there and get back to some normalcy, and myself included, just do it with some sense and be safe, certainly, and, you know, know that it's a marathon, it's not a sprint, and so we still have to be, you know, cognizant. But, yeah, it'll be nice to start to stretch the arms again.
- Indeed, it's coming, life is coming back slowly.
- Life is coming back.
- Which is good, which is good. So I think that is all we have. I thank you all for watching and listening. If you are watching on YouTube, if you could subscribe to our channel that means that you'll get our latest and greatest as they arrive. And if you're listening to this on on iTunes or whatever podcast medium you're on, if you give us a rating, whatever that honest rating is, you can subscribe there as well. And we will be back shortly. All right, take care.
- All right, see you next week.
- Nice.
- How long was it?
- Your sports to home sleep study segue is mwaah, ready for radio perfection.
- There you go, there you go.
- No, that was great. You did some good stuff in there. My favorite was the implication that if you grew up on a farm, you roll in dirt and eat dirt--
- That's a stereotype. That's what I thought of Wisconsin. Remember, when I lived there, I had no idea that the city here.
- Is it getting better or what's your guys' feedback?
- Yeah
- I thought it was great, nice and fluid, I mean, there's no awkward pauses or breaks or anything like that. This is exactly what we need to do is just, you know, book in the beginning to end and just makes it so seamless that way, so I thought it was really good.
- I mean, I thought that first video has the long segment but I haven't--
- Oh, you want to see here, I can send you the most recent out here in the, it's much .
- Are they getting hits though?
- Yeah.
- Okay.
- And the micro content is really where we cut up pieces of it, and they go out on social and we promote them there as well. So that's where the value is, yeah.
- Okay.
- Sarah, what did you think?
- I thought it was really interesting, I think. So can they see you on video as well, or is it just audio?
- Yeah.
- Okay, yeah, I think that's, I think like, obviously, you guys play off each other very well. And I like that there's an element of humor. I think people see you more real that way. So I appreciate that it's not stuffy, it's not, doesn't have that corporate feel. It's professional, but approachable.
- What are we doing after lockdown?
- Are we? What do we think in there? Are we gonna to go in-person?
- Yeah, we can do that or we can keep doing this.
- I mean, what about, a part of me is where he is.
- You know, like, like , but you know how like some of these ones have, like, who's "Mike & Mike" in the morning, you know, like the ESPN stuff. Like they're talking, there's a video but then there's also an audio. But they're also talking to microphones like it's radio, but it's being recorded. Like, would that be stupid? Or is it similar to this except we don't have to do it via Zoom.
- I mean, we're beginning to turn out like just audio segments for podcasting now that we're doing it this way. We haven't launched anything. We're gonna kind of get three or four of these episodes together and then push them out all at once so that we have something there for people to land on.
- Yeah, I mean, I guess, you know, this is my own opinion, I have no knowledge in the social media is what what gets traction or not. But it'd be cool to do it, like, if we had a background that had ADVENT or whatever it was that we needed and then us to have a mic in front of us and do this and have some interactions for the video kind of component, kind of like, you know, what's the guy's name? I just sent you the video.
- Yeah, Z Dog.
- Z Dog is like a video feed too. He has the video thing on the same podcast.
- Yeah.
- Yeah, I think that's that's probably where we'll end up once we're back, back at innovation where it'll be a podcast that's recorded for video as well.
- Okay, I need to be 12 feet away from him.
- Yeah, exactly.
- All right, good. Are we doing this next week?
- Yeah, I think we're in for what, 10, on 10:30 on the 20th, I wanted to say?
- Okay.
- 10:30 on the 20th is what I'm told doesn't affect schedules.
- Okay.
- Okay, sounds good.
- All right.
- All right.
- Yeah.
- From you guys perspective, all good. I mean, no issues that we need to address for next time?
- We need to have a faster computer, I guess. It was a little glitchy mode in the first maybe 10 minutes. And then it kind of mellowed out but it still came in and went a little bit.
- Yeah.
- I hear you.
- I was gonna do this from, well, you're in my office, so I couldn't, I was gonna, I mean, I was going to just come in and do it over there.
- Oh, my God.
- So maybe I'll try that next time. We'll see, I don't know. I don't know if it's better or not better. But
- I mean, if we're not on the same house, I still got it.
- What's that?
- What you have right now looks really good.
- Yeah.
- It's be a big improvement from last week.
- I gotcha, all right.
- We will take whatever credit comes about by you doing this, completely unprompted by us. It's already been, "Oh, did you, did you tell him about that "his camera looks better now?" And I was like, "No, but we'll take credit for it."
- It was my own self critiquing bit. But yeah, no, I just, it's easy enough to turn my monitor. It's just that I do need to get a better computer though, it seems like.
- Yourself, do you have a gateway?
- Not so.
- I'm joking, you guys remember the gateway? Everybody had a gateway at one point.
- I never had a gateway, I had a Dell back in the old days. I never had a gateway.
- Gateways were, where was that?
- All right, well, are you jumping onto another call? Do you have five minutes teams me back?
- Ah, I have five minutes and then I'll just touch base with Sarah, so I'll touch base with you and then Sarah.
- Call Sarah.
- We'll see ya.
- All right, thanks, sounds good. Thank you so much guys.
- Thank you guys.
- See yah, bye.