Come on Bob muscle. Yeah, oh muscle man. So Bob, what are you? What are we doing today? We got one hour and I think we're gonna get you ever catch them fish first time first time I'm gonna get you and we Say a second kind of second hour. They're not supposed to know that so we went. What am I looking like? Dude my hair was looking weird right there. They had a stray bull cut for a minute there So guys we are going on to Ogechi River today. We got about one hour Maybe an hour and a half if we're lucky. All right, we're gonna be trying to catch some bass today We've only been we've been once but not really if you know what I mean Like we went like for just like an hour or so Alan Bob got one I'll not missed a few and it just wasn't like a video made video. So um, yeah So we're going for technically our first time today. We've never been here We're gonna try to catch some fish. I hope we're gonna whack them I've been dying to get on the boat. So that's what we're going to do boys. So we about to hop into truck Oh, by the way, we got Alan Bob's truck dude. You we haven't introduced your truck Alan Bob So Alan tell us about your new toy, dude. I really just got a brand new 2019 F-150 Look at this. I'm gonna put it to good use. I know I told Alan we like pull up in my driveway I'm like should we take your truck or my truck and I was like we have to break it in right? We have to do that whole deal.    I got a bobber stop on gotta wait I know you guys already know, but you know, I tie a uni knot clean and simple and It is stronger than the polymer. It's a fax guys the grand test on it I've had I've had the most best luck with that. I seem to break off a lot of fish on a polymer I don't know I could be wrong. You know, a lot of us have confidence knots and that's just been my You know confidence confidence knot for the past couple of years throwing a little june bug Speed crawl as simple as it gets especially on the river That thing a catch em boys boom That is sexiness right there. Let me show you what I got. Oh baby, look at that thing That's juice right there boys and girls. This is gonna catch them tonight What are you hitting? Is it something at the end of the ramp? Hey Just pull up Alan and back in right here get hidden something at the bottom It's like the back of the ramp is like something that just stop in the boat I told him just pull up and drop in this one. That was weird It's like we're going back and it's just he couldn't go back any further like there's like a curb or something. That was weird All right boys We're ready to go the gnats are cooking cop just waved at me.  What a nice guy We're about to drop it. We're already in we're already in we about to pick up Alan Bob We're gonna be fishing dude. The gnats are so bad guys. Yeah, it is bad man. I mean it is nasty These things are just tearing at me. Look look at this. I don't know if you guys can see that Look at all the other biting the heck out of me, too It is not gonna play no games. Our boys got a little Texas rig Current is whipping Water is flowing gnats are biting but are the fish biting if the fishers as active as the gnats, man We yeah, I would not mind man. We will have a bag today boys This is a solid bank.  No, like you're breaking out Alan Bob No, no, I like you are you like Why are you dude? You're allergic to him or something man.  Yeah, but not like that dude. Look at that. That's like some whelps, bro Dog dude. This is big Alan. I don't know what it is. Oh my god. It's a bass. Oh my god It's a bass. Yes, it's a bass Well first no geeky basses a toad a three look it just came right off man That's a three pounder bro. That's a three pounder boys. That's what we came here for men Oh, man, does that feel good after all these and that's Biting us all over the place and you hook it to a big one And it's for the rivers big guys. I'm gonna warn you that's a big bass for the river now that was worth the Nat biting said I got on what I called that too, dude I was like there should be a fish in this little divot sure enough. He was man Do you see how hard he was fighting the this fish but those fish in the current man They you know, they live in this current. They're strong is all can be but man That's a big river bass at least on the Savannah River, dude. I I don't know if they'll get you's any any different But for river fishing guys like if you catch a three pounder, that's a dang good fish Let me tell you two weeks later Uh-oh, I got him. Yep. It feels pretty good. Oh my god. Yeah, he's good. Oh Yeah, I got you One-handed scoop bro That's some good stuff right there. Oh, look at that guys. That's a good fish man for the river First fish of the day beautiful two and a quarter. I mean maybe two and a half. That's a beautiful look Stubby is it's awesome for the first fish of the day guys beautiful bass Big Alan Bob is hooked up, baby. Is it small? Put them up in here. Oh, yeah, it's a keeper Alan Bob's on game on board now Look at his side, dude, something wrong with this fish.  Good job Alan Bob. Alan Bob caught him a mutant bass for his first fish of the day Good job, bro Fricking backlash. He's pretty good. All right, let me get the camera Alan Bob hooked up Get I should have got the net Oh How you doing? No, sir. I got just don't go back. I got you Yeah, for sure. I don't mind. Oh, I actually I'm being honest with you. I didn't see it is our first time They catch for you Really? Yeah, we just got a decent decent little two-pounder It's awesome. Yeah, for sure. I won't go past right here Yeah, all right. Yeah, I won't go past right here for sure, man. Thank you, man.  We just talked to Mike. He said it's all right if we just fish right here He said we're all right as long as we don't go past the boats But I mean we can you can ask him when he comes back, but we'll get out of your way either way I'll get out of here You can ask him when he comes back. I don't want to For sure I understand. Yeah, we'll get out of your way. What is work bag this way? All right boys, so you're probably wondering what the heck just happened. Oh, we're doing I got Alan Bob right here We're back in this little cut now and so let me explain something really fast So we were fishing this but we know that I haven't been here This is like my second trip here. We were combined combining the two videos and we're fishing this marina It's supposedly here Alan Bob hold the camera supposedly. It's a private marina. Okay, which I've never heard of before I've fished plenty of marinas for our marina. Okay, so when we're about to pull up start fishing it We saw this guy we talked to him. He's like, oh, this is a private marina This is nice like but I don't care if you guys fish it. He's like just don't go by the boats I said, all right, that's cool. And he said if the security comes tell them Mike told you you could fish you Yeah All right. Yeah, I won't go past right here for sure man. Thank you, man So we're fishing we're when we knew this security is gonna eventually come I've never seen anything like this by the way I mean we put our boat in the water We're just going to fish but the security guard comes out and he's just like dude. You can't fish here I was like, I was like, yeah, I get it. I was like, I can get out of your way He's like but Mike said I could just fish these rocks right here. So as long as like don't get by the boats I was like, but I can leave us. It's not a problem. He's like, yeah He's like, well, you're not allowed to fish like he just was saying I was being respectful towards him But he was just coming at me like dude. I like I know I can't if that's like I'll leave He just want to keep going on and I was like, oh Mike's never let anybody fish here. No, no, I'm like, bro I'm fine with it. I told him I said I'll leave once someone starts to question my integrity Like he really like I was pulling some out of my butt. First of all, I don't even know how I know Mike's name I mean Mike came up to us and said it but it's whatever man. We could have went in there We could have caught a lot Allen hooked one as the guy was coming up and I missed one I had my he ate my crawl as a guy was coming up.  Hopefully we're gonna catch some more and hopefully you're just running Some big ones. We've caught some fish, but we're still kind of hung around What I was stuck on your line Allen Bob with the fish man We just hit a random spot another another random one just got a man do that's the fattest little thing That's awesome, bro. That was good. I'm stuck on his line Yeah Make sense, man.    Look at that bass. That is the stubbiest fattest little fish Ever and just beautiful colors on these fish in this water That was awesome. I was on a frog guys. We've been trying it and I guess we're bass back here, man. Heck yeah Allen's hooked up. I'm trying to get a thumbnail And now I'm freaking catching them Let's go Let's go Freaking trying to get a thumbnail and Allen's just whacking them right? That's fatty too. Don't look at the colors on them That's like the the best thing about these fish, man. It's the colors are just Outstanding on these bass look at them. Let's see the colors on them. Oh My gosh, beautiful. He is a chubby one. Good job, bro I'm just trying to take our final thumbnail and Allen Bob just just whacking them, man Let's get him back in the water Good job, bro. Good job Could have fished that marina because it was loaded with bass guys. I just want to be respectful You know, man, I'm not you know, even though he questioned my integrity and did that whole deal I'm still gonna be respectful about it. We pulled up to take a quick juicy thumbnail You know, we had to do that and Allen Bob actually caught on doing that So, you know, it's whatever but we had a great time on the waters today I hope you guys enjoyed it if you guys are new to the channel and you guys have not subscribed yet You need to hit the subscribe button because we're the latest fishing channel on YouTube, baby So be sure to hit that thing hit the notification Bell right next to the subscribe button and also hit the like button if you guys have been enjoying the content But thank you guys so much for the support. I love you guys so much and I'll catch you guys in the next


