COVID-19 Risk for SIBO, IBS, and Autoimmunity Q&A 04/17/20 - YouTube

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hi Creston
I'm going to get started shortly just
trying to figure out how to livestream
I might be recording I'm just trying to
check on Facebook to see if I'm actually
live-streaming or if it's just live at
zoom then we'll get going okay I think I
might be good well either way I will
record the zoom recording and then I'll
put this on youtube if nothing else so
welcome welcome I think the big question
on everybody's mind is whether or not
you are at higher risk for kovat 19 and
that's what we're going to try to cover
with this Facebook live I will be able
to see your comments definitely in the
chat I will try to log on to Facebook
towards the end of this and see if I
could pull up the stream on there
hopefully I can get to your live
comments while we're going and if not I
will double back look at them after the
video has ended and then I'll answer
them in the comments so don't worry I
will get to them at some point let me go
ahead and share my screen in just a
second because I'm going to do an awful
lot of this in my very favorite program
hold on my favorite
which is Microsoft Paint yes I am an
elder millennial as we are called
so to establish the framework that we're
going to talk about we first need to
talk about immunology and even if you're
not an immunologist I think it's
important to have at least a broad
understanding of how the immune system
works and particularly there's going to
be an emphasis on antiviral immunity and
the autoimmune piece of this because I
work with a lot of folks with
autoimmunity or gut problems those are
kind of my two big areas of expertise
and I've seen this come up in a lot of
forums with autoimmunity and as well as
IBS and SIBO the question is whether or
not you are intrinsically at a higher
risk of complications from kovat 19 due
to pre-existing gut health issues or
autoimmunity and to frame that we're
going to talk about immunology a little
bit so here we have the wonderful
program Microsoft Paint I'm going to
scoot myself over a little bit and one
of the things that comes up in the
autoimmune world in particular is this
idea that there's an immune seesaw or a
teeter totter depending on what you grew
up calling it and that is going to
strike a balance hopefully between th1
that's T helper 1 mediated immunity vs.
th 2 now most of my patients have heard
this schtick before so bear with me
broadly speaking this is totally
oversimplifying a complex system th1
immunity is going to be largely your
anti tumor and antiviral immunity and
th2 immunity is the side of the immune
system that's good at smoking out big
things like parasites and worms they
also are the side responsible for
creating histamine and the allergenic
response now with autoimmunity there's
been a lot of talk over the last couple
of decades whether or not there is a
skewing of this immune seesaw where one
side goes up and the other side goes
down whether it be this way or that way
is very contested amongst the autoimmune
crowd and that's a topic for another day
but suffice it to say these are two of
the big arms of your immune system now
what I think is possibly not being
talked about enough or be
oversimplified is that there's a lot
more to the immune system than simply
these two types of th cells you also
have th 9 th let's see there's th1 th2
th 3 aka the T helper cell cell T
helpers I'm sorry th 3 also called T
regs sorry there's th 9 th 17 and th 22
so even amongst these T helper cells
there's an awful lot of different ones
and in the discussion of covin 19 our
focus is probably going to be a little
bit less on this look where else could I
make a beautiful thing like that the
Microsoft Paint our discussion is
probably less about this and more about
the cytokine storm that seems to be
related with th17 I'm gonna toggle back
to myself here and I'll kind of zoom
back here okay so you have these two
sides of the immune system you've got
th1 and th2 that's going to mediate how
well you could smoke out the virus
initially what seems to be the problem
with Koba 19 is less about those arms of
the immune system and it's more about
the inflammatory cascade that gets
cookin a couple of days into the
infection and that's more related to th
17 now th 17 and its associated chemical
messengers do seem to be associated with
autoimmunity particularly if you have
more aggressive form of disease and
autoimmunity there is war th17 activity
so it seems so theoretically I do think
that a lot of people with autoimmunity
particularly if it's severe could be at
a higher risk of Koba 19 risk more
complications now whether that is true
for you as an individual we'll get to in
a little bit but I wanted to frame that
first while I'm on this topic I also
wanted to mention though that there's
discussion about the use of herbal
remedies like elderberry and echinacea
and whether or not that would set you up
more for a cytokine storm and whether or
not you should or shouldn't be taking
these things so for what it's worth and
I'm gonna link to some herbalist that I
really respect
some of their blog posts as well the
