Articles, Blog

The Flu, Flu Shots, and Flu Treatments: Expert Q&A

November 5, 2019

[MUSIC PLAYING] Hello, and welcome to the
University of Chicago Medicine at The Forefront live. And we’re heading
into fall, and that means flu season is
right around the corner. The flu is a miserable illness
that can mean days away from work or school,
and for some people it can even be deadly. Millions of Americans
get the flu each year, and thousands will die. Now flu is, for the
most part, preventable. Dr. Allison Bartlett
and Dr. Emily Landon join me today to discuss
flu, how you get it, how you prevent it. And we’ll also be taking your
questions, so start typing. As always, we want to
remind our viewers though that our program
today is not designed to take the place of
a medical consultation with your physician. Now, let’s start right
off with our physicians, and if you guys could
introduce yourselves and tell us about your
areas of expertise. Sure. My name is Dr. Allison Bartlett. I am a pediatric infectious
disease specialist here at the University of Chicago
and Comer Children’s Hospital. I also work with Dr. Landon
in the infection prevention department. I’m Dr. Emily Landon, and I’m
an adult infectious diseases doctor. And I’m the medical director of
our infection control program here at the
University of Chicago. All right, let’s get
right to our questions. It’s mid-October. How is the 2018 flu
season going so far? Is this one look like it might
be better than last year? Or worse? Or what are the thoughts so far? I think the flu season’s
pre-contemplative. It hasn’t decided to show
up yet, which is great. Every day that we don’t
have flu is a good day. Yeah, I think we’ve had
occasional sporadic cases. But unfortunately, no trends
yet, which could be good. We’re going to go with
it’s going to be good. Let’s talk about
trends for a minute because it always
kind of fascinates me when we talk about the
flu vaccine each year and the trends that are spotted
by physicians and scientists. How do you do that? What do you look for
in the flu season to determine how to treat it? Influenza treatment is
pretty much the same for most different
kinds of influenza. But how we prevent
it is really where it matters most
about what strain is going to be circulating. The people that develop the
flu vaccines go ahead and look at what’s happening in
the southern hemisphere that had winter just over when
we were having our summer. And they figure out
what’s been spreading through the southern
hemisphere and use that to make the vaccine
that we’re going to use and that many people are already
getting for this year’s flu season. So last year’s flu season, I
remember, was a pretty bad one. How bad was it, and why
was it so bad last year? So last year was one of the
worst flu seasons lately. So 2011, when we had a
pandemic, was bad, but last year over 80,000 deaths from the flu. Several different types
of flu circulating– so people were able to get
the flu more than once. And unfortunately, the main
kind of flu that was circulating is one that we
just haven’t quite figured out how to make the
vaccine work quite as well for. It’s interesting, I think
when we kind of discussed the topic of flu, people
just think of being laid up for a few days. But you mentioned 80,000
fatalities due to the flu. So it’s very serious, and
it is important for people to get the flu vaccine no
matter your fears of it. You should go do it. Yes. And the recommendation
here in the United States is for everyone who’s six
months of age and older to get the flu vaccine. There are certain groups that
are at more increased risk from getting extra
sick from the flu, but really everyone is at risk. And so everyone
should be vaccinated. And we want to
remind our viewers we are taking questions
for the physicians, so please start typing. We’ll try to get to
as many as possible over the next half hour or so. So are the types of flu– the
strains different year to year? And how do they differ? Yeah, they do. They switch up a little bit. They’re sort of these
main types of influenza. Like you sometimes hear about
H3 influenza and H1 influenza. And sometimes you hear about
the avian influenza, which happens to be an H5 influenza. These are all sort of different
major types of influenza A, and each one has to require
a different kind of vaccine. Although the vaccine
that we use here has four different
strains– two of influenza A and two of influenza B in it. But it’s whether or not
the septic subtype of H3 matches up exactly or H1. The years that we have
H1 disease predominating are usually not as bad. The years that we
have H3 predominating are usually the tougher ones. That’s what Dr.