Everybody panic the Nintendo switch lost the holiday sale season Well, all right Let's let's dial it back a bit. So we have some information on the November MPD It technically releases next week So we might have another video on this with exact numbers and more data But it appears Nintendo switch fell to the number three spot this holiday season or at least November Here's what we know. I'm gonna read this this comes from reset era the report itself comes from a Mizzou securities equity research They sent out a monthly update on US and Japan console game sales to their clients And this person at recent era could not publish the actual report because that would be a breach of contract But they did give some information And here's what he says And by the way, this company uses the MPD numbers. So the MPD numbers usually get passed around before they become public So here's here's what this user on reset era said game hardware including the SNES classic as etc Sales volume in the US was up 44% in November And that's a cumulative April through November fiscal 13 18 below we're up 38% or fiscal year three. Sorry A lot a lot of information the dissect here. It says while software sales were up 2% The PlayStation 4 came out on top for hardware sales with a likely large impact from black friday sales Again, you can get a PlayStation 4 for 200 and under on black friday The xbox one which launched the new high spec x console came in second Both consoles saw roughly a 40 growth year on year Just as an fyi because we know what the sales of the systems were last november That means PlayStation 4 sold roughly 1.5 million units in the us in november Just just to kind of give you Where the top dog was at there Moving on the switch saw a large increase in sales volume in comparison to october But we still sense that the trends are slowing down We do not explicitly forecast monthly sales volumes in each region But we have the impression that the us sales volume for the switch in november was within expectations Nintendo's hardware sales tend to see strong trends in december Thanks to a seasonal demand and thus we believe the sales will grow month on month in december And then there's a little side note to this call of duty world war 2 was the most popular game sold in november And it was the number one seller and the PlayStation 4 version of it was the top selling one xbox one second No surprise pc's usually nowhere near that those kind of sales and the second best selling game was super mario odyssey Which obviously we know is a switch exclusive Uh, and to say there's no specific numbers in the update, but the included fingers seem to show PlayStation 4 Was about two to one to switch and xbox one was marginally Maybe 10 less than playstation 4. So a playstation 4 sold 1.5 million Maybe you know xbox sold 1.4 million or so again, they did launch new hardware this holiday And then that's about twice as much as switch So if you put that in perspective switch sold, you know, roughly 700 800 000 units So is that a bad thing? Is it a bad thing that switch lost to playstation 4 and xbox one so handily? no I don't actually Put a lot of stock in this and there's a few reasons one switch would have been the most expensive base model Out there on the market this holiday you had xbox one s and the base xbox one and playstation 4 and playstation 4 All selling at $200 or less coming with games packaged in For most of november not just during black friday and cyber monday and all that stuff But most of november that seemed to be the case a lot of companies were discounting these platforms a week before black friday Whereas switch did not come with a game unless you bought a more expensive pack like the splatoon The splatoon 2 or the mario pack out at like walmart or something, which is like 380 bucks And I had to admit when I went out it was not impossible to find that bundle Every walmart I went to had the splatoon 2 bundle in stock Throughout the entire holiday season and I went to four different ones So that should give me an idea that people weren't hot really all too keen on spending $380 on a nintendo switch But I did see a lot of the $300 units sell out now You could say well nintendo they must be underperforming they couldn't even sell over a million units in their first holiday period Well, they didn't launch now Xbox was likely helped not just because of the cheaper the cheaper xbox one s I actually think this indicates that the xbox one x had a pretty strong start out the gate There's usually a lot of early adapters And I won't even be surprised if around 1 million people picked up the xbox one x during launch in november It's just a number that makes sense to me And I know it's not that hard to get your hands on an xbox one x there are tons of stores That still have more of them and microsoft over delivered for demand on the xbox one x But I mean the sales don't lie the xbox one had a nice bounce back this holiday And I'm not too concerned that switch is behind all of this As I said no bundled in games for the base price Uh and 300 is a lot to swallow For what some people might perceive as a handheld system We saw this issue with the pricing actually on the 3ds too But the big note is that the sales practically doubled for switch from october to november And nintendo sales trends kind of show that there's going to be even more units selling in december In fact nintendo switch may even be likely to crack a million in sales this month Because unlike the other platforms where the prices go back up that that makes switch more price competitive After the sales season and people start to do all their last-minute shopping for the holidays And again, it's you an increase in sales now switch maintained its sales lead in japan You know every single week in november and and so far in december, so This is just mostly a us thing But yes nintendo switch was in third place fourth place was the snes classic edition We don't have any specific numbers for it, but it was suggested in this report that the snes classic was behind the switch Which makes sense. Uh, they probably didn't get 700 000 snes classics out there november um so yeah, I The I was asked a lot not just by one particular person, but I saw this question happen Um probably a dozen or so times Uh over the past three weeks where a lot of you guys asked me Who do that? Who did I think was going to win the holiday season? And obviously if we're just talking about the month of november PlayStation 4 and xbox for big winners here, uh switch kind of maybe underperformed Uh for what some of you guys might have expected then again Uh, they are saying that switch actually met expectations for sales this holiday and maybe that that's I feel like this is good Believe it or not switch began in the position it is I think is good even getting trounced by xbox one I don't think this is a big deal We're talking about two platforms that launched at 400 plus dollars years ago that are now half off Plus we have a brand new platform launching xbox one x and nintendo switch is a brand new product that came out this year That doesn't have any discounts yet and by next holiday. I guarantee bare minimum They're going to be able to be like look during the holidays. You can buy a switch for 300 And get a game Or maybe two games or maybe three games or maybe nintendo will knock 50 bucks off the price, you know for black friday Uh, this to me just bodes well because the switch starting at a price point that was lower than those consoles in the first place Yes, obviously the PlayStation 4 