elderberry piece of it I think is very
shaky at best for what it's worth
elderberry has traditionally not been
used so much as an elderberry syrup but
elderflower has been used more
traditionally as an herbal medicine we
actually don't have a lot of good
clinical data on elderberry we have a
handful of studies that suggest that it
can either prevent colds and flus or
shorten their duration if used in an
acute setting but other than literally
like a couple of studies we don't have a
lot of good clinical evidence on
elderberry it's delicious it seems to
work I do recommend it a lot for
prevention but as far as chugging it all
season longer all year long I don't know
if I'm a big fan of that there's one
study that suggests that elderberry
could increase levels of il-6 and I am
flat ori messengers that is seems to be
involved in the cytokine storm
particularly with cope at 19 so
theoretically if you are already
inflamed and then you take elderberry
and that jacks up your il-6 a little bit
more that could be a bad thing for you
but again we have shaky data at best
whether or not
elderberry does in fact do that and if
it does that across the board or in very
specific circumstances what I would say
is a few things is that hardly anybody
including myself measures interleukin 6
on a clinical day-to-day basis we I just
don't do it it's cost prohibitive and
measuring inflammatory mediators in
blood doesn't always reflect the
inflammation load in the tissue which is
what I'm really trying to get at when
I'm helping somebody with a specific
illness there are other ways to assess
inflammation and blood work that I think
are much more useful and you could even
have some of this done already if you're
a patient of mine you darn sure I've had
all of this run at some point on you but
even if you haven't been a patient of
mine somebody like your primary care
doctor or your GP of whatever form could
have done this on you already the couple
of things I would pay closest attention
to is a marker called c-reactive protein
or CRP that comes in either a high
sensitivity or a cardiac marker
both I think could be used for this
purpose CRP is an inflammatory marker
that's made in the liver secondary to
aisle six elevation so I use that as a
marker not only of inflammation but of
this particular flavor of inflammation
and also I tend to see it more as a gut
liver axis type of inflammation so if
you have an elevated c-reactive protein
anything above one is noteworthy in my
opinion if you go based off of LabCorp
or quests ranges then they would say
anything above three or four or
sometimes they'll use a range of ten
which is absurd anything about three
typically is going to be elevated per
standard lab ranges but that is
something that is very tightly
associated with il-6 and il-8 okay and
that seems to be in question for the
cytokine storm so if anything I doubt
anybody on this webcast has had il-6
measured in serum but I bet a bunch of
you have had CRP drawn in the last
couple of years that's probably your
number one bet as far as assessing your
inflammatory load and your particular
predilection towards this type of
inflammation beyond that there are other
ways to measure inflammation at odds
even but they all mean slightly
different things what we're looking for
is markers of this particular
inflammatory soup so an example of what
I think has less promise to assess your
risk is a marker like homocysteine
homocysteine is a marker of inflammation
but it has much more to do with your B
vitamin metabolism and how you're
recycling some of your amino acids it
doesn't to the best of my knowledge have
any correlation with il-6 and cytokines
and immune system activation it's more
of a metabolic type of inflammation so
in my opinion high homocysteine is
probably less of a risk factor high C
reactive protein I do think is going to
show promise for that I follow a lot of
my colleagues on social media and some
of them have shared posts from other
colleagues who are in emergency rooms at
Urgent Care right now and I've seen a
couple of them mentioned that prior to
the cytokine storm lab values of C
reactive protein seemed to go up in the
patients with kovat so that would make
sense for that context but that's just
you know I wanna off from an ER
physician I think that was in San
Antonio that I saw that so herbs I would
say we just don't have a lot of clinical
data as far as herbs exacerbating aisle
six type inflammation what I would say
the silver lining to all of this is this
particular inflammatory soup as I call
it where this particular flavor of
inflammation this il-6 interleukin-1
beta nasty cytokine store business for
all that it is not a good type of
inflammation to have if you were going
to pick one it is how previously well
researched the cellular machinery that
turns on this type of inflammation is
very well understood and very well
researched so if you look up natural
compounds that are anti-inflammatory
quote-unquote almost all of them will
have some research involving interleukin
6 C reactive protein or something called
stat 3 which is the gene the the gene
activator that turns on il-6 production
and if you could inhibit one of those
