Speaker 2: Hello.
Speaker 1: This is the Itchy and Bitchy Podcast because being itchy
is bitchy and our medical system sucks. I'm doctor Keith Nolica,
a vetnary, allergist and dermatologist.
Speaker 2: And I'm Stephen Miller, a doctor of nursing practice and
a Q Care nurse practitioner.
Speaker 1: Send us your questions at ask at itch not dot com.
We love you, but we're not your doctors. The information
we discuss is not direct medical advice. Please talk to
your provider who is the expert on your care. The
Itchy and Bitchi podcast is sponsored by doc Itchy Medical
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send us a question at it ask at itchn dot com.
Thanks hello, and welcome back to Itchy and Bitchy podcast.
How are you, doctor Miller?
Speaker 2: We are so good?
Speaker 1: Okay, So this is our first first episode of questions
that we got from our listeners, and we actually probably
Karen has listeners from all over the world actually, so
we definitely have some from the United States, but we
also have dozens of listeners in Australia about Canada, Europe, Alaska.
Speaker 2: Hello out there.
Speaker 1: Yeah, big wide world. So hello to everyone, and thank
you guys for listening to us.
Speaker 2: Thank you, yeah, thanks for listening.
Speaker 1: So we got some questions from our listeners and we're
gonna ask us many our answer as many as we
can as we go along. We don't want to make
this too tedious, but we picked out some of the
most interesting and useful to answer. Doctor Miller also got
a screenshot of us recording and we're wearing our Puerto
Rican San Jose bling. We have a studio set up
in Puerto Rico that we visit sometimes, so that's why
we're all decked out in our Puerto Rican attire.
Speaker 2: So we are we support the island.
Speaker 1: If you're interested in that, you can check out our
website at where would the website be Itchy and Bitchy.
Speaker 2: Dot combitchi dot com or please go on and like
I and b Podcast on Facebook.
Speaker 1: Yep, okay, so ready, So we're gonna divide this up
and we're gonna have a few breaks. We're going to
try to get to as many questions as we can.
Are you ready care, captain, We're ready to roll. Okay,
So the first question is from Tiffany from Atlanta. She's
fifty six years old female, and she asked us that
her doctor. She said, my doctor started me on GLP
one and HRT simultaneously, so at the same time. And
then she says Reddit went crazy and she wants to
know am I over medicating? And so my opinion is, doctor,
Reddit is not a thing, So check with your provider.
Your provider is the expert on you, and that would
be my first response to that. Probably there's some medical
data as far as GLP ones and HRT.
Speaker 2: Yeah, so it's worrisome, but you know, when you and
your particular situation have a therapy change and you put
that out there in the world, and so then all
kinds of people with varying opinions weigh in, and so
I think it's important to definitely trust your provider and
at least balance ideas and questions off your provider. Now,
on the hormone side, it is the interesting More and
more information is coming out on the GLP one ras
and in women with PCOS, which is polycystic ovarian syndrome
which can be tied to obesity and hyperinsulinism. In this
and that there is an issue related to testosterone levels
rising as part of PCOS and so lyriglue tide is
found to reduce serum testosterone levels over about a three
month period, which then it leads to improved androgen profiles.
And so it's important to remember too with weight loss
that all the six hortomones are fat soluble hormones, so
there's this shift that happens. This particular study came from
a systematic review of glp ones in patients that had
metabolic syndrome.
Speaker 1: Okay, so that was a lot of information. So what
I got from that is that the hormones and the
glp ones are definitely interacting. When you start losing weight,
some of the hormones that have been deposited in the
fat are going to be released. You're going to have
fluctuations there. It sounded to me like you need to
have an expert that would be your provider monitoring hormone
levels and checking and really doing a frequent revisit monitoring
rather than in every six months kind of situation.
Speaker 2: Yeah.
Speaker 1: It also you mentioned and polycystic ovary disease. How common
is that?
Speaker 2: It's extremely common, certainly as BMI goes up, people start
to develop pcos and then there's also some reproductive repercussions
that come from that. And so the GLP one a
is also are thought to impact estrogen mediated pathways and
reduce viseral fat, which then can potentially have impact on
gonatal effects and weight loss mediated effects for reproduction.