xbox one xbox one x they're also going to continue to get cheaper as the years move forward Um, and that's always going to present a problem This is always going to be a unique problem for nintendo because they launched this console mid generation Uh, well other companies were doing mid generation refreshes Nintendo's like hey, look, we're going to give you a whole brand new platform because the wii u is just not selling Uh, it's just an interesting perspective to see what's going to happen I I don't think this means anything for the switch's sales the switch's sales have been highly consistent month to month to month And I don't think that's going to change I think what we see here with the switch now that nintendo has enough units out there to meet demand Is that we're seeing a leveling off period where it might still increase in december and it's obviously going to have a drop off in january But that there's this consistent 200 to 300 thousand unit mark that nintendo is going to be able to sell every single month and I feel like That's more important than winning the holiday season like why is PlayStation 4 so dominant in the sales charts every single year It's not because they win the holiday which they normally do But it's because they usually win the sales every single month They consistently sell 200 to 300 sometimes 400 thousand units every single month So if nintendo can sit in that range every single month, they're going to be fine So this isn't a panic button. This isn't me talking about how I'm worried about nintendo In fact, I think this is pretty good for their very first holiday season And it wasn't a launch during the holiday like if they had launched in the holiday nintendo would have shattered it They sold 2.7 million Back during launch month if they had launched in november god You're talking about if they had enough units they could have broke launch records They could have sold three four five million of these things But that's not what happened. So without early adopters without a super price cut You're looking at you know people being willing to spend 300 dollars on a non-discounted item during the holidays and For that 700 thousand units roughly we'll get exact numbers next week. I'm good with that I'm pretty pretty content With those figures And the fact that the analyst groups here think that hey, you know what like nintendo's going to sell even more in december Because they usually sell more in december than november That's a good sign for switch as well. It means that they see the growth continuing They just see that you know the rapid fire like if anyone was expecting switch We like sell 1.5 or 2 million units or sell out every single unit possible during the holidays They were saying people who anyone who thought that was going to happen probably were over projecting The value of a 300 system with no discounts But anyways, I'm pretty happy with this. You guys let me know what you think Obviously, we've had a pretty eventful week with the announce of mega man 11 And that's not even like the biggest announcement, right? We got bayonetta three announced of the game awards the breath of the wild dlc Just came out. Uh, hopefully we'll have a conversation on that coming up I might be bringing back zelda inquiries just so I can get some zelda experts on the panel Uh and talk at length about um our experiences with that dlc And whether or not we feel like it was you know one worth the weight two worth the money Um and three, you know just in general how we feel about some of the new additions And yes, I am going to warn and I'll warn this when we release all the inquiries that uh It is going to contain spoilers because we are literally going to be talking about everything to do with the dlc pack The champions ballad as it were, uh, so yeah You guys let me know what you think about this news about the mpd and about the switch of sales Are you happy with it? Are you not happy with it? Does it not really matter because none of this money goes to our pockets Um, it's all of all perceptions for us as gamers What we have to deal with is perceptions and is this a good perception for switch Or are a lot of fans going to be like, hey, look xbox one PlayStation 4 rocking look at switch It lost it lost it lost even though it's won like six of the last eight months Anyways, I'm Nathaniel ruffle dance from nintendo prime and if you like this video, you know what to do And if you dislike the video hit that dislike button subscribe content And I'll catch you in the next one


You guys have probably already seen this tag going around but it was done by Samantha March and Ally Glynes and they thought up this tag together and it's all about palettes, all about our eyeshadow palette collections. So they just thought up a few questions as is this is my most whatever palette and you grab a palette out of your collection and that's what you show. So that's what I'm doing today. I'm doing this tag that these gals thought up. I'll make sure that I link both of their videos below so that you can see those. They did a fantastic job on them. I've been a Samantha March fan for a long, long time and then Ally is from my home state. So I've been a fan of hers for a little over a year since I found her. So really exciting to see two of my favorite YouTubers come together and create a tag that other YouTubers like myself can do. One thing is I do know that I have recently been doing a lot of palette videos. I did my top 10 palettes for spring and then I did a ranking palette for Juvia's Place. So I know that this is coming on the heels of all that.  So I wanted to do this tag right away. I hope that you do enjoy this. If you're new to my channel, I do invite you to please subscribe and hit the bell icon so that you can be notified of any videos that I'm having coming up and also if you're new or if you have been around for a while. I thank you so much for spending a bit of your day with me. Please don't forget to give this video a thumbs up because it does help me so much. And I love all of you guys and appreciate you so much because without you, my channel would be nothing. So let's get into these questions and we'll find out all about my eyeshadow palettes. Okay. So the first question is, is what is your newest palette in your collection? And that is the Sigma Enchanted. I purchased this, oh, I don't know, probably three or four weeks ago. And I would, I have been wanting this palette for such a long time, but I actually found a code and I had it on a day when they had free shipping. So it was like, that's perfect. So I'll list the code below. It is not my code. It's not an affiliate code. I do have one myself, but it's not as good of a discount as the one I'll get for you guys. And by the way, that's her glitzy fritzy. Mary, if any of you know it, she gets a better discount than I do, but I would love for you guys to use her discount code because you do get it better. You do get more off with it. So I love the packaging, the holographic packaging has the colors on the backside does come with a really nice brush. It's Sigma. It has to come with a brush, right? But I do enjoy these colors and I have enjoyed using this so far. I feel like I'm stuck in a little bit of a rut with it because this color right here is really the only transition color for my light skin that I can use. And so when I do go into that, I feel like I go one certain way, which is more towards the Mavi side. So I'm enjoying it, but at the same time, I feel like I'm not seeing its full potential yet. I'm not sure if I'm a hundred percent sold on it yet. But yes, that is the newest one to my collection right now. The second one is what is the oldest one in your collection, and that would have to be the Juvia's Place Masquerade Mini. This is the first palette that I can remember purchasing. And I just loved it because it was my introduction to Juvia's Place, and it was one that I was just like, these colors are amazing. The formula was amazing. You know, as YouTubers, our palette collections go through lots of declutters, but this one has stuck with me and you're going to see another one in here in a minute that has stuck with me. But I feel like this one for me is very nostalgic because it is the oldest in my collection. And I still love it and use it all the time. The next one is what is the most expensive one in your collection, and that has to be the Hood of Beauty Noon Nudes Palette. This one, when it came out, I was just absolutely enthralled with how beautiful these colors were because they're just the most beautiful, mauve, peachy, they're just gorgeous colors. And I was so excited about it, but I knew at the time I couldn't afford it, so I did wait until the sale went on and I was so excited about it. I think that this palette is about $65 by itself. That's the most expensive thing I've ever spent on a palette, but I do