In this episode of the Disrupted Podcast, Scott opens up about a personal caregiving experience with his father that nearly turned tragic — all due to a misunderstood medication. What unfolds is a revealing look into how easily things can go wrong when communication breaks down between caregivers, providers, and pharmacists. Scott challenges assumptions about medications, shares why supplement interactions are underestimated, and makes a compelling case for why pharmacists need a seat at the healthcare decision-making table. If you care for an aging parent — or ever will — this episode could change how you approach their care.
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Welcome to the Disruptive Podcast. My name's Jamie, and today we are back with another episode and we're going to continue our series Parent Talk. And today we're going to be talking about something that is so, so important and it's critical that this is always taken into account. We're going to talk about medication and the danger of misunderstanding prescriptions and how to deal with your primary care when it comes to medications. And we're here today with Scott Middleton. How are you doing, Scott?
I'm doing good. I'm actually being a caregiver today, so I'm taking care of my dad. He's had a little episode this past week and a lot of things going on with him. What's interesting about it, when you talk about medications, he really doesn't take anything. He never has taken medications and in fact, the nurse practitioner who looked at him the other day ran his labs and she said his labs are better than most of our 30 year olds out there. Nothing was absolutely wrong, but we're going to talk about medication. So we've been trying to figure out now for about three weeks what has been going on with my dad, and I'm going to have to walk into the room because he may be trying to get out of the bed. Hey, hey. Hold on a second. Dad, what you need? Do you want some water?
Hey, no, I just want to turn the clock around and see what time
The clock's gone. Yeah, it's one 30. Yeah, lay down and sleep a little bit. I'm on a call with somebody. Okay. Okay. I'll come get you up. Actually, you might want to leave that in the podcast.
There we go. This is real life caregiving right here on the podcast. So yeah,
So the most frustrating thing of the whole day is I can't make any of his TVs work. He's got cable, but they're not working. And so I think I'm pretty sophisticated when it comes to technology, but this week has been a challenge. I had a new car and it all works differently, and so I can't figure out how that works. My earbuds won't work on this phone and now I can't get a TV to work, so maybe I need a technology class, but I couldn't even get in the door in my apartment because it all works off my phone. And so I called it today Ben, and I said, Ben, I can't get in the phone. Well, he actually went back and said, I can see why something knocked you out. And he said I had to reset the whole thing and then he didn't give me all the permission. So I was trying to get the PT and OT to come in to see my dad. I had to give them access to the door to get into the apartment, and he had forgotten to give me access. So it was just comedy of errors out there
With things not working today. But getting back to the medications, and I don't know if this is the case or not, but because I had multiple providers that were involved in helping my dad, he literally got to where he didn't know his name, he couldn't communicate. He was rattling crazy off, and yet all of his labs are good. We had a CAT scan, then they took him for an MRI last night, which was so disruptive to him. He was scared to death at the emergency room. And of course, unfortunately he's heard me say for years and years, don't go to the hospital. Don't go to the hospital. They kill you at the you could die. They don't know what they're doing. And so he kept yelling with Greg last night. I was still out of town. I drove back and got in town about two o'clock last night and he was saying, yeah, they're going to kill me, Scott, they're going to kill me. He was talking to me on the phone.
Poor guy
Today, he's much better. The other was that the medication that Dr. Uda had ordered on Wednesday got here this morning.
And so I thought he had been on the medication that Dr. Uda gave him and he didn't. And so I gave him his first pill. He only has five pills. He takes one a day for five days. He took the first one this morning and he is much more mentally alert. But I also had PT and OT up here. We got him a walker, he's unsteady on it. He's got this dizziness. So I'm pulling up looking on his kitchen counter and I see this bottle and I said, what is this? And he said, oh, I take that from muscles cramps. But I just started taking it back last week because when they took him off of his testosterone, they were afraid about that could have been causing something. It wasn't. I had three doctors confirm it wasn't, but they took him off of it. What that does is it drops your iron levels and it also brought the muscle cramps back. So I look at this medication, I was unfamiliar with it, Google it, and it said the side effects are hallucinations in dizziness. I dunno if that's the case or not. I'll have to call the doctor in a little while or the pharmacist. But again, that's the whole piece of it. You don't know when people go home.
