February 9, 2025 • 40 mins
Dr Galati starts the program by sharing a story about telemedicine. He also talks about his meeting with Dr. Grace Su from the University of Michigan on the state of liver disease. Dr. Galati continues on to talk about a Wallstreet Journal article on an increased risk of heart attack on Super Bowl Sunday and the continued notice of “Making America Healthy Again”.
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Episode Transcript
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Speaker 1 (00:01):
Initial Life Sequenzy coming to you live from Houston, Texas,
home to the world's largest medical center. Bunch everything looking ability,
I'm this is Your Health First, the most beneficial health
(00:23):
program on radio with doctor Joe Galotti. During the next hour,
you'll learn about health, wellness and the prevention of disease.
Now here's your host, doctor Joe Bellotti.
Speaker 2 (00:44):
Well a good Sunday evening to everybody. Doctor Joe Galotti,
thanks for tuning into Your Health First. We're here every
Sunday between seven and eight pm. And as we like
to start the program off with our little mission statement,
(01:05):
we are here to make you better consumers of healthcare,
make you truly understand how the body works, how you
the consumer, can do a better job of staying out
of the hospital, staying out of the emergency room, early intervention.
(01:29):
And we have to raise your health IQ. That is
our mission, raising your Health IQ, one listener at a time.
That's why we're so happy you were tuned in, dialed
in and listening to the program Your Health First. Our
website Doctor Joe Galotti dot com, d R J O
E G A L A t I dot com. And
(01:51):
when you get there, Sona for our newsletter. You can
send me a message. All of our social media is there.
Our past podcast and presentations are there. So doctor Joeglotti
dot com is your portal to communicating with us, all right.
(02:11):
So hope you're all having a great Sunday evening. I
hope you had a great week. The weather in Texas
has settled down a bit. It's giving us a glimpse
of maybe spring is in the air. But I know
a lot of you around the country are still dealing
(02:32):
with cold weather. I was on the phone with a
colleague of mine in New York on Thursday, and I
was embarrassed to say it was seventy one degrees at
seven in the morning and they were dealing with fourteen
degrees up in the northeast. So hope you're all doing well.
All right, lots of talk about today. The one story
(02:55):
I wanted to share with everybody. Nothing too earth shattering,
but it has to do with telemedicine. Now, a lot
of you listening out there may have had a doctor's
visit through telemedicine. Now, there is no doubt that since
(03:20):
COVID around twenty twenty, the number of patients and doctors
that were offering telemedicine visits really went through the roof,
and I personally believe that it is a tool that
we need to allow to still hang around. Now, there's
(03:42):
a lot of pressure in Washington through Medicare and other
agencies that want to scuttle the idea of telemedicine, and
it all comes down to payment. Because if Medicare, and
keep in mind what Medicare does from a payment standpoint,
(04:06):
private insurance companies Blue Cross, United, ETNA, they are going
to follow suit. And their excuse is, well, you know,
excuse me, but if Medicare is cutting, we should cut
as well. Likewise, if there's a service that Medicare endorses
or supports, the private insurance companies are more likely to
(04:29):
follow along and play that game as well. Now a
lot has been talked about with regard to insurance companies,
and I know first hand from my patients the insurance system,
the machine that is in place clearly is not optimized
(04:51):
to take care of patients. That is the absolute truth.
But with regard to telemedicine, they relax the ruling that
doctors could offer telemedicine and be paid. Keep in mind,
we are a provider of service, no different than you know,
(05:13):
you getting an oil change, You're you're providing a service.
You're going to get paid. Physicians offer a service, and
we need to get a customary and reasonably priced payment
for service. So those rules during the pandemic were loosened
(05:33):
where they said they were going to pay. There's some
discussion in Washington that it's going to be cut. The
last word I received is that it was given a
three month lifeboat to allow continued usage and payment for telemedicine. Now,
(05:58):
I think the value of tele medicine, and for everybody listening,
I would reach out to your physicians, be it a specialist,
be it a primary care, you're gynecologist, whatever the case
may be, you're allogist, and you want to make sure
if they offer a telemedicine option. Now, the value I
(06:24):
see in telemedicine is severalfold. A lot of patients live
away from the city center where your doctor may be.
Now it may be a thirty minute ride, may be
a forty five minute ride. As our patients are getting
a little bit older, transportation becomes an issue, and it
may not be that they don't have a car. It
(06:46):
may be that they are not well enough to drive.
And so they're dependent on a spouse, a friend, a neighbor,
a child, a relative, somebody from church to drive them in,
and it does become a asshole. People have to take
off work, they have to change their schedule to take
you to the doctor. But for a follow up, somewhat
(07:10):
non urgent clinical visit, there is certainly a great role
for telemedicine. Let's say you had Let's say you had
some sort of infection, you had pneumonia, and you received
two weeks of antibiotics, a little bit of an inhaler therapy,
(07:34):
and you're generally on the mend, but the doctor wants
to check in on you. This may be a visit
that would be perfect for telemedicine. You'd be on the video.
They could take a look at you, how are you breathing,
ask you questions, how's your cough, how's your mucus? Are
you having fever, any stomach pain, any side effect from
(07:56):
the antibiotics, and you could have a good conversation. I
think most physics could figure out is mister Smith doing better,
mister Smith is doing about the same, or mister Smith
is doing worse. If you're doing worse, then that could
trigger either more testing or a trip to the urgent
care center, maybe to get a chest X ray, additional
(08:18):
blood work, or you may need to be admitted to
the hospital. So there is a trim inous value in that,
but it allows I think, greater participation by the patient
that will say, yeah, no problem. Friday, at ten o'clock
(08:39):
in the morning, we could have a telemedicine visit rather
than ten o'clock on Friday, driving forty five minutes, I
have to get my kid off work, parking, traffic and
all of that. So I think that as we are
most likely still going to remain in the telemedicine environment
(09:01):
in a sense, talk with your doctor to see if
that is an option, And a lot of practices don't
advertise it as much as you would think. It's almost
like sort of a I don't want to see. It's
a secret, but you you may have to ask and say, hey,
can I have a telemedicine visit instead of having to
(09:25):
come in, et cetera, et cetera. So I would I
would do that. It's it's something that as consumers, I
would think that that would be a good thing for
all of you to have an idea of doing it's
just another way of accessing care so that you are
(09:48):
not neglecting a problem. It's access to care. You want
to have that FaceTime with the doctor, all right, Doctor
Joe Galotti. Always a pleasure being here on Sunday. Don't
forget Doctor Joe Galotti dot com is our website. Send
me a message. I love to hear from all of you.