love it. I'm so glad that I got it. I use it over and over again. And as a matter of fact, this spring has been a time when I have been reaching for this again and finding that I love it all the more as I wanted a more pinky, mauve, corally look. So really have been enjoying that one again. And yeah, that's my most expensive one. My most affordable one is this little tiny palette from Wet n Wild. These palettes are $2.97 at Walmart. I think this one is called Petal Premavera. I love this one. I use it all the time. When it came, it actually, I ordered it and it actually was shattered right here. So it's kind of a mess, but I really do like it. I love how this just kind of works so well together. It's a no brainer. Any of these little quads that you get, you can put them on and, you know, make them work and have a very, very quick eyeshadow look that is kind of just ease and because they kind of have done the whole thing for you. So at $2.97, $2.98, that was my least expensive palette. The next question is, what's your what's your everyday palette? What do you go to when you want just an everyday look? And for me, that is the Sultry Palette from Anastasia Beverly Hills. And I know that a lot of people look at this palette and they think smokey palette. But for me, this is such a beautiful everyday palette. Now, this palette has been discontinued since then, since I purchased it. But I will show you a dupe for it that is just as good in just a second. But I love that I can reach into here and I can go cool or neutral and just have a gorgeous look. And then I've got all these colors to reach for and put across my lid and they brighten up my eye look. And it's just one of those palettes that even this coral down here and kind of this light saddle brown, the colors just suit everybody that I've ever heard that has gotten this. They just they look at it and they use it and they love it. But since you can't get it anymore, the Temptress Palette by Alter Ego is the best dupe that I've found for it. And I've seen several different dupes for it. But this one in texture and quality and coloring matches it better than any other. So if you were interested in the Sultry, you can get the Temptress. And then the next question is what is your most colorful palette that would have to be the Warrior 3 by Juvia's Place.  These colors are super vibrant, super over the top. You would have to if you're fair like me, you have to blend these out. But they have some next level gorgeous colors up here that I love to use on my lid. These two colors right here, the bluish almost ocean blue and then this grayish color or the silver color. So pretty. But these colors are wild. They're wild and crazy colors. I love them. I have used almost all of them except for that bright, bright yellow down there. But I have tried them all and I like them all. But yes, this has to be my most colorful palette. Not that I reach for it constantly, but it is my most colorful palette. The next one is what is your smallest palette. Now, the Wet and Wild was a small palette. Yes, it was an inexpensive one. But when I compared to gram for gram, the Elf palettes are a little bit less than the Wet and Wild one. They have more product in the Wet and Wild one. Now, I will say that these little Elf palettes, these bite size ones have just been ones that I really do like a lot. This reminds me, this color scheme right here reminds me of the Sultry palette from ABH. So it's really pretty. I have enjoyed using it immensely. And I like all of them actually. I think I have like six now. I want to get the other two. I don't know. I might not get the rest one because that's not really my colors. But I enjoy all of them.  I just think they kind of really knocked it out of the park with that. So these are the smallest palettes that I have. And that one, let's see, make sure I tell you truffles is what that one is. My biggest palette is from Morphe. And this one, I don't know what possessed me to get this palette, but I think that it was obviously my love for purple. This one is called the Such a Gym palette. It is huge, you guys. This is a huge palette. And I like it, but it is so big that I find myself not reaching for it. I think that they came out with two others that are this big. I don't like this big of a palette. I found that out after I purchased it because it's not easy to hold. It's not easy to just, you know, put it down on your vanity. It's just, it's a really, really big palette. But I like some of the colors in it. I didn't like all of the colors in it, but I keep it because it's so beautiful and purple and pink.  And it's crazy big. The next one is what palette has the best memories for you. And this was really sad, you guys, as I was picking out palettes for these questions, it was like, I don't really tie any memories to my eyeshadow palettes. But then I got to thinking, okay, what would be though? What could I find in, you know, purchasing and using all that kind of stuff? What would be my best memory? And it would have to be the modern renaissance. Now, I did see this in Samantha and Ally's videos for different reasons. Mine is because when I got this, I felt like I'd arrived as a YouTuber because everybody at the time was using it. I mean everybody. And I've used this a ton. It has got several divots in all of the colors. But I really did. I felt really special that I was using this on camera and showing people how to use it and doing tutorials with it. So I felt like this one had really good memories because it was tied to doing my channel and becoming YouTuber. I guess it was just kind of like the thought of having big girl makeup or something. So yeah, that has the best memories tied to it. The next question is, is what was worth the hype? Okay, that is the Sydney Grace and During Love Palette. Sydney Grace is eyeshadows that I'd been hearing about for a very, very long time. And everybody was talking about how fantastic they were and how they were something very special. And I had just been in a color pop and Juvia's Place mode where I felt like, you know, eyeshadows, they really are nice. ABH is nice, that kind of thing. Oh my gosh, you guys, when I got this first of all in opening it up, first of all, the packaging was fantastic. It was packaging that was special. This is embossed, raised up on the little lace that it looks here. Beautiful mirror inside of it and then the pans are huge. So all of that checked off all the boxes and then you get in here and you guys, this is eyeshadows that are great. And then you also have the cream of the crop. I, granted, I have a little mini Natasha Dona one. I've never tried any from Pat McGrath. I have tried some from Visiart, but I think Sydney Grace is above it personally. I can't wait to get some of her singles. I can't wait for her to release other palettes. I want more of them because they are that good. So I felt like even though it took me such a long time to pull the trigger on it, I am so enamored with this and so in love to do a look for you guys so that you guys can see how great this palette is. If that's something that interests you. But yes, that was definitely worth the hype. And to me, it was so exciting when I got it and saw what it was all about and how gorgeous it was. Okay, what was one that was not worth the hype? Don't anybody throw stones at me. Don't get me wrong. But this was the one that I wanted it. I kept trying to get it. I couldn't get it when it was first out and then I later on I got it. It's the Jacqueline Hill and Morphe palette and this originally came out. Everybody lost their minds over this palette. It came out about the same time as everybody was losing their minds over the Renaissance palette, modern Renaissance and the peach palette from Too Faced. But this palette for me, you guys, I've used it. I like it. The formula is good on it. But I don't reach for it that much and partly because it has all warm tones. It's mostly just four rows. Four of these rows are just straight warm tones. So about 28 of these shadows, I can't use that much. And for me, it just really fell short because it just created an orange or a berry look on my eyes every time. And that doesn't look really good on my coloring. So for me, this one was very overhyped for me and I was let down by it when I got it. Please don't hate me on that because I know so many people love it and I've done tutorials in the past in it. And yeah, the looks turn out great. But yeah, it's just one that was overhyped in my mind. Okay, the next question is really interesting. Your favorite palette from your favorite brand, my favorite brand that makes palettes is is color pop, obviously. I love their diversity. I love that they're just thinking outside the box. I love that they have good quality. They haven't skimped on that even though that they have gotten so big and grown so much. And I fell in love with them originally from the Super Shock formula, but of obvious for obvious reasons you can't do a palette with the Super Shock formula. But when the Blue Moon palette came out, I actually did already have the purple one and the green one. But when this one came out, I was so excited because I hadn't seen blues hardly at all anywhere. And when they did come out with this, they're just such different blues. This one right here is like a periwinkle blue that I think is so pretty. I'm not talking about doing a whole entire look with this, but for accent colors and for their imagination on where they went with the blues, you know, very deep, very bright, very different blues like the periwinkle. And then over here you have this icy shifting duo chrome blue color. So pretty, you guys. This Blue Moon palette is it just blew me away. It's just one of those ones that all of the textures, all of the formulas, all of the colors I love. And last but not least is my most used palette. And the reason that I put this in here is because, first of all, fantastic quality from LA Girl. This is their Fierce and Wild Eyeshadow Palette. And this one is in the one untamed.  