Daniel C. Snyder, M.D. talks about hip replacement with Dr. Glaser.
Sun, 4 Dec 2011|
Hip replacement is becoming a common occurence. Young athletes are able to benefit from advances in technology. Dr. Synder talks about the different categories of hip problems that could affect a person.
The deterioration of aging males sexual functions
Mon, 24 Sep 2012
The issues relating to the sexual function of men and how it relates to their age. The show discuss tests and studies that have been done and can be found at http://androtrials.org/
How Spenco Sandals offer better orthotic-quality than other footwear.
Wed, 25 Jul 2012
Joel Rosen, VP of Belmont Medical Supply, talks with Dr. Glaser about the Spenco Sandal.
Dr. Jennifer Green from Newton Wellesley Orthopedic Associates
Mon, 11 Jun 2012
Dr. Jennifer Green, a hand and upper extremity surgeon, completed her undergraduate education at the University of California at Berkeley. She completed medical school at Georgetown University School of Medicine where she was elected to the Alpha Omega Alpha Honor Society. She did her internship and Orthopaedic Surgery residency at Tufts-New England Medical Center and completed a hand and upper extremity fellowship at the Philadelphia Hand Center at Thomas Jefferson University.
Sports Injuries and Concussions in Children
Sun, 6 May 2012
On this weeks Health and Wellness show, Dr. Alan Glaser is joined by Dr. Matthew Messina from Newton Wellesley Orthopedic Associates. Today's discussion focuses on sports related injuries and children. Dr. Messina served as Team Physician for the University of Maine Division I Ice Hockey and Football Programs. His interests include Sports Medicine, Joint Reconstruction and Fracture Care.
Automatically Generated Transcript (may not be 100% accurate)
-- -- Meant this is doctor -- blizzard and we welcome home the world our our policies. 8680 -- WRKO. It'll tell you -- freed me. No that's -- -- -- and I think -- welcome doctor Daniel -- from -- we'll see what. So since mid afternoon. Of them that you're joining us in this. -- Sunday. -- I going to be speaking about hip replacements. And it's very important to note that. 1520 years ago. Who was beaten by hip replacement. It would be very unusual. -- detain that in someone younger than the age of 65. But as we're gonna hear from doctor -- with today's materials. At today's technology. Into these surgical approaches. That young athletes. Do not need to wait until the age of 65. They're having hip replacements. Younger and younger. In improves their quality of life. Fans. That are benefiting from the advances in technology. Dana if you could tell us a little bit about. -- disease and who that affects me me what you see him. Go practice. And cruel but talking mostly about hip arthritis. And if you look at hip arthritis. It has different categories. There are other people that run into hip disease because they were born with abnormal. If anatomy. And Allenby in the category of what we call the display Asia. Or CD HD DH for dislocated hip as a child but hip displays as the main category. Then there's inflammatory. Types of diseases where people get. Arthritis -- destruction of their joint commitment from inflammation that would be in the category of rheumatoid typed -- or other inflammatory. -- -- -- -- Beyond that there's there's the standard. Osteoarthritis which is less of an inflammatory arthritis -- for the genetic pattern of disease. Would pony destruction of the joint. And and is really in new categories -- million new category but recently. Appreciated. Which is really post traumatic arthritis. Which is really what our athletes. I'm getting. From specific sports. Leading to destruction of the joint for example. Hockey. This is big in the Boston area and hockey players without one specific injury just because of the repetitive. Will. Injury hit. Unknowingly. Even in their teens or twenties. To show up in the office in their forties. Would severely arthritic hips and his -- Inflammatory disease it's not the disease of arthritis. It's secondary to having played hockey and portable Lieberman hip joint. That's also. Called FAI. Or ephemeral assets have learned henchmen. To CNN any of the flexed rotation sports. Hockey number one. Soccer. All the racket sports especially squash. Third baseman in baseball like Alex Rodriguez or Michael lol here. All -- category of sports injuries. Showing up in my office and yes there is a Ford is unable to participate. -- not just not -- to participate in sports anymore but also being uncomfortable daily living. For the hockey player. Within repetitive motion. Is it more from the shooting motion that we that the rotating their body or more related to the skating motion it's the skating motion it's reflection rotation and tries. That gets them in trouble. And with respect to soccer what type of movement -- the soccer player be putting that's -- and there. Again deflection rotational lot of jumping and landing in the flex position. Is willing getting in trouble. As screw over the -- players are a -- to squash player standing at the T. Will they would squash their flexed. And rotated left or right over Netflix tip. Picture third baseman standing flexed a third baseman rotating left to right from -- similar action. So when my six year old Daniels lining up for his one timers. And the -- -- had quite yet but Verizon starts to skate. And as -- field leaders that's when we need to a pay