I bet you none of the other providers knew this was a prescription that his former doctor has left the practice six months ago, had written him, and so nobody maybe knew he took it. And so yeah, that may have caused the whole thing. I don't
Know. And just to give our listeners some perspective, your dad is sharp as a tack. He plays golf every week. He is active and active, active senior.
So even though he's 90, I'll say this, he's in great health. He eats well. He has been eating properly now that I'm in his apartment the last two weeks, I'm a little concerned. He's been baking a lot, but he ate a good dinner today. He was actually hungry, ate a good breakfast. Yeah, but he's very alert and oriented. He does everything for himself. And he probably knew more about the TV today, although he's still a little confused. It's much, much better. But again, like Dr. Uda said yesterday, he said, so the problem was we sent him over. There was a couple of concerns just because the CAT scan came back clear. So they were going to send him for an MRI. Well, they took him to the emergency room at five o'clock yesterday and so he didn't get home till one o'clock. And my son, Greg was there and he said, I think we're just going to try to leave him. Well, they couldn't have a diagnosis to leave him in the hospital and they had already given him a shot. He was agitated and I think that's why he's so sleepy today. I don't think he slept well last night after having that shot. And again, so all this medication is going to have impact and especially when you are, he has short bowel syndrome and he's only five four. So the man's got weighs 113 pounds.
No telling what all that medicine did to him. But again, the meds are so important. There's so many side effects. But I was going to start off, if it hadn't have been for my dad, I was going to start off the podcast today with this, met a lady the other day. She graduated from hospice 11 years ago.
Wow. 11 years ago.
11 years. So she's lived and she was actually in good shape. And so I asked her, I said, what do you think happened? And she said, I got off all the medications when I went on hospice. They took me off these meds and I started getting better. Here's what I'll just say. Medications can be great, they can be wonderful for you. There's so many things they can be helpful for. But you also have to know what the side effects. How many people right now are taking Ozempic and Gobi and other GLP S
And
They don't understand the side effects. That's what scares me about it. Then they take other things for the side effect. The next thing you know, you're on so many different things, then people take these supplements. Everybody is like vitamin C or vitamin B, and you got to be careful because those can also overdose or interact with other things. So the key to this is the pharmacist
And
Our pharmacy review on a constant basis, but we get so much bite, not from patients love, but every provider we have, I think in our organization at 0.1 point has said, yeah, my patient doesn't want to see the pharmacist. Well, most of them unfortunately, and I'm talking to you guys out here and I hope to make some providers uncomfortable. They don't think the pharmacist can add anything. But what I'll tell them right now as a provider, I guarantee you do not know everything your patients are taking. Nope. Even if you're in an assisted living or nursing home I was talking with, we created a new position called a cognitive behavioral specialist. And that's the person that will go out, do evaluations, look at the behavioral issues that are going on with the patient, and then they will work with the provider. So their goal is if they need the psych nurse practitioner or a psychiatrist, then they'll call and do a telehealth with them. They'll be able to explain here's what the real behaviors are because families get that all confused
When you're with a patient, and I'll do the same thing with my dad. When you're with a patient for a long period of time, you start beginning to discount some of the other things that are going on. So what these cognitive behavioral specialists will do will be really talk it to the patient, look at the behaviorals, and then communicate that with the psychiatrist or the nurse practitioner, but the psych np. But then they'll also after as we change meds, job is to come back with that patient in three to five days and then call the doctor, call the internal medicine physician
Or
Call the regular nurse practitioner because you want to make sure they're aware of what this person's been taking. And also are we seeing a behavioral change with the medication if we're not need to take 'em off? And what happens too often in these facilities that I'll tell folks is the facility will contract with a site group that will send a provider in once a month and they don't look again at the patient for another month unless they're called. And so you just don't know. A lot of this stuff happens gradually. And so it may be a week or 10 days and people are going, well, that couldn't be the new meds. Well, yeah, there was a medication last year I was looking up and I was talking to Missy Jones, who's our director, I guess vice president of pharmacy services. But anyway, Missy made the comment, well, you could have a delay in symptoms by two weeks in this medication.
Wow.
In fact, she said, most of the time you won't see the symptoms on the medication for two weeks.
That's interesting. Wow. You would think it would, most people probably think within a couple of days you're going to see the side effects.