I don't know if it's in stores or not. I don't think it is. But I love this palette, you guys. It's a 16 pan palette. And I used it so much that the top came off of it. So it's not great packaging, but the mirror is great. I mean the mirror is huge. I'm not going to blind you with that, but the mirror is really huge and it's, you know, really a great mirror too. But I love using this. I love that there is such a great diversity of the colors that I love, which is that mauve tone. So I can do like a spring, corally pink look. I can do a mauve look. I can do a purple look. I can go into the greens and do that. I can do all just neutrals if I want to do that. So this is definitely my most reached for. And then it has this color right up here, which is just a matte. And if you get too much on your transition, you can buff that into that and soften that. So this is definitely my most reached for my most fun palette to me. I can go smoky. I can go every day. I can go colorful, all that. So this one, I have been finding myself reaching for it the most since I bought it probably about, I don't know, two years ago, maybe a year and a half ago, something like that. So yeah, that is my most used palette. I hope that you did enjoy this tag. It was a lot of fun for me because it's on one of my favorite topics, eyeshadows. So thank you so much for sticking around. Don't forget to give it a thumbs up if you would. Let's do. Let's talk about the most hype palette that let you down or wasn't worth the hype. So let's do that one in the comments section. If you guys want to tell me about the one that wasn't worth the hype to you, I would love to hear that. And then if you want to tell me about the one that was worth the hype to you. So those two in a comment would be great. And we can kind of talk about it and interact and we can know what's good and what's bad at the same time. So thank you so much, guys, for spending a bit of your day with me. As always, please stay safe, stay sanitized. I love you so very much and I'll catch you in my very next video. Bye guys.


A warm welcome to the 35th lecture on the subject of wavelets and multirate digital signal processing. In the last lecture, we had developed a computationally efficient structure to realize an orthogonal filter bank. We called it the lattice structure. The word lattice relates to a uniform periodic repetition of a given module or a given modular piece. Now, in that lattice, we notice that we had a little bit of complexity, the minimum possible where the two inputs to the lattice interacted with one another to produce the two outputs. In fact, let me put down the structure and let me also put before you the theme of the lecture today. The theme of the lecture today is to build one step ahead of the lattice. In the lattice, there was a simultaneous working on the two inputs to produce the two outputs. What we are going to do today is to simplify that even further to make it even more modular or even more unitary in terms of operation. So, we are going to decompose that lattice stage into two sub stages which have even more elementary operations involved. That is going to lead us to what we call a lifting structure. So, today we intend to talk about what is called the lifting structure or a decomposition of the lattice into even more elementary operations and subsequently we are going to introduce a greater generalization. So, we start by a specific modular structure and we are going to a more general formulation of what we expect when we want to do computationally efficient realizations. And that is going to lead us to the idea of polyphase matrices as we mentioned in the title here. Now, what we have done last time was to build a structure that looked something like this. You know the unit or the module had an appearance of this kind and here this was what we called a one lattice stage and this was called the lattice parameter. This was what distinguished one stage from another the value of k. We also put down a systematic procedure for constructing the lattice and in fact, we illustrated the calculations involved in constructing that lattice for a length 4 orthogonal filter. I had left it to you to generalize to longer lengths. We had given the basic approach and we had shown that this generalization was possible. Now, if you look at this lattice stage once again what we notice is that you are doing two computations at once. You know you are taking a combination of these and producing this output and you are taking a combination of these and producing this output. So, in some sense there is a crisscross involved here. We wish to think of this in terms of matrices. So, let us call this input 1 in 1 and let us call this in 2 and let us call this out 1 and let us call this out 2 here. Let us put down a relation between in and out. So, it is very clear you see what I wish to do is to think of a 2 cross 2 matrix that relates the Z transforms of the outputs to the Z transforms of the inputs and this is what we are going to call a polyphase matrix here. So, you see the idea of polyphase I would like to introduce that idea in a little greater depth before I begin the details. Remember even before we put this module in place here you know this stage is repeated with different values of k one after the other in cascade, but at the beginning of all these stages is the following operation.  Now, if you speak the language of Z transforms here. So, if I denote the Z transform of the input by capital X of Z then one could use the symbols capital X 0 of Z for the Z transform the sequence that appears here and capital X 1 Z for the Z transform of the sequence that appears here and we would like to relate capital X 0 capital X 1 and capital X. So, let us put down the problem we see that we seek a relation let us put down graphically the sequences that produce capital X 0 and capital X 1. So, you know let us write down the indices n a few sample ones. So, minus 6 minus 5 let us begin with minus 6 let us say for variety I am putting more on the negative side and so I of course, I have the corresponding samples. So, for example, you have X sub 0 here X sub 1 here X sub 2 there and so on X sub minus 1 here and so on. Now, what is going to happen on this branch? So, if I look at this branch what I am going to get graphically is X 0 followed by X 2 preceded by X minus 2 and then X minus 4 behind X minus 6. So, let me write down graphically what I get on the X 0 branch I get X 0 followed by X 2 X 4 X 6 and so on this way X minus 2 X minus 4 and so on this way and similarly on the X 1 branch I get X 1 first you know here again you have to be little careful you get X 1 followed by X 3 followed by X 5 and then X 7 and so on in this direction and X minus 1 X minus 2 and so on in this direction the only catch is where do you put the 0. Now, what we will do is rather than to call the Z transforms here as X 0 and X 1 we will say they are related to the Z transforms X 0 and X 1 where we shall give a specific meaning to capital X 0 and capital X 1. So, for capital X 1 we shall consider the sequence which is equal to X 1 at 0 and then subsequently X 3 X 5 X 7 as shown here and X minus 1 X minus 3 and so on behind this should be X minus 3 there is a little correction required similarly here on the X 0 branch what I am asking for is a sequence that is X 0 at the point 0 X 2 X 4 X 6 subsequently X minus 2 X minus 4 and X minus 6 and so on behind. So, what I am saying in effect is if I consider the sequence X the sequence X is obtained by interleaving the sequence on the X 0 branch and that on the X 1 branch. So, what I am saying is essentially if you want the sequence X you would take this point from the X 0 branch followed by this point from the X 1 branch followed by this point from the X 0 branch and followed by this point from the X 1 branch and so on.  