Speaker 1: Yeah, so previously we did an episode and I compared
this whole hormone pituitary cascade, like having fifteen toilets interlinked,
and you have all of these water flows and crazy
ups and downs and feedback loops and everything, and it
really is a very very complicated system just with the
HRT and the hormone issue, but then you add on
to that the GLP one which can have some dreg
influence on hormones, but also as you start degrading the
fat and losing the weight, then that also changes the
water level and the tanks and the hormone levels. So
it gets really really complex. So would you would have
if this were your patient, and we're not your we're
not your doctors, but it would have been better to
do one for six months and then do the other,
or is it bad to do both at the same time?
If they're not, you know, and this depends on.
Speaker 2: How I think it met it possible to make that
call because we just don't have enough information on this
particular evaluate the patient, and so I think a full
evaluation with full hormone levels. I do think that we
underestimate the impact of weight gain, and certainly even among men,
there's been some association with gp one ras and increases
in testosterone levels as people lose weight as well.
Speaker 1: So definitely contact your your doctor. Taught asked these questions
to them. But Reddit is not really a great source.
You know, I've been involved in Reddit and various marketing
and science and data and you know, I have a
textbook that I've written, and Reddit is public source and
there's some usefulness in that. But these are not people
that know your situation. They can say, you know, space
aliens came down and stole your ovary and there's just
no you know, rhyme or reason to some of the
stuff on Reddit. So talk to your provider. Definitely, there
can be some interactions. If you're definitely having any symptoms
that seem a typical, absolutely get evaluated again. Okay, any
last thoughts on on.
Speaker 2: Tiffany Tiffany Yeah, thank you so much for engaging with us.
And I think you are certainly inquisitive and would like
more information, so make sure that you follow up with
your hormonal expert that you're seeing perfect.
Speaker 1: Yes, So Reddit's not a doctor and we're not your
experts on you your provider, so seek more information. Okay, we're
going to do one more question, then we're going to
take a break. So this is from Luke, who's fifty
nine years old from New York and this is actually
a guy, so that's good. So mainly we have women
listening to the podcast because of all the work Karen's done.
So Luke wants to know do I have brain fog
or Alzheimer's And he doesn't really give much more detail
than that. So definitely, we're not your provider. We're not
your doctor, so seek medical assistance. But I think this
is a really common question. I'm fifty eight. I think
maybe fifty nine. I'd have to calculate. I'm not so
great at math. But I actually ask this to my
groc I have a Tesla so it comes with free
groc Ai and I couldn't remember what day of the
week it was, like, I really had trouble remembering if
it was Thursday or Friday. I have a housekeeper that
comes on Friday, so that's important if I have to
get the house set up. I really couldn't remember, so
on the way to work, I actually used the AI
in the car and asked, do I have early on
set dementia or Alzheimer's if I can't remember what day
of the week it was? And it said, what do
you think?
Speaker 2: It said doctor Miller, Well, I mean dementia among our
age group, early dementia is very rare, very rare.
Speaker 1: Correct, so statistically probably not. And then it also said
that really most likely not, that you're probably stressed, fatigued,
overwhelmed with other issues. That true, Alzheimer's is not necessarily
dementia is not really forgetting where you park the car,
but it's totally forgetting that you have a car and
that you can drive, like way more serious.
Speaker 2: And the issue really comes down to figuring out what
the root cause is. Right, So root cause of that
scenario in a fifty year old man would be something
like anxiety and depression and chronic stress or sleep disorder. Medication, polypharmacy,
metabolic and indricin causes chronic alcohol substance use and then
is subjective cognitive declimb. But again the point being that
it's important to do a root cause and make sure
that you're following up with someone to if it becomes
a persistent problem.
Speaker 1: Yes, so I actually for two weeks about horribly uncontrolled
migraine headaches because my insurance company wouldn't cover my Ajovi,
which was working great for a year. That's a whole
another episode of why this system sucks. But so my
not being able to remember what day of the week
it was is probably related to stress activities and work,
but also my severe migraines for two weeks. Yeah.
Speaker 2: Yeah, so certainly we've got to get that evaluated and
checked out.
Speaker 1: Yeah, Okay, we're going to take a break and then
we'll come back and we'll answer a couple more questions. Anything,
last comments before we take a break. No, great question, perfect, Yes,
And just those questions, Luke and Tiffany, we really appreciate them. Okay,
we're back. I hope you hung with us after the break,
And so we have a couple more questions from our listeners. Again,
these are probably actually Karen's listeners, but thank you very much.