(10:09):
Stay tuned. We'll right back every time May between seven
and a pm. We're here bringing you all the best
in health and wellness. Just a small town. I'm doctor
Joe Galotti. Our website Doctor Joe Galotti dot com, d
R J O E G A L A t I
(10:30):
dot com, just the city. Over the years, we've loaded
it with lots of health and wellness information. You'll find
recipes there, info on food, how to get your fruits
(10:52):
and veggies in and again it's all on the theme
and orientation of making you a better consumer of healthcare.
And I would say realizing that you have far more
(11:13):
input on the destiny of your health and wellness and
at the end of the day, your happiness, because if
you're sick chronically ill, life ain't so great. And coming
(11:36):
from somebody that deals with patients with liver disease and
orrsis and liver cancer. It's not a pretty sight, you know.
I many of you have seen this. I gave a
Ted talk a year ago and the theme was Misery
(11:58):
is optional. Misery is optional. And I tell a little
bit of a story how that happened, having to do
with a Christmas ornament that somebody gave us when I
was ten years old. And I open up this gift
and it's a block of wood that has painted on
it Misery is optional. And at ten years old, I
(12:19):
thought it was a total ripoff that this was in
any way considered a suitable Christmas tree ornament. But my
mother and all of her divine wisdom told me one day,
one day, Joseph, you will understand what this means. And
(12:40):
here I am, many, many, many decades later, realizing misery
is optional, and you can't live that way. There's so
many you know, there's so much that we could do
to take care of ourselves, all right. I had the
great pleasure on Friday to meet doctor Grace Sue from
(13:04):
University of Michigan. She is a hepatologist like me, and
she is the current president of the aa SLD which
is the American Association for the Study of Liver Diseases,
which is our liver organization. It really is an American
based organization, but it really is a global liver organization.
(13:24):
And she was in town here in Houston meeting with
our hepatology and transplant team and giving talks and talking
with the fellows and giving lectures, and I had a
little while to sit and talk with her one on
one about really this state of liver disease. Now, you know,
(13:49):
the old saying is to a carpenter, everything looks like
a nail, and you may say everything to Joe Galatti
looks like a liver. But the the amount of liver
disease that is amongst us is quite astounding. If you
just look at fatty liver. It is estimated that there's
(14:11):
about one hundred million Americans with fatty liver, which by
the way, can lead to cirrhosis and liver cancer, all
kinds of complications. There are people that have hepatitis C,
which is a viral infection that typically you get through
blood transfusions and or past history of experimenting with needles
(14:36):
and tattoos that are still walking around with hepatitis C
not treated. There have been wonderful, marvelous treatments to eradicate
hepatitis C for the last good number of years. But
yet people will come into my office nearly every day
(14:57):
having hepatitis C and never treated. And so if you
are somebody that has hepatitis or you know somebody that
has hepatitis C, first of all, you can reach out
to me and I will help direct you to get
into a liver specialist in your area. Whether you're in
Houston or you live in Sacramento, I don't care. I
(15:18):
will give you some direction. But there's no need for
people to still be walking around with hepatitis C that's
not treated and cured. There's better than a ninety nine
percent chance you're going to be cured. Ditto on hepatitis B.
Hepatitis B, again is a viral infection. And for those
(15:41):
that come from certain parts of the world, and let's
realize America is a melting pot. Certainly those that are
coming from parts and really all through Asia, be it China,
be it Japan, be at Korea, be a Vietnam, A
(16:01):
lot of hepatitis B. There's a lot of hepatitis B
in the Middle East, there's a lot of hepatitis B
in Russia, and so again, if you're coming from an
area that has a high number of hepatitis B cases,
you should be tested. The other thing is that there
is a safe and very effective vaccination against hepatitis B
(16:24):
as well as hepatitis A. So another point Tomorrow Monday,
go to your doctor, send them a message and say, hey,
have I been vaccinated against hepatitis A and B. So again,
in talking with Doctor Sue, as president, she's tasked with
an awful lot but to try to drive home liver
(16:46):
disease awareness, making sure that all of our young doctors
are well trained, making sure that our gastroineurologists are trained,
our primary care physicians are trained and understand liver disease,
our obgyn are trained and understand liby disease. So it's
a huge task, but I believe that still a lot
(17:08):
of it comes from all of you. You have to
take inventory of your own health and wellness, your own history,
your own family history, your risk factors. Have you had
blood transfusions in the past, and you may say, well,
you know that was nineteen seventy eight, I had a miscarriage,
(17:28):
or I had a car accident and you know, had
my two fingers cut off and I bled a lot. Well,
if there was something wrong, I would have known it.
You know, you can't really assume that. Assume nothing is
Galotti rule number one. So you have to be armed
with the knowledge. If you experimented with drugs in the past,
(17:52):
either inhaled drugs or intravenous drugs, you should be screened
for hepatitis B and hepatitis C and vaccinated if you're
never been exposed. How about alcohol, there's a tremendous problem
with alcohol related liver disease. Are you consuming excess amounts?
(18:15):
Has your doctor told you that your liver enzymes are elevated?
This is one of the most basic things we all
get drawn when we go to the doctor. But unfortunately,
as you've heard me say a million times, many times
doctors will say, oh, you just have a touch of
these elevated enzymes. Just a touch. That's like saying you
(18:35):
have a touch of being dead. It doesn't make any sense.
A touch of anything needs to be worked up. So
all right, well, look we're going to take a quick
break here. News weather, traffic is is coming up, so
time to refill your cup of coffee, your glass of water,
(18:57):
take a potty break more. Your Health First is on
the way. Don't forget doctor Joglotti dot com is our website.
Everybody be well, well, we're right back, all right, everybody,
welcome back. Thanks for tuning into your Health First. We
give every Sunday between seven and eight p m. Even
on Super Bowl Sunday. Yes, indeed, this show is dedicated
(19:24):
to all of the football widows that may not be
interested in partaking in the Super Bowl today, and we
are giving you options to entertain yourself with your Health First.
And don't forget our website Doctor Joglotti dot com. Sign
up for our newsletter. All of our social media contacts
(19:49):
are there information about our practice, which is Liver Specialists
of Texas. For those of you that have any questions
about liver disease, hepatitis, fatty Levy know segment I was
talking about fatty liver and hepatitis B and hepatitis C
and all of the other things that we take care of.
