Ep. 17 | Laura Guadiana Sanchez, MD, Obesity Medicine, SGMC Health

Transcript

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- Welcome to another episode of What Brings You in today.

- I'm Erika Bennett. And I'm Taylor Fisher We wanna thank everyone for tuning in. If you haven't already, please subscribe to our podcast and leave us a review so that you can stay connected with all of our episodes.

- And if you have any questions or topics you would like us to talk about, you can submit those at sgmc.org/podcast.

- And today we are here with Laura Guadiana Sanchez, MD family medicine physician. So Dr. Guadiana Sanchez, what brings you in today?

- I'm gonna talk about obesity medicine.

- Awesome. A big topic, something that's really gained a lot of interest in the past couple of years, I guess the past year really. Well, before we talk about obesity medicine, let's just get a little bit about your background.

- Yeah. So I'm originally from California and everybody asks me like, California, what, what are you doing in Georgia? But my husband was stationed at Moody and so I got here because of that. But I was born and raised in Los Angeles. Okay. And yeah, I always had this thing about being, you know, I was gonna be a doctor since I was little. I always said I was gonna be a doctor. And so I was really focused, you know, I liked school. Like since I was little, I liked school. So I was one of those like, you know, weird kids, like nerdy kids. But I was super focused. I would, you know, did pre-med in undergrad and then I did medical school in California at uc Davis. I thought I was gonna be a pediatrician. I actually thought like that was my interest, that I wanted to like help kids. And I had this call to service, you know, like I wanted to help people and I really like kids, so I thought I'm gonna be a pediatrician. But pretty much like that first week of medical school. So they let you, you can go to like the student run free clinics and volunteer like, it's like your first day of medical school and you can go volunteer. And so I knew nothing about medicine. I didn't even know how to put like my stethoscope on. And I was there volunteering and it was like, since then I was like, you know what? I wanna do family medicine. This is really, really cool.

- Well, you get a little bit of both world worlds with family medicine, right. With the pediatrician, pediatrician, pediatrics, excuse me. Oh my God, I can't talk. Okay, go ahead. No, yeah, I, I'm okay. I might need medical evaluation, but you're here, so let's keep on.

- No, yeah, I, I like it because you can see like what we call a cradle to the grave, right? You can see kids, you can see adults, you can see people in older age, pregnant women. So I love that. I love that. Like I didn't know what I was gonna see next. And you have to know a lot about, a lot. Like some people say like, you need to know a little bit about a lot, but really you need to know a lot about a lot. Yeah. So, you know, some people have a lot of, you know, really complicated chronic diseases and you're helping them navigate that in like the healthcare system, which can be really hard to navigate when you don't know exactly what's going on. Why am I on all these medications? And I love being like that family doctor who can like sit down with people and like explain things to them and like just be an advocate for their health.

- Yeah. I think that's what we try to instill in all of our episodes is the importance of having a primary care provider for that reason. To have that advocate and that person you can go to with your questions that's gonna be there to support you and help you get through your health journey.

- Definitely. So you're a family med medicine physician. See now Erika's disease is wearing off on me. It's

- Contagious.

- But you had an interest in obesity medicine. So can you tell us about how that got started and everything?

- Yeah, so, you know, we didn't really get a lot of training in nutrition or weight management. Even when I was in medical school or in residency. Really, obesity is like a disease wasn't actually, it wasn't called a disease until I think 2013. So it was actually pretty recent. Before it was kind of like, you know, something like, almost like a symptom, right? Like it, it, they're vital signs, it's like your weight. But we realized that obesity is actually super complex. It's not just about calories in and calories out. Right? Because if that was the case then nobody would have a problem with it. So, so I didn't have that much training, but when I came here, a lot of people would like ask me about their weight or you know, what can I do about my weight? And all I had to offer them was like, well eat less and move more. Which is like not really helpful Right. Because that's what they've been doing. Yeah. This whole

- Time

- Or trying to, yeah, we're trying to, and we did have some medications, you know, not as effective and you know, we'll talk a little bit more about it, but like Ozempic Yeah. And all of these. But there were some drugs that had come out for the treatment of diabetes that, you know, people started to find out that actually was helping weight also. So when I started seeing these medications come out, so the first FDA approved medication that was like an injectable and was really like changing the way that we treated obesity was, I think, I wanna say like me 2014 or 2015. But it was hard to like get, you couldn't really have insurances covering it. It wasn't really something like people talked about. So I started doing more like training in it. I started taking more classes and going to conferences and just to have more tools to help my patients. And there is a obesity medicine association. There's an American Board of obesity medicine. So if you do this extra training and there's certain stipulations you have to abide by and then you take a really, really difficult test and then you can become board certified in obesity medicine. Wow. So I decided to do that just to help my patients and have better tools to help them because

- We probably have a high prevalence of obesity here in south. I'm imagining.