I hope you hang with the podcast as we transition
and make the transition. And so I mentioned that we
have people all over the world listening to us, mainly
from the United States. So this next question is from
Violet from Dallas, and Violet didn't say how old she
is or what the exact situation she is, but she
said my dog is fat, that she have menopause, And
we tend to answerpomorphize that means we put human characteristics
on dogs. And so this is kind of thinking, Okay, well,
I'm getting older and maybe having some menopause symptoms. Probably
I don't know how old Violet is or her situation.
I'm not her provider, and you know, kind of transposing
this onto the dog who's also gaining weight. And it
turns out dogs don't have menopause. So the way they
go through cycles and the way they're ovaries and uterus
work is that they never really extinguish all of the
population of eggs and hormones and have the depletion of
the ovaries and hormones, which then caused the feedback loops
of the pituitary to go crazy. So the weight gain
in dogs. Unfortunately in America, we tend to have really
heavy dogs, and that is also reflected in the human population.
Speaker 2: But so I'm curious like that, how do we know
if a dog has Yeah, so menopause, So we're not
so menopause.
Speaker 1: I thought you were going to ask me if they're
overweight or not. So if they're overweight dogs, you should
be able to feel their ribs, but not see their
ribs as kind of a good standard, they shall also
have a little bit of a waste, but for menopause.
So we actually and dogs can do really things that
you can't do in people. So a lot of studies.
We can actually put them in a kennel and for
twenty four hours, seventy two hours, seven days. We can
know exactly how many calories we're giving them. We can
collect their p and poop so we know exactly what's
coming out of them. We can do culture's DNA analysis
on the feces. We can do like crazy things analysis.
So we can also do hormone levels and actually do
monitoring of hormone levels every hour for seventy two hours
and every week for five years in a research setting,
which would be really really difficult to do in humans.
So we actually have much much more fine granular data
in a lot of our animal species because we can
do better, more detailed research that you really could never do.
Speaker 2: In a huge female.
Speaker 1: Dogs have estrogen, yes, so they do cycle and they
have eggs. But the whole menopause system is that the
ovaries get depleted and then they stop producing the hormones,
which then the pituitary gland goes crazy and tries to
get the body to produce more and more sex hormones
because the ovaries have kind of burned out, and dogs
never get to that burned out station. There are situations,
so you can actually have a very old dog that's
still going through heat cycles metabolically. They may not be
able to get pregnant because of the nutrition and variety
of other reasons, but they can still cycle, so they
still have the hormones at the appropriate levels. And so
menopause is not really the lack of reproduction. It's the
lack of sex hormones and the balance in the body.
Speaker 2: And those sex hormones among older dogs start to drop
off just the same way as with they do.
Speaker 1: But yeah, so in humans, as we age, our hormones
and males and females drop and pretty much all the
hormones drop, so melatonin and thyroid and everything, and that
absolutely does happen in dogs. Dogs only live nowadays about
fifteen years, but absolutely there's an age related decline, and
some of that we don't even understand. So now we
have a geriatric hormone imbalance that seems to respond to melatonin.
So it's a geriatric hymns is what we've been calling it.
But that's still not a menopause situation. So for instance,
twenty percent of large breed dogs over thirty pounds will
have true hypothyroidism, and up to forty fifty percent of
small breed dogs as they get older will have cushions
or atypical cushions, which we now cause this call this
a geriatric hymns melotonin responsive hormone imbalance, but it's not
true menopause.
Speaker 2: To me, it seems like we don't really know. No,
I think we absolutely do. Flashes and all of those
symptoms you can't really assess in a dog, right, I mean.
Speaker 1: Correct, I mean they can't tell us if they're having
a hot flash, but they're not panting and things like that,
except our older dog, which that's another story. But we
actually do know for sure. So if you call menopause
like the symptoms of menopause, they can't really tell us that.
But if we look at the hormone levels and what's
happening with the ovaries, the uterus, and the pituitary, we
know that what's happening in human primates and whales is
very very different than what's happening in dogs, cats, horses, cows,
so very very different. So the overweight from Violet who
asked the question, going back to the original is from
calories in calories out, American lifestyle, not menopause.
Speaker 2: And so that was a violent just maybe should cut
back on the feeding a bit.
Speaker 1: Yeah, calories in calories out, so you know, it would
be good to get up and move for both Violet
and puppy dog. That's always good. So that would be excellent. Okay,
so you want to do one more question or take
a quick break here and come back.