But a lot of this stuff is it has to be a buildup in your system and they titrate it. And I remember when I first heard the word titrate, I was going, okay, well, I kind of understand that. Well, no, you really don't. So your body has to get adjusted to something. So we may start you at a lower dose, increase it because we also don't know based on your body what's going to be the right dose.
Sometimes
Yes, there's recommendations from the pharmacy company, but I can't really trust the pharmacy companies. They want you to take more than less because that's how they make their money.
Yeah. Yeah. Scott, I think a lot of people, they just take medications for granted. Again, like you said, they take the supplements. Even the supplements tell the story about when we first started having a pharmacist that were part of the clinical side of your health. And I remember there was a time where you said, I don't take any medications. I don't need to see the pharmacist for, but once you did, she started asking you, Hey, what supplements do you take? And you guys had an entire discussion about your supplements,
Right? And so once I started telling her everything I was taking, I realized that, and she was writing all this down and she put it all into the system. I go back to see my doctor probably two or three weeks later and he said, Scott, where did all this stuff come from?
And
I said, well, what do you mean? And he said, well, you never told me you were taking all this stuff. And I said, well, you kind of never ask. And he said, well, we give you this form to fill out coming in. And I said, yeah, but it says medications, all this, I'm doing essential oils and other things. Well now I'm doing peptides and stuff. I'm not sure all that's in my chart right now. So we need probably go back and look at it and I probably need a pharmacist looking at it to see what's going on
With
Me. So yeah, I feel good. I actually, Jamie, I'm in the best health that I can have ever been in my life. I look better her feel better, but there's a lot of contributing factors to that,
Right?
So yes, it could be some of the peptides, but it was also the weight loss and stop alcohol drinking and the change in everything else.
And not to mention, you work out and you eat healthy. There's a lot that contributes to that
Right Now, I will say that since I stopped drinking, I probably eat dessert more often than I used to, but it hasn't affected my weight. And so that was a nice sideline benefit to it. The key to it is snacks. I heard a doctor last week say, the worst thing I have is potato chips. Get 'em out of your house. There's nothing good about potato chips. It's like alcohol. There's really no nutrients in there, so get the bad stuff out of your house and stop even eating it. So I think just diet exercise is extremely important and especially as you get older, and with my dad, he immediately just got weak from the diarrhea and the other issues that were going on with him. And that's really what caused that. It was an acute delirium is really what it was. And those can be caused by everything. But here's what's really interesting. I spoke at a conference this week and I was talking to 'em about our model of care and there were about 500 people in the room, and most of them were doctors and nurses. And I know that because I asked them to raise their hands, I offered them all to come work for us.
I'm always recruit. So I said, how many nurses we have in the room? About half the hands went up and I said, okay, if you're in South Carolina, Georgia or Florida, and we are going to go to Virginia, Tennessee, and North Carolina, so if you're in those areas, be watching for your health, I want you to come work for us. And they all laughed. And then of course I had to ask the doctors later, but these doctors, I was telling him, I said, guys, I said, I'm a little upset right now, but I said, as soon as I finished speaking and I was in Orlando, I'm getting in the car and driving home because my dad has been having a really hard time. And I explained to him how we played golf two weeks ago. He cut grass, he was doing everything fine
And then all of a sudden can't walk and he is completely mentally confused. So anyway, afterwards this lady comes up to me and she hands me a piece of paper and she said, check this. And so I read the diagnosis on it. And so later I texted that, well, actually I called Dr. Uta called me. That was so nice. About nine 30 last night, Dr. Uda picked up the phone and said, Hey, Scott, tell me about your dad. And I said, well, I'm driving back right now. And I said, this lady that came up to me, she was a doctor, came up to me and gave me this diagnosis. And he said, yes, that's what I diagnosed your dad with on Wednesday. And that's why I gave him this medication. It was really all it was was a bicarb pill. And he said, that's going to cleanse his system out.
And he said, I gave him that. I thought he was already taking it until I found out today he wasn't. So I thought, wow, that's kind of cool. So at the end of the day today, he's much more alert and oriented. He's not as agitated as he has been. And I think part of it was we've given him two IVs this week. He needs to have another one. He's supposed to get one this afternoon. But I haven't seen the nurse yet. But I think that's the key fluids. If we can get fluids in people, old people dehydrate. And Dr. Uta was great about this. He said, here's the thing about an older person. He said, you hold water in your muscles and so when your body needs the water, then it can release it from the muscle. But what happens? And that's why my dad was having muscle cramps. He has dehydration, and he was getting ramped up. The testosterone helped his muscles hold and retain more water. So when we took him off of that, then all of a sudden that's part of what was getting him dehydrated again.