you're basically inhibiting the same
thing and that should put you in a
better position for the cytokine storm
and if you think about it resveratrol I
will link in the doobly-doo below on
YouTube / Facebook I found one article
not specific to kovat but I found one
article looking at the cytokine storm
particularly I believe was for the flu
and they documented that tumeric shocker
but like one of the big
anti-inflammatories everybody's talking
about tumeric suppresses the cytokine
storm and could be useful for the
influenza cytokine storm so it stands to
reason it would be useful for the
cytokine storm as well so things like
tumeric resveratrol green tea buzz well
iya you know heck even fish oil a lot of
the traditional anti-inflammatory things
that you would have gotten from a
functional medicine provider or an
herbalist probably have some impact on
this particular type of cytokine storm
so that's the good news the bad news is
that this type of inflammation really
sucks and it could kill you with Koba 19
the good news is that we know that it
sucks and we've known it for many many
years and the thing that that has done
is it's given us a lot of research so
any of these anti-inflammatory compounds
I will list some of my favorites but to
work was very tall green tea fish oil
kind of top out the list as far as I'm
concerned and then everything else
beyond that is kind of gravy so those
are the big things as far as suppressing
that cytokine storm from an herbal
medicine perspective I did see an
article which I will also link that
vitamin D could be used to reduce the
risk of infection and death from kovin
19 which oh I see that I've got one
question I'll get to the questions in
just a minute I did see that I would say
the vitamin D Association I also I
recommend vitamin D practically for
everybody through cold and flu season
anyway I do think vitamin D is going to
show to be protective against Coppa 19
there's mixed reviews as far as Co vyd
I'm sorry as far as influenza pneumonia
and vitamin D the biggest area where
I've seen that research lacking is that
they frequently don't dose vitamin D
appropriately so in studies if they
actually look at people serum levels and
try to get them up to a respectable
level or if they do a high enough dose
that it'll just get everybody up to a
respectable level vitamin D does show
promise for influenza and pneumonia risk
and it'll probably do the same for Kovan
the key is that most people need at
least 2,000 IU's of vitamin D per day
every day preferably with a fat
containing meal because it's fat soluble
a lot of people do really well on 5,000
I one of those people I typically start
people at 5,000 and then I adjust up or
down if I need to based on lab values
but even if you haven't had vitamin D
tested in the last year you will
probably tolerate 2,000 IU's of d
marvelously and there's very very little
risk with vitamin D for 99 percent of
people so vitamin D I think also makes
the list as far as I'm concerned and
then I also found an article more
recently that I shared on my Instagram
account and then cross posted to
Facebook that there's a research article
hypothesizing that melatonin might be
useful for Kovan now the reason
being is that not only hold on let me
see if I could share my screen again
sure screed okay so going back to this
lovely doodle that I created for you
guys like I said before th one immunity
is really the site of the immune system
that is in charge of antiviral immunity
more than anything else th - less so
when your seesaw is skewed in favor of
th - in favor of the allergenic and
hissed emetic response
you're probably in less of a position to
fight your viruses efficiently melatonin
in addition to being a really potent
anti-inflammatory and side note
prokinetic for all of you SIBO people it
is also a pretty potent th1 promoter so
if you are taking melatonin you get the
nice added benefit of it being an
anti-inflammatory which is good for the
cytokine storm potentially and it
increases your antiviral th1 immunity so
I think melatonin is probably going to
show a lot of promise now because I said
that and because the study just came out
in the last week or so mellow tones
probably gonna fly off the damn shelf so
people like me who take it more
regularly are gonna see a shortage but
melatonin if you tolerate it well could
be really useful the only thing that
melatonin really does that I've noticed
is a look at people really funky vivid
dreams so if you're one of those people
that melatonin is probably not the best
bet for you and you're better off going
with something like turmeric or
resveratrol or green tea but as long as
you tolerate melatonin well that is
something that you could have in
addition to everything else and then the
you know kind of the given coming from a
nutritional therapy practitioner and
what I do is to try to continue to eat
as healthy as you can even amongst all
of the craziness and the grocery
shopping is the nightmare I know frozen
fruits and vegetables have become kind
of a mainstay in our household at least
as well as just going out about weekly
to get fresh but trying to get as many
fruits and vegetables keeping your
microbiome healthy and as diverse as
