Sentinel Phenotypes & ADHD

Devon: [00:00:00] Hi there. Welcome to Dr. D on ADHD, the podcast where we discuss all things ADHD with Dr. Samuel Dismond I’m Devon Meadows together. We operate NorCal ADHD, and we take the time every now and then to record a podcast episode. It often reflects the learnings that we gain in serving our patients. And today we talk about Sentinel phenotypes. Um, this is something that I am just learning about from Dr. Dismond. So you’ll hear us discussing people with ADHD and Sentinel phenotypes.

I should also define phenotype before we jump in, because we don’t define it in the podcast and I think this would be useful. The term phenotype refers to the observable physical properties of an organism. So this would be the appearance, development, and behavior. An organism’s phenotypes is determined by its genotype, which is the set of genes the organism carries as well as by environmental influences upon these genes.

With that, let’s get into it. So it’s been a while since we’ve done a podcast and and that’s because both of us are working generally around the clock on Norcal ADHD.

Dr. D: [00:01:30] Yes.

Devon: So that is worth mentioning. I wanted to actually point out in this podcast that we are both managing this ADHD service full time
and when we make a podcast, I’m recording it and editing it and publishing it around the time that I’m helping with the ADHD practice. So these have been trickling out, I think, slower than what people want us to be trickling these out as. And so that’s what’s going on. Let’s get into it.

Dr. D: [00:02:05] Okay. So my motivation for this was I, I try to stay up on the literature as much as I can. And, I came across, a journal article. A book and a podcast all in the same area. And that was telling me, okay, I need to make clear, some things. And, other than saying it was a Joe Rogan podcast. I’m not going to point to anything in particular because it was just in passing. It was a statement done in passing, but the journal article, is important. That was in science and as well. Um, there was a section of the book. I was reading, on people with the Sentinel phenotype.

And so I wanted to make very, very clear my perspective about treatment.
So, what I know is that, there is nothing wrong with people that have the Sentinel phenotype. It is not a disease per se. It’s not a defect, it’s not a disorder. And it is an expected variation given that we are social mammals. Period.

 And it is just a fluke of how we have created so-called civilization. And it’s really picked up in earnest after 1950. That’s a really remarkable thing. It’s a really, really, really recent phenomenon. The difficulties that in particular sentinels have, but people in general, I mean, I think if anybody was a multi-trillionair.

And he said, here built this city from the ground up, you have unlimited resources. You can hire anybody else, anybody you want do all the research you want. Nobody would end up making what we call a “contemporary city, contemporary jobs”. Nobody would design it that way and it’s just kinda happened. So, getting back to.

[00:04:22]The principles of treatment. So I want to make very clear what I hold as the bullseye. Yeah. And the bullseye is for any person. if we had unlimited time and unlimited resources for any Sentinel, that the goal would be to create a way of sustaining oneself and enjoying one’s life a sentinels life that didn’t require medication.

The, and that typically would involve for most people, a lot of upheaval and a lot of change, and it would be a process. It wouldn’t happen quickly and it would be a process, but I am completely confident that with unlimited resources and unlimited time, everybody could get there to a place where they didn’t need any kind of medication to the analogy.

The analogy I use is, people sentinels have around nervous system. And most of the things they have to do in their modern life are square boxes. And so what stimulants do is decrease the diameter of the roundedness of their nervous system, their radar dish nervous system, so that it can fit to the width of the square box. They got to climb into

 Devon: [00:05:48] What are some round things that sentinels do?

Dr. D: [00:05:53] it’s constantly being aware of the periphery. Many patients who, when I express this a modern perspective on who they are, they laugh. And they say that they’ve, they realize that when they walk into a room, they always spontaneously look at the exits. They look around the room where the exits, what are the windows?

[00:06:15] And they’re not consciously thinking about planning, an escape. They’re just aware. And that when there’s too many people around them, they’re crowded. Close to them that, they don’t feel like they can get an accurate sweep of the room. And so it makes them feel anxious, a little bit anxious and uncomfortable.

Uh, sitting stacked up in an audience is difficult for the same reason they get fidgety, they feel fidgety, always wanting to move his genetic programming, presumably over hundreds of thousands of years, uh, for this Sentinel DNA, that to explore the periphery of the environment, just to know what’s going on, it’s like doing the rounds.

