AHi, all good, how are you? Sorry, your voice is a little.
BI just asking how you feeling?
AOh yeah, feeling good. I mean, so I've been taking like the dupixent pretty regularly. I think the first time I took it was August of 15th, 15th of August. And it's been exactly two months now. So maybe I've taken eight doses or seven and I've essentially tapered down my omeprazole to zero, essentially, sorry, pantoprazole. But I do however have to take famotidin like once or twice a week.
BOkay.
AAnd yeah, so like the burning sensation that I used to have is completely gone. I don't have that sensation anymore. But I do still feel reflux. I still do like get that sometimes. Maybe again, like I said, once or twice a week. It's more intense than usual and that's when I take the fermotid in. But yeah, that's the general. Yeah, that's how I feel right now. Yeah. Okay.
BI mean, you know, if you want to try something else, even non medication related, there's this option called Reflux gourmet and it's like seaweed based. It's like a little paste actually and you can take it like after meals and, or before bedtime. And it kind of just creates its raft of allergenates which is like just derived from the seaweed of kelp. And it can help, you know, like prevent reflux symptoms. If you want to consider just, you know, potentially something that might also be helpful. You know, you could consider that also. They have a website and it's also on Amazon and it's like just like single serving packets you can keep on you. There's also like cheapes of it and it's just a really small amount. They have a couple flavors. It tastes pretty good actually. If you wanted to try something else.
AWhat is it called again? Reflux Gourmet.
BIt's called Reflux gourmet.
AOkay, I will look it up.
BYeah, yeah, yeah. It's pretty useful and I feel like a lot of patients who end up liking it and find helpful helps them, you know, minimize use of medicines or able to get off of medicines for reflux as well a lot of times and occasionally a patient, you know, may say, hey, I tried, it wasn't helpful. But I think a lot of probably more often than not patients do have found it to be helpful.
AOkay.
BAnd it has like abdominal spinach use too as well. So you could consider that if you wanted just another option, you know, to that. How long have you been Occupantal placel at this time.
AI mean, like I said, I've been gradually tapering it off so it's more like a linear curve downwards rather than. So I mean, I must have hit zero, like just a week ago.
BOkay. Yeah, okay. Okay. Just thinking in terms of time about, you know, like, when we want to repeat the endoscopy just to kind of, you know, because we don't want to have it. We'll have a clear answer, I guess. Right. To make sure the depiction is working. So, yeah, so we started a week ago. Maybe we can we just wait, like, you know, give it at least a solid two months on the dupixent alone, you know, without the PPI in the mix, just to make sure that it's controlling your, you know, the eoe. Well, so I guess that would put us in like, maybe early December. Ish, right? The 15. A week ago we could say, like, let's see, 1, 2, 3, 4 weeks, 5, 6, 7, 8 weeks. I guess December 1st would be like, right around 8 weeks. Ish. If you wanted to, you know, we can set it up for like, then or anytime thereafter. That works for you?
AYeah, that works.
BOkay.
AAnd I just wanted to ask, like, before the appointment, do we. I mean, is it. It's quite possible, like, the reflux and the EOE are two separate conditions that coexist. Right. And like the dupixins basically, like tackle the eoe, but the reflux is still, still exists or something like that? Is that how it works?
BI. I think so, yes. I think so. Because, yes, there's some, like, overlap between the two where, you know, like in the past we used to treat, like sometimes and it depends, like it's. It can sometimes be, like, hard to tell the difference between the two. We want to make sure it's not contributing versus just straightforward, very straightforward eoe. But yeah, of course, you could definitely have both, potentially. So I think, you know, if you feel like the formaldehyde, do you feel like the pomodidine is working to control the reflux symptoms and you take it.
AHard to say because it happens so rarely. I don't pay much attention to it, but it does. Yeah, it's. I mean, it is uncomfortable when it happens, but it happens, like, like I said, once or twice a week. Like it's much better than before. So I don't pay much attention to it anymore. But it does happen. Like, I do feel the reflux.
BOkay, yeah, yeah. Because if you wanted to, like, you could even add in the thermogen a little bit more often perhaps, you know, see how you feel. Do you want to help prevent the symptoms? You know, you could try taking it if you wanted to do it nightly for a little bit of time and then, you know, you could even, you know, kind of see how it goes. We could even go to like a lower dose. Like instead of 40 milligrams, you can do like 20 milligrams nightly, you know, to kind of add up to almost the same amount of taking the higher dose like a couple times a week. You know what I mean? So there's different things we could do. But of course you gotta make sure you're feeling well. And of course like we talked, you know, in terms of like other non medications measures that can be helpful in terms of preventing symptoms, you know, common food triggers for reflux, which, and we talked about a while back, you know, coffee, spicy foods, chocolate, peppermint, tomato sauce, alcohol. And then you know, eating dinner, like if you're able to leave at least three hours between dinner and bedtime, that can be helpful as well. So. Yeah.