And they took him off of it. They were concerned about his PSA levels because his PSA levels were about eight months ago were a six. They went to an eight and then to a 12 after he started taking testosterone. So what I've found out from Dr. Short, who is our doctor physician that's over our wellness program and it does all the testosterone stuff, he says, yeah, Scott, we expect that. He said, when you supplement testosterone, it's going to raise your PSA. That doesn't mean you have cancer. It doesn't mean that it's feeding cancer. He said, testosterone does not feed cancer. Let's make that clear. Steroids might remember we got a lot of athletes who are popping in steroids, but testosterone actually prevents you from getting prostate cancer and other types of cancers if your hormones are balanced,
Right?
So yeah. So I think the piece of it that I have to say more than anything guys, is that in our practice, we've got a lot of specialists involved with our providers, not just inside our practice, but outside. And we've got to get really good about communicating. And what I want to say is talking, this is not an Athena text, this isn't a text message. This isn't any, is picking up the phone and calling the doctors and other providers and saying, Hey, I see they're on this medication. I'm thinking it's causing this problem. What do you think? Let's do something about it.
Right? Yeah. It's so important to communicate. And speaking of communicating, especially because right now you're on the caregiver side, you're taking care of your dad, and what would you say to families about doing a medication audit in a way that's respectful? Because you still want your loved one to have that independence like your dad does, but you have to be able to get in there and work. What would you say to families about doing a medication audit?
So that's one of the things that we're using our nurses and our community health workers to do is, and really the community health workers, we tell them that when you go out, one of your priorities is doing a visit with the pharmacist.
And if you have an appointment scheduled with the pharmacist and your community health worker, you should go in, get all their medication, put 'em together on a table or a box or whatever they're at, and have it ready so that when you're going over this with the pharmacist. So the consult, it was interesting. I had a friend of mine just brought his mother on our services, and so the nurse went out and she was going to do a pharmacy consult and the daughter said, oh no, we don't need a pharmacy consult. Yes, you do. And it wasn't for them. She said, my mother doesn't really understand any of this anyway. What's the point? That wasn't the point. The point was that the pharmacist reviews all the medication, puts it in the chart to tell the doctor everything that's going on. But see, people think this. They truly believe that if you go today to Walgreens tomorrow to CVS, to the local pharmacy down the street, when you do that, they think all of these computer systems are seened together and everybody knows,
Nope,
They don't. They don't. The only way they sink is that we can share information, but a lot of the pharmacies don't share the information. We don't have that knowledge. So we have to capture that knowledge somewhere else. So what I have to help your health staff understand this, guys, the pharmacy consult is there to assist the doctors and nurse practitioners, but the only way that a pharmacist can bill for a consult is to actually talk with the patient, which is good verifying. Are you still taking this? Because it could be in the system, like in assisted living, here's the thing that people don't think about either. They have the right, A patient in assisted living has a right to refuse their medicine. If they refuse the medicine though, most of the time they don't notice. They put it on the medical administration record, Hey, patient refused. But the doctors and nurse practitioners aren't going in and looking at those Mars. That's not their job to come in and check. Well, it really is their job, but in most cases, most of them. So we send in a pharmacist, we like to send a pharmacist into a facility to review the Mars so that we can verify that whatever they're taking at the facility is also in our records.
And we could tell you right now, we're never 100% correct because a patient went out to an emergency room or there was a telehealth visit and a new med got started by someone other than us. And so it's not in our records, family member mom to urgent care, and they start 'em on something from muscle cramps like they did my dad. And the next thing you know with that particular medication, he's actually got hallucinations going on,
Right?
Yeah. The pharmacist would've picked up on that. And so this week I'll make sure that a pharmacist my dad has taken and do take and really look at everything that's going on about it, but there's no way you could have one doctor or one provider that does everything for your loved one.