more attention. Correct it's the regular figure skating doesn't seem to do it and it's the deep end flexed position of hockey player though it's more -- at the trouble wouldn't. And again just don't want specific injury it's usually the competitiveness of so -- looking back. If we could go get go back in time about ten years. And you have this hockey player in your office who's forty years old. Who's having pain. Even just getting around it just the regular activities of daily living. And what we would do ten years ago step wise. Vs what we're doing in the year 2011. Let's go back ten years. Ends. What would be the approaches that we would say and then what would be less than that he's. So typically. Ten years ago. This forty year old general come into the orthopedic office. Unable to do with sports anymore and having difficulty tiny -- And having pain. The -- that he -- with Salem -- you're too young to have hip replacement you need to wait cause that'll last a long. Star was aspirin Motrin. And did -- take large amounts of aspirin Motrin for as long as they could. And then. They would start any entity either different medications even narcotics at that point but anything but have surgery. It would also be told to try physical therapy. That at that point was not that beneficial. And -- and in 2011 and 2011. We actually trying to. In my -- from minimize the use of anti inflammatory is because it can be very destructive in its own right both of these systemic. Aspects of the patient but also of the joints. Can have more rapid destruction. I like to rely more on. Activity modification early. Certain activities can really give view healthier hip to start -- for example. Activities such as Tai chi or yoga. Very effective. Beginning at of people few more years of lights on of that hip joint. Then beyond that would doing its specific. We directed the cortisone injections. Or he'd been Disco supplementation injections. Which is notice in this typically. To the hip joint. To buy some time. We also use glucosamine which -- 80% of the time people again and get some temporary relief from. If they do take glucosamine have to take it released. Two months before will notice any difference but if there on the two months but 80% people will notice. Some some diminished -- -- How would you explain to our listeners and the simplest of terms this and this injection. It's it is the lubrication of your dried out joint and its. It's a it gives you back of this custody of and -- is -- in the chilling but it becomes very watery in on non discus. It gives you that this -- which is really an oil in a duplication of the joint. How many patients who receive benefit of that treatment. Person Angeles it's about 80% again with the injections 20% don't get worse but they -- no value at all from the injections. And now again comparing ten years ago. But that percent of the population. Who don't get better from an injection. We now can recommend hip replacement. Too much younger population. And we would have analysts. Correct so the surgical option is not yeah yeah. To be considered the horrible life ending event any longer it. It's very important my practice. To. Preserve. -- -- preserve. I wanna preserve soft tissue and I wanna preserve bone. I wanna preserve soft tissue. And wanna preserve bone for for two main reasons one. -- Bone preservation and soft tissue preservation. The person. Of forty years age. Can return to their sport they can remain a very active I don't we -- patients at all after. The type of tips that we use because of preserving the soft tissue envelope. And we're preserving their own bone. So it's good for that category the other reason you want preservation. Is because of putting these young people. To -- preserve bone. Now won their 65 or seventy we have to presume. That. Their prosthesis may start to Wear out in May need to be -- -- But a -- preserve bone I can basically treat them as if this were their first -- -- entry. I think this is unbelievable. That we're talking about patients. Who were in their early forties who can not only. Coli and enjoying daily life without having pain. Bending down to pick something up off the ground their timing issue is you referenced earlier but that they're able to get back to their own sport. That's unbelievable. And ten years ago. These patients would really be struggling. To get through life with the amount of pain so it's really nice advancing. Is that they often come in and saying I don't even care if I get back to my sport anymore I just I I want that the sleep that night but some of reached that level. And then their very pleasantly surprised when six months to come -- post on this thing you know what I'm skating and and then at twelve months as -- on -- -- -- hockey and we're skiing again -- playing squash Ian. It's not just the the preservation that I talked about. In terms of -- soft tissue that has to do the surgical approach. The surgical approaches. What's different now as it's called the direct interior approach and that's what's different. That would doing now and I'm doing now and Wellesley hospital. The direct interior approach. Like it sounds like it comes from the front stop the back which is standard. And that doesn't cut any muscles at all -- between Mosul -- So therefore recovery is easy. Andrews and rhetoric or much faster. Very little pain post properly. And high levels of function. The other thing besides the soft