You can reach us at our website which is nested
(20:14):
in there. You could find our practice website which is
Texasliver dot com. So do that so that you could
stay engaged with all that we do. It really is fantastic.
So I you know, in my notes here I neglected
(20:34):
to say that it was Super Bowl Sunday. And in
the past, over the years, in the one or two
weeks leading up to the Super Bowl, we would have
various people on talking about how to have a health
full or at least a healthier super Bowl party, the
(20:55):
dues and the don'ts. But you know what, the feedback
that we got over the years people not that they
didn't want to hear about it, but this is one
of those days that it is very, very difficult to
move the needle and change behavior. So it's not that
we neglect it. It's not that we don't like to
(21:15):
talk about it. We sort of do the same thing
around New Year's Eve. Too much booze and mixing with
tile and all and stuff like that. But anyway, lo
and behold. In Today's Wall Street Journal February nine, there
is an article which in a sense we've sort of
(21:35):
touched on in the past, but it has to do
with increased risk of heart attack on Super Bowl Sunday.
And as you could imagine when you have adults, and
let's face it, as mostly adult men. And if you
look at adult men in their late thirties to sixties,
(22:01):
just simply based on the current demographics of this country,
a lot are overweight, a lot have high blood pressure.
They may be pre diabetic, they may not be exercising
as much. They're really not in good shape. Now that
is not a blanket statement on football fans that you're
(22:25):
out of shape and don't exercise and all have diabetes.
I am not saying that. Do not reach out to me,
don't yell at me. But let's face it, there's a
lot of people that are overweight and have high blood pressure,
high cholesterol, and they are sitting time bombs for a
heart attack or for a stroke. Now that said, when
(22:49):
you start mixing a lot of emotion, you love your Chiefs,
you love your eagle, or maybe you're totally ticked off
that the Green Bay Packers are not in and you
hate both teams, whatever the case may be. You don't
like a certain player, you don't like a coach. The
(23:14):
emotional increase, the excitement, well, what does that do? That
raises your blood pressure, that raises your heart rate. The
various stress hormones, adrenaline, catecholamines, we call them, are jacked up,
(23:36):
and so you're excited. And what happens is these hormones,
these stress hormones. Even if you're you're you're enjoying yourself,
yelling at your neighbor, yelling at your brother in law,
who who's you know, things the chiefs need to win again,
it puts a tax on your heart and the blood vessels.
(23:57):
The blood vessels tend to construc ricked or narrow, which
can decrease the amount of blood going to the heart,
which can trigger a heart attack. You may with all
these stress hormones, you may be at risk of getting
an arrhythmia. The heart may start beating too fast, or
(24:18):
you may develop atrial fibrillation, which is not good. Lastly,
worst case scenario, you can develop cardiac arrest. Just go
into a very serious we would say, a malignant heart
rhythm that results in sudden death and you'll need to
(24:38):
be defibrillated shocked to get out of that rhythm. Now
you may be saying, hey, this is a little bit
too much information too late. Well, hopefully there is a wife, girlfriend,
somebody listening that may say, hey, you know, this party
in my house is getting a little out of hand.
We have to sort of rein in it, or at
(24:59):
least for the next twenty four to forty eight hours,
which there is sort of this glow effect of the
Super Bowl that you may be at risk for some
sort of cardiac complication. Now the other thing is alcohol.
Now again I tell everybody, I am not part of
(25:22):
the anti alcohol lobby, but let's face it, everybody, this
a hell of a lot of alcohol being drunk today,
drinking what's the right word, A lot's being consumed, let's
put it that way. And this also raises your blood pressure.
(25:44):
The alcohol can put a added stress on your heart
to develop these arrhythmias. And there is actually a well
documented syndrome called the holiday heart. So the holiday heart
is not necessarily Super Bowl Sunday, but this was, you know,
(26:04):
identified fifty years ago. More around the holidays, Christmas, Thanksgiving,
New Year's that kind of stuff where people consume excessive
amounts of alcohol and it can trigger these arrhythmias and
heart problems. So the holiday heart, you have to think today,
super Bowl Sunday is a prime time where you can
(26:27):
have problems related to holiday heart. So the really the
perfect storm of increased stress anxiety, yelling, excitement number two
increased amounts of alcohol, which really compounds what's happening on
with the stress and the yelling and the excitement. And
(26:50):
then lastly the food consuming a whole ton of fatty foods,
high calorie foods, greasy food duds, ultra processed foods. This
is sort of the perfect storm to have a problem. Now,
(27:10):
it's interesting, it's not just the Super Bowl. There was
a study in two thousand and six related to the
FIFA World Cup which was in Bavaria, and what they
found this is fascinating. The incidents of cardiac emergencies was
two point six six times higher on days when the
(27:35):
German team played. According this was written in the New
England Journal of Medicine. The events were highest in the
quarterfinals when Germany beat Argentina in a penalty shootout. And
so this is not something unique to America and the
Super Bowl. This is a lot of these other sports events. Now.
(28:00):
Two thousand and nine, a study in the American Journal
of Cardiology found an increase in the risk of cardiovascula
deaths and deaths from all causes, which means people died
of any other cause in Los Angeles County when the
Rams lost to the Pittsburgh Steelers in the nineteen eighty
(28:21):
Super Bowl. So this was a study that was published,
you know years later. The death rates were higher on
the day of the Super Bowl and the following two
weeks compared to other days. So there is in this
study there was a two week zone that you had
to be careful. So what do you all do. It's
(28:43):
you know, the game has been going on. It's after
seven point thirty Central time, And what I would do
is limit the amount of alcohol. Cut off the alcohol
maybe by the third quarter, try to walk around and
(29:05):
really be on the alert tonight, tomorrow, in the next
few days. If you're feeling a little weird, you feel
like your heart is having palpitations, you're a little short
of breath, you're a little nauseous, you have a headache,
chest pain, some sort of abdominal pain, nausea, vomiting. I
(29:31):
would say friendly advice here from doctor Galotti. Get it
checked out, Call up your primary care doctor, get it
checked out. Do not do not sit on this. And
so again, as I said earlier, we don't want to
be a big downer on Super Bowl Sunday, So fun day.
(29:51):
A lot of people love it. It is a great part
of the American fabric. But let's not get sick over it, right,
all right, Final segment coming up Doctor Joe Galotti, our
website Doctor Joegalotti dot com. Stay tuned, we'll right back.