AOkay. I will definitely like try out like reflex reflux gourmet. And one more thing I wanted to confirm. Like, is it possible like the, let's say the dupixin has worked, but because of the reflux, is it possible like the eosinophils are like still recruited to like because of the irritation from the reflux.
BPossible, but the numbers we found, it's confusing to be much lower. I see with reflux alone, I definitely don't think it's reflux alone. Your stock, of course, enough reflux contributing probably. But you know, when we did the endoscopy and you're on the panel twice a day, the eosinophils were still over 30 in the upper esophagus. So when numbers are higher, when eosinophils are higher than 20, it really does mean more towards EoE as an underlying cause than refluxable.
ARight.
BSo I think that a small component, reflux, I think the heal is probably driving that. You know, history of food allergies, these other things, what the esophagus look like, all that together. I think that EOE is probably the driving force. They can be smoked flux, but I wouldn't expect the numbers to be that high.
AGot it. Okay. Okay. Yeah, I think december first week sounds right for like doing an endoscopy and I'll keep off the pantoprazole till then and like try other like try my femotidin and like other measures before yeah. To control the reflux. Yeah.
BI think if you want to even try the Fumadi nightly for a period of time, you know, we can do that because. I agree, like, can it be a small component of what we're seeing on the doctor? That is definitely a very, like, a reasonable, you know, consideration to think about. We want to think about it too. Right. We want you to feel well. Of course, as well. So. But overall, you're doing okay in the medicine? You don't feel like you've had any symptoms concerning. For side effects or anything like that?
ANo, I feel like. I mean, one of the side effects I read about was, like, propensity to throat infections, which I might be making up. But I don't know, I just feel a little bit of, like, my throat feels like more prone to feeling like it's going to catch a cold. But yeah, that's it. That's about it. Nothing else.
BOkay, well, you know, I mean, in terms of general recommendations, like for vaccinations and things like that, I mean, know, definitely recommend, like the COVID and flu shot. Have you gotten them already?
ANo, I did not. I felt pretty sick last two weeks ago, that might be like, that coincided with the flu season, I'm guessing. But do you still recommend I get it?
BYeah. I mean, who knows? Could have been just any old viral infection. There's so many just, you know, colds and stuff going around as well. But yeah, now is actually like the perfect time. Like, early to late mid October is kind of the perfect time to get the flu shot where it will cover you through most of the flu season. Because sometimes if you get it, like very early, it may not cover you for the whole system. But right now it's actually the perfect time to get the flu shot and the COVID booster. You know, it has been popping up and they can just give it to the same time. They can go in. They'll give you the flu shot and the COVID booster. Just walk in the pharmacy. I need an appointment. That's how I did mine a couple weeks ago, because I was like, I just walked in, I was like, all right, give me both. Get it done.
AOkay, nice.
BSo, yeah, I definitely recommend that. And, you know, preventing the things we can prevent. Right. So I would do that. And so awesome. So I guess, you know, if, you know your schedule, we can get a schedule for December, or if you want to wait a little bit, we can. What would you prefer?
ANo, I think we can put it down on the calendar and like, if. If there's a problem like a week before. I can obviously, like, call up and reschedule.
BOkay, sure. Do you want to do some first or do you want to do a little later?
ALet me just look at the calendar. Yeah. December 1st looks fine.
BI have the whole day open at the moment. What time would you like?
AAnytime after 11:00am okay.
BYeah, you said 11:00am or what?
AIf possible, later than 11. Like, 11's fine.
BOkay, you can do 11. Okay. I'll have my assistant give you a call to get that set up. And I think if you want to touch base maybe just once before then, we can. If you want to. Just make sure your reflexes, you know, if you want to optimize it, it's up to you. Tell me. I know you started the extent after July. I know you started it before.
AThe first dose was August 15th.
BOkay. August 15th. Okay, perfect. Just so we know the dates and so you'll have been on it for a good amount of time.
AYeah.
BOkay, Perfect. Okay. All righty. So. Okay. I like to send a call. If there's anything else you need, you know, please let me know.
AOkay, of course. Yeah. Cool. Thank you.
BGood to see you. You're welcome.
AGood to see you, too.
BBye.
ABye. Bye.
BIt's.
ACan you make the script shorter like it was originally? I feel like there's a lot of duplicated code everywhere.
BIt's.
ACan you make it even shorter? I feel like you're being very defensive in your code.