So, in other words we can define X 0 n and X 1 n in terms of the sequence X n X 0 n is simply X of 2 n for all integer n as regards X 1 n it is X of 2 n plus 1 for all integer n and it is very clear that X z X of z which is summation n going from minus to plus infinity X n z raised to the minus n can be decomposed into two summations. It is 2 n z raised to the power minus 2 n plus summation n going from minus to plus infinity X 2 n plus 1 z raised to the power minus 2 n plus 1 by definition and very clearly since X 2 n is essentially X 0 of n and X 2 n plus 1 is essentially X 1 of n let me put back that definition before you X 2 n is X 0 of n and X 2 n plus 1 is X 1 of n and therefore, this becomes X 0 n into z squared raised to the minus n plus summation n going from minus to plus infinity X 1 n z inverse and then we can call this sequence small X 1 n. And then z squared raised to the minus n all that I have done here is to rewrite this a little bit rewrite this a little bit note that this is essentially X 0 of n and this is essentially X 1 of n to get here. Now, here I am trying to bring out a new idea the idea of what is called poly phase components I shall now define these components X 0 n and X 1 n that we speak about here are called the poly phase components of X. Now, the word poly phase comes from the idea of a number of phases being operated in parallel. So, you know if you think about it in the sense of a machine suppose you had the sequence of X coming sample after sample and you wanted to extract the sequence X 0 and the sequence X 1 think of two branches two streams going out of X 1 is X. So, X comes in here X 0 goes on one branch and X 1 goes on the other it is as if you had a switch a poly phase switch you know this idea of poly phase comes from the idea of switching from one phase to the other. So, you switch on to one phase for one sample to the other phase for the other sample and again to the first phase for the next sample and then to the second phase for the other sample that is where the idea of poly phase components comes from a switching mechanism between phases that is essentially what is happening in constructing X 0 and X 1 it is very clear that the z transforms of the poly phase components relate to the z transform of the input in the following way capital X of z we have just shown is capital X 0 of z squared plus z inverse capital X 1 of z squared. So, essentially it is the relation between the poly z transforms of the poly phase components and the z transform of the input what we are doing in one stage or one module of the lattice is to operate on the poly phase components. So, in fact you could think of the whole of the analysis filter bank of that matter the whole of the synthesis filter bank also as an operation essentially on poly phase components instead of thinking of it as an operation on the original sequence it could be thought of as an operation on a 2 cross 2 sequence. So, if you look at it carefully when we do this in the beginning and we wish to express what comes out here and here in the language of z transforms noting that X of z is X 0 z squared plus z inverse X 1 z squared what comes out on this branch is essentially X 0 of z. Now, what comes at this point is z inverse of X z and therefore, you have a z inverse factor multiplying this which puts it into odd locations. So, when we down sample those are all destroyed, but this becomes z raise the power minus 2 times X 1 z squared. So, when we down sample what we get here is essentially z inverse X 1 z that is interesting. So, what we are doing essentially is to operate on X 0 z and X 1 z. So, you know the first stage of the lattice of that matter any stage is essentially an operation on these poly phase components. So, we could think of each stage of the lattice as essentially a matrix a 2 cross 2 matrix operation on the poly phase components. Let us try and speak this language of matrices. For example, when we simply delay the lower branch with a z inverse and leave the upper branch unchanged the corresponding matrix is essentially a diagonal matrix. So, what I am saying is this stage here I would not keep drawing these. So, the criss cross stage here is one stage and this stage is another where we have a z inverse here. So, we have 2 sub stages again. So, you can call it operation 1 and operation 2 with a k n minus k there. The matrix corresponding to operation 1 is essentially keep the upper branch as it is and multiply the lower branch by z inverse simple enough. So, what I am saying is you know if you call this in and out in 1 in 2 and out 1 and out 2 not quite there, but intermediate. So, this is in 1 and in 2 and what I am producing at this point is essentially these 2 outputs here. The matrix is this correspondingly the matrix corresponding to operation 2 can equally easily be written down. So, we have taken the outputs of operation 1 and own them to produce the upper branch. We have taken 1 times this and k times the lower branch for the lower branch it is minus k times the upper and 1 times the lower and this gives us out 1 and out 2 look back again at the drawing to convince yourself.  So, composite operator between in 1 in 2 out 1 and out 2 is as follows out 2 out 1 is 1 k minus k 1 1 0 0 z 1 minus k 1 1 0 inverse in 1 and in 2. Now, this entire operator here a matrix operator acting on the polyphase components is called a polyphase operator or polyphase matrix. So, in fact each lattice stage has a polyphase matrix corresponding to it and when we cascade these lattice stages we are placing these polyphase matrices in cascade 2 we are essentially multiplying the matrices one after the other that is the interpretation in the language of matrices. When we look at it from a matrix perspective things become much easier to understand we also see what is very elementary about these operations. These matrices are indeed very simple matrices for example, one of them is a diagonal matrix. The other matrix is essentially you know it is essentially with only one parameter two of the entries are 1 that means there is no multiplication involved the other two entries are identical up to a sign change. So, these are very elementary simple matrices and what we have done in the process of constructing the lattice structure is to break down the entire low pass and high pass filter on the analysis side into small matrix operators of this kind. Now, what we are going to do now is to ask whether we can even further simplify and break up these matrix operators. So, let us look back at the operator here. The operator here is just too simple to break down any further there is little that we can do to simplify this, but we could possibly consider simplifying this. This is still in some sense a full matrix a matrix of full rank you know all the entries are non zero and the entries none of the entries are trivial in well these two entries are trivial, but you know you have a full amount of computation to do here. We can decompose this matrix into a product of two even simpler matrices. So, we could consider decomposing 1 k minus k 1 into two sub matrices like this. One matrix which has a 0 here and non zero entries there and one matrix which has non zero entries here and a 0 entry there this is called an upper triangular matrix and this is called a lower triangular matrix. So, what we are asking for is essentially a decomposition of this rather simple two cross two matrix into even simpler two cross two matrices one upper triangular and one lower triangular. What does it mean in terms of computation? When we have let us say for example, an upper triangular matrix as is here. So, let us let us put numbers in this matrix or at least symbols if not numbers. So, consider the upper triangular matrix let it have the form a b c a 0 here. What is the computation meant? The computation meant is the following. We are saying the upper product of the lower branch is a times this plus b times this. The lower branch is just c times this. So, this is what is essentially a so called upper triangular computation and similarly we can put down a lower triangular computation. So, a typical lower triangular matrix would look like this with the associated computation looking as follows. What is interesting about both the upper and the lower triangular computation here is that we have further simplified what was essentially a crisscross operation before this. So, it is the most elementary thing that you can do if you want to do something that can help you progress. It essentially means make a linear combination or make an operation on only one of the branches and combine it with the other. So, at one time we do only one combination. We do not let branches interact both with each other at once. This is even more