possible with plant foods and fiber is
going to be really key and also that
will ensure that you're hopefully
getting adequate levels of selenium
vitamin C etc you could certainly run
out and try to find the last remaining
bottles of vitamin C and zinc and
selenium or you could just get as many
fruits and vegetables in your system as
humanly possible and then maybe take a
multivitamin on top of that depending on
the multivitamin a lot of them do have
fairly robust amounts of zinc and
selenium in them so I don't know if I
would recommend taking extra for most
people I think just a multi will cover
that base let me scroll back up I had a
couple of topics I wanted to really make
sure I hit all right I bored you with
immunology 101 cytokines think
autoimmunity has the potential to be a
risk factor in addition to you know the
CDC has posted a list I don't like that
too of conditions that put you at higher
risk like asthma chronic lung disease
diabetes obesity liver disease actually
made the list I noticed so there's a
myriad of chronic diseases that put you
at a higher risk automatically but I do
think that autoimmunity broadly we're
probably going to find that that makes
the list in some way at some point
another one that I actually wanted to
touch on I stumbled on this article a
couple weeks ago right at the beginning
of the co-ed madness particularly low t3
levels so now we're jumping into thyroid
world low t3 levels or what is called Yu
thyroid sick syndrome where your TSH and
t4 are possibly normal but your t3 is
low that does have a little bit of
research being associated with worse
outcomes in situations of I believe it
was hospital acquired pneumonia and I
will post a link to that I don't want to
fear monger or get people worried over
nothing but if your t3 levels are low or
on the lower side of normal that may or
may not bode well for you as far as
kovat risk also it's hard to say this
was again in a pneumonia research
article it was a couple of years old
probably 2017 I think but I thought that
that was noteworthy anyway so your
thyroid might also play a role in how
you recover from kovat and the cytokine
storm although that was not specifically
mentioned in that article
okay I think that's a lot of what I
wanted to cover and then to circle back
to the gut health piece of the
conversation what I've seen a lot too is
people asking again are am i at higher
risk automatically because of IBS or
SIBO or autoimmunity
so autoimmunity had already answered I
think that there's a solid maybe leading
towards yes for a lot of autoimmune
people unless you're in remission if
your autoimmunity is well controlled or
in remission then you're probably at no
higher risks and your average Joe but if
you have autoimmunity that is still
running but anchors then yes you're
probably at a higher risk you could try
to assess that more accurately with
something like C reactive protein
possibly inflammatory markers like
elevated ferritin or other acute phase
reactants type markers could be useful
in this situation but I think C reactive
protein is really going to be the most
commonly used and best way to assess
that now for IBS and SIBO folk I don't
know if I'm convinced that you guys are
going to be at a higher risk
intrinsically because of the
pre-existing condition of IBS or C Bo I
don't know if I'm gonna go with that I
think that you guys are probably at
average risk with the caveat a lot of
people with autoimmunity also have IBS
or C though and it goes both ways
so if you have C Bo and autoimmunity
then you're going to default to the
conversation we had about autoimmunity
if you have post infectious IBS if you
have the C Bo that is inherently
autoimmune and it's your immune system
attacking your nerve endings that's
destroying your MMC that's a variant of
autoimmunity and you would be more in
the camp with autoimmune people in that
circumstance but if you have C Bo for an
unknown reason or you develop SIBO
secondary to PPI use or adhesions or
something else unrelated to food
poisoning and the autoimmunity then I
don't know if you're intrinsically going
to be at a higher risk what I would say
with SIBO and IBS is a couple of things
is that you guys are going to be at a
higher risk of malabsorption
so making extra super double mega sure
that you're getting all of your
nutrients from food
and covering your bases with a
multivitamin I think is going to very
much behoove you getting you know a
normal person theoretically you could
get by with just 100 percent of your
daily value of zinc maybe you want to
get a hundred and twenty percent to kind
of make up for any sort of malabsorption
that you may or may not have because of
the SIBO your microbiome does very much
influence the immune system that's kind
of the shtick that functional medicine
and naturopathic medicine has been
saying for a lot of years how it will
affect COBIT outcomes is hard to say
what I would say is that you could
probably use your body's tendencies in
your history to your aid in this case I
always ask my patients is your immune
system strong or like are you the kind
of person who somebody could sneeze in
your face and you're not gonna get sick