It’s kind of like what security, dark security guards do they make the rounds and they gotta touch the tag to prove that they’ve actually looked at the place where they’re supposed to on the rent. It’s like that.

So, that’s the roundness of the nervous system. Go ahead.

 Devon: [00:07:14] and so you’ve noticed is that Sentinel qualities are often negative qualities to this society.

 Dr. D: [00:07:24] It’s well, it’s not that they’re negative. It’s that, the way most people are squares. Okay. That, and that’s okay. I don’t mean any pejorative or derogatory connotation, but they’re squares. And so squares kind of built up stuff. And it’s just that a mostly square circumstance doesn’t fit very well.

 Someone who has a big round of nervous system. And so there’s, no, I don’t want to put any kind of judgment on either condition.

 Devon: [00:07:56] I know you don’t. I just. As the person that is like, I’m, I’m kind of speaking to where people probably are right now.

[00:08:05]people have told them that fidgety, isn’t something that you want around in your life, probably their, their whole lives. Right? Like that to me, seems like they may have experienced these negative feelings towards their attributes, but your saying that those aren’t negative.

Dr. D: [00:08:22] That’s correct. That’s correct. And it’s just, you know, the, We humans are funny in that way.

Most of us. When we’re in a group of folks who are like us, if there’s somebody not like us, we do one of two things, very predictably, and this has been amply documented and all kinds of experiments and observations.

We do one of two things faithfully. We either try to convince the other person that doesn’t seem to be like us in the group. We try to convince them to be like us overtly or covertly. You know, most of it is covert. It’s subtle pressure to be like us or, the person who is different gets completely ostracized and in a very, very, um, painful way to the person being ostracized.

So fidgety would be one of those things. It would be one of those things. You’re you’re, it’s a sign that, the Sentinel is not like a squares. And so you’ve got to, you’ve got to be different and I got to hand it to a Waldorf. The man, he’s the one that came up with this of devising educational circumstances that better fit the type of child.

 And so, kids who have the opportunity. One of our patients had such an opportunity growing up and that’s why he didn’t realize he was a Sentinel until he got knee deep in the square world. But growing up, he had the opportunity to learn any way that was good for him. So he would do his math swinging from a tree, you know, he would get his math.

And it’s great that some kids have that again, that’s one of those unlimited resources, unlimited time type of situations.
Devon: [00:10:19] Why don’t people know about like, as a broad society and educational system, it seems like phenotypes would be just such a, an important part to put at the, at the foundation Why is that? Not at the foundation of everything.
Dr. D: [00:10:41] That’s a really good question. So, Francis Bacon has a famous quote. well, people quote him, he asked the question and it goes something like this. if I can paraphrase, “how is it that we humans have so much information that’s readily available yet? We know so little?” And he was posing it more as a philosophical question.

[00:11:06] And I’m an old man and I’m a huge consumer of information and I’ve done a lot of things. And I am of the opinion, it’s purely an opinion that we have not as a people, as a, as a species, learned to select our leaders, uh, in a different way, different from our primitive genetic. Uh, machinery. So at T to understand, like if, if I was an alien and examining human beings and looking at how Americans have selected someone like the person who is the current occupant of the oval office, his outward traits are, um, signal positive qualities for a primitive species.
[00:12:01]that is constantly struggling to survive and facing danger. You know, that the outward appearance of his, his phenotype is I got this now, unfortunately, he he’s deranged a little bit in that, He’s got a lot of the mechanics for expression, but, he doesn’t have enough to fill up the trousers.
[00:12:30] You know, he, he wears the pants, but he actually doesn’t, he’s not packing it to fill up the pants, so to speak. There’s a guy, his name escapes me. He wrote a book called on violence, he’s a Lieutenant Colonel. Really really smart man. He talks about, the distribution of the phenotypes, uh, when it comes to combat.

[00:12:55]And so there’s in the tail of the distribution. It’s about 15% of people have the, have a certain kind of genetics, such that they run into danger. but half of those people. our, what we would call pathologic. They are the sociopaths or psychopaths. The other half, they are the wolves and the other half are sheep dogs.
[00:13:19] They can be justice ferocious of the wolves, but they’re, they’ve got this quality of wanting to take care of the flock. So what sheep dogs do. And so, we have not faced up to the fact that., what we need our sheep sheepdogs to lead us to be the heads of our corporations, the heads of our political office.