Thanks so much for spending part of your weekend and
(30:14):
Sunday evening with us. We're here every Sunday between seven
and eight pm. The name of the program is your
Health First, and that is indeed what we are trying
to do. Putting your health first, we want to think
about your health, your own health, the health of your family,
your spouse, your significant other, your children, your grandchildren, your coworkers,
(30:36):
your community. It is a very very big task and
a lot of people, a lot of my patients just
have a tough enough time taking care of themselves adequately,
let alone trying to take care of people in their
house and in their community and their family, both directly
and indirectly. So I understand how tough this is, but
(30:59):
we really have no choice. We have to stick together,
we have to band together. We have to build a
much larger community of health and wellness. Talk about it.
Talk about it at the kitchen table. Talk about it
on the phone with your friends and relatives, talk with
your children. It is that important now. And don't forget
(31:22):
our website doctor Joegalotti dot com, and do make it
a point go there, sign her for our newsletter. There's
a tab that says newsletter, subscribe, and you could get
a copy of my book Eating Yourself Sick. There. All
of our social media is there. It's our hub in
a sense, it is the hub for wellness. So in
(31:46):
this notion of your Health First, and as I've said
many many times, we put a lot of thought into
the name of this program twenty two and a half
years ago, and it really does make sense that this
is the name of the program, your health First. We
want you to put your health first. But let me
(32:07):
let me just sort of go off on a little
bit of a tangent. So we have been talking for
the last few months about this notion of make America
Healthy again. Now it is difficult to talk about this
make it America Healthy again without having the name or
(32:32):
face of RFK Junior in the equation. And there are
people you talk about an emotional subject, there are people
that absolutely detest RFK Junior. There are people that love him,
there are certain people that are neutral. They could, they
could sort of care less. And when I talk about
(32:58):
this the make America healthal the Again movement, they automatically
assume by association. I follow everything that RFK Junior says,
lock Stock and Barrel. Now, he has said a lot
of things over the years. Some are pretty out there,
(33:23):
some are okay, some are more benign, And especially with
the vaccines and things like that, it is such an
emotional trigger. But I am going to ask all of
you to look beyond that, and I guess to a
certain extent, Make America Healthy Again also is overshadowed by
(33:47):
President Trump. And again, there are people that love President Trump,
people that are neutral, and people that absolutely detest them.
I believe, and this is my feeling that even before
and I don't think as of tonight, RFK Junior has
been formally approved or nominated approved, I would say there
(34:09):
are people already that are changing their behavior by the
mere thought of the idea make America Healthy again, by
the mere thought of, you know what, there are too
many ultra processed foods. You know what. Our kids are
eating a bunch of crap, and they are obese, and
we should get the artificial colors and flavors out of
(34:31):
our foods. Okay, So you have to give credit to
the mere mention of make America healthy again, to positive change,
with or without RFK Junior in any seat of authority.
(34:52):
So I would say for everybody, let's try and stay
calm about this and focus on what we need to do.
And as I've said before no less than a thousand times,
for me in my practice and all of my fellow
liver specialists, we are battling fatty liver. We're drowning in
(35:17):
patients with fatty liver, and it is a result of obesity.
Why are people obese. They're eating a lot of the
wrong foods, They're eating ultra processed foods. They're not walking around,
they're not paying attention. The obesity needs a diabetes, heart disease, hypertension,
kidney failure, etc. You've heard the drill before. So why
(35:38):
I'm saying this, Why I'm bringing this up there earlier
in the week. PepsiCo our friendly Pepsi people. And not
only do they make soft drinks, which by the way,
are a major contributor to obesity and metabolic syndrome and
narrow health decline they also make a lot of snacks.
(36:02):
Freed O Lag, I believe is a PepsiCo company, and
so they are feeling the pressure. And again there has
not really been a single law passed state or national
on what we have to do with our food. It
has been the sense that the American people are really
(36:24):
getting sick and tired of the ultra processed food, or
they are learning about ultra process food. They are seeing
what is behind the curtain, and so what are they doing.
They are capitulating to current pressure and pressure that is
in the horizon or on the horizon, and so what
(36:47):
they're doing is they are trying to create a new
family of snacks that may be lower in salt. And
it seems like what they're trying to do is to
sell us instead of a giant bag of Doritos, they
(37:07):
are going to sell us a really, really really small
bag of Doritos with like six chips in it. And
you could do the math if you only have six
doritos versus sixty because this stuff is so damn addictive
because it's ultra processed. On the surface, you could say
(37:29):
that is a good thing, but I'm still betting that
they are going to sell a big bag of Doritos.
People are going to look at the bag with six
chips in it and say, who the hell are they fooling.
I'm just gonna get the big bag. That's one thing.
The other thing is, I would bet you that no
matter how they manipulate the recipe to make it healthier,
(37:53):
less salt, less processed, guarantee, this is still going to
be an ultra pro processed food, which in my book
is no boy. And on the other sneaky thing that
they're going to do is they're going to be starting
to put back protein into these snacks. Now why protein, Well,
(38:14):
the issue is there are a whole bunch of people
that are on ozempic, these GLP one agonist drugs, the
white loss drugs. One of the issues is that they
lose muscle, they're not getting enough protein, and so they're saying, hey,
maybe all these people on ozempic, they allegedly need more
(38:35):
protein in their diet, You're going to get more protein
in your favorite snack, and that may resonate with the public.
I would again say, beware, the best place for you
to get protein in your diet is going to be
in a serving of beans, real beans, whether they're out
(38:59):
of a can or not, you could decide. But a
serving of beans, nuts, eggs, and fish, lean meat and
other vegetables that contain protein. By getting it from the
natural source, you're getting all the extra phyto nutrients and
(39:22):
the fiber and the added vitamins rather than a manufactured
protein aka ultra processed food in return. So again the
goal here, what do I say every week? We want
you to be better consumers, raising your health IQ. And
so I want all of you, the army of all
(39:44):
of you out there, to look at this. And as
soon as friedola or PepsiCo, whoever the heck is going
to do this, you start seeing smaller portions. Beware still
ultra processed, this added back protein. It is a rude.
It is a gimmick to have you buy their stuff.