for are you the person where one person
five cubicles away gets a cold and you
automatically know you're gonna get it
because your immune system sucks that
bad if you are in the latter category
then you're probably at a higher risk of
catching kovat because it's just it's a
viral infection just like anything else
if you're at a higher risk seemingly to
catch a cold or flu then that probably
will stand true with Co good
likewise knowing your immune system
where do you get inflamed do you get
super inflamed or does your body seem to
regulate at least somewhat like are you
a person who needs to go hit the
steroids or get a prescription
medication to take down inflammation or
are you good if you just rest and
hydrate for a couple of days and your
body naturally seems to recover if you
are a person for whom you need that
prescription intervention and your body
goes just all in when it gets inflamed
or if you get really aggressive
autoimmune flares that probably means
that your ability to ramp up those
inflammatory cytokines is exaggerated
compared to the average Joe and that
could put you at a higher risk if you on
the other hand are a person who you get
inflamed and then you bounce back within
a couple of days and you just need to
like rest and hydrate and maybe sip on
some tea for a few days then I don't
know if I would necessarily think you're
at a higher risk
I think IBS and SIBO could go both ways
depending on
going on now IBD which I also work with
IBD is automatically loved in with the
autoimmune folk so that's that's gonna
kind of default back to our autoimmune
conversation let's see alright so let me
try to answer questions now because I
feel like I've talked a lot okay hold
that thought
and I'm gonna try to pull up the
Facebook why
I'll check there and then I'll pull up
zoom and like I said if for some reason
I can't get the technology to cooperate
/ if there's user error on my part then
I will just read the comments later and
answer them as they come up okay I can't
figure out how it's telling me that I am
live so that's good but I can't figure
out how to see the questions as they
appear so I clearly have more learning
to do on that front I do have one on
Zoom Kristin asked what do you think
about Astros anted supplements I don't
have a lot of experience with it
honestly it's not as well researched of
a compound as tumeric or was very tall
or green tea or fish oil so as far as
like picking out things in a hierarchy I
would probably reach for those first it
does have anti-inflammatory effects I
believe it has an antihistamine ik
effect if I remember correctly I just
don't really have any any real
experience with it as a nutraceutical so
I'm sorry I can't offer more of an
opinion on that one I might do a quick
you know a quick PubMed dive and get
back to you though and I'll put it on
the Facebook live feed and I'll I'll let
you know if my opinion changes but I
think as far as herbal medicines and
anti-inflammatories I think those four
would round out my top my top four fish
oil which I think most people should
take just indefinitely probably vitamin
D you could also lump in as an
anti-inflammatory and obviously it's a
vitamin in and of itself tumeric
resveratrol green tea I think all of
those are probably going to beat out
most other supplements and if you could
get them in a cocktail or combine them
they seem to have a synergistic effect
Oh sulforaphane that is another one my
god it's a little hard to source right
now Jaros been on backorder for a little
while and I think they just got it back
in but there is a antioxidant from
broccoli seed you could either get the
broccoli seeds and grow them yourself
which I encourage most of my patients to
do or you could do you know a product
like brocco Max or some sort of
sulforaphane supplement and that does
have beneficial effects and
anti-inflammatory effects for your
microbiota as well as your immune system
and it is a stat3 il-6 inhibitor so that
is also a very useful one in the same
category of usefulness as tumeric and
resveratrol I've got another question
what brand of vitamin D there's a lot I
tend to recommend designs for health
they have a nice product that has
vitamin D with a little bit of k2 thrown
in which I do think is important there's
also an ortho molecular product I use
called kforce and that has a bit higher
of a dose okay so for my people who have
osteoporosis or lots of cavities and I'm
suspicious that they have a vitamin K
deficiency I'll usually use kforce for
somebody who doesn't have overt signs of
K deficiency and I'm not super super
worried about it but I want to just have
that insurance policy I'll usually use
decides for health I think they just
call it vitamin D supreme if I remember
correctly but I could double-check that
if I'm incorrect I'll let you know okay
well I wasn't sure if I'd be able to
fill up a whole webcast odd Kovach
because I don't I'm not an immunologist
I'm not a coping expert by any stretch
of the imagination but I wanted to at
least put out some information and
answer a question since I've seen this
pop up in so many of the autoimmune and
SIBO forums lately so as I think of
things I will probably comment on this