And guys, it just doesn't work. What we've done in our practice is that we've put a doctor and a virtual nurse practitioner, and those two together are responsible for your loved one's care. Now, up underneath that, there is also in-person nurse practitioners going to the house as well as the visiting nurses and community health workers and the cognitive behavioral specialists and the PTs and codas and the PTs and OTs. So there's a lot of people that are involved, and it can be a great system. It's much better than I see Doc Jones, but every weekend when my mom is sick, I'm taking her to urgent care. They don't communicate with each
Other
At your health. Our goal is to keep everything we can in house and then if they do go out to an outside doctor that someone in our organization picks up on that, gets those records, puts those in our system so that we have an accurate understanding of what's going on with the patient.
Yeah. And kind of going back to the part where you're saying don't go to five different pharmacies, how important is it for not only to do that, but to get a pharmacy that say delivers like SC Home RX that is packaging all this for the patient, getting that and organizing it for them? Man, I look at, I'm caring for my wife. She just had surgery this week. There's like 10 pill bottles. I have to read it every time. I have to go down every pill bottle, make sure I'm giving her the right medication at the right time. It can get really confusing, especially if you're a senior or whoever it is. How important is it to have the right pharmacy, not just go to one?
Well, and then you have to look at pill planners too. So people will fill all these pill planners up and then they take 'em all and they don't remember which one they took. In fact, my daughter was telling me, she came up here a couple of days ago to my dad's apartment and said, and there was just piles of pills everywhere. And so she was real concerned about that, what he does and has been doing for years. My wife does the same thing. He takes all his vitamins and sits down once a month and he puts 'em all in little plastic bags. And so those were all his vitamins, but it concerned me because this other medication for his cramps was sitting on the table and I said, did you take this? Now he's had delirium, so I don't know what's true and what's not. And he said, oh yeah, I've been taking that for my muscle cramps. And so that's what made me start looking at, well, what's going on with this particular medicine? But you've got to pull all this stuff together and somebody has to look at it. And here's what I'll tell you. I love my docs and nps. I mean, they're smart as a whip, but you know how they learn about new medications is through a pharmaceutical salesperson
And of course their own watching patients. So when you're on a medication for a long period of time, and it's been a drug that's been around a while, the doctors really are good about it. But all this new stuff like the GLP with the weight loss stuff, yes, it's great for heart, it's great for weight loss. And they're even now saying that OZEMPIC might help with dementia. Well, I know it does because what the GLP that's in or the GLP that's in Ozempic is a peptide, and I've researched that peptide and that peptide increases blood flow, which would then cause you to have better blood flow in your brain,
Which
Can help prevent dementia. So I take a peptide and it is for brains for blood flow. It's called PT 1 41. It does not cause me to lose my appetite. It's just not that. That's not a side effect of this one. So I do have one peptide, I can't remember which one now I take that will reduce my appetite a bit, but I take another one that actually increases my appetite. And those are just side effects. So you have to know everything these drugs can do. And the only person who really knows that is the pharmacist because they literally spend four after their undergraduate degree where they learn all the chemistry, all the biology. They understand that concept they spend the next four years or maybe longer now are required to have hd. And just for my pet peeve, I'll tell you this, the government has not acknowledged pharmacist as a legitimate care provider. So they will tell you who is a healthcare professional, I think is what the government defines them as. They're fine with PTs, OTs, they're also fine with respiratory therapists. That's a four year degree. It's not a doctoral program. It's not even a master's program in most cases. But they will consider them a healthcare professional, but they don't a pharmacist. And it's crazy because the pharmacist have a better impact. And the government has acknowledged that every patient should have a pharmacist and should be doing things, but they don't trust them to make a medical decision,
For example, or labs. They can do that under the umbrella of a doctor, but they know the labs to draw. I don't know how many times our pharmacists have said, Hey, we need to draw this lab every three months while they're on this medication. And the doctor was just unaware of it. But there's thousands of drugs, hundreds of different types of medications out there, and we just have to have the experts in the field looking at this. Because again, what happens when you go on the wrong meds? You could be on hospice and dead in six months where they could take you off all the meds and you live another 11 years.
Exactly. Yeah.
That's
Amazing. Yeah, somebody could go that much further and have that much more life and it could just be a simple medication error. That's amazing. Scott, as we're kind of closing this episode, what would you tell to caregivers? A lot of your health employees are caregivers of somebody, they're taking care of their senior parents. What would be your final word is, especially when it comes to medications or when they're choosing a primary care provider, what would you say to somebody who has a primary care provider that doesn't utilize a pharmacist?