Go buy a bag of lentils and learn how to
(40:06):
cook them. All right, We're gonna wrap it up for
this Sunday night. It's always fantastic to be here with
all of you. This really is the best day of
the week for me. I'm doctor Joe Galotti, don't forget
doctor Jogalotti dot com. And with a little luck, we'll
be here next Sunday evening at seven o'clock. Be well,
and God bless everybody.
Initial Life Sequenzy coming to you live from Houston, Texas,
home to the world's largest medical center. Bunch everything looking ability,
I'm this is Your Health First, the most beneficial health
(00:23):
program on radio with doctor Joe Galotti. During the next hour,
you'll learn about health, wellness and the prevention of disease.
Now here's your host, doctor Joe Bellotti.
Speaker 2 (00:44):
Well a good Sunday evening to everybody. Doctor Joe Galotti,
thanks for tuning into Your Health First. We're here every
Sunday between seven and eight pm. And as we like
to start the program off with our little mission statement,
(01:05):
we are here to make you better consumers of healthcare,
make you truly understand how the body works, how you
the consumer, can do a better job of staying out
of the hospital, staying out of the emergency room, early intervention.
(01:29):
And we have to raise your health IQ. That is
our mission, raising your Health IQ, one listener at a time.
That's why we're so happy you were tuned in, dialed
in and listening to the program Your Health First. Our
website Doctor Joe Galotti dot com, d R J O
E G A L A t I dot com. And
(01:51):
when you get there, Sona for our newsletter. You can
send me a message. All of our social media is there.
Our past podcast and presentations are there. So doctor Joeglotti
dot com is your portal to communicating with us, all right.
(02:11):
So hope you're all having a great Sunday evening. I
hope you had a great week. The weather in Texas
has settled down a bit. It's giving us a glimpse
of maybe spring is in the air. But I know
a lot of you around the country are still dealing
(02:32):
with cold weather. I was on the phone with a
colleague of mine in New York on Thursday, and I
was embarrassed to say it was seventy one degrees at
seven in the morning and they were dealing with fourteen
degrees up in the northeast. So hope you're all doing well.
All right, lots of talk about today. The one story
(02:55):
I wanted to share with everybody. Nothing too earth shattering,
but it has to do with telemedicine. Now, a lot
of you listening out there may have had a doctor's
visit through telemedicine. Now, there is no doubt that since
(03:20):
COVID around twenty twenty, the number of patients and doctors
that were offering telemedicine visits really went through the roof,
and I personally believe that it is a tool that
we need to allow to still hang around. Now, there's
(03:42):
a lot of pressure in Washington through Medicare and other
agencies that want to scuttle the idea of telemedicine, and
it all comes down to payment. Because if Medicare, and
keep in mind what Medicare does from a payment standpoint,
(04:06):
private insurance companies Blue Cross, United, ETNA, they are going
to follow suit. And their excuse is, well, you know,
excuse me, but if Medicare is cutting, we should cut
as well. Likewise, if there's a service that Medicare endorses
or supports, the private insurance companies are more likely to
(04:29):
follow along and play that game as well. Now a
lot has been talked about with regard to insurance companies,
and I know first hand from my patients the insurance system,
the machine that is in place clearly is not optimized
(04:51):
to take care of patients. That is the absolute truth.
But with regard to telemedicine, they relax the ruling that
doctors could offer telemedicine and be paid. Keep in mind,
we are a provider of service, no different than you know,
(05:13):
you getting an oil change, You're you're providing a service.
You're going to get paid. Physicians offer a service, and
we need to get a customary and reasonably priced payment
for service. So those rules during the pandemic were loosened
(05:33):
where they said they were going to pay. There's some
discussion in Washington that it's going to be cut. The
last word I received is that it was given a
three month lifeboat to allow continued usage and payment for telemedicine. Now,
(05:58):
I think the value of tele medicine, and for everybody listening,
I would reach out to your physicians, be it a specialist,
be it a primary care, you're gynecologist, whatever the case
may be, you're allogist, and you want to make sure
if they offer a telemedicine option. Now, the value I
(06:24):
see in telemedicine is severalfold. A lot of patients live
away from the city center where your doctor may be.
Now it may be a thirty minute ride, may be
a forty five minute ride. As our patients are getting
a little bit older, transportation becomes an issue, and it
may not be that they don't have a car. It
(06:46):
may be that they are not well enough to drive.
And so they're dependent on a spouse, a friend, a neighbor,
a child, a relative, somebody from church to drive them in,
and it does become a asshole. People have to take
off work, they have to change their schedule to take
you to the doctor. But for a follow up, somewhat
(07:10):
non urgent clinical visit, there is certainly a great role
for telemedicine. Let's say you had Let's say you had
some sort of infection, you had pneumonia, and you received
two weeks of antibiotics, a little bit of an inhaler therapy,
(07:34):
and you're generally on the mend, but the doctor wants
to check in on you. This may be a visit
that would be perfect for telemedicine. You'd be on the video.
They could take a look at you, how are you breathing,
ask you questions, how's your cough, how's your mucus? Are
you having fever, any stomach pain, any side effect from
(07:56):
the antibiotics, and you could have a good conversation. I
think most physics could figure out is mister Smith doing better,
mister Smith is doing about the same, or mister Smith
is doing worse. If you're doing worse, then that could
trigger either more testing or a trip to the urgent
care center, maybe to get a chest X ray, additional
(08:18):
blood work, or you may need to be admitted to
the hospital. So there is a trim inous value in that,
but it allows I think, greater participation by the patient
that will say, yeah, no problem. Friday, at ten o'clock
(08:39):
in the morning, we could have a telemedicine visit rather
than ten o'clock on Friday, driving forty five minutes, I
have to get my kid off work, parking, traffic and
all of that. So I think that as we are
most likely still going to remain in the telemedicine environment
(09:01):
in a sense, talk with your doctor to see if
that is an option, And a lot of practices don't
advertise it as much as you would think. It's almost
like sort of a I don't want to see. It's
a secret, but you you may have to ask and say, hey,
can I have a telemedicine visit instead of having to
(09:25):
come in, et cetera, et cetera. So I would I
would do that. It's it's something that as consumers, I
would think that that would be a good thing for
all of you to have an idea of doing it's
just another way of accessing care so that you are
(09:48):
not neglecting a problem. It's access to care. You want
to have that FaceTime with the doctor, all right, Doctor
Joe Galotti. Always a pleasure being here on Sunday. Don't
forget Doctor Joe Galotti dot com is our website. Send
me a message. I love to hear from all of you.