Bartlett was mentioning about the vaccine isn’t
quite as effective for those. Last year was an H3 year. If we’re all really lucky,
this will be an H1 year. OK, you’re getting into an area
that I really find fascinating when it comes to
the influenza virus and how we try to
prevent against it. So there are actually
four vaccines in one– is that how it works? Yeah, there’s protection
against for different kinds of influenza in one vaccine. OK. And so do you have to hit
it right on the money? Or you get pretty
close and you’re good? Both. Well– yeah. I think we can all
agree that there’s sort of like a scale of how
well influenza vaccines work. And sometimes they work better. Sometimes they
don’t work as well. Certainly, we know that
people who get a flu vaccine, even if it doesn’t
match exactly, tend to get less
sick with influenza than people who didn’t get the
flu vaccine and got influenza. So the vaccine
provides protection even if it doesn’t keep you from
getting the flu all the way. And that can be really, really
important for decrease– if you’re not as sick, then
you’re not transmitting as much to those immunocompromised,
and young people, and old people around you. And if they don’t
get sick, it can make the overall epidemiology
of the flu season– or how many people get
sick, how many people die, how many people
have complications– can be a lot improved even with
a much less effective vaccine. So why does the influenza
virus take on different forms from one year to the next? And what influences
the mutation? I think that’s a great question
that a lot of scientists are working hard to
figure out, and we don’t have all the answers. Certainly, this sort of
changing between major groups and switching in between minor
groups happens all the time. The flu virus is one that’s
not just affecting humans. It affects animals as well, so
we hear about avian influenza. It turns out that flu
likes to infect birds. It likes to infect
pigs, and a lot of recombining of the
genetic material happens. And so in areas where there
are people, and pigs, and birds together, more mixing happens. And that’s when we get some
of the new strains that can happen. OK. Talk to us a little bit
about the biomechanics of the flu shot. What’s a good time
to get a shot? Can you get one too early? That’s another
question and a concern that I’ve heard
from several people because I think we’re starting
to lineup to get our flu shots. I haven’t had mine yet. I will get that very soon. But can you get it too
early in the season and then not be protected at
the back end of the season? I don’t think so. I think as long as
you get the flu shot. It doesn’t come out until like
the beginning of September each year, so maybe if you
got it in July or August. But no one’s able to do that
because there is no flu vaccine available for that season yet. So I think if you get
it when it comes out, that’s a good time to get it. Whenever you’re
seeing your doctor, whenever you’re walking
by a Walgreens, or a CVS, or wherever it is that you are
and you think, huh, flu shot– they used to have a sign
outside– get it then. Whenever you have a few minutes
to spare, just get it in. Even if it’s later
in the season, it can still protect
you from some of the influenza that’s around. It takes about two
weeks for the flu shot to become completely effective. And so the right
time is two weeks before flu gets really bad. But– Who knows when
that’s going to be? Exactly. So you getting yourself
into a routine of going back to school in the fall, time to
start thinking about getting your flu shot for the year. Well, you mentioned two
weeks before the season gets– but we’ve already
seen flu cases haven’t we. Yeah. Yeah, we’ve seen some
sporadic flu cases, and that’s not atypical
for this time of year. But it hopefully will be
several weeks or months before we start seeing
a rapid increase in the number of cases. So you mention two
weeks is what it takes to really get going within you. How does the flu shot actually
work inside your body? What does it do? Well, the flu shot works the
same way any vaccine does. It takes particles of influenza
that have been killed. Mainly it uses the outside
of the influenza virus– the capsule, which is the
part that your immune system recognizes. And it puts some of those into
your body in advance of the flu so that your immune system
can be like, ooh, hey, flu. And then it like has this
system where your b-cells start to make extra
antibodies for the flu because it’s now
seen some influenza. It’s basically like an
early notification system. It says, immune system, watch
out for this kind of flu. It’s coming and be ready for it. And that’s sort of the cartoon
version of what happens when you get a flu shot. There’s nothing
unnatural about the flu vaccine or about any vaccine. In fact, it’s really
just a lot like what people say is homeopathy. You’re giving people
just a little bit of the infection in order
for their immune systems to respond to it. In the case of
influenza, the shot doesn’t have any live virus
in it that can replicate. It’s actually just pieces
of the killed virus. So you definitely can’t get
the flu from the flu shot– not unless you believe in things
coming to life on their own, which we don’t. When I talk to my
kids about it who are complaining that
they have a sore arm after they get their
shot or feeling a little bit achy and tired
