Duenos today. So this patient is Todd Lenert, and he is one of our patients who was in clinic on Monday. He's not my patient, so I'll be interviewing for the first time as well. And then we'll rotate through as well as we go through. But these times of meeting the patients are unique for you. So I see them every day in clinic. This is a time for also you to ask questions you have. So I've got some questions that Todd and I will go through. But certainly feel free to ask things that are interesting to you from a rep perspective as well, too. So Todd, it's good to meet you. If you want to introduce yourself to the team here. Sure, yeah. My name's Todd Lenert. And I don't know what you want to know about me. I live in Mustang, Oklahoma, which is around Oklahoma City. But I am from Southern Illinois, so I'm very familiar with where you guys are. I went to the University of Illinois. And so I know where Downers Grove is. That's awesome. Well, I'm Dr. Mike. I'm one of the esophagologists at Vanderbilt. So I appreciate meeting you as well, too. This whole goal is just to give a patient experience. A lot of us are also patients. And so I appreciate yourself putting yourself out there. It's a bit vulnerable being in a group. You can't see all of us as well, too. But they're all really nice. I've met them for a while now as well, too. So we're going to just try to understand what your life is, both as a patient and also going through navigating insurances, procedures, endoscopies, and care as well. So in a bit of it, how were you first diagnosed? And also, how long do you think you've had symptoms for? So the first time I ever experienced symptoms, I think it was 1999. And I was out to lunch with a friend of mine. And I can tell you exactly what we were having. We were at a Chinese restaurant. I was having cashew chicken. And I was in the middle of a conversation. All of a sudden, I could not talk. I could not swallow. I was like, I didn't know what was going on. I ran to the bathroom. And of course, somebody was in there. And it was a one-person bathroom. And I'm banging on the door. And they're like, you know. So I think eventually, some of it came up before I was actually able to get in there. And I was in there for 5 or 10 minutes trying to drink water. And then you'd feel it fill up. And then I'd have to let it go in the sink. And finally, I felt this, like something had just unplugged. And it went, bloop. And I was fine. But it was the weirdest feeling. And after that point, it happened several more times. Finally, I went to see a gastroenterologist. And they scoped me and stretched it out and basically told me to chew my food more, which I've been told all my life. So I didn't have any problems with it that I can recall, no serious problems with it, until probably about 9 or 10 years later when I moved here to Oklahoma City. And it was similar things. I started getting stuff stuck. And so I went in to see Dr. Tierney. And that was the first time I had heard of eosinophilic esophagitis. So I think it was at that time he scoped me, stretched me out, and started me on omeprazole and the flow vent. And I've had some issues since. But I think the last time I was scoped was in 2019. And I really haven't had any issues since. And I can talk about specific incidents later if you want me to get specific, because I do have some that were. It's good to talk about those. Have you ever had to go to the ER for a food impaction? So I have not. But it seemed like they were getting progressively worse. Like when I first started having symptoms, five minutes or so, and I could usually get it up or put it down. I'd drink a little water, throw it up, drink a little water, throw it up, drink a little water, and it'd go down. Gradually, those got worse. And I'd be in there for maybe 20 minutes. And my family took a trip to Spain in 2019. And we were in a restaurant. I was eating steak. And I literally had had like three bites. And I got a piece of steak caught in my esophagus that I could not get out. I went down to the bathroom. And my family was eating. And they kept coming and checking on me. I was literally in there for probably an hour and a half and could not get it dislodged. And finally, we decided, well, we're just going to go back to the hotel. And I kept trying there. And finally, I regurgitated it, full-fledged regurgitation. And that cleared it. But that was as close as I've ever been to having to go to the ER. And I really didn't want to do that in Spain because that would have been more difficult. But that was very unsettling. So I came back, immediately made an appointment with Dr. Tierney. He stretched me out again. And I have not had a food impaction since. But I think I've had some that I felt like were maybe it wasn't going down as nicely as I'd like it to. But yeah, that was a scary one. Yeah, I think he brings a good point. So when we have eosinophobic esophagitis, there can be vocal strictures. It sounds like he's been diagnosed several times. But he gets relief pretty immediately after it as well. Eosinophils also cause muscular dysmotility of the esophagus. Some people have no muscle dysfunction of the strictures for them. But they still feel slow propulsion as they swallow. So usually, you can tell when I see you guys eating dinner, I can figure out which one you have it because you're the slowest one to eat all your meals. You're drinking lots of water to force it down as well for you too. So it's