Speaker 2: Who can do another question?
Speaker 1: I take that. The next question is from Amy who
is in Alaska. So thanks for listening to us, Amy
and Alaska, and she's fifty nine years sorry, fifty two
years old. And this is pretty typical maybe for the
Canadian and Alaska listeners, but Amy's question is is drinking
as bad as people say or is this just another
health panic? And I think this actually goes back to
Tiffany's question, which is interesting that Tiffany is the one
that's on GLP one and HRT and is taking Reddit
seriously and very worried about what Reddit says, doctor Reddit,
and Amy is the opposite, wanting to ignore the information
from people. We don't really know who the people is,
but it sounds like Amy wants to keep drinking. So
I guess the question is is alcohol how much alcohol
is good and bad? My belief I drink. I do
love wine oftentimes this we have a podcast. Sometimes we
have a glass of wine. But it is a neurotoxin
alcohol absolutely.
Speaker 2: And the current recommendations is actually moved toward greater caution.
And you know, the only entirely risk free behavior is
no alcohol at all. Now, the reality of it is
that the dietary guidelines for Americans from they did an
evaluation from twenty twenty to twenty twenty five, and for
men it's less than are equal to two drinks per day,
and for women it was less than one drink per
day and one drink equal a twelve ounce beer, five
ounces of wine, or one and a half ounces of
some distilled liquor. And the reason that there are differences
among sexes is because there was a trending toward cancer
among women who went beyond one alcoholic beverage day. So
it's important to point out that, you know, the US
Surgeon General Advisory says, this is a toxic substance that
you're taking into your body.
Speaker 1: So two added little comments here. So one is five
ounces of wine is not very much. When we go
to restaurants, they all ask us if we want to
see sounds for nine ounce poor so they don't even
offer a five ounce por So the amount of alcohol
that's considered safe is really small compared to what most
of us drink. The other kind of funny thing I
think about this, we have various acquaintances, and you know,
if you're taking vitamin supplements or going to the METI
spot to get IV treatments so that you can drink
more wine and more alcohol, you know, you're kind of
taking a toxin and then you know, over amping the
recovery phase on the back end, and that's kind of
an illogical process. So if you really want to be
as healthy as possible, don't drink alcohol.
Speaker 2: Well, major healthcare organizations have shifted their opinions, and those
opinions have shifted more recently. The American Heart Association basically
says avoid alcohol entirely, and the American Cancer Society says
it's best not to drink alcohol. The World Health Organization
says there's no level of alcohol consumption that's safe for
your health, and of course, the American Diabetes Associated advises
against drinking it, the point being that it is a toxin,
and if you are going to drink alcohol, you should
do it in moderation and certainly take into consideration the
current findings from our recommendations from the dietary guidelines.
Speaker 1: So I used to lecture for a living traveling all
over the country and internationally, and one of the things
I would point out is with various medications for allergies
and dogs have a lot of side effects. And so
I'd ask the audience, well, you know, this is like
asking your provider how many cigarettes is safe? So what's
the different way? How many cigarettes is safe? Doctor Miller? Zero? Okay,
So how many drinks are safe?
Speaker 2: The shift is now towards zero. Now it's interesting for our.
Speaker 1: So we like wine and we like to drink, is
why we are so hesitant to give up. But the
answer the question is zero.
Speaker 2: Well, it's also interesting for our Canadian listeners, which I
think they'll find this interesting. Is at in twenty twenty three,
Canada their guidelines went to a continuum of risk approach
rather than a single threshold approach, so they consider the
Canadian entities consider low risk less than two standard drinks
per week week, moderate risk was three to six drinks
per week, and increased high risk was greater than are
equal to seven drinks per week. So kind of differing
opinions around the world on this topic, but culturally.
Speaker 1: The ultimately how many cigarettes are saved zero? How many
drinks of alcohol are safe? Zero?
Speaker 2: Alcohol is a Grade one carcinogen.
Speaker 1: There you go, So okay, we're going to take a
quick break and when we come back, we're going to
go a little bit faster and try to get as
many questions in as we can. Thank you very much,
Amy and Violet for sitting us questions and Alaska from Amy,
I think that's just kind of part of Canada. So
there you go saying okay, listen stay tuned, come back,
and we'll be right back. All right, we're right back.