- Well, even just everywhere. Everywhere. I mean in the United States it's like 40% of people have a problem with overweight or obesity and people who are board certified in obesity medicine doctors that is, is about like 8,000 doctors in the United States. So that's like 1% of doctors. So it's really something that's important. That's why it's coming to the forefront. There's these new medications that are really changing the way that we treat obesity and I think they've been super, super helpful if you use 'em in the right way.

- Right. Well let's talk about, before we get into the medications, like what does being overweight or not, you know, at your prime weight, what impact does that have on your overall health? I mean, imagine it, it's huge causes, it's a indicator of so many,

- It's huge different things. Yeah. So a lot of times we see people with obesity have higher likelihood of having heart disease, diabetes, actually, certain cancers are high. You have higher likelihood when you have overweight or obesity. So it's super important. And that's why, you know, family medicine, it's a lot about prevention. Right. So that's kind of also what led me to like look into obesity more, because if I help somebody with their weight and prevent them from having a heart attack Yeah. Or developing diabetes, I mean, that's huge, right? They're gonna be so much healthier and feel so much better. And there's this huge stigma, right, with weight because it feels like, well one, you can see it, you can walk around with like a thyroid problem and nobody knows what you, you know Right. What your

- Medical

- Issue is. Yeah. But there's a big stigma in like, never thought

- About that, but yeah.

- Yeah. When you, you can see it and people deal with a lot of anxiety and depression. Yeah. 'cause of their weight. Because it's hard, it's hard to treat.

- I know the mental toll that that, that takes on people that, I mean, especially if they feel like they're trying to do whatever, but they're just never successful. And then having to always feel like you just feel like you can't do it. Like you're hopeless. And how do you battle that? So it's very interesting that it's, it's like coming about now. I feel like it's definitely time. No, definitely. And in our world that we take a look at this and see what we can do.

- Yeah, I think so too. For sure. I mean it's, there's like a lot of factors I think that probably go into being obese or overweight. And it's not all the stigma of someone that can't just control their eating, right? There's a lot of other factors. You know, there could be family factors, history and then also like things that have happened to them. Trauma,

- Right.

- And different things like that.

- Yeah. So that, that's why obesity like now is designated as a disease, right? It's chronic. Like this is something that is like ongoing. Some people can struggle with, with weight problems since they're very young. Some people maybe struggle later, maybe because they started on a medication that they needed that might caused them to gain weight, but now they're at like this higher weight and it's really hard for them to lose weight. So there's environmental, you know, component because you might not have access to fruits and vegetables, right? You might not have access to those things. Or that's what you grew up with. You're not really sure what you're sup what you're supposed to be, what's healthy, what's not. There's a genetic factor. Of course, just having a, a mother or father who have problems with weight, overweight or obesity gives the child a 50%, 50 to 80% likelihood of having problems with weight despite, you know, eating the same or exercise all the other same things that somebody else who doesn't have a family history of obesity, it increases their risk of having obesity later in life.

- Hmm. I know I had met a woman one time that had, she had experienced that, which you said was when I owned a, a studio, a fitness studio. And she was very like up hard on herself because she had been on a medication that caused her to gain like 50 pounds. And I just remember the feeling of despair like that, you know, and she just wasn't herself anymore. And she didn't feel like it. And she felt, I mean, and it was so sad. I mean, it's so sad to see that and that people are living that every day and just suffer, you know, suffering in silence or whatever. 'cause it's not something you talk about really openly, unless you're successful at losing weight, then you wanna share it with the world, you know? Oh.

- And that's like a super, super small amount. Right. And I'm not saying that you cannot lose weight with diet and exercise alone, right? Like that is obviously it's huge for your, like your overall health. But when you struggle with problems with weight, it has, it's way more complex than that. And so we have to take into consideration those things because there's like a, you know, society is telling you you have to look a certain way, which isn't necessarily equate to health either, right? Right. But, and you have like that thing of like, it's me, it's I because I'm eating too much or because I'm not exercising enough. So you have like, you're kind of blaming yourself. You kind of feel like society is blaming you. So it's really, it's really hard. It's really hard to navigate. And so that's why I feel like now that I have these tools to help people, it really has kind of changed one, how I approach a patient and how like I try to help them and also how they see themselves.