We just haven’t faced up to that. That’s what we want. And instead we go on these really primitive, superficial qualities, signaling qualities, it’s kind of like plumage on a bird. And so these people who are mostly sociopathic, they’re on the disease. The pathologic end of that 15%, the other half that doesn’t care about people.
[00:14:07] Well, Mark Benioff is a good example of someone who has more of the sheep dog qualities with what he does. But unfortunately, most of the people who rise up percolate up to the top, they’re more on the social pathic, psychopathic end of the spectrum. uh, and so that’s why we have the society. We do.
That’s my perspective.

Devon: [00:14:29] So Mark Benioff, he’s the CEO of Salesforce, right? I think, um, yeah. What, what are the things that you see that he has as a leader that, suggest that.

Dr. D: [00:14:41] Oh my God is Salesforce is consistently the best or one of the best it’s like in the top five places voted by employees to work.

 I think he’s still giving away, folks out there can correct me if I’m wrong. It’s like something like 1%. Of his profit goes to charities and, and you know, all the good works he’s done, the children’s hospital, yeah, the guy’s just, he makes he’s, he’s a good business leader.

He’s, you know, he’s a Titan of what he does and he’s got, he likes people, just from the outward example of what he’s doing. It seems like he generally likes and cares for people.

Devon: [00:15:25] That seems like the, the important one. I think that a lot of people can, can check the boxes as far as to how much they’re giving away and what things look like. But actually, enjoying and liking people is something that I feel like is much harder to pretend and to check the box on.

 Dr. D: [00:15:47] Yes. And, and so as, as a species, we, we really need to have, I mean, it’s going to be a fluke that certain people get into positions where they can make decisions, but it needs to start like in the educational system, that should be the emphasis is people should, you know, like K through 12, there are these types of people. And, I mean, there’s even, doctor-ish names for it. It’s called cluster B or category B personality disorders. Every kid should learn what a category B or cluster B personality disorder is so they can recognize it.

Devon: [00:16:32] What is that?

Dr. D: [00:16:34] The current occupant of the oval office is a good example of it’s a textbook example of someone who has. A huge helping of the genes that create the phenotype. That is , the category B personality disorder. So, without, without going down that rabbit hole, it’s just, just think of that.

[00:16:57] Just think of the current occupant of the oval office. That’s a huge example of category B.

Devon: [00:17:03] Yeah. Yeah. We have some other principals to talk about. I could see, we don’t want to go down that particular rabbit hole of defining that and, and breaking that out. But you were talking about the bullseye. Let’s go back to.
Dr. D: [00:17:16] yeah, yeah. So the bullseye is, um, uh, so you know, folks who are sentinels. Because they didn’t know about this and the people around them didn’t know that they were sentinels. They didn’t know to tell him, you know, you really should, uh, like, hi, you know, it’s just a couple of simple questions to a kid or to an adult, to it, to a teenager.

[00:17:38] It’s like, how do you leap, like feeling tired at the end of the day? Is it from using your mind or from using your body? Okay. That’s the first slice. The second slice is, would you rather be indoors or outdoors doing that thing, making you tired? So many sentinels, um, can answer that question when they think about it.

And so that’s the first cut. um, I’ve had the privilege of working with families, Who have had Sentinel kids. And I really get on him about this too. Um, make sure they’re not trying to make their child fit into square boxes and I’m grateful that they actually took my advice and the, you know, it’s like, you’re going to go to college and the kid’s not going to college, but is actually enjoying their life immensely because they are outside constantly and , this young lady likes to be tired physically and so her parents allowed her to do that and she is loving life. so a lot of people who are sentinels don’t have that opportunity. And so the choices in front of them was one or more of a square box. And so now they’ve like gone way down into two square box Advil and they’re having difficulties.
[00:19:07] And so it would require a lot of uprooting and sometimes, you know, their partner is really square and they actually don’t get along, you know, honest to God, they don’t get along with their partner. And, and, um, I have seen that I’ve witnessed that circumstance. Whereas Sentinel has figured out who they are and have realized that the person that they were currently with is not the right person for them.
[00:19:36] And so that that’s the kind of upheaval that would be involved. So unlimited time, limited resources, the goal is um, for a person to feel like they’re in their right place in their right time. Period.
[00:19:52] And so to the extent that they can’t do that, Dan we’re in a different ball game. Okay. So resources are limited. Time is limited and the opportunities to make changes are limited. It’s like, you know, they’re just working like a dog just to, to, from paycheck to paycheck. And so, um, it’s important. To an understand that goal, but in the here and now with limited resources and time, uh, folks who have the Sentinel female phenotype are very fortunate.