We're going to take a few more questions and a
couple of breaks in between, but we're going to go
a little bit faster. So this next question is from
Brenda from Baltimore, who's actually says she's turning sixty this week,
so bretty birthday, Happy birthday, Brenda. So Brenda wants to
know can I get addicted to my GLP ones?
Speaker 2: Yeah, there's been no evidence at this point to show
that GLP one is having any addictive property at all.
Speaker 1: So that I think going taking a step back is
what's the definition of addiction. So if you stop taking
the GLP ones, will you have withdrawal and get sick
like a heroin addict? No? Probably not, most likely not
based on everything we know.
Speaker 2: But if you have not modified your diet your exercise regimen,
then clearly once the GLP one A washes out, then
certainly dositiety and diet and exercise returning to get and
you have to continue to moderate that.
Speaker 1: So if you lost weight with the GLP one and
you stop it, you will gain weight unless you've changed
your lifestyle with exercise, food and all of those things.
So is that addiction? You know, again, the definition of
addiction can be flexible. The other definition of addiction it
relates to abuse. And what is this o zimpic face
that I've been seeing on social media and TikTok A's
that skeletal face when you take too much ozimpic or
any of the GLP ones. I'm not just picking on ozimbic.
Speaker 2: Well, I mean, I think there are some patients who
are pursuing utilization of GLP one a's who clearly need
to pull back on therapy healthy therapy, which.
Speaker 1: Is kind of the pfinition of abuse. Is that if
you're damaging your body by using a drug or product,
then that's also a flexible version of addiction.
Speaker 2: Well, and they are FDA regulated drugs with FDA indications,
and so if you are on them, you need to
be routinely seeing your a provider to evaluate the dose
response and where you are health wise, you know you
are you below and optimal weight and now looking malnourished.
But so I think that all has to be tethered
with the having accountability.
Speaker 1: So I would divide this question into three answers. I
would say, are you addicted that's the question. I would
say that if you stop the drug, will you likely
gain weight? Yes, you are. You probably going to require
the drug to maintain the low level or weight loss
that you've had. So yes, you stop the drug, the symptom,
the weight gain will come back. So that's one definition.
Are you will you suffer symptoms of withdraw and have
physical discomfort or pain like a heroin addict from the
stopping the GLP one? No? And then psychologically, are you
using the drug for sort of abnormal physical appearance or
body morphism or problems that you're having that you're dependent
on the GLP one psychologically, but it's not a true
chemical dependence, and that definitely can be So, you know
a lot of people are taking glp ones that don't
really meet the FDA guidelines and they're taking it for
cosmetic reasons and that can easily go too far.
Speaker 2: Well, and then you also have to take into account
that people are food addicted, and so the class is
that it tends to have some impact on addictive substances
and for example, decreases an alcohol intake. And from that so,
I mean, I think it's important to weigh that in
a bit. If someone has an underlying eating disorder.
Speaker 1: So will that addiction come back? That and it could
be shopping addiction, por an addiction, whatever kind of addiction
definitely seems to go away with the GLP ones or
at least diminish, and that would come back if you
stop the GLP one.
Speaker 2: But seeking proper care to address the eating addiction I
think is more important, So that focus on.
Speaker 1: So the answer is how you define addiction. So, okay,
we're going to take a quick break and then answer
another question and hang tight. Will be here on the
other side. All right, we're back. We're actually going to
do two questions real fast here and then say goodbye.
So the next question is from Jason and they and
say where or how old? But they wanted to know
why does every woman I know have autoimmune disease? And
maybe that's why they didn't tell us where they're from.
That seems a little snarky. I don't think every woman
has autoimmune disease unless he's working in a loopus room
and toward arthrotists practice or something. So we're actually going
to do an episode. The next episode is going to
be on autoimmune diseases like lupus, pemphigus and we'll talk
about the risk rates and statistics in women and men,
in older, younger, middle aged people. So listen for the
next episode and we'll answer that question. So then our
final question comes from Becky from Canada. So you mentioned
Canada before, so thank you very much Canadians. Becky is
fifty five year old woman and she says, or wants
to know that I've been taking probiotics every day for
two years and I have no idea if it's helping.