- How do, so how do you approach it with a patient? Like what are, what's the, I know you can't tell us all you've learned thus far because I'm, it's way vast. But I guess the most helpful things that the general public or population should be aware of that now exist in this field.

- So, well one, I think the medications have really been game changers because now we have a treatment for it. It's not a cure, right? Like it's, this is a chronic disease like any other, but is a treatment that has been much more effective than some of like the older medications that we used to have. So, you know, a lot of times patients will bring it up to me, they want to talk about their weight. Sometimes that, you know, we do kind of bring it up in a way like, hey, do you wanna talk about it? Like, you know, your weight, whenever you go to the doctor and you have your blood pressure checked, you also have your weight checked, right? So it's another vital sign. So sometimes like, you know, if I'm going through their, their medications and their vitals and I'm looking at their blood pressure, I might bring it up. Like, do you wanna talk about it? And a lot of times people are, are open to it and you know, we can go into, you know, maybe there was a medication or maybe you're going through perimenopause or maybe something happened where you can't exercise like you used to. So you really have to take like an approach. Like every person is different and they're gonna have different reasons for why they may have a problem with May. It might be genetic, it might be, you know, their environment. It might be a whole load of things. Yeah. But you have to kind of tease through those things and kind of figure out what this person needs. Yeah.

- So, so what are some of the medication options that are available now that you're seeing help patients?

- So we do have like these, the older medications, right. Which are still actually pretty effective if used correctly. What I had seen before. So we have like Aex or Phentermine, which is a super old drug. It actually came out like in the late fifties, early sixties. So it's been around forever. Yeah. I feel like I've heard that Aex or several times. Yeah. A lot of people have tried that medication. It's a stimulant. And so what it, it works on like your central nervous system and basically it, it does help with your hunger. It helps cut your hunger. It's kind of like in the realm of like kind of A-A-D-H-D type of medications, you know. So like some people who are on a DH ADHD medications, which are also stimulants often, like they don't, they're not hungry, right. So things like aex can be helpful. There's another medication that's also oral. We don't talk a lot about these because you know the sensationalizes like Ozempic. Yeah. But these other medications have been around for a while and are also quite safe. So there's another medication called emia that has phentermine, which is that you know, old drug which is a stimulant. And they paired it with another medication called Topiramate. And Topiramate is a medication we use for like seizure disorder we use for chronic headaches. We use for a bunch of other things. But when they put them together, they actually worked synergistically to help people's weight. Like the Topamax kind of helps with cravings. It also makes food taste funny. So people like, so you're not as hungry, you're

- Like, I don't enjoy it as much. You

- Know? Right. It because it tastes a little weird. Or like carbonated drinks sometimes like will taste flat so that you're not gonna have like especially people who like drink a lot of soda. Yeah. They're like, I can't, I can't have my regular soda. So, which helps, right? If you're not drinking the sugary drinks. So EMIA came out, I'm not sure when that one came out, but it, that one's been out for a little while too. And also helps people with weight loss. Something like 10 to 12% of their body weight on average. And then you have like these new drugs, right? Which are the GLP-1 receptor agonists that's like OZEMPIC or Monro. And now they came out with like the FDA approved for obesity, which is wegovy and set bound. But actually like back in, I think the first one that was injectable FDA approved came out I think in like 2015. That one was like a once a day injection and it's in the same class as like Ozempic and all of those. It did help. It does help with weight loss. It's like not as much as like ozempic in these new ones, but that was like the first drug that really changed how you could treat obesity. So GLP one receptor agonist, the way that they work is we have a bunch of GLP one receptors in the body, right in our brain, in our stomach. 'cause that's where they mainly work for weight loss in our pancreas, in our heart, in our kidneys, everywhere. So the medications go and they, they stimulate those receptors and like in the brain will help you feel full faster in the stomach, it'll, it delays gastric empty. So food stays in your stomach longer. So then you stay full longer. So it works a little different obviously than like a stimulant or this other one that helps cravings. And they've been really effective, you know, so people have lost anywhere between 15 to 20% of their body weight, which is a lot, right? Yeah, it's a lot. It's like you're going towards like bariatric surgery type weight loss. Yeah. And that's like the majority of people. Some people might lose less, some people might lose more. But like in on average

- It's so interesting that you can change your weight basically by changing how your brain perceives different things.