Well, I would start with this. First of all, don't use a primary care provider that doesn't have someone taking call 24 hours a day if you can't reach 'em. And I know we've had fun system issues in our company, but that's fixed now. And I will say this, if you call your health one 800 number, it'll prompt you to put in your zip code and your name and it will tell you if you're already our patient, it will transfer you during the day directly to your care team,
Which
Is great. You don't have to worry about learning a bunch of different numbers or I've actually been sitting here, everybody who walks in the door, PTOT, the community health nurse worker, the nurse, I've been putting all their numbers and their cell phone numbers in my phone because I'm thinking, well, if I need something, that's how I get ahold of them. But the truth is, I should call that 800 number. You have to leave a message unless we are creating an emergency number. But when you reach that emergency, they're only going to be able to do clinical emergency. So don't call in there. If you want to change your prescription or change your visit or something, just leave a message. That way it gets to the right person. So I'm always afraid we used to have what we call patient advocates, and there was just a group of people that answered phones, but they didn't know anything and they didn't even know the provider. So it really messed it up more than it helped it. So I always say, reach out as best you can. And then, yeah, the pharmacist should be reviewing not the pharmacist at Walgreens and was told the doctor wrote the order. You fill the med, I don't care what you see.
So I will say that's prevalent because big box pharmacies that they make their money that way. Our pharmacy and the reason we have one guys, I lose money in our pharmacy. You can't make money when you don't have huge volume. But I lose money in our pharmacy and I'm okay with that because it's saving it on the other side. Financially, we'll come out better with healthier patients and them not going to the hospital because we're in a value-based system.
But
That's why I say it's always so important. You got to know the incentives of the people who are servicing you. And most people just think everybody went into healthcare for the love of people and they wanted good quality care. It's not the truth.
We
Have people that are getting into it. At the conference this week, they used a term about locums, and I don't know if you know about a locum is a doctor generally that floats from hospital to hospital, but they pay 'em a lot of money to do that because the hospital needs a coverage. Nobody's there. So they're paying a lot of money for somebody to come in and work a week or two while somebody's on vacation or somebody's out sick, they're bringing in those guys. Well, those guys are there for the money. And he said, actually, the doc, this was a doctor. He said, here's what I feel about locums. They do it because they don't have ultimately any long-term responsibility. They don't have to work very hard and they make a lot of money and that's why they're doing it. And so I think we got to be careful in this healthcare world. You want a physician, nurse practitioners that somebody in their practice is going to answer, that phone going to be available for you, and we keep you out of the hospital. My dad's trip to the hospital yesterday, now looking backward, I agreed. We were all concerned we wanted to get him to the hospital, but it was the wrong decision.
And I can tell you, he went to the hospital, there was nothing wrong. He was so confused because of this medication causing the hallucinations that he was having, and he felt like he was being trapped. He called When I got on the phone with him, he said, I think they're trying to kill me. And I mean, he was just really having a tough
Time. Wow.
And actually what Dr. Uta later said, he said, yeah, unfortunately, basically this put him backward quite a bit because of the stress. He said, hospitals are stressful places and stress will induce physical stress or mental stress will induce more issues with the hallucinations out there. So looking back, we shouldn't have sent him, but at the time we all agreed that there was no other choice because he was so confused.
Right? Yeah. You make the best decision you can at the time. So Scott, this has been great. This has been eyeopening, I think. I hope this speaks to our providers and our pharmacists work to together. You've got to work together to give these patients the very best care that they can get and they deserve that and communicate. I think that's the other thing that you talked about. And you've got to not just, like you said, not just an Athena message. Pick up the phone, call them, talk it through, and I guarantee you it'll save lives and it'll make people a lot better at the end of the day.
Absolutely. And I'll tell you my motivation in all this. I mentioned, I don't know why this hit me the other day. I looked over at somebody and I said, I'm in the best shape I've ever been in my entire life. I feel good. Everything is great. And then I looked and I said, I wonder how I'll die if I'm that healthy. And I'm looking at my dad. His labs were so normal. Everything was great with his labs. And so you wonder what is he going to die of at the end of the day? Alright, I think my nurse is here so I'm going to give him the podcast and go take care of them.
Alright Scott, thanks so much and we'll talk to you later.
Thanks Jamie. Thanks. Bye.