elementary than the lattice in some sense and what we want to investigate is whether it is possible to decompose each lattice stage into these upper and lower triangular forms. So, let us in fact assume that it is possible and then find a set of values for it. So, let if possible this elementary part 1 k minus k and 1 be equal to a, b, c and p, q, r written this way first a lower triangular operation followed by an upper triangular operation. Of course, one could possibly conceive a reversal of role here, but that is a different issue. So, in fact now we have four equations and six variables. So, obviously this has some degrees of freedom in the solution. We will exploit those degrees of freedom in a minute, but let us write down the equations that we get from here explicitly. So, how would we get the equations? We would get them by comparing term by term. So, for example, 1 is a times p plus b times q minus k is essentially what you get by dot product of this with this. So, c times r and so on. So, let me write down the four equations that we get. a p plus b q is equal to 1, c r is minus k, b r is k and finally, well the last one well just a minute I think there is a slight mistake minus k that is right. So, that is c r, c q in fact c q is minus k. So, you have this into this. So, 0 times p plus c times q. So, c q is minus k, b r is k, b r is k, b r is and c r is 1 is the four equations and as expected we have two degrees of freedom here. We can only solve for four variables. So, we are free to choose two variables in a way that we deem appropriate. Now, if we look at this operation the first operation here the lower triangular operation what we would like to see is whether we can avoid these multiplications here. So, you know we would like to make this lower triangular operation as simple as we can. So, if I go back to the actual computation suppose we could ensure that one of at least some of these are just one. You know these multipliers here if we could make them one and yet get a solution for the others what it means is that for example, if p could be made one we just passing it as it is, if r could be made one we just passing this as it is. So, we exploit in these equations we exploit the degrees of freedom by choosing very simple values for some variables. So, for example, let us consider choosing p equal to one and r equal to one in this lower triangular form. So, make the diagonal entries one here where upon we have a plus b q is one c q is minus k b is k and c is one if we substitute back in these equations. Remember p and r have been made one and this is very easy to solve now c is one.  So, all that we need to do is to essentially collapse all these equations into this. So, we have a plus k times minus k is one which means a is one plus k square and of course, the others are known b is k c is one and q is minus k. So, overall we have a decomposition of this matrix one k minus k and one into one plus k square there k here zero and one followed by one on the diagonals here and minus k off diagonal there and in fact, it is very easy to verify this by multiplication one plus k square into one minus k square is indeed one one plus k square into zero plus k into one is indeed k zero times one plus one times minus k is indeed minus k and zero times zero plus one times one is indeed one this is verified. Now, what we have done here in this decomposition is to break up one lattice stage into even simpler stages of an upper diagonal or upper triangular and lower triangular operation. So, what we are saying in effect is that one lattice stage computationally we have broken down this crisscross operation into a cast scale of two operations. So, in the first operation we have one zero obviously, this matrix operates first. So, one zero minus k one essentially meaning one zero is for the upper one. So, this goes as it is minus k one means minus k there and one here. So, the lower triangular part followed by the upper triangular part. So, if you wish I will just put a mark of separation here and the upper triangular part I have one plus k squared k zero and one zero and one essentially means just this pass this as it is to get this. The upper row means one plus k squared here and k there this is the upper triangular part just for neatness I mean this is just for neatness we could make these lines vertical. So, we will just redraw it that way and also include the delay. So, if you remember we had a delay before this let us keep the delay as it is. In fact, you know after all we are making the delay and then we are bringing it as it is here. So, we might as well bring the delay here what I mean is all together I have the following. A delay this going as it is, but going with a minus k here to produce this followed by this going with a one plus k squared there this going with a factor k to add to this and this going just as it is to produce the lower branch. What we have done here is to redraw the structure in a way that makes it very clear that at one time we are essentially just doing one combination operation and this is the central idea behind what is called the lifting stage. In fact, this is called a lifting stage you know the idea of lifting essentially means to lift from no transform to a meaningful transform. So, in fact suppose you were to take just the outputs of the down samples. So, you had this here and the down samples here if you were just to up sample these and then recombine so I could just put a z inverse there. What would I get? It is very easy to see that what we get here at this point is x 0 z where x 0 z has been explained earlier. What we get here is z inverse x 1 z what we get here is this with z replaced by z square. So, all in all what I get here is essentially x 0 of z square and what I get here is z raised the minus 2 times x 1 z square and if I add these 2 what I get here let me call this point y is y z equal to z inverse x 0 z square plus z raised to the minus 2 x 1 z square which is easily seen to be z inverse times x z the input reconstructed with a delay of one sample. So, in some sense this is what we have here is what is called a lazy wavelet transform it does nothing at all if I had no lattice stages at all I would have a structure like this. So, from a structure which does nothing at all we have building up stage by stage to a structure which has a meaningful frequency response each of these lower and upper triangular forms essentially builds to a better and better frequency response. So, it lifts that wavelet transform from an ineffectual useless wavelet transform to a wavelet transform which does a great deal both in time and frequency that is why we use the term lifting that is one interpretation of the word lifting. So, in the literature people have talked about lifting implementations lift one step at a time and what we had in this structure here is essentially two lifting stages the first time you lift by combining the upper with the lower to modify the lower in the second step we combine the lower with the upper to modify the upper and by alternate improvements of lifting of the lower and then the upper we improve the quality of the wavelet transform step by step. What we have built here has been called the lifting structure in the context of discrete wavelet transforms. Now, what I have shown you here is a mechanism to obtain a lifting structure for an orthogonal wavelet transform one can also build corresponding lifting structures for bi orthogonal transforms. So, for example, it is the lifting structure which is recommended for implementation in the jpeg 5 3 filter bank which we had described in elaborate detail a few lectures before this. In fact, that lifting implementation is also possible for many others such bi orthogonal filter banks and one of the reasons why those particular filter banks 5 3 and 9 7 have been chosen in the jpeg 2000 context is because they are amenable to lifting implementation implementation with very elementary operations. In fact, a part of the recommendations in jpeg 2000 is to implement the filter bank with a lifting structure because of its computational efficiency. As a part of the process of building this lifting implementation we have also seen the idea of polyphase matrices essentially matrix operators on the polyphase components. And we can see that essentially an analysis filter bank is a composite or is a total matrix operator 2 cross 2 matrix operator in the z domain on the polyphase components of the input. Similarly, the synthesis part can also be thought of as a 2 cross 2 operator on the synthesizing part to get back the polyphase components of the input or rather to construct the polyphase components of the output starting from the outputs of the analysis polyphase operator. We shall build further on these ideas of polyphase decomposition and polyphase matrices in some subsequent lectures. Thank you.