- So Right. Well this is why, you know, we're studying obesity more and like how it works because it really is affected by the hormones in our body that tell us when we're hungry, when we're full. Whenever you eat something, you have hormones that are released that tell you like, okay, you're about to get full. Or when you're hungry, right? There's something in your body, your brain is controlling that. Your brain is controlling when you're hungry to keep you alive, obviously. 'cause you need, you need energy. That's what food is. But with people that have problems with obesity and overweight those hormones, they're just not functioning correctly. So if you have something that's helping those hormones work better, then you'll see

- The, yeah, because I feel like in the past I've always heard like to get your hormones checked or even your thyroid levels or different things that could, you know, other things outside of that that I feel like people are like go-to when they were trying to lose, you know, thinking that they're gaining weight unnecessarily or something. But,

- So these are not hormones we can really like test for necessarily. Like there's not really good tests that say like, oh you're making, you're not making enough leptin. Which is leptin is like the hormone that tells you you're full. A lot of times people, yes. They ask for like, can you check my

- Hormones?

- Like women especially. Right, right. Which hormones can play a role. Like you'll see a lot of women, a lot of women will come to me like when they're in that almost menopause or menopause because things have changed. And like even our, the, our bodies change, right? We start losing muscle, right? Even after the age of 30 we start losing muscle. So that's gonna change like the way our metabolism works. So it doesn't really help on that much I can tell you. Right? Yeah. Other than like we know you're in menopause

- Safe. Yeah. I not really heard it ever be successful. I just remember I've heard several people like say that. So,

- Yeah. So

- It's in the past.

- Yeah. But you know, hor like some hormones, like the thyroid hormone can affect, like some people can have some weight gain, like if their thyroid is not functioning fast enough, if you're not making enough thyroid hormone. So that can also affect thyroid hormone is something that I will check when someone is like worried about their weight or they're having some weight gain or, or they're losing too much weight, which is another problem too.

- So how do you determine out of those medicines, like what will work best for the patient? Is it kind of like a trial and error kind of thing?

- So first, the first thing I wanna say, like about medications, 'cause you know, sometimes people will come and they're, they're like, I

- Want this. Yeah, gimme this. Like,

- But it doesn't

- Necessarily, sometimes I'm sure a lot of times, so they've done their research at home, they already know the cure. Tell me what I'm gimme

- This. But whenever I talk to people about medication, the first thing I tell them, it's like, okay, this medication is kind of like a blood, like you can kind of think about it like with blood pressure, right? A blood pressure medication, it's gonna help control your blood pressure. But if you stop taking the medication, your blood pressure is gonna go up. And that's very similar to weight loss medications. So one, I, there's a few things that I have to take into account. One is the cost, right? Some people are probably good candidates for the injectables, Wago V and bound, which are FDA approved. But their insurance might not cover it. It might be super expensive. And so, you know, the other medications that are oral medications be a little bit more affordable. So sometimes it, it really boils down to like the expense and other medications can, can be good in the right patient. They, that might be what they need. Some people do not like needles. Some people do not wanna inject themselves and they might just want an oral medication. And again, I talk to them about like, this is a treatment, it's a tool that you still, it's still

- Hard work. It's not the end all. Yeah. Like you still, yeah,

- It's still super hard work. You still have to change your eating habits. You still have to like focus on your overall health. And I would say like the majority of people do come and ask about weight loss because they're worried about their health because their parent died of heart disease because they're have a strong family history of diabetes. They don't wanna get diabetes. I would say like the majority of people are focused on their health. And so, you know, whenever we talk about medications focused on like, okay, let's see what, you know, if you're a good candidate for this medication or maybe we can try the oral for a little bit. It just kind of depends.

- So you mentioned that, you know, it still is work, having to take medication and adjust to a new lifestyle. Medications change how you feel and stuff. Same thing with like bariatric surgery. I mean, because that's a big deal too. You have to go through several evaluations beforehand. Yeah. Work with dieticians and then you have the surgery and then you have to basically adapt a new lifestyle with eating, which is also hard and, and requires effort.

- Yeah, no, definitely. And so you do see a lot of people like regain weight after bariatric, you know, not immediately, right? Of course you like lose weight immediately, but over time if you haven't made like the changes to your lifestyle, a lot of those like habits start coming back and that's when you start seeing some of that weight regain. So that's why whenever again, whenever I talk about medications, we're like, okay, this is a tool. We also have to focus on your nutrition on physical activity. Which physical activity I don't pair to weight loss itself, but more for like your overall health. Health and you know, how much are you sleeping? Like are you like your stress level, like you taken all of those things into account because those things are the things that are going to also affect your weight. They're gonna affect like how much you can lose or when you have like times when you can stall out. So all, all of those things are factors.