and sore the next day– that is exactly what’s
supposed to happen. That means your immune
system is recognizing that. It’s getting ready
so that if and when you’re exposed to the virus,
itself, you’re ready to go, and you can fight
it off, and you don’t get sick at that time. And you’ve answered
this question, but I want to hammer this
home a little bit more. You can’t get sick
from the flu shot. And the people who say,
oh, I get the shot, it’s always made me sick– you’re not getting sick
because of the shot. They’re getting sick because
they were getting sick. Yeah, this is also kind
of the time of year when colds start to
come back into play. You have this nice summer where
you’re outside all the time and in the water, and
you’re playing around. And then you go back to
school, and everybody’s stuffed into their
little offices and start closing their windows. And they’re into to
their classrooms, and all the kids
are sharing germs. And then they bring home colds,
and then we share them at work. And so it’s the time of year
when people get a lot of colds again, and that doesn’t
really have anything to do with the flu shot. But because we get the flu
shot at the same time of year, people tend to put them
together in their head. There have been a lot of
studies done about the flu shot where they give the flu
shot to a bunch of people. And to a bunch of other people
they give them a saline shot. And it turns out that
people with the flu shot are more likely to have a sore
arm than the saline people. But other than that,
they’re not any more likely to get a cold
than everybody else. So Ashley has a question for us. We have our first question at
the Forefront live on Facebook. Does vitamin D help protect
you from the influenza virus? And should I talk about
him in the supplement to help stay safe? So vitamin D is
something that I mostly associate with bone
health and a good thing to do for your bone
health when you’re not getting some
natural sun exposure in the winter in this
lovely tropical environment that we live in. There’s– Sub, sub, subtropical. Some folks like to think
about getting more vitamin C in an attempt to help
ward off infection and boost your immune system. I think the verdict
is not in yet. But also drinking some
extra orange juice is not a harmful thing too. Yeah, one of the things to
remember about vitamin D is that some vitamins you
can take as much of them as you want. You can take as much vitamin
C as you want and not much is going to happen to you. Vitamin D is one
of those ones where you can take too
much of it, so you might want to get a
doctor’s advice if you’re going to take vitamin
D. But some people in this part of the world do
need more vitamin D in order to support their immune
system health in addition to their bone health. But most people don’t. And so it’s sort of an
individual question for you to raise with your doctor. OK, we have a
follow-up question also from Ashley concerning
herd immunity. Heard a lot about
herd immunity when it comes to immunizations
for things like measles. Does the same
thing apply to flu, and does it really even work? That’s a great question. And my new favorite term
that I learned last week at the national conference
for herd community is “community protection.” It makes us sound
less like cattle. So community protection
is very important for diseases like measles
but as well as for influenza. So measles in particular
is very contagious. And so it takes a very
high level of immunity in the community to
help prevent the spread. Influenza is less
so but especially with the incomplete effects
of the vaccination itself. The more people that are
more protected and less contagious at any
given time really does help protect
those of us who, because of their immune
system or other reasons, are unable to get the vaccine. Another Facebook question–
why do some people get a nasal spray vaccine
rather than the shot? What does that do? And did we even do the
nasal spray last year? So last year we did not. There’s a big controversy. So there was initial evidence
that giving this nasal spray, which as Dr. Landon
mentions, is a little bit different than the shot. This is actually what we
call a live attenuated– so a weakened form
of the virus– that we were hoping that that
was a more biologically similar way to deliver a vaccine. Turns out that some
of the strains that were in the vaccine
the past few years did not add any benefits at all. There was no immunity conferred. And so last year the decision
was made in the United States to not offer that product. It was different in
Europe, and it’s back on the market this year. And I think all we can say
is that the jury is out. We are hopeful, right? It’s a much easier sell to
get the intranasal vaccine than to convince– Especially kids. –kids to get a shot. I got a second call from
my husband with my kids. Are you sure we have to? Yes, I’m sure. My son said the same thing. You have to get the shot. I’m hopeful though with sort
of the scientific improvements and continued follow-up it will
be a reliable product again. But unfortunately
this year we just don’t know how well the
nasal one is going to work. Just remember there
are some people because it includes live– what
we call “attenuated influenza,” in other words
influenza that’s not supposed to make
because it doesn’t make normal people sick. It doesn’t mean that