not an uncommon pattern we've developed. Now, once you had symptoms of food infections, people tend to get really scared, what we call hypervigilant, about the next meal when you're abroad, eating that steak as well too. You've had endoscopies. You're on therapies. Do you still have fear that you'll have a food infection again if you're traveling abroad or somewhere else? Would you feel comfortable eating steak again if you go to Spain again next time? Yeah, I mean, I still eat the foods that I want. I like food. So it's hard for me to give things up. I do worry about it. And I do try to chew my food more. But a lot of times I forget and scarf it down. But yeah, I try to drink a little bit more. And if I start feeling like things are slow going down, I'll start drinking a lot more. And you mentioned the motility. And I do feel like, I was telling Dr. Tierney yesterday, it's almost like the peristaltic movement in my esophagus isn't working properly. And that, coupled with constrictors, is not a good thing. And there's certain foods that I would say, like baked potatoes, chicken, a dense, moist cake, all things that I like, those tend to be the most prone to getting stuck. And steak, if I'm not, sometimes you get a big piece of steak that you have to chew for five minutes. And I get tired of that. So I usually swallow it. I don't blame you. In terms of quality of life, you've had to go through endoscopies and medications now as well, too. How do you think EOE has impacted your quality of life? In terms of the endoscopies, it's one day. So it's not that big of a deal. It costs some money. And yeah, it's inconvenient. So in that way, yeah, it's inconvenient. I think the biggest quality of life issue is just being able to go out, enjoy a meal, and not have to worry about it. And it's something that is on my mind a lot of times when I go out to eat. I'll forget about it if I haven't had an incident in a while. But then I'll get something where it's like, ooh, that almost got stuck. And then I'm worried about it again. So it's just not a fun experience, especially when you're out to dinner with friends or family. And all of a sudden, now I'm affecting their meal. And they're worried about me. And I'm not there anymore. I'm in the bathroom not having a good time. And so yeah, it's not a fun experience. You talk about family. Any of your family members, children, or cousins also have eosinophilic esophagitis or allergic conditions? No, I've not run into too many people. Every once in a while, I'll mention it to somebody or I'll talk about it. And they'll say, oh, yeah, I know somebody. Or oh, yeah, I've had that problem. But none of my family have had that. I've had allergies all my life, mainly hay fever, pollens, and stuff like that. I did develop an allergy to shellfish when I was in high school that gradually got worse. It started with clams. And then by the time I moved to Houston in 2001 or 2002, it started to I was having trouble eating shrimp and stuff like that. It just felt like somebody was poking their finger in the hollow of my throat. It was just uncomfortable. And it would last for about 24 hours. And I finally did go in and get tested. And yes, I was allergic to shellfish. Underwent allergy shots, not for that, but for my other allergies. And then I had been off allergy shots for probably 5 to 10 years. We moved to a place that had new allergens. So I went in, got tested again, and now I have no shellfish allergies. And I've gone back, and I'm eating shellfish again. So that's weird. So I'm just relaying that to let you know I have kind of a weird allergy history. And it's, I don't know. Yeah, it sounds weird, but it's actually pretty typical. So shellfish is on our six food elimination diet, our six food. It's actually when I tell them to do last or even first, we're going to do endoscopy because it's so uncommon actually as well. So that's the only part that's a little bit atypical. Typically dairy or gluten are one, two. So I usually start dairy only and then gluten. Then work to eggs, tofu, tree nuts, and then shellfish last. So one thing to point out is that when they do skin testing, we talk about the counters are using allergy to help us as well. That is what's called IgE. So imagine you're going up a road 440. It's a bypass road. And you have another road that's CC5 North in Nashville. Those don't always meet together. Sometimes they do. And for you, you probably have an IgE skin reaction to shellfish as well. But that mediation is not always esophageal disorders as well. So they can be together and sometimes they roll together. Sometimes they don't. So allergy shots will help you with the IgE skin reactions. That's where allergy people can help us with. But we've actually injected milk and dairy and shellfish into the esophagus. And it has EOE as well. See what happens. Kind of like an allergy skin testing we do with skin. And nothing would actually show up for those patients who we know have true IgE reactions as well. So a little different, but I think for you, it's important to listen to because we know that's one of the reactions of food to the esophagus as well. So it probably was a good common source of symptoms for you as well. Whether you grow it into it and now out of it, which is actually helpful as well, but something probably to keep avoiding only because shellfish may be one of your triggers for EOE as well. Do you have any eczema? I had eczema for a little while, and