 And then in that stimulants can help shrink the diameter of their roundness to fit in the square boxes where they need to go.

So that’s the key. And so, um, I think. Some clinicians, um, maybe don’t have a full grasp of this, that, but they have, they have, their intuition is telling them that, um, being a Sentinel is not a disease. And so unfortunately, you know, because in the West we are like all up in our heads. It’s like all in the head, you got to think different thoughts, think this way, think that way.

[00:21:03] And so, um, Therapy, a lot of therapists. I sh I dare say, most therapists are invested in the head game. And so, you know, that’s their box that they’re in. And so they want to, ,

Devon: [00:21:16] The head game, like intellectualizing or what is the head game?
Dr. D: [00:21:20] no, it’s just talk therapy. I mean, talking is, yeah. Talking is fundamentally a head thing. So talk therapy. Yeah. So they, they, their intuition is that this is not a disease. And so they want to believe that talk therapy will help a Sentinel fit better in their square box.

Devon: [00:21:42] Will it? Could it?

Dr. D: [00:21:43] No, the data are overwhelming that that’s not the case. Yeah. Their heart’s in the right place. It’s just that talking is not it.

You know, most, most of us sentinels challenges have to do with the structure of the place where they find themselves. So it’s like the, the, you know, the goal of talk therapy is, or the supposition, the presupposition of talk therapy is that somehow I can think a change in my personality so that I can meet my place better.
[00:22:22] And it’s like, nah, for sentinels, it’s too deep. It’s in the DNA and you can’t, you can’t, out-think your DNA. Furthermore, the problem is not in the Sentinel. It’s in the place, it’s in the place and that’s why medication works. It’s just, I, this analogy is completely appropriate. It decreases the diameter of a Sentinel’s radar dish.

Round nervous system function to fit the width of whatever square box they find themselves.
So the rule of thumb is for a Sentinel when they can’t modify their place. That’s that’s when you. You gotta turn to medication. And, and once a Sentinel is on medication and has the capacity, like all the anxiety and depression of not fitting into their square box drops because they’re, they’re now more successfully fitting into the square box , that they have to use.

[00:23:35] Then they can gain some perspective. And so place modification can be gradual. And we have had patients in our practice for whom that is exactly happened. They’ve get on medication, they’ve increased their perspective and made some place modifications and they found they need less medication.

Dr. D: what is, um a general example of a placement modification?
So, the, one patient I have in mind had. The opportunity to move up in the organization in two different kinds of ways. One way was, very much, it sounded attract, it sounded attractive. Let’s call it strategic thinking. It was very much up in the head. It involved, designing processes, executing against processes.

and then the other is, it is very dynamic projects are from weeks to months changes all the time, location changes, fair amount of travel. And then, on medication, we actually had the opportunity to discuss, the, this choice. After the person was optimized on medication and just in conversation, they figured out that, um, even though the traveling and jumping around might disrupt their current network of relationships and friends, it actually suited them better. And so they chose that. And after being in that circumstance, they actually realized that they were forgetting to take their medication. And it wasn’t a problem.

 Yeah. So they would go longer than a month and a month turned into two months before they needed a refill because they weren’t taking their medication that much. And so that’s that like, that’s ideal, that’s the ideal circumstance.

But without having that, you know, the, the freedom that comes with understanding Who you are and what kind of places are best, who I am and what kind of places are best for me without that understanding, I can’t make good choices. I’m just rolling the dice. So that’s why, you know, it’s pretty easy to, look at the service that we provide and say, it’s all about the medicine.

And it’s not, uh, our service is about, um, making it easy for trustworthy, respectful, reliable people. To get what they need easily without a whole lot of stigma, without a whole lot of judgment. that’s the business opportunity. That’s why we have done what we’re doing. It’s about that. It’s not because, Pills are the way and we’re just popping out pills. No. So, um, I try to , emphasize this, uh, to everyone and if I haven’t emphasized it enough, I apologize. But that’s what we’re about. It’s coming from this perspective.