tissue preservation talked about is the prosthesis itself. And there really two categories a prosthesis that you have to talk about when you talk about these new techniques. One is resurfacing. -- surface thing has been around for about twenty years and had a high peak. In the United States probably five years ago who's been very popular in Europe. But there's been a recent downturn was resurfacing because of metal on metal ion concerns there's been a lot of -- literature expulsion New York Times. Regarding mental I was being an issue. That in reality it's an issue in the worst cases about 3% of patients need to be concerned about -- islands. The majority of patients who should be -- concerned about metal irons -- resurfacing in our women. Not because of being women but because of size so small. Stature. People smaller bones and a higher rate of metal -- metal. Island release. So resurfacing as one category which is still very popular with the young strong man with good strong bone for hockey. But we've also try to bridge and on the category where it's still very. -- preserving prosthesis and that's called the mini hip. And these are short. Stones then on to stand systems have been made sure. Their stems that are designed. To preserve the neck of the femur. So yesterday's tips would go down the shaft of femur. These new stands. Out the resurfacing systems but a true to plus system. Is a bottle -- preserving stone feels the neck. -- doing that you have higher levels of pro perception back to the patient and again you preserve all that shaft phone. For future needs. This is contrary -- and you listen to a halt and Wallace are. I'm Boston's fox station -- succeeding WRKO. For any questions. Where doctor Daniel Snyder what are get more information you can callers station at 617. 2666868. Again that's 6172666868. New wells and orthopedic associates have a great website. Www. And Newton W Wellesley. -- orthopedic -- associates. Dot com. Again that's www. NW only dot com. Doctor Daniel Snyder and I have been speaking about hip replacement. Into how. In the year 2011. Younger and younger patients. Are having their hips replaced. That we really weren't able to operative people comfortably. 1015 years ago -- was still doing hip replacements. But in a much older population. Because. We thought that the life of the hip replacements. Would be. Ten to fifteen years. There they are my right with the correct Freddie. Who we thought years ago whereas now especially with the hip preserving. Methods that you're speaking about with preserving as much of -- as we can't. Tissue rise muscle wise bone wives. We can expect these tips to wrestle with thirty years. We definite spent the new technology. That these tips will last thirty years for not using cement. Negate the bone in growth the bone metal interface. Could potentially his last forever the weak link is the bearing surfaces. The various services community metal on metal. The parent services that we are very happy -- now and we feel very popular right now are ceramic on polyethylene. In the new polyethylene that's been. Developed right here in Boston most of -- general hospital. It's impregnated -- vitamin. Last forever. We've spoken a lot about the young male athlete. The hockey player in the soccer player the racquetball player. For female patients. Who present to you in the office with hip -- what is their background that you -- Well then you right there a lot of women in their forties have today we're not allowed and didn't have the opportunity to play very. Aggressive sports when they were in high school so their injuries. Are from later on. Typically a lot of runners. But mostly most of the women that we're seeing a more in the category of -- displeasure. They were born with a shallow hip socket. And so biffle early in age they start coming in with the pain. So the female is more of a hit displeasure category. Older of those certainly. Coming up more more female hockey players -- will start to see in a single lot of female. Soccer players. With hip label pathology. And luckily was current. Awareness of it would start to see them in their teens. And now with tipoff prosper B which we haven't discussed yet. With tipoff prosper if we pick up to label -- as early enough. They're being repaired not just removed. If we can repair Lieberman an eighteen year old female soccer player in the NC that -- From future surgery. That's go back to him by thrust at me. And speak about the roles. That in both male and female patient and wages. Its most beneficent and so when you tell you what about trust company. Earlier has better. So in in the the old. Way of dealing with things when -- -- -- after playing soccer and they have purges it was to the facility you know -- pulled groin. -- stranger hit walk it off takes a man they'll come back and six months and may not be the most appropriate approach. Because if you find. Muscles to actually having label players. If you can find label too early I was just when it happens. That misery parable. -- into an arthroscopic -- which means no open incision. And you can who truly were Mac. Very similar to what's being done and shoulders now and we're in athletes dislocated shoulder. -- does that put the clintons slings for three months and have a -- dislocation rate of about a 100%. And now they're -- to -- -- repaired. The same. Pattern. Buchanan. -- stop the repair Italy from. If you waiting too late