(10:09):
Stay tuned. We'll right back every time May between seven
and a pm. We're here bringing you all the best
in health and wellness. Just a small town. I'm doctor
Joe Galotti. Our website Doctor Joe Galotti dot com, d
R J O E G A L A t I
(10:30):
dot com, just the city. Over the years, we've loaded
it with lots of health and wellness information. You'll find
recipes there, info on food, how to get your fruits
(10:52):
and veggies in and again it's all on the theme
and orientation of making you a better consumer of healthcare.
And I would say realizing that you have far more
(11:13):
input on the destiny of your health and wellness and
at the end of the day, your happiness, because if
you're sick chronically ill, life ain't so great. And coming
(11:36):
from somebody that deals with patients with liver disease and
orrsis and liver cancer. It's not a pretty sight, you know.
I many of you have seen this. I gave a
Ted talk a year ago and the theme was Misery
(11:58):
is optional. Misery is optional. And I tell a little
bit of a story how that happened, having to do
with a Christmas ornament that somebody gave us when I
was ten years old. And I open up this gift
and it's a block of wood that has painted on
it Misery is optional. And at ten years old, I
(12:19):
thought it was a total ripoff that this was in
any way considered a suitable Christmas tree ornament. But my
mother and all of her divine wisdom told me one day,
one day, Joseph, you will understand what this means. And
(12:40):
here I am, many, many, many decades later, realizing misery
is optional, and you can't live that way. There's so
many you know, there's so much that we could do
to take care of ourselves, all right. I had the
great pleasure on Friday to meet doctor Grace Sue from
(13:04):
University of Michigan. She is a hepatologist like me, and
she is the current president of the aa SLD which
is the American Association for the Study of Liver Diseases,
which is our liver organization. It really is an American
based organization, but it really is a global liver organization.
(13:24):
And she was in town here in Houston meeting with
our hepatology and transplant team and giving talks and talking
with the fellows and giving lectures, and I had a
little while to sit and talk with her one on
one about really this state of liver disease. Now, you know,
(13:49):
the old saying is to a carpenter, everything looks like
a nail, and you may say everything to Joe Galatti
looks like a liver. But the the amount of liver
disease that is amongst us is quite astounding. If you
just look at fatty liver. It is estimated that there's
(14:11):
about one hundred million Americans with fatty liver, which by
the way, can lead to cirrhosis and liver cancer, all
kinds of complications. There are people that have hepatitis C,
which is a viral infection that typically you get through
blood transfusions and or past history of experimenting with needles
(14:36):
and tattoos that are still walking around with hepatitis C
not treated. There have been wonderful, marvelous treatments to eradicate
hepatitis C for the last good number of years. But
yet people will come into my office nearly every day
(14:57):
having hepatitis C and never treated. And so if you
are somebody that has hepatitis or you know somebody that
has hepatitis C, first of all, you can reach out
to me and I will help direct you to get
into a liver specialist in your area. Whether you're in
Houston or you live in Sacramento, I don't care. I
(15:18):
will give you some direction. But there's no need for
people to still be walking around with hepatitis C that's
not treated and cured. There's better than a ninety nine
percent chance you're going to be cured. Ditto on hepatitis B.
Hepatitis B, again is a viral infection. And for those
(15:41):
that come from certain parts of the world, and let's
realize America is a melting pot. Certainly those that are
coming from parts and really all through Asia, be it China,
be it Japan, be at Korea, be a Vietnam, A
(16:01):
lot of hepatitis B. There's a lot of hepatitis B
in the Middle East, there's a lot of hepatitis B
in Russia, and so again, if you're coming from an
area that has a high number of hepatitis B cases,
you should be tested. The other thing is that there
is a safe and very effective vaccination against hepatitis B
(16:24):
as well as hepatitis A. So another point Tomorrow Monday,
go to your doctor, send them a message and say, hey,
have I been vaccinated against hepatitis A and B. So again,
in talking with Doctor Sue, as president, she's tasked with
an awful lot but to try to drive home liver
(16:46):
disease awareness, making sure that all of our young doctors
are well trained, making sure that our gastroineurologists are trained,
our primary care physicians are trained and understand liver disease,
our obgyn are trained and understand liby disease. So it's
a huge task, but I believe that still a lot
(17:08):
of it comes from all of you. You have to
take inventory of your own health and wellness, your own history,
your own family history, your risk factors. Have you had
blood transfusions in the past, and you may say, well,
you know that was nineteen seventy eight, I had a miscarriage,
(17:28):
or I had a car accident and you know, had
my two fingers cut off and I bled a lot. Well,
if there was something wrong, I would have known it.
You know, you can't really assume that. Assume nothing is
Galotti rule number one. So you have to be armed
with the knowledge. If you experimented with drugs in the past,
(17:52):
either inhaled drugs or intravenous drugs, you should be screened
for hepatitis B and hepatitis C and vaccinated if you're
never been exposed. How about alcohol, there's a tremendous problem
with alcohol related liver disease. Are you consuming excess amounts?
(18:15):
Has your doctor told you that your liver enzymes are elevated?
This is one of the most basic things we all
get drawn when we go to the doctor. But unfortunately,
as you've heard me say a million times, many times
doctors will say, oh, you just have a touch of
these elevated enzymes. Just a touch. That's like saying you
(18:35):
have a touch of being dead. It doesn't make any sense.
A touch of anything needs to be worked up. So
all right, well, look we're going to take a quick
break here. News weather, traffic is is coming up, so
time to refill your cup of coffee, your glass of water,
(18:57):
take a potty break more. Your Health First is on
the way. Don't forget doctor Joglotti dot com is our website.
Everybody be well, well, we're right back, all right, everybody,
welcome back. Thanks for tuning into your Health First. We
give every Sunday between seven and eight p m. Even
on Super Bowl Sunday. Yes, indeed, this show is dedicated
(19:24):
to all of the football widows that may not be
interested in partaking in the Super Bowl today, and we
are giving you options to entertain yourself with your Health First.
And don't forget our website Doctor Joglotti dot com. Sign
up for our newsletter. All of our social media contacts
(19:49):
are there information about our practice, which is Liver Specialists
of Texas. For those of you that have any questions
about liver disease, hepatitis, fatty Levy know segment I was
talking about fatty liver and hepatitis B and hepatitis C
and all of the other things that we take care of.
You can reach us at our website which is nested
(20:14):
in there. You could find our practice website which is
Texasliver dot com. So do that so that you could
stay engaged with all that we do. It really is fantastic.