everyone can get it. So really young kids, people
with asthma, very old people, and people that have a lower
immune system for whatever reason– some of you take medication that
make your immune system lower, some of you have
other conditions that make your immune system lower– you shouldn’t get the intranasal
vaccine for that reason. But it’s OK if someone
else in your house gets it because they’re not
likely to spread it around. And we know that for sure
from some good studies. Absolutely. Interesting. So Mike has a question. Can you be a carrier of
the flu and not feel sick? And could you pass
the flue on to someone who is not immunized? Turns out yeah, you can. In fact, some people do get the
flu and don’t get very sick. And we don’t know very much
about why that happens. We think some of it maybe
because people get vaccinated, and they don’t really
realize that they have full-on influenza. But other people just get the
flu and don’t ever feel bad, and they can pass it
on to other people. We’re really worried about
what happens when that happens in the healthcare system. So we screen people and watch
really closely in the hospital. But it’s something to
think about at home. If you’ve been
exposed to influenza, you could get flu and not
really have many symptoms, which is good for you but bad
for the people living with you. Courtney has a question for us. Is the high dose flu vaccine
really more effective in seniors? I would say that– I’ll take this since
I take care of adults. Allison gets a pass. I think that there is some
evidence that older adults get a little bit better
immune response from getting that senior
or double dose, high dose flu shot. That doesn’t necessarily
mean that they have less cases of
influenza, and it’s not clear whether they have
fewer symptoms of flu if they do get sick than people
who got a regular dose flu vaccine. So honestly, the best flu
vaccine is the one you get, not the one you didn’t. So if your doctor has
the high dose flu vaccine and you qualify
for it, then by all means get the high
dose flu vaccine. But if you walk in
to get a flu vaccine and all they have is the
regular dose flu vaccine, then get the regular
dose flu vaccine. We just want to get some
vaccine into everyone. And I think building on that as
the child advocate here, right? From a community
protection standpoint, many elderly adults
are going to be exposed to influenza
through their grandchildren or other kids around. So the more that we
can vaccinate everyone around the more vulnerable
elderly, the better. So the next question– how long
does the immunization last? Are we talking six months? Four months? Eight months? It’s probably hard to
put an exact date on it. It really is because the
flu season is time limited, and so we don’t really have a
lot of experience with someone who gets the flu
in June having been vaccinated the previous August. But certainly the fact that we
have to get repeat vaccinations every year– we do that because we know that
the immunity is not as durable as we would like it to be. And that flu changes. So the flu you’ve got
vaccinated to before may not be around so
much after a year or so. So there’s a lot of reasons
why flu vaccines are pretty challenging. Now, let’s talk a little bit
about folks who might actually have the flu. First of all, we’re sorry. Secondly, so what do you do? What’s the best course of
action if you or your child has the flu? Let’s talk with [INAUDIBLE]
Let’s talk about these first. Sure. So when someone comes
down with influenza, it’s first you have to
figure out is this the flu? Is this just a cold? So things that make us think
more strongly about influenza certainly if it’s flu season. But having the sudden
onset of a high fever– kids may not be able to describe
as much that they are achy all over, a lot of
times if there’s some vomiting and diarrhea
symptoms associated with it. Cough is another common symptom
that happens with influenza. So a couple of things–
there is medication that you can take early on in
the course of flu that we think shortens the
duration of illness. So it’s worth reaching out
to your healthcare provider if that’s the case. Much of the other
things that we do are really what we call
supportive– making sure that you are well
hydrated, making sure that you’re comfortable
from a fever standpoint. In kids, we keep an
eye– in adults as well– for secondary infections. So once you’ve had an
infection with a virus, we know you’re at risk of
getting a bacterial infection as a follow-up. For kids, it turns out
it’s mostly ear infections, but it can be pneumonia as well. In adults, it’s
mostly pneumonia. And it’s very important
to stay hydrated as well. Yeah, fever really
takes it out of you. You lose a lot. It’s like running a marathon. Your body’s sort of working
just as hard as you would if you were
exercising vigorously. And you need to stay hydrated. You need to rest. You need to take
care of yourself, and that’s a lot
for some people. Yeah. And that needs to
be done at home. Not at work, not at school. Not at the grocery
store or the library. No. It’s hard, and no one likes
missing school or missing work. But really for the safety
of all of your colleagues and the health of
your classmates, it’s the right thing to do. So back to the high
dose flu vaccine. Kathy wrote a question to us
or wrote to us with a question and asked do the higher