they are secondary changes. And then the F Roscoe is much less effective. With some comes in in their thirties forties and synchronized with the pot prosperity. -- Tor only -- it's often very disappointing. Because you can't repair the damage. For the patient. Who will present to do must who have competed associates. Tomorrow on a Monday morning. In the coming describing. Their pain. What is certain. Descriptions that we'll point you to a certain diagnosis. That's a really good question. The that the classic line is I pulled my growing and so they talked about growing pain. Pain in the upper aspect of their hip. And they don't. Associate that with the -- They think of the hit more towards the background but -- but the -- truly right up there up in the decrease. Of the upper leg union torso so the growing area. And so the first thing that -- -- present when this is growing pains. It's not till -- wrong. When they've had a problem for a long period time with the start to get radiation and the pain down towards their knee. Or secondary ninety changes. So the growing pain is the first thing that we're gonna see in typically. It's with reflection in turner rotation. They also in their report early on. As fatigue or stiffness after the playing soccer. But they just have a hard time putting -- issues. After applying. Possibly some of the earlier signs I think it's really important for a athletic trainers. Parents. To pick up on early signs of hip injury. And their young especially female athletes -- we're seeing a lot of that and its repair. When you're saying. The earlier is better. Visit with the respective front drastically. What is what is the general timeframe of course -- -- you know individualized but is there a certain time when we can say -- once you've gone past. This many weeks when this many months. The outcome from surgery is very different -- for no real difference. I think that any anything we learn this from the shoulder. If you get to a a label terror. True acute label -- if you get to inform in the first six weeks. You're likely to have an outstanding results. And may never have -- problems. Certainly. And I can be considered -- repair. I think that we'll start to see -- changes are secondary changes once it's gone on beyond two years. Put together a window of European the first six weeks you can really win but if you within the first two years is still probably and win. After I think you've really missed the opportunity. So I think -- -- at. Early diagnosis and unfortunately. It's one of those categories of diagnosis that you need to get. You can have clinical suspicion which is reflection rotation pain. And stiffness. But unfortunately point and have to -- the MRI -- Graham route which means an injection of dye into the hip joint. In an MRI. To really identify a label terror straightforward MRI will miss most label tenors. And extremists has little chance -- at all. This is doctor Alon Glazer and you listen to a -- almost an hour on Boston stock station am succeeding. WR TO. For any questions for doctor Daniel Snyder would get more information please call 6172666868. Again that's 6172666868. Do check out the website. Renewed wells who have competed associates it's. Www. NW a -- dot com and www. NW always dot com. Bin for an appointment. For tomorrow morning you can call 617964002. Again 61796420024. Doctor Daniel Snyder and I speak about different placements. We just spoke to us throughout history. Dance. We've spoken about being young. Athletes and more than males. And females. We know that's the outcomes today. Are much better than you. Says the young athletes that we weren't able to offer before. Legislators. Stressed to us that. Here preserving. Preserving any part of they have is very beneficial. That direct interior approach is a surgical approach. That knew who was orthopedic associates utilizes. A much quicker recovery time. Much better outcomes. We've -- about its invest injections. Help lubricate. They have. And very beneficial especially neighbors dried out and this is giving back some of a natural lubricant of the body would have had otherwise on its own. And -- -- to switch gears so to speak about the older population. And how they're doing with their recovery. For the population over the age of 65. For the hip replacements. Being what have you found in those patients. So glad -- in the legal field. Because certainly hit diseases still. The majority of problem for the geriatric patient. And the same technologies that allowed us to offer these things to the on the patient. I've still. Certainly available applause for the elderly patient. They don't have to go through a very difficult operation anymore surgically. To get their new hip. So if they were medically. On the fence in terms of being stable enough. Not to go through this. This into your approach. Allows them to either have it either a spinal anesthetic or even a local with heavy sedation and aesthetic. And this procedures quick. It's by not. Again by not dealing with. Taking any of their soft tissue. The recoveries or are quite nice and they're usually. Geriatric patients just taking Tylenol. To in the post operative period. So have you been able to avoid to have the anesthesia. And able to avoid heavy post operative narcotics. Which would be difficult recovery for geriatric patient. We also are able with the soft tissue and bone preservation there was blood loss so the whole event. There's