So I you know, in my notes here I neglected
(20:34):
to say that it was Super Bowl Sunday. And in
the past, over the years, in the one or two
weeks leading up to the Super Bowl, we would have
various people on talking about how to have a health
full or at least a healthier super Bowl party, the
(20:55):
dues and the don'ts. But you know what, the feedback
that we got over the years people not that they
didn't want to hear about it, but this is one
of those days that it is very, very difficult to
move the needle and change behavior. So it's not that
we neglect it. It's not that we don't like to
(21:15):
talk about it. We sort of do the same thing
around New Year's Eve. Too much booze and mixing with
tile and all and stuff like that. But anyway, lo
and behold. In Today's Wall Street Journal February nine, there
is an article which in a sense we've sort of
(21:35):
touched on in the past, but it has to do
with increased risk of heart attack on Super Bowl Sunday.
And as you could imagine when you have adults, and
let's face it, as mostly adult men. And if you
look at adult men in their late thirties to sixties,
(22:01):
just simply based on the current demographics of this country,
a lot are overweight, a lot have high blood pressure.
They may be pre diabetic, they may not be exercising
as much. They're really not in good shape. Now that
is not a blanket statement on football fans that you're
(22:25):
out of shape and don't exercise and all have diabetes.
I am not saying that. Do not reach out to me,
don't yell at me. But let's face it, there's a
lot of people that are overweight and have high blood pressure,
high cholesterol, and they are sitting time bombs for a
heart attack or for a stroke. Now that said, when
(22:49):
you start mixing a lot of emotion, you love your Chiefs,
you love your eagle, or maybe you're totally ticked off
that the Green Bay Packers are not in and you
hate both teams, whatever the case may be. You don't
like a certain player, you don't like a coach. The
(23:14):
emotional increase, the excitement, well, what does that do? That
raises your blood pressure, that raises your heart rate. The
various stress hormones, adrenaline, catecholamines, we call them, are jacked up,
(23:36):
and so you're excited. And what happens is these hormones,
these stress hormones. Even if you're you're you're enjoying yourself,
yelling at your neighbor, yelling at your brother in law,
who who's you know, things the chiefs need to win again,
it puts a tax on your heart and the blood vessels.
(23:57):
The blood vessels tend to construc ricked or narrow, which
can decrease the amount of blood going to the heart,
which can trigger a heart attack. You may with all
these stress hormones, you may be at risk of getting
an arrhythmia. The heart may start beating too fast, or
(24:18):
you may develop atrial fibrillation, which is not good. Lastly,
worst case scenario, you can develop cardiac arrest. Just go
into a very serious we would say, a malignant heart
rhythm that results in sudden death and you'll need to
(24:38):
be defibrillated shocked to get out of that rhythm. Now
you may be saying, hey, this is a little bit
too much information too late. Well, hopefully there is a wife, girlfriend,
somebody listening that may say, hey, you know, this party
in my house is getting a little out of hand.
We have to sort of rein in it, or at
(24:59):
least for the next twenty four to forty eight hours,
which there is sort of this glow effect of the
Super Bowl that you may be at risk for some
sort of cardiac complication. Now the other thing is alcohol.
Now again I tell everybody, I am not part of
(25:22):
the anti alcohol lobby, but let's face it, everybody, this
a hell of a lot of alcohol being drunk today,
drinking what's the right word, A lot's being consumed, let's
put it that way. And this also raises your blood pressure.
(25:44):
The alcohol can put a added stress on your heart
to develop these arrhythmias. And there is actually a well
documented syndrome called the holiday heart. So the holiday heart
is not necessarily Super Bowl Sunday, but this was, you know,
(26:04):
identified fifty years ago. More around the holidays, Christmas, Thanksgiving,
New Year's that kind of stuff where people consume excessive
amounts of alcohol and it can trigger these arrhythmias and
heart problems. So the holiday heart, you have to think today,
super Bowl Sunday is a prime time where you can
(26:27):
have problems related to holiday heart. So the really the
perfect storm of increased stress anxiety, yelling, excitement number two
increased amounts of alcohol, which really compounds what's happening on
with the stress and the yelling and the excitement. And
(26:50):
then lastly the food consuming a whole ton of fatty foods,
high calorie foods, greasy food duds, ultra processed foods. This
is sort of the perfect storm to have a problem. Now,
(27:10):
it's interesting, it's not just the Super Bowl. There was
a study in two thousand and six related to the
FIFA World Cup which was in Bavaria, and what they
found this is fascinating. The incidents of cardiac emergencies was
two point six six times higher on days when the
(27:35):
German team played. According this was written in the New
England Journal of Medicine. The events were highest in the
quarterfinals when Germany beat Argentina in a penalty shootout. And
so this is not something unique to America and the
Super Bowl. This is a lot of these other sports events. Now.
(28:00):
Two thousand and nine, a study in the American Journal
of Cardiology found an increase in the risk of cardiovascula
deaths and deaths from all causes, which means people died
of any other cause in Los Angeles County when the
Rams lost to the Pittsburgh Steelers in the nineteen eighty
(28:21):
Super Bowl. So this was a study that was published,
you know years later. The death rates were higher on
the day of the Super Bowl and the following two
weeks compared to other days. So there is in this
study there was a two week zone that you had
to be careful. So what do you all do. It's
(28:43):
you know, the game has been going on. It's after
seven point thirty Central time, And what I would do
is limit the amount of alcohol. Cut off the alcohol
maybe by the third quarter, try to walk around and
(29:05):
really be on the alert tonight, tomorrow, in the next
few days. If you're feeling a little weird, you feel
like your heart is having palpitations, you're a little short
of breath, you're a little nauseous, you have a headache,
chest pain, some sort of abdominal pain, nausea, vomiting. I
(29:31):
would say friendly advice here from doctor Galotti. Get it
checked out, Call up your primary care doctor, get it
checked out. Do not do not sit on this. And
so again, as I said earlier, we don't want to
be a big downer on Super Bowl Sunday, So fun day.
(29:51):
A lot of people love it. It is a great part
of the American fabric. But let's not get sick over it, right,
all right, Final segment coming up Doctor Joe Galotti, our
website Doctor Joegalotti dot com. Stay tuned, we'll right back.