I don't really have it anymore. A little bit of dry skin, I don't know if that's what you would consider eczema on my back. But I don't know if I'd consider it eczema. What do you consider eczema? Yeah, it's a good question. For you, if it's on the back of your skin and it's dry, it's probably more seborrheic dermatitis. So that's probably unlikely to be true eczema. Eczema for kids are usually on plantar surfaces, on the arms, behind the legs as well too. Sometimes on the eyelids as well too. That's where my son gets it now, even though his skin's been on his arms. We think early on when you get it, that's your first allergy change for why you then get EOE as you get older as well. So we're pretty aggressive treating childhood eczema to prevent long-term EOE for them as well. So thankfully, it's not like you don't have that. But if you have concomitant eczema, that's where your drug probably has real value. Th2 response, ATP, eczema, those are probably where this medicine may help. So he puts you on two therapies of the phrenic. He must have been scared about you, PPI and fluticasone and dilation. You got three for one. That's not necessarily super uncommon. We tend to work our way through them unless you had a pretty severe esophagus. So what I don't know is, what was your lumen like? What was the size? Did you have a lot of bleeding in the procedure as well? Sometimes we do everything because there's a little harm of adding all the PPI and the steroids at one time, knowing that you'll probably back off at some point. So currently now, you do endoscopic dilations. What symptoms? Are you still both on an anti-reflux medicine and a steroid? Yes. Yeah. Yeah. Omeprazole and fluticasone. And how do you take your medicines? So I'm doing the 20 milligrams of omeprazole once a day and in the morning. And then also in the morning, I'll take two puffs of my fluticasone or Flovent and try to swallow that. Sometimes I see the vapor go. So I do the best I can. And it's kind of hard because you don't know how much is actually getting down. And you do your two puffs before meals or after meals? I do them. A lot of times, I don't eat breakfast in the morning. But yeah, I usually do them first thing in the morning. OK. And I, you know, he told me to take a couple puffs. And then I'll brush my teeth because he said, you know, rinse your mouth out. So that's my routine in the morning. And to talk about compliance, we use anti-reflux medicines always 30 minutes prior to meals. And I'll move that. I'll say, when is your first meal? So you don't even eat breakfast. So you're not going to interact with parietal cells very well then. So I probably would push it before lunchtime. But the counter is that in, I'm not Dr. Tierney, so he knows you more than I do. But I would probably move it. I usually move it before. And that's where compliance matters in terms of why he may not need two medicines versus one as well. But we're not necessarily worrying about parietal cell acid production, more TH2 response. But it's activated no matter what. So some people take it before bedtime. And that's really do nothing for you in terms of EOE or acid production as well. The fluticasone is not easy. So it's easier than Budesonide. But it's a puffer. Now, cost for you? Is your insurance covering your fluticasone for you? For the most part, yes. Some payers, it's $400 or $500 just for the spray as well. Your patients who have ATP or lung issues, they're used to using a spacer and how to take a breath in and breathe in their lungs. And I say, unforget what you just learned. We're going to do it again together. Take your spacer off. Take a deep breath. Then spray it twice after meals and swallow it down. Brush your teeth is really smart. I'll have them drink water and spit it out. But they can't swallow water down because everything you just did is now contact time of esophagus. So fluticasone or Budesonide, the only value is to coat your esophagus like an iron shield in there. And if you drink water or eat a meal afterwards, it's all gone. It won't help you at all for you as well, too. So good approach for you. Now, what are your thoughts about if you had to be on something you had to inject? Right now, you're taking stuff out of your mouth. I'm currently injecting myself with allergy shots. So it's not a big deal for me. Yeah. And that's actually reasonable. And then how about access? Do you have access to a refrigerator? Or do you travel outside your work as well, too, that you could have access to your shots if you had it for you? Oh yeah, I've got access to a refrigerator. I don't think that would be a problem. I don't travel a whole lot with work. Okay, good, good. So, you know, for you, escalation therapy is probably not necessary now. If you're doing well on PPI and steroids for you as well, you wonder if you optimize the PPI dosing time, you may be able to come off one of them as well. Now, but why do you take your medicines? What makes you want to take these medicines for you? Well, I think just it's preventative. I mean, I have stopped before and, you know, and then I don't know, I guess I kind of feel like, oh, maybe I'm starting to get a little bit more, you know, symptoms and so I'll go back on them. I've experimented with one puff versus two and I just felt like the two were probably helping more than the one, but it's hard to say. I mean, you know, cause I can sit here and say, well, you know, it's because of the medicine, but