less traumatic to them more. Precarious. Condition. So they can definitely very much take advantage of the new technologies. When patients aren't planning to have surgery. And especially in the geriatric population. Oftentimes. Many patients get cleared for surgery and the go through a pre operative clearance. It sounds to me that because of the types. Of hip replacement that we're offering today. As opposed to a decade ago that many patients who may have been turned down. -- surgery saying you know mrs. Smith you're. We've got to be replacing him but because of all your underlying medical illness and it's every anesthesia involved. Any anticipated recovery. We think that's too high risk for you that's patients who we may be on the fence. Of being approved for surgery. Now with these new approaches. More patience we approve them be able to tolerate it then before you -- that's the first thing. The very much so the yeah it's hard issue when you're 92 years old and new hip is bothering you in in not. Concerned about playing hockey namely concerned about getting out of bed and not being -- about. It's I think it's very important for people even nine. For thirty minutes and -- -- 930 minutes straight -- ten minutes three times -- day. It's coming very beneficial to their overall overall health. And I think it's important. If they can tolerate it. Have the opportunity to have their hip replaced if that's what makes the difference between being bedridden. Indians have a small amount walking in the -- the pain relief. Some -- most active happy. Patients are between 88 and 95. Who have had their hips down and their active. They're doing Tai chi in a regular basis. It's allowed them to stay in the game of life not just their their athletic endeavors it's hard. When you do when someone comes in their 92 and knowing I'm just tool and I I just can't -- going through this. But if they do go through it. They're so relieved that their back in and active again. There was recently -- patient I'm not mind that the -- state it was a 103 years old the oldest known. Total hip replacement was just on. This past month. I'm myself 93 year old patient who. Totally active with the gentleman but as hip had reached the point where he was not able who's -- anymore he was not getting out of his chair. And he you know I decided together that because. A spinal anesthesia and easier surgery he could do and recovered never to anything -- Tylenol. And he's back he's even think about going skiing this winter. I think it's so important. And I'm glad that we've been stressing this. That's for the older patients in the geriatric population. For patients even in their eighties and as you -- even a few patients even in their ninety's with your success you've had a -- replacements. That is so great. To do whatever we can't. Regardless of the age and putting these aside and not saying to someone. You know you're 85 years old to go through this probably isn't worth that. Isn't really the right approach. The 85 year old patient who sped down. Who is paying even getting up from a chair who is paying even just finished an up and get a drink from refrigerator. Is really sad to see. If we can offer something to that patient in the year 2011. And help their quality of life. I think it's amazing. That's unbelievable. And we really need to push ahead. Tell people. -- older means category. That we cannot -- quality of life. That you should get Overton who was who have to be your associates. Get a console regardless Snyder. And see what's available. For patients who -- living in pain for years and years. And putting off surgery thinking -- that's too much to go through. The -- 2011. In going into 2012 soon. Is a great time to look into this hip replacements. As we've heard from doctor Snyder. -- recovery. Is much easier. That type of anesthesia. That's needed is much easier. And most importantly you can get back to quality of life. And I think that's great. It also shouldn't be forgotten that when we're looking at quality of life. And we're also looking at an individual. Further impact on the health care system. A patient who's active. There's going to be a healthier patients. The patient -- -- downs. Who's in the chair all the time who can't get out of bed who's trying to fight upper respiratory infection. You're much much better outcome when you're active when you're getting out of bed when you're walking around when you're getting fresh air. As far as American medical conditions. People develop. Breakdown in their skin when their -- confined to bed. Confined -- -- So I can't stress enough that. Even if you're older. You're in your eighties. You're -- -- ninety's. Go to your doctor. Get checked get over to new laws orthopedic associates. And get evaluated. By hip replacements. Can really change your life into really great greatly change the quality of life. This is doctor Alon -- again -- listen to -- health and -- our names succeeding dot WRKO. And doctor Daniel Snyder and -- are speaking about hip replacement. Not only how amazing it is today for the younger athlete. And they younger population. In and that's only because the life expectancy of these hip replacements. Is much much longer than it was years ago. We're hoping is less over thirty years. But with the recent technology. And all the advances medically. That we can really offer this comfortably. Older patients. Daniel for their patience was in their