The ideal thing is for a person to be in their right place, in their right time for them.
[00:27:01]And to the extent that that’s a process given where they are now, then medication can be considered a bridge, a functional bridge, just so you can, uh, not have anxiety and depression trying to fit your roundness into a square box.

So that last thing I want to, discuss is medication. I rely on a human history data as opposed to animal models, and there’s a lot of reason to doubt, animal models., there’s a guy named Brett Weinstein. Very, very, very smart man who was an evolutionary biologist who became famous at evergreen college for some other reason. But in the course of, him becoming known, he told his story about long telomeres. And I think everybody should just, hear his story. If you got a minute, it’s really fascinating. Punchline, long Tilo mirrors, T E L O M E R E S.

Telomeres.

[00:28:15] What’s the tale of the long telomeres. he tells a story on a variety of podcasts and every time he tells it, it’s a good one. It’s a, you know, wherever you find it, it’s great to hear him tell the story. And, and it it’s quite shocking because basically, he, he proved an important evolutionary biology theorem.

[00:28:39] proved it by fluke. He’s the one that discovered it. But the consequence says that the mouse models we’ve been using are completely screwed up. They’re wrong. The mouse models used for drug testing. They are completely unreliable. I’m sure everybody has heard about. Uh, drugs that went through all the testing, but then once they get out into the human population, like three, five years later, people start dropping dead or have problems with it

 It’s because of the screwed up. It’s probably because of the screwed up mouse model. So, um, I trust him and experience data. So the rule of thumb is the longer a medication has been taken by humans. And the, and the record of its use as available, the safer the medication is.
Devon: [00:29:30] Okay.
 Dr. D: [00:29:32] That that’s my general rule of thumb.

 And, and that is why I feel I’m extremely comfortable helping people obtain. And experiment with stimulants because they were discovered between world war one and world war II. And, they’ve been widely used in the military and we know who can take them and who can’t, people that can successfully take stimulants are, people with the Sentinel phenotype when they find their optimal regimen.

[00:30:05] apparently there is no longterm detectable damage and people have been looking really hard at this and I’m here. Let me pull it up real quick.

I’ll tell you the reference book I use. I, I continually block on this guy’s name. Uh, Okay. Here we go. It’s it’s called, “Attention deficit hyperactivity disorder”, fourth edition. And it’s by the what’s the guy that does it. His name is Russell a Barclay’s the editor and it’s 700 pages. And it’s a summary of all the current research about, folks with the Sentinel phenotype. And so that’s my reference.

[00:30:51] And when you go to the section about complications from longterm use, the summary is can’t find any, if the person is optimally dosed properly diagnosed, there’s no problem with longterm use of stimulants. And so that, that’s why I feel I’m pretty good about helping people, uh, use stimulus. that’s the punchline, the safety data is human history.

[00:31:19]And that’s pretty much all I wanted to, I wanted to get off my chest, uh, after coming up with those three things. I want people to know that, you know, it’s not about, ah, yeah, just take this pill and get out of my face.

[00:31:32] It’s it’s not that, I mean, folks have an hour of time per month and they can use it any way they want, uh, some folks just shoot the shoot, the shite with me.
Um, talk shop about computers. I’ve been like, I think they call them life coaches. I’ve, I’ve served that function for short time for people. It can be like, just checking in 15 minutes every week. Some people use it very intensely for a short while and then don’t use it at all. But that time is there.

[00:32:03] It’s a fundamental part of our service. Most of the time, it’s just dealing with pharmacies and insurance companies, for people trying to, you know, kick over the garbage cans in front of them. So they have a smooth path
to getting their medication, but that phone time is there for them.

Anything they want to talk about, I’ve actually helped some people with public speaking. Um, one person went into Toastmasters and we talked a little bit about that, how good it was, when she realized who she was as a Sentinel at, gave her the oath to like to take a stab at public speaking. And she actually found she’s really good at it.
So she got into Toastmasters, Which is really great So yeah, that time is there for everybody.
Devon: [00:32:50] It’s really like, you’re a, you’re a Sentinel consultant that is also a doctor and is also a programmer. And so it’s become a really neat, like you have a really great background for the people that we serve, which tend to be like a, a tech savvy person.