dose of flu shots cover more strains or
the higher dose vaccines? No. The higher dose, the double
dose, this senior flu shot, the high dose– we have a
lot of names in the media– it really just covers
the same strains. But it gives you more, a
larger dose of flu particles in each injection. It doesn’t have additional
protection for additional virus subtypes. Another question from a viewer. Skip asks, I got a
flu shot last year, then ended up getting
the flu in mid-April. The ED physician who diagnosed
me said it was likely a mutation that occurred
late in the season. Does that make sense? Well, last year’s flu was not
as responsive to the vaccine as we wanted it to be. So it could have been, but
it also could have just been the flu virus. But yeah, flu shifts enough
over the course of a season even that we see slightly
different viruses at the end than from the beginning. OK. Now, you’ve piqued my
interest because I’ve never heard that one before. So we actually see a shifting? Well, we don’t see a
change in the strain, but it’s like sort of
very subtle changes. Influenza’s always doing this
really subtle changing thing. It’s really tricky. I figured once you had
the strain nailed down, that was it for the season. No. Wow. OK. I wish. That makes it a little more
challenging then, doesn’t it? It is. And of course the
time when you’re trying to nail down the strain
from a vaccine perspective, it’s six months in advance
of when the virus actually appears. Now, you should have protection
against these subtle changes in influenza just from having
the right kind of strain in your flu vaccine because
it’s not that different. But over time those
differences build up to create a majorly
different flu virus. Next question. Aside from a vaccine,
what are some of the ways people can minimize
their exposure to the flu virus? And are there over-the-counter
remedies that will maybe stop? Or– we already talked about
lessening the impact of it. This is where I wish we had
some cool fancy technology to share with everyone. But really, minimizing exposure
is taking care of yourself from washing your hands,
covering your mouth when you cough, disposing of
tissues when you use them, staying home from
work when you’re sick, when there are sick
people at your work encouraging them to go away. Nothing rocket science. A lot of these things
rely on other people to do those things
when they’re sick. But what you can do
is clean your hands. Clean your hands, clean your
hands, clean your hands. That’s how stuff gets from
surfaces and from around you into your mouth, nose,
and eyes, which is how you pick up the flu virus. And so the rules at my house
are you clean your hands when you come
inside from outside or when you switch buildings. And you clean your
hands before you eat, and you clean your hands if
you been doing something dirty because you’re supposed
to do that– like if your hands are dirty. Like paint for example. That’s for the furniture. But the other thing
I think people can do is when you see other people
that are sick around you, especially those
that are coughing, keeping some
distance between you and then makes a difference. Coughs and sneezes
only travel so far– about six feet. Sneezes travel
further than coughs. But if you step back even
from someone a few feet, you can reduce your
exposure significantly. And so I’m not suggesting that
imposed social isolation is a great thing for society. But the person that’s
coughing on the train– don’t sit by them. Move down. Go to another car. Step away. Even just leaning back
is better than nothing. So entry points on your
body where you have mucous membranes– your eyes like
you mentioned, mouth, nose. So if you touch
your face, you’re going to have a much higher
likelihood of getting this or if you have
somebody coughing. It is, right? And it’s one of those
behaviors that you don’t know that you’re doing. And I think to
Dr. Landon’s point about it’s being around
someone who coughs. You think about it– they have coughed also germs
onto all their potentially shared surfaces. And so you touch them,
you can pick up the germs. And so your first line of
defense to protect yourself, again, is washing or
sanitizing your hands as frequently as you can. Because you don’t know
whether what you’re touching is contagious or not. And then you’re just
instinctively touching your face more than
you think about. And when it gets colder,
think about your gloves. We put those gloves on, and
we wear them everywhere. And we’re touching our face, and
your nose runs when it’s cold. And you rub your nose. And then you’re just taking
them off and throwing them. Your hands are not clean when
you take those gloves off. You need to clean your hands. And you can throw them in
the wash in many cases. Although, I don’t know that
many people who do that. I strongly recommend it. That’s an excellent point. I never thought about– I wear gloves all the
time during the winter. And I have never
thought about that. Aha, see? It makes perfect sense. Another question from a viewer–
can you get the flu shot if you’re allergic to eggs? So that used to
be a big concern, and we’ve had a
lot of experience over the past 5 or 10 years
that are incredibly reassuring. So now we don’t even
need to be asking about whether someone has
an egg allergy or not. Even the vaccines
that are made in eggs do not cause problems
even with people who have had