eighties. In their early ninety's. Who's been reasonable health. What we tell them they're going to expect for the recovery. And as far as that also. The degree of create the ability of care that's going to be needed. It's. So the typical recovery for the elderly patient who's gonna look something like this first of all their their anesthetic again will be very light. There will be awake and alert very quickly. And they'll probably just be taking Tylenol -- obviously. They should expect. Two to three nights of inpatient care. And and often times and going home with home health services. If they're completely alone and don't have anybody -- we recommend usually. Now after three days of the hospital they do go to a rehab of some sort of probably ten days to two weeks and then they go home the independent. But as they have even just a little bit health at home especially if they live on one level they can expect to go home after three days in the using just a -- Within a week and on us and getting off there walker. And I do want them to. Really live and more active lifestyle. I like tight chief for us for all my hip patients but it. There's some nice easier -- chief the only patiently even before the hip surgery. They should be focusing on. And I really appreciate you the year stressing how important. It is to the elderly patient that's exciting and it's fun for the young -- to thinking of -- to their sports but I think the real. Most important message we can deliver today as for the elderly patient the out of bed. And to be active the world helpful and -- native very important point thirty minutes a day of walking the -- knowledge of personal for the elderly patient. For the overall health and that relieves -- Let's go back to us as we start to. Wrap up today's show. For the young athlete. Male and female. In their forties. With persistent. Hip pain. What are. The three most important take home messages. That you can -- to our listeners. One that's important that they stay active physically. So they don't necessarily get it. Overall out of shape. To be able to do that take whatever measures it takes to be able to maintain. Daily physical activity. Which. If that means. An exercise program. A light medication. Or going as far as getting your hip replaced or resurfaced. It's important enough to do that. To maintain your overall health. And now if we can speak to our older geriatric population. And follow those listeners. What are the three most important. -- messages there. Again doesn't sound like it's very different from the from the young. Athletes. Stay active physically. Keep their mind active. So tight she is a good way to do that or yoga. Try to read something every day. And and get to their physician. And don't give up and saying I'm too old to do something. One of the point that I want to stress that I know you mentioned earlier on. That's the wrong approach is to not get checked into just go to the pharmacy. And pick up. Bottle upon bottle of Ibuprofen. Or Advil Motrin. Or any of those non destroyed only anti inflammatory medications. Those. Are not without risk. And you should not be taking those medicines. Without the guidance. Of health care provider. They can affect the kidneys that can effect stomach lining they can put you at great risk. So please be safe when you're taking those medications. If you do have approval to take those medications. Be sure you take them with food and as we for an earlier shows and a common theme. Is that a prescription strength. Of equal milligram. To that same milligram over the counter. Is different it's only different regular regular and -- pay an -- Out of the pocket. For the over the counter but 600 milligrams of Ibuprofen prescription strength. Is different than 600 milligrams over the counter. And you need to realize that as well so -- of all of our listeners. Will remember that. Just wrapping up today I I've -- appreciate. So much the advances. That have come along. News that physicians like doctor Daniel Snyder. Are able to affect lives. Not only now for the younger population in their forties. And fifties but that were able to offer this hip replacement. In a much older patients and really help quality of life. I want to thank you again Dana for joining us this on the afternoon. Stands to reach doctor Schneider. Or any of his other associates. And new miles north of -- X. It's 6179640024. Again it's 6179640024. The website is www. NW always dot com. Again www. NW always dot com. We ask our producer bill -- fewer minutes for patients to call and so if you wanna call and the 617. 2666868. Against 61726660. Succeed. You can leave a message here productive slider. And you'll be sure to get back to you as well. I want to thank everybody today for a taken time to listen. To our show on hip replacements. In and of disease in an abrupt Roscoe -- It's very important. To know that what we can offer. In the year 2011. Going forward. Are amazing advances with hip surgery. Hip replacement. Jerry given the will be gone for years ago. As doctors there I was speaking. If you're older. And you injuries and you -- in June 90s. And you're living with hip pain my advice to you is don't live with -- pain. -- called into us who have -- associates. And call your primary care provider. Get evaluated. And -- options that are available. And I wish you all I hope they do. I wish you all happy week and thanks for listening. Hey it's. Me. Yeah.