How do I know if they're working? And this is
actually one of my favorite pet peeves is that the
whole gut neuro skin axis, the gut immune system axis
is definitely a known thing. We have hundreds of species
of bacteria in our gut, over a trillion organisms, and
the probiotics that we have are very few probiotics, and
they're based on really limited understanding of how we influence
the gut bacteria. So we know that there's a problem,
we know that there's a link between inflammation, neurology, skin
allergies even but we really don't know how to fix it.
So we're at the infancy of really understanding how to
modulate the gut bacteria and then how that affects the
disease and symptoms that we're having. In dogs, we actually
have a few more studies than they do in people. Again,
we can do kind of weird dog research that they
couldn't do in people. So, for instance, we have organisms
that we know improve dental tartar. We have organisms that
we know improve infections and allergies of the skin and ears.
We know, so we have very select bacteria, species specific
bacteria that affects certain diseases and symptoms in the body.
Speaker 2: Right. And then also for our audience, I mean veterinary medicine,
their studies are very very small ye, and so the
confidence intervals are a little wider on that data set. However,
it is important to remember that probiotic supplementation is not
recommended just for generalized daily use in the US. It's
strained specific, and it is indication specific, and we just
really don't understand a whole lot but sort of indications.
You know, you're looking at things like, you know, antibiotic
associated diarrhea or C deficile you know.
Speaker 1: Yeah, so after you disinfect your GI tract then repopulating
it with bacteria, it's not a bad idea. So one
of the other questions I'm sure you do this as well,
is when I have patients in the room and they say, hey,
I've given this or supplement or whatever it is, and
they say, what do you think about that? And I
asked them, well, do you think it helped? And if
you can't tell it helped, I say, we'll try stopping
it and see what happens. And if you can't really
tell a difference between taking it and not taking it,
then you know, probably it's not doing anything obviously good.
The good news with probiotics is that they don't seem
to be harmful. We don't have a lot of side
effects that we know of, so you're not doing any
damage as far as we know. But are you really
having benefit? Maybe maybe not, So you can try stopping them. Again,
we're not your provider. Check with your provider, but you
may be wasting your time and money, or you may stop.
They will take a few weeks to really kind of
kick in, and also the benefits to kind of clear out.
Speaker 2: There actually are two conditions where the American Gaess Rentrology
Association Association recommends against using probiotics, and that's with Crohn's
disease and all sort of colidis. So it gets complex
when you start getting in the weeds on this.
Speaker 1: Is that because of the absorption that your barrier is
broken down, you can absorb the bacteria more directly than
get septic made.
Speaker 2: So there are multiple reasons to take probiotics. Certainly follow
someone that you're seeing. That's a healthcare person's advice, but
you know there's some impact with cardiovascular risk factors and
gut microbiotom modulation and immune factors and vational health and
mental health and autoimmune disease.
Speaker 1: Potential benefits really amazing. My prediction is that in five
to ten years, we're going to know that if you
have this disease, these symptoms, you take this bacteria the species,
and you'll know the dose and the duration, and that
it'll be very specific. Basically a biological treatment for a
disease and a symptom set. We are nowhere near that yet,
but you know, I would I would tell that if
you're not sure, tries stopping them and see what happens.
But as always, talk to your provider. Okay, any last
words were We ran out of time for our Legit
and Bullshit section. So any wrap up comments, Doctor Miller.
Speaker 2: Yeah, I would just say, don't just go out and
start popping pills randomly off the countertop because TikTok or
whoever talked or TikTok. I just think we are over supplemented.
I have had patients in the past who are on
five indicated pills, medications that are prescribed, and then in
addition to those five, they are on ten or fifteen
supplements for which they haven't brought them into the office
and had those adjudicated. So just use caution.
Speaker 1: Yeah, I mean a lot of these supplements we don't know,
and the lack of information does not mean that we
have good information or bad information. It's just no information.
So do they help? Maybe? Do they hurt? Maybe? Do
they interact with other medications you're taking?
Speaker 2: Maybe interesting, it's a lot of money to spend either
to poop it down or pee it down the drain.
Speaker 1: You know, that's a lot of audiomens. If you take
too much that you just kind of pee or poop
them out is where that comment comes, you know. But ultimately,
if you can't tell a difference, then I would definitely
be suspicious. That would be my trigger. Any last words
all right, so thank you for listening. Sorry we ran
out of time for legitter bullshit. If you really liked
that episode or that segment, let us know. Send us
an email at ask at itch not dot com. As always,
stay safe, stay well, and get up and move Okay,
bye bye guys,