[00:33:08] Cause we’re in this Bay area location. Yeah, it’s, it’s fun to watch it. And it’s really formed in some ways around
Dr. D: [00:33:23] I’m really grateful too. I’m so grateful. I can’ttell you how grateful I am for our patients. So that’s it. That’s it. That’s all I wanted to express. It’s a wrap.
Devon: [00:33:38] you, one of the last things you said, what that book was talking about, um, optimally dosed. Stimulants and correct diagnosis. There aren’t any known long term effects.  And I’m often the customer support person, um, you know, we have a lot of help from, from our, uh, customer support team.

[00:34:00] Now, Karen and Rina are amazing. And so they take care of a lot of things now, but for a long time, I was, I was talking to almost everybody. And I ju I think that is a, I feel like that’s a big hurdle. I think what a lot of people know as stimulants is not being funneled into only the people that are optimally dosed and properly diagnosed.

Um, just because of the, bad press about the other people. So often that.
[00:34:30] People come in confused, by the way, we’re talking about things, because we talk about things through that lens of only optimally dosed and properly diagnosed. And I don’t think most people have that lens yet when they, when they see us possibly
Dr. D: [00:34:45] yes. Yeah. I think that’s true.

Devon: [00:34:47] but yeah, I wanted to point that out because I find that a lot of people are, um, not calibrated yet.

 Yeah.

Dr. D: [00:34:58] Yeah.

[00:34:59]The challenge is that, there are, meth addicts who are not, who are not sentinels. They actually have depression. They actually have depression. And they take stimulants street stimulants. If they can get their hands on the prescription stuff, they will, but they actually have depression and they’re using the stimulant to feel up. And that the marker for that is tolerance is wicked for that up feeling. That’s why I always encourage. People who start using stimulants to not to look inside themselves, to see how they feel, that’s the wrong direction. When someone is optimally dosed, most people who are optimally dosed actually can’t feel inside themselves. Any difference.

[00:35:53] What they notice is retrospectively their performance is better, you know, tiresome, Ted. Comes up. And, you know, before finding the optimal regimen, when tiresome, Ted paid a visit, it’s like within the first 15 seconds of him talking, I was off somewhere else, you know, but now that I’m optimally dosed, actually I can listen to tiresome.

 Ted’s 30 minute rant and lo and behold, there’s actually some good stuff in there. Even though I got to suffer through 30 minutes, I can. Okay. But when I look inside myself, I don’t feel any different being on a stimulant that’s that’s ideal. And that’s the experience of most people contrast that with someone who’s not a Sentinel who’s depressed and who is, uh, using a stimulant illicitly to treat their depression.

[00:36:49]So for a person who is optimally dosed, and only working on performance, there’s virtually no tolerance. The technical word is tacky. Phylaxis there’s no tacky. Flexes they’ll stay on the same dose for a really, really long time.
[00:37:04] Like years there’ll be on the same dose for someone who is neuro-typical, who has depression and is using stimulants to fill up the tolerance is wicked.
[00:37:15] So first they were, taking it orally when they could, and then they went to smoking it because they couldn’t get it orally. And then smoking it didn’t do it. So then they started shooting it and then they couldn’t get enough shooting it. So they started going right close to the brain as they could. So they’re shooting it in their nose and some people would shoot it in their eyeballs, which is just horrible.

 Right. And, and the doses are just mammoth and they will say with a straight face, they will say, I need stimulants. They really helped me. You know, I’m completely functional on stimulants. Except for they’re taking massive amounts, spending thousands of dollars a week, taking massive amounts and, to apparently just tread water and they will tell you they can’t live without it.

That it, it really helps them. Okay. So that with those massive amounts and in that circumstance, Oh, there are all kinds of problems, heart problems, brain problems, you name it. Really, really horrible. So, so that’s, you know, that’s the crystal meth culture. That’s, that’s, that’s what people know at sensationalized by the media, but that’s absolutely not what happens.

[00:38:35] Two sentinels appropriately diagnosed and optimally on their optimal regimen. Not the experience at all. So that’s a wrap.

 That’s a wrap. It’s been good chatting there’ll be show notes over on the website for people that are interested in some. Some references, some sources, some

Yeah. So I’ll put the references up.

Devon: [00:39:02] Yeah. And so if you, if you want that, wherever you’re listening to your podcast, right now, there should be a link to the page that has some, some notes and yeah, let’s, close it out. It was good chatting.

Dr. D: [00:39:13] Thank you very much. Bye. 

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