it's like, I look at my first issue and it was like, well, it was 10 years before I had another issue after I got stretched out. So is it the dilation or is it just, you know, the medicine that's keeping, you know, keeping me from having to do that? But so I don't really know. And sometimes it can be kind of subtle. Yeah, I'm with you. Do you know on your last biopsies, how many eosinophils you've had? I do not know that. Yeah, yeah. I mean, your point's valid. When you get these strictures, dilation is critical to help open up for you as well. If there's inflammation at one point on your last endoscopies your anti-reflux medicine and your steroid are actually helping prevent stricture to form again. So you can enjoy your trips abroad and not worry about a food impaction as well for you too. So they probably are still helping maintenance wise. We know if you stop everything within 240 days your median, you'll get a recurrent stricture needing probably a repeat dilation as well. But it's a counter, that's almost a year. You know, is it worth being on the medicine for that long? And maybe a year later you get a stricture for you as well too. That's the balance we have with our patients because we know for you thankfully your risk of esophageal cancer is normal. There's no increased risks at all for this condition for you. But the quality of life of swallowing and problems swallowing, you know, getting food stuck as well too, that is an issue as well. Are there worries you have with your condition that we haven't really addressed well with you? I don't think so. I mean, I think the, you know, I've heard Dr. Tierney talk about, you know, a serious impaction to where they had to go to the ER and have it removed. That is frightening to me. I've never had that. I hope to never have that. But I guess I'm like, man, if it's that bad, it's bad. Because I've always kind of felt like I'm getting it up one way or another. And I'm not going to the ER. So I guess, you know, I guess there's a point where you say, yeah, I need help. But yeah, I think that's my biggest fear is having to go to the ER to have that procedure done. And I think that's a real fear for us on the provider perspective. Our fear is a perforation. So you're at home, you can't manage it. It's been too long before you come in maybe as well. And you tear your esophagus as well. And that's where we need a feeding tube and can't eat by your mouth for six, eight weeks. And then we have to repeat things afterward as well. So we'll hope you'll never get there. One thing I always say to my patients is that's our goal. We want, all my EOE patients are foodies, I feel like, especially in Nashville. They're always eating out, having a good food scene as well. And I said, my goal is that you have this condition, but nobody knows about it, right? So if you have symptoms that are subtle where things are moving slower for you, where things are going down, let me know. At that point, we probably need to repeat your endoscopy at this point. But otherwise you'll have something you'll live with, but it's not precancerous. You'll have a perfect quality of life as well too. We may have to change things over your lifetime as you get older as well, but ultimately this really should impact what you want to do life-wise, your family or traveling abroad as well. I've monopolized a lot of my time. I'll leave it up to you guys. Questions you guys have for him? I'll ask a question. Yeah. Thank you so much for talking to us. My question is, you definitely talked a lot about avoiding an impaction. What about sort of your daily life with meals? Do you have to still do, you know, cut up your food in smaller pieces or chew a lot? Or how has that been impacted since you've been on your PPI and the Clitica Zone? So first of all, I appreciate, I was happy to speak today and happy to help any way I can. Second, you know, if you talk to my wife, she gets mad at me because I don't cut up my food small enough. I still take larger bites than I should. So non-compliance in that realm. I don't think about it that much. You know, I eat what I want to eat. And, you know, if I start to notice symptoms, I just don't feel like things are going down the way they should, or maybe it's, you know, I'll start to drink more liquid. I might even stop eating, but I have not let it affect my enjoyment of food very much. So I'd say it's minimal until it happens, put it that way. Great. What is the process for, you know, kind of walk us through, because I don't have any real experience with patients who've had dilations. Like what is your prep for that? What is your recovery like? Is it painful post dilation or, you know, walk us through what that's like for a patient. Sure. So the first time I had it done was in, I was living in Dallas and it was, you know, like I said, like 1999, something like that. And they did the dilation and really it's been the same prep and everything for each time I've had it done. It basically no food for, you know, several hours before you go in, you get in there, you have to have somebody that can stay with you and take you home because you're going to be sedated. You know, they'll go in and, you know, they'll tell you what they're going to do. They run the drip, you're out. You don't remember anything. You come out, you know, they'll start the drip, you're out and then you wake up and you're like, they're done. And the first time I had it done, I don't know if they just