anaphylaxis or very bad allergic reactions to the eggs. We do recommend that they’re
given by a healthcare provider. But short of that,
that’s all we do. And if you’re really
still very concerned, you can get the flu vaccine
that’s not made in eggs. They now make one that doesn’t
have any egg in it at all. But we know it’s safe
to get either one. So is it as effective– the version without eggs? Mhm. Interesting. We understand it to be. The best evidence is that
it’s just as effective. OK. And you touched on this
a little bit earlier, but I want to kind
of reinforce this. Some people just think
they have a bad cold and not realize maybe they’re
quite as sick as they are– stay home. But how do you know if
it’s actually the flu? Well, you know if
you go to the doctor and they do a test
to see whether or not you have flu viral particles
in your nasopharynx, or the space between
your nose and your mouth. That’s the best way
to tell for sure. But without that– again,
the typical flu case is, as Dr. Bartlett said,
quick onset of fever, really bad chills,
and this aching that just feels like you’ve
been running a marathon and you didn’t even
get out of your bed with this kind of
hacking cough that comes in that just feels
like your chest is just absolutely sore. Yeah, that’s what
people describe, and that’s what we see when
we see people with the flu. But there are plenty
of people that have influenza that don’t
have all those symptoms– only have one or two, or
have different symptoms, or really bring up a
really productive cough. Any of those things can be true. So you can’t ever be sure
you don’t have the flu. I think that’s where sort of the
respiratory etiquette and just protecting those around you when
you have any respiratory virus is really important. I think we worry about the flu
and the potential severity. But the good news
is if you are one of the people who gets
one of these much more mild cases of flu and
don’t have the high fever and don’t have the bad cough– I think your risk of progressing
to anything more serious is much lower. Yes. Let’s talk about hand
sanitizers for just a minute. We’ve got a question that
came in concerning that. And I’ve got the bottle
of hand sanitizer on my desk, which I probably
use a little bit too much. But– No, you don’t. You don’t? OK. It’s impossible. Promise. That’s the question then. Some people have said
that that will actually cause mutations of the– No. So there used to be
hand sanitizers made that had an antibiotic
in them called triclosan. That’s no longer allowed
in the United States. That’s not recommended
in soap or anything. Antibiotics and
anti-viral medications should only be used
in patients that have confirmed influenza or
infection as the case may be. And they should be
used by a doctor that can use the right one to
treat the right thing. So these hand
sanitizers are mostly just alcohol and some emollients
to help keep your hands soft. And alcohol works
differently than medications because
it doesn’t have to disrupt the way the virus
lives or the bacteria lives. It actually just dries
it out to the degree that it can’t survive anymore. And it’s very difficult for them
to become resistant to drying, and so that’s why we can
still after many, many years use alcohol to clean
your skin before you have your blood drawn
in the hospital. And we don’t worry about that
causing any sort of mutation over time. And the same thing’s true
of those alcohol-based hand sanitizers that you buy
at the grocery store. Well, the Purell
company’s going to be happy to hear that, because I
go through bottles of that stuff pretty quickly, and others. One final question
from a viewer– we’re about out of time. Kathy is asking, again, should
I wear a mask and gloves? And she works in a
salon, so she has a lot of contact with the
public and is obviously worried about the flu. Good idea? Bad idea? What do you think? I don’t know of there’s
any benefit to gloves. I think that good
hand washing or hand sanitizer will be sufficient. I think if you can’t trust
those who you are encountering wearing a mask in the height of
flu season is not unreasonable. Yeah, especially if you
have a low immune system. Wearing a mask is probably
better protection. The problem with gloves– they
might keep your hands clean, but they don’t keep you
from touching your face. And certainly we see people
touch their face all the time with their gloves on. And so unless it’s going
to stop you somehow– maybe you need one
of those like collars they put on dogs so you can’t
touch your face anymore– that might work. I don’t know. You might not be able to
see what you’re doing. As someone who works in the
salon, it may not be ideal. Well, you know. Or when you’re driving
to and from work. Correct. I recommend a clear
path of vision. Probably shouldn’t do that. But yeah, it’s interesting. Mask– not a bad idea
then potentially. All right, you guys
did a fantastic job. That was very informative. Good. I’m, glad. I learned several new things
today, so that’s good. That’s all the
time we have today. We want to thank Dr. Bartlett
and Dr. Landon for their help with this program and all
of the wonderful information that they gave us. If you want to
learn more, please visit our website site
at or call 888-824-0200. Thanks, again, for watching
at The Forefront live. Hope you have a great week.

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