Thanks so much for spending part of your weekend and
(30:14):
Sunday evening with us. We're here every Sunday between seven
and eight pm. The name of the program is your
Health First, and that is indeed what we are trying
to do. Putting your health first, we want to think
about your health, your own health, the health of your family,
your spouse, your significant other, your children, your grandchildren, your coworkers,
(30:36):
your community. It is a very very big task and
a lot of people, a lot of my patients just
have a tough enough time taking care of themselves adequately,
let alone trying to take care of people in their
house and in their community and their family, both directly
and indirectly. So I understand how tough this is, but
(30:59):
we really have no choice. We have to stick together,
we have to band together. We have to build a
much larger community of health and wellness. Talk about it.
Talk about it at the kitchen table. Talk about it
on the phone with your friends and relatives, talk with
your children. It is that important now. And don't forget
(31:22):
our website doctor Joegalotti dot com, and do make it
a point go there, sign her for our newsletter. There's
a tab that says newsletter, subscribe, and you could get
a copy of my book Eating Yourself Sick. There. All
of our social media is there. It's our hub in
a sense, it is the hub for wellness. So in
(31:46):
this notion of your Health First, and as I've said
many many times, we put a lot of thought into
the name of this program twenty two and a half
years ago, and it really does make sense that this
is the name of the program, your health First. We
want you to put your health first. But let me
(32:07):
let me just sort of go off on a little
bit of a tangent. So we have been talking for
the last few months about this notion of make America
Healthy again. Now it is difficult to talk about this
make it America Healthy again without having the name or
(32:32):
face of RFK Junior in the equation. And there are
people you talk about an emotional subject, there are people
that absolutely detest RFK Junior. There are people that love him,
there are certain people that are neutral. They could, they
could sort of care less. And when I talk about
(32:58):
this the make America healthal the Again movement, they automatically
assume by association. I follow everything that RFK Junior says,
lock Stock and Barrel. Now, he has said a lot
of things over the years. Some are pretty out there,
(33:23):
some are okay, some are more benign, And especially with
the vaccines and things like that, it is such an
emotional trigger. But I am going to ask all of
you to look beyond that, and I guess to a
certain extent, Make America Healthy Again also is overshadowed by
(33:47):
President Trump. And again, there are people that love President Trump,
people that are neutral, and people that absolutely detest them.
I believe, and this is my feeling that even before
and I don't think as of tonight, RFK Junior has
been formally approved or nominated approved, I would say there
(34:09):
are people already that are changing their behavior by the
mere thought of the idea make America Healthy again, by
the mere thought of, you know what, there are too
many ultra processed foods. You know what. Our kids are
eating a bunch of crap, and they are obese, and
we should get the artificial colors and flavors out of
(34:31):
our foods. Okay, So you have to give credit to
the mere mention of make America healthy again, to positive change,
with or without RFK Junior in any seat of authority.
(34:52):
So I would say for everybody, let's try and stay
calm about this and focus on what we need to do.
And as I've said before no less than a thousand times,
for me in my practice and all of my fellow
liver specialists, we are battling fatty liver. We're drowning in
(35:17):
patients with fatty liver, and it is a result of obesity.
Why are people obese. They're eating a lot of the
wrong foods, They're eating ultra processed foods. They're not walking around,
they're not paying attention. The obesity needs a diabetes, heart disease, hypertension,
kidney failure, etc. You've heard the drill before. So why
(35:38):
I'm saying this, Why I'm bringing this up there earlier
in the week. PepsiCo our friendly Pepsi people. And not
only do they make soft drinks, which by the way,
are a major contributor to obesity and metabolic syndrome and
narrow health decline they also make a lot of snacks.
(36:02):
Freed O Lag, I believe is a PepsiCo company, and
so they are feeling the pressure. And again there has
not really been a single law passed state or national
on what we have to do with our food. It
has been the sense that the American people are really
(36:24):
getting sick and tired of the ultra processed food, or
they are learning about ultra process food. They are seeing
what is behind the curtain, and so what are they doing.
They are capitulating to current pressure and pressure that is
in the horizon or on the horizon, and so what
(36:47):
they're doing is they are trying to create a new
family of snacks that may be lower in salt. And
it seems like what they're trying to do is to
sell us instead of a giant bag of Doritos, they
(37:07):
are going to sell us a really, really really small
bag of Doritos with like six chips in it. And
you could do the math if you only have six
doritos versus sixty because this stuff is so damn addictive
because it's ultra processed. On the surface, you could say
(37:29):
that is a good thing, but I'm still betting that
they are going to sell a big bag of Doritos.
People are going to look at the bag with six
chips in it and say, who the hell are they fooling.
I'm just gonna get the big bag. That's one thing.
The other thing is, I would bet you that no
matter how they manipulate the recipe to make it healthier,
(37:53):
less salt, less processed, guarantee, this is still going to
be an ultra pro processed food, which in my book
is no boy. And on the other sneaky thing that
they're going to do is they're going to be starting
to put back protein into these snacks. Now why protein, Well,
(38:14):
the issue is there are a whole bunch of people
that are on ozempic, these GLP one agonist drugs, the
white loss drugs. One of the issues is that they
lose muscle, they're not getting enough protein, and so they're saying, hey,
maybe all these people on ozempic, they allegedly need more
(38:35):
protein in their diet, You're going to get more protein
in your favorite snack, and that may resonate with the public.
I would again say, beware, the best place for you
to get protein in your diet is going to be
in a serving of beans, real beans, whether they're out
(38:59):
of a can or not, you could decide. But a
serving of beans, nuts, eggs, and fish, lean meat and
other vegetables that contain protein. By getting it from the
natural source, you're getting all the extra phyto nutrients and
(39:22):
the fiber and the added vitamins rather than a manufactured
protein aka ultra processed food in return. So again the
goal here, what do I say every week? We want
you to be better consumers, raising your health IQ. And
so I want all of you, the army of all
(39:44):
of you out there, to look at this. And as
soon as friedola or PepsiCo, whoever the heck is going
to do this, you start seeing smaller portions. Beware still
ultra processed, this added back protein. It is a rude.
It is a gimmick to have you buy their stuff.
Go buy a bag of lentils and learn how to
(40:06):
cook them. All right, We're gonna wrap it up for
this Sunday night. It's always fantastic to be here with
all of you. This really is the best day of
the week for me. I'm doctor Joe Galotti, don't forget
doctor Jogalotti dot com. And with a little luck, we'll
be here next Sunday evening at seven o'clock. Be well,
and God bless everybody.
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