weren't gentle or what, but I felt like I had a sore throat all the way down my esophagus. And I had never had that feeling before. And so that was, yeah, that was not comfortable. Everyone that I've had since, I guess it's been Dr. Tierney. So he's done a good job because I've not had any really any symptoms after that. You know, maybe a little bit of sore throat, but not really that I can remember. It's been pretty easy. So that answer your question? Yes, thank you very much. Anything on the provider's side? It's a relatively easy procedure. We basically have to fast after midnight or four hours before they come in with liquids only. We can do it. You've only had it with propofol, which is fully anesthesia. You can do with moderate sedation, which are kind of twilight or unsedated. I don't like to dilate unsedated, but some people have no families or drivers or they're military and they got to get it done. So we can do anything for them as well. It becomes higher risk when you dilate them unsedated just because if they're coughing and sneezing and having pressures, they can perforate more as well. What you probably felt in your first and DASI was you probably had a tight stricture. So that sore throat was probably them going back and forth, not just once, but maybe a couple of times, trying to open things up, maybe in biopsies as well too. And the tighter it is, I tell them, you're going to have discomfort potentially as well too. If it's really tight, I'll give them medicines on the front end to go home with because we don't want them having pain post-procedure as well too. They're not narcotics, but they're just medicine they can take to kind of cut their esophagus as well. It's a pretty easy procedure. We're studying the risk of you going to sleep over and over again. So what we don't know is, I have patients I bring every two weeks for their whole life. They got other diseases, not EOE, but they got to come in, otherwise they're strictured down and then they close over totally. We're studying what's the impact of sedation on you going to sleep, it's five, 10 minutes, but over that lifetime, it's an impact as well too for them as well. So us technically, it's actually an easy procedure. It's easier than a colonoscopy, is why I like doing it super quick and fast. But it's also very gratifying because they wake up like, I can swallow now, I could not do that 10 minutes ago. So for us, an EGD is like, it's relatively quick, unless it's one of the very stricture disease. We have different ways we can dilate. You guys have done some hopefully last night and you'll do some today as well too. So play with those dilators back and forth as well. But you put it down the pig's esophagus, think about him. I mean, that hurts the throat as well too. If you tear the esophagus, they're going to have to come to the hospital. It's a huge bill and payment for him as well. So things we don't want to do, and you'll size it over and over again is make sure you don't hurt somebody as well too. So we want to help them, but also not cause complications. Thankfully, sore throats, not super uncommon. And his repeat ones have done really well. So I bet you had a tight structure they opened up for you and had to go a couple of times looking at it, make sure it did okay. Yeah. And I will say the first time I had it done, they didn't put me under all the way. They wanted to be able to talk to me and I didn't care for that. I'm like, just put me out. And I do recall one of the times that Dr. Tierney did dilate me. He wasn't able to get me as dilated as he wanted to. So I did have to come back like two or three months later. He scheduled me to come back and have it done again. So. And that's actually pretty smart. So the worry is when you dilate somebody, you think you'll go to a big size and you go there and you've tore the esophagus. So what he did was he had a plan. I'll get to 42, 45, 50, 60 at that point. But once you start getting tears and blood there, you probably need to back off because it'll tear for him. So you've got a good GI doctor taking care of you, which is awesome. And he was smart to say, let's hold back because if they keep going higher, you're looming while you saw in their pathology how thin these esophagus walls are as well. You know, you didn't have to come to the hospital thankfully as well too. A repeat endoscopy is not great, but in that situation, probably the right move for you as well. Go ahead. Can you hear me okay? Can you guys hear me? Okay, perfect. Thank you for speaking with us today. I'm just curious, when you do experience an impaction, like the stake, what does it feel like? Are you able to talk? Can you breathe? Is it painful? What are you, the patient experiencing at that time? Sheer panic. No, so it's a very odd feeling because you can talk until the fluid level rises to where you can't. And it starts to, you know, you'll start to choke. I've had experiences where, you know, you get to a point you're trying to breathe and then it's like, and you're not gonna drown, but it feels like you're drowning. Most of the time it's, you know, you start to feel it coming up and it chokes you enough. And then you have to throw up. Now it doesn't, you're not throwing up everything. You're just throwing up that liquid that's, you know, on top of the impaction. And then you start the process again. You start drinking a little bit of water and try to force it down. You know, and my thing is, it's