- What is it about stress that makes you want to eat?

- So have you learned that?

- Did they figure, have they figured that out? I definitely feel like I like wanna stress eat sometimes. So we eat like what I'm stressed, I'm like, especially wanna eat like unhealthy stuff,

- Right? So I mean I get that from a lot of people because we eat for a lot of different reasons, not just because we're hungry, right? Yeah. Like when you're stressed sometimes it feels good, it's

- Just comfort. It brings you like a comfort Yeah. Level.

- That's interesting. There is a part of your brain, right? Like where you felt good having ice cream and like, so when you're feeling down, like having a bowl of ice cream kind of fills something else else for you. So yeah, we, we eat for a lot of different things. We don't always eat when we're hungry. Again, this is has, this is why obesity is so hard to treat because it's not just calories and calories out. It's not just like, yeah I'm just gonna eat less and I'm just gonna exercise more and that's it. 'cause then everybody would do it.

- Or it's using food as a reward, which I feel like is something that we're taught a lot as kids by our parents. Right. If you're

- Good reward.

- Yeah. Yeah. So now I'm like, oh well I adult all day today so I deserve a little treat. Yes. Or

- You need to clean your plate to the, to another end of what we're taught as a child. Eat all your food, don't leave anything behind then.

- Which now I rarely clean my plate. Yeah. Because I just don't eat. I'm one of those people that are on the A DH ADHD medicine that don't eat as much. Right, yeah. As I used to. Right. Which I feel like I've realized I was probably eating more than I should have anyway because now I I feel fine. I'm not falling over because I'm not starving yourself. Right. But I'm, I'm not cleaning my plate, but I'm still getting enough nutrients. I'm trying to get, you know, as much protein as I need.

- I think it all just goes back to figuring out, you know, what lifestyles maintainable for you and then to help you with whatever genetics, with whatever you've conditioned yourself or you know, you have been conditioned to believe in your brain is how it's operating and

- Yeah. Wild. The medications aren't magic. Yeah. Like if you're taking, you know, some people are will find a way to get, get them somehow online or, and, and you might lose weight for a little bit of time. Right. Because some, sometimes when you are using it in like maybe in not the correct way, you just maybe not, are not eating and you're not getting the nutrients that you need, which is also not good for your body. Right. Your body needs fuel. Your body needs energy.

- Yeah. I feel like I have heard that there has been a rise of people coming to the hospital because they are like malnourished that because they are using those type of drugs and that it causes other issues if they're not like, you know, making sure that they're getting what their body needs to sustain itself.

- That and, and some of these medications like, like these injectable medications, like one of the main side effects is gonna be like nausea and constipation and the nausea can be really bad. I mean, where people are, you know, like physically ill. Yeah. A lot of times that has to do because they're, they're going up on the medication way too fast. Yeah. You know, they're, they just wanna lose weight. Like just gimme the medication so I'm not hungry and I can just lose the weight. But you know, you have to weigh your risks and benefits to everything you take. And like the, the nausea and the GI upset can be even reasons that people can't take the medication. Sometimes people just don't even tolerate it. Yeah. The reason that you get nauseous is because, you know how I mentioned those GLP one receptors that are in, in the gut, they slow down the gut. Right. So food is staying in your stomach longer. So if you eat too much you can feel sick or you know, and so you'll have like also like a lot of GERD symptoms. I mean it can, you can have really bad side effects also end up in the hospital with really bad constipation. Yeah. Constipation can hurt. Yeah. I mean it could be really bad. You can end up in the hospital. I know it sounds silly but it

- Could really painful. It's, yeah.

- So you have to be aware of those risks and that's why I think it's important if you are thinking about this medication that you, you know, you're being seen by a physician or a practitioner who knows what they're doing, knows how to administer the medication, knows some of the side effects to the medication. Yeah. And that this isn't like a just get skinny quick. Right.

- Because and everybody wants that. I mean that's human nature. Everybody wants the easy fix to make me be exactly what I want. And unfortunately I think what we've learned is that it's just not out there. Like it's gonna be a journey and if it's gonna be sustainable, you gotta make the right decisions over over time, a period of time

- And, and being thin or being like some number on the scale. That's the other thing that I talk to my patients about. It's it sometimes I'll come in and say like, what is, what weight should, should I be? And and it's very, it's gonna vary from person to person. Right? Okay. So skinny doesn't necessarily mean you're healthy. You might be at a lower weight but that doesn't necessarily mean you're healthy. You can have other health issues and still be at a lower weight.