thread and let you know as I chew on
this more let's see have been another
one recommend are these recommended
additionally to the multis yeah so I
would say your multivitamin you're gonna
want to do just indefinitely in my
opinion I think most people would do
well on a daily multivitamin just to
cover your bases and that's going to
make sure that you're getting adequate
levels of vitamin C zinc's
etc usually bull ties are pretty lacking
as far as magnesium and calcium but most
other nutrients they do okay on the
vitamin D would be in addition because
multivitamins typically only have like
400 IU's which is a total wuss dose you
really need 2,000 minimum for most viral
infections maybe even five for a lot of
people Christine hi Christine yes I do
have the DK in in my office if you want
to orchestrate a time where we can do a
pickup and you don't have to come in
contact with me my cooties I'll just
wave at you from my back office how
about that but yeah so multivitamin I
think multivitamin and fish oil
everybody should already be on those
anyway if you're not go ahead and start
for multis there's a lot of them that I
like I tend to be pretty choosy because
I work with people with complex
conditions Thorin has a good one I
really like the seeking health products
also and I carry a lot of their
multivitamins in my office depending on
what I'm going for
so everybody should be on a multivitamin
and a fish oil probably for fish oil I
really like Nordic Naturals they don't
smell fishy
they don't have fishy weird verbs they
are the triglyceride form of the fish
oil and that seems to be absorbed better
and their purity tested out the wazoo so
there's no metals or weird stuff in them
so Nordic Naturals is definitely worth
the increase premium price for them the
multivitamin there's many that are good
but I really like seeking health that's
probably the one that I use the most of
is one of their products and then the
anti-inflammatories on it as the basis
if you're at an average risk and you
know you have a run-of-the-mill case of
SIBO that's not due to autoimmunity and
you're not suspicious that you have on
immunity then I don't know if I would
run out and tank the shelves up there
tumeric it's kind of like the toilet
paper right like if all of us run out
and get toilet paper when we don't
actually need it yet then the people who
really need it are could have access to
it so I don't want people to run out and
immediately buy out all of the sulfur Oh
Phaedra spiritual turmeric and green tea
but from a food based standpoint throw
some to work in your food and my husband
bless us all he just put tumor in his
coffee the other day because Joe Brogan
does it was the cutest thing ever
I might keep your watching so you know
you could sneak to work in just about
anything heck you could even just mix
tumeric with a little bit of coconut oil
make it into a paste and then just take
it down like a champ get it done and
over with and then you got a pretty high
dose with the fat that'll help it get
absorbed resveratrol you officially have
my blessing to have one or two glasses
of red wine per week I think that's
reasonable if you want to supplement
beyond that that's gravy and then green
tea there's a lot of reputable types of
green tea try to get organic if you can
Trader Joe's green tea I think tested
pretty well in purity testing so that
could be a good one that's successful to
most people but having a few cups of
green tea a day also wouldn't be a bad
idea and it's food based and it's pretty
cheap so that um I think that's gonna
cover the bases for most everybody and
with that I think we're gonna wrap up
and like I said I will look at the
questions as they come up on the
Facebook live once it posts and the
YouTube video I'm gonna just share this
directly on YouTube so once this post on
youtube I will monitor comments on both
Facebook and YouTube let me know if you
have questions and I will share a couple
of those links that I promised in both
of the descriptions and I'm also going
to link to a an article that a herbalist
trying to mind shared and it's just so
thorough and such a breath of fresh air
I really highly recommend hey I
recommend this book he has a book on
Amazon and elsewhere he has a marvelous
herb school and if you want to do a
consult with one of his herbalist
students I highly recommend that and
this article in particular is really
useful so go check out Thomas's stuff
I'm gonna link to that it's the eclectic
school of herbal medicine and he has an
article about Kovach 19 where he gives
other ideas for herbal strategies and
some of his non bullshitting advice
which is great the and I meant to
contrast that not that he has
advice normally just like the Internet
in general it's refreshing when
somebody's not biessing you so I'm going
to link to Thomas this article and I
will put other goodies in the doobly-doo
as I think of them but thank you all for
joining me hopefully that helped you
understand whether or not you're truly
at an increased risk of coping 19 in the
meantime keep washing your hands stay
stay far
away from everybody in there cooties and
I'll see you in another video at some
point I'm sure take care