kind of like a plunger. You're putting water down, you're bringing it back up. And you keep doing that until it goes one way or the other. And, you know, it's very uncomfortable. And it's, you know, when you get that point where, and it's scary for others. If other people see you doing it, it's frightening because you're gasping for air when you have that point where it's right there and you can't, you know, and it's this. And so they almost, they're like, what do we do? And, you know, so it's scary. So in your mouth, you make a liter and a half of secretions every day. So imagine drinking almost a two liter of Coke, but it not going down and just sitting in your back or throat for you as well. So that's what they're feeling. That's when we come in, and we can marginally take this out of their esophagus as well, too. Not only to help protection for perforations, but also it's a very uncomfortable thing to happen as well. It also brings up a concept we call hypervigilance. So when things got stuck for you at one point for you, even if your esophagus has no strictures or eosinophils as well, too, you may still have worries sometimes that things get stuck or it's like it's moving slow as well. And that's where we say, do we get more therapy for them? Do we actually just back off therapy? Do we keep scoping them as well? And that's one of the harder ones that happen. When someone's had a food impact, that's a very stressful, traumatic event that's happened to your life as well. And it's to be mindful of patients will ask for more and more therapy, but sometimes esophageal-wise, there's nothing in there anymore. But that concern for food infection is still real for them as well, too. So I always ask, have you ever had a food impact from your visit? That's a trauma we can't ever undo for them as well, too. We try to give them positive reinforcement. You're on your medicines. You've done your endoscopies. Things look really good in there as well. Let's add back more foods for you as well, which you've done greatly. But some people cannot get over that, and it's really hard. So we do have our psychologists meet with them as well and work through eating habits as well, to sort of restrict food options as well. Maybe one more question, if we have any concerns. There's a question. Yeah, it's here. Hi, good morning. Thank you for being with us. I mean, it sounds like you've done very well from your EOE standpoint. I'm just curious, have you gone on the internet and looked up treatments, therapies, focus groups, people with EOE, found friends who have EOE, talk about it? This is like the world we live in, and a lot of patients like having a group of people they can talk to about their disease state and compare notes, how they're doing, compare doctors. What has your experience been with, say, looking things up on the internet about your condition? I try to stay away from the internet and medical issues. No, honestly, I really haven't done that much research on it. It's like I go to the doctor when I have the issues and I don't, it hasn't been so traumatic for me that I've felt like I needed group therapy. So, you know, I feel like I've, you know, it's like, it's a part of my life. You know, I just deal with it. It's not, I'm not letting it affect my life in too much of a negative way. It's a good question though. I mean, a lot of our patients come see us at Vanderbilt who are from everywhere in the country, but I'm like, you've bypassed several excellent centers for EOE, but because of TikTok or Reddit or, you know, Twitter, they see one of my names on there, which is good, but I'm like, you have a provider who is excellent at Northwestern and you just bypassed him to come see me as well. So there is a real impact, I think, as well for you too. My last question for you is, let's say you can imagine your perfect drug for EOE and it could be dietary or something else. What would that be like for you if you could design what you wanted to take, something you could use for you long-term for EOE? I mean, a pill would be great, that you just took a pill and everything was fine, but sometimes that's not the case. You know, not really sure how to answer that because, you know, I would do whatever the treatment was that could get me to where I wanted to go. If it's an inhaler, fine. I feel like the inhaler, I don't ever feel like I know that it's getting where it needs to be. Dr. Tierney mentioned a slurry that you would drink. You know, that seems like that would be a little bit more effective, but I mean, who doesn't want a pill that just makes things go away, so. Well, some good news there, you've got three tablets coming up that will dissolve in your esophagus for you. So those are gonna be steroid, ophloticosone, but steroids instead for you. So that'll come to you probably next year for you. So that will be a good option for you as well. So, well, I want to steal you from Dr. Tierney. You're a perfect patient. I want to take you to Nashville. I'll fly you back and forth as well, too. So I really appreciate your time. It's a good place to be at. We really appreciate your experience as well, too. And if we can be helpful for you, let us know. And I think we'll do it again in about 30 minutes. So take a little break, Todd, and we'll regroup here a little bit, okay? Okay, thank you. Thank you so much.

eosinophilic esophagitis

diagnosis

treatment

endoscopies

dilation procedures

medication compliance

food impactions