- Yeah. And even like your percentage of like body fat per versus whatever. I've seen several people on Instagram. Yeah. And that, you know, they'll do side byside and they'll be like, this is when I weighed like 116 pounds and this now I weigh 130 something and they look fitter and better in the one where they weigh 130 and obviously feel better. Right. Because they're actually, you know, building muscle. Right. They're eating nutritionally, you know, so yeah.

- That's probably a better indicator of health. Right. Is your body composition more than like that number on the scale Scale? So we do use that, right? A BMI. Yeah. If you've heard of BMI, which is kind of like a screener, right? We know that at super high BMI is you're gonna more association with heart disease and all of these other comorbidities really low. BMI too, right? Like people who have problems with disordered eating for example, that that's also not healthy, but it's really a screener. It's not really going to tell you like how healthy you are because you can have two people. 'cause it doesn't take into account if you're male or female, it doesn't take into account your ethnicity. It does. You know, some, some people just have, their bodies are just different. They may have more muscle. So if you have two people, same heightened weight may have total different, like in terms of their health, one might be way more healthy than the other. So we can't just go based off of that number on the scale. That's the other thing that I'm, that I try to talk to my patients about the, like we have to change our mindset. This isn't about just being thin.

- Yeah. I definitely, when I'm working out, I like to track, like go to do one of those scans where you can enter in your weight and stuff and it does tell you the difference. And that, that was one thing I did like try to focus on was that I was just gaining muscle, losing fat. Not necessarily losing body weight per se, but that, but that

- Can be frustrating too, right? There's like, there's something in

- Your brain

- That's

- Fluctuate is like, so like

- Right. Especially women are on your cycle. You're gonna like, you know, have a little, you're gonna feel like you've gained 10 pounds, you didn't really gain

- 10 pounds. Yeah. I feel like you fluctuate like five within five pounds at least. But day to day, I mean if you weigh yourself every day it, it's a different number

- Every day. No, you don't do it every day. I think I do it like every like three months or something just to make sure I'm not going off the rails unexpectedly. Oh because that can be Yeah. Real frustrating if you're having, if you are like obsessing over of a, over a weight number.

- Right. So a lot of people feel like I should just go from this weight to this weight and that's really not how things work. Like you're gonna have fluctuations. There's gonna be times when you go up a little bit times when you go down and then times when you go back up because life happens, right? Yeah. There's gonna be things that you might be more stressed and you're gonna be more, you know, stress eating more or there might be when you're like working more so you can't make it to the gym like you easily do. So life you to take to those to account

- Life happens. Important thing is just not to stay in a bad place. If you get to a bad place, like, you know, get, you know, get help and see what

- You can do. Erika talking to herself right now.

- I'm getting these ups and downs, but we got good doctors that can help us out. So.

- Well I think we have to wrap up. I think we're close to our time now. I feel like we could just talk to you forever and ever.

- I love to talk about this. So

- It is so fascinating and there's so much, it's out there everywhere, but it's hard to get like credible like insight into where it came from and how we're moving in that direction. So if anybody's interested in learning more, we of course will link information to Dr. Guadiana Sanchez. It's information below. Yes. So be sure to tune in and then, yeah. So we'll wrap it up. Are you gonna ask your famous question? I don't think you eat here much 'cause you're not hardly in the hospital.

- Yeah. I normally ask what people's favorite meal is here because a lot of

- Our at like at the cafeteria.

- Yes. Because a lot of our doc are here. But you're in a, so I just don't think that you eat here.

- We I don't, but I do. There is a cafeteria at Smith and so sometimes I will get food there and they make like the best guess. Yes. Okay.

- They're, well see, I don't even think we get those here. So I'm not Do you not?

- Oh, you guys have to come over? No. Okay. I think it's on Thursdays they come. All right. Not

- On Thursday. I've never, never seen that here. But we're, we might have to take a road trip. So

- Good.

- Very. All right. That's a new one. We haven't gotten that one. Shout out to the SGMC Health Smith Northview cafeteria. Hmm.

- All. Well everybody be sure to leave us some comments if you have questions about anything that you've heard about, you can send those to us as well. We can help get you in the right direction. But overall, we just thank you for tuning in.

- Yes, thank you guys.