Hello, I'm Dr. Lewis Myers. Welcome to Health Care Today. We're going to be talking today about common lung diseases or lung diagnoses and how do we diagnose and treat those. And I'm very honored to have as our guest today Dr. Veronica Jodlowski, who is the Chief of Pulmonology at Rutland Regional Medical Center. Dr. Jodlowski will be joining us from Rutland via Zoom. Dr. Jodlowski went to medical school in her native Hungary, then came to the United States where she did her residency training at Mount Sinai in New York City and her pulmonary and critical care at Columbia Hospital in New York City. She's been with us here in Vermont for many years. She was the Director of Critical Care and Pulmonology at the North Country Hospital for a number of years and has been at Rutland, I believe, for three or four years now. So, Dr. Jodlowski, welcome and thank you for being with us. Thank you for inviting me. It's very exciting. Well, we have a lot of things to cover. We're going to talk about some of the more common things we see at the hospital and in Vermont. These include COPD or emphysema and asthma, sleep apnea, lung cancer and lung cancer screening. And then, perhaps at the end, we'll talk a little bit about COVID and the long COVID syndrome, how COVID has affected people's lungs. So, let's start with very common and smoking-related disease of COPD. Tell us also what is COPD and how does it differ from asthma? So, COPD is a lung disease that is caused by exposure to different irritants. In our country, the most common irritant that is involved is cigarette smoke. But certainly, if we look worldwide, other exposures could be wood fires or burning different materials for heat and for cooking can also cause COPD. So, COPD basically encompasses two different diseases. One is what we would call chronic bronchitis, which is an irritation from the smoke, irritating the mucus glands and the inner lining of the airways and causing permanent damage and permanent structural changes eventually. And the other form of COPD would be what people would know as emphysema, which is where the cigarette smoke eventually causes structural damage at the smallest part of the lung tissue called the alveoli and ruptures them and causes these bigger, what I usually explain to the patients, as airfield bubbles in the lung that just don't participate in the breathing so well. But those are permanent changes in damage in the lung. One of the other perhaps contributors here in Vermont in Barry and Rutland and other communities is people who have worked in the granite quarries. Do you see much of that? That usually causes the granite quarries and also up north in Eden and Lowell, the asbestos mines. They tend to cause more interstitial lung disease rather than COPD. And of course, if the person who worked in the quarries and the mines was also a smoker for many years, then their risk of developing severe lung disease is even higher than the general population. But those interstitial lung diseases would include pulmonary fibrosis where there's actual scarring occurring on the lung rather than damage to these small breathing surfaces, the alveoli. How does smoking actually damage the lungs to cause the COPD or emphysema? So it's partly the cigarette smoke and partly the actual burn products in the tobacco as it burns are the damaging factors. And as such, of course, it doesn't have to be tobacco smoking. It could be marijuana. And the damage can also occur from not just smoking but vaping or using the bomb or anything like that. We don't hear as much about marijuana, but there's perhaps some misconception that it doesn't cause harm to the lungs. You're saying that's not true? No, it does cause harm to the lung. I think that the reason why we don't hear all that much about it, perhaps, is most people don't smoke at so much marijuana, which would be maybe an equivalent to a pack of cigarettes a day every single day. There is also the perception that when people cut back on their smoking that they can undo the damage or prevent damage. Is that true? So some of the damage is permanent, but some of the damage is actually reversible. And as people cut back or quit smoking, some of the reversible damage can be mitigated and can get better. So for example, we're talking about how the mucus glands are starting to put out more mucus. And before those glands go through a permanent change, they could be just irritated and inflamed. And that can get better with the irritation seizing. How do you diagnose COPD or emphysema? So COPD is diagnosed partly by getting a good history, including exposure history, and then partly by physical exam. Most of the time, by the time the airways are involved, we hear that people have some wheezing when they exhale. There's some coughing, there is chronic mucus production. And then the actual definitive diagnosis would be made on inconjunction with the history would be made on pulmonary function testing, which is a lung function test where they measure how much air one can move with different maneuvers. And there are very specific findings for obstructive lung disease like asthma and COPD. And of course, if we get a CAT scan or any kind of imaging modality, we could also see changes that reflect that the person might have COPD or emphysema. And once you have a patient with COPD, what are some of the treatment options that you have? So number one is stopping whatever the irritation is that's causing the COPD. So the smokers do very extensive work in smoking cessation counseling and offering resources and medications to help people quit smoking. Number two is based on the severity of the disease and the patient's symptomatology. We can offer inhalers, which different medications are put into the inhalers, but some of them will relax these tightened airways in different mechanisms and help the airway open up bigger so that can help with the wheezing and the shortness of breath. And some other medications in the inhalers such as some of the inhaled steroids perhaps help with the inflammation around the mucus glands. There are other medications that are also used in the care of the patient with COPD but in more specific situations or scenarios. For example, for patients who have very frequent flare-ups, lending them in the hospital or in the emergency room, we have other medications that are proven to help slow down the frequency of these flare-ups. And then lastly, we do pulmonary exercise rehabilitation program to help the person learn how to use the remaining healthy lung in a more efficient way and exercise specifically the respiratory accessory muscles that help with some of the symptoms, especially the breathlessness. And then we also encompass kind of a more overall care such as making sure that the vaccinations are on board and if a patient needs supplemental oxygen, then prescribing the appropriate amount of oxygen. Which are the important vaccines for someone with COPD to get? So for people with COPD, age-appropriate pneumonia vaccination is very important and the guidelines changed a little while ago. So people with basically any significant COPD at any age would now qualify for pneumonia vaccines. Yearly flu shots, the COVID vaccinations and the RSV vaccination, which just came out this year, would be, I think, my top four choices. And if we could switch gears and just talk a little bit about asthma. Again, very common. Tell us, what is asthma and how is it different than COPD? So asthma, in some ways there are some similarities and that in some other ways it's a very different disease. Asthma is more of a reactive airway disease. This is more of an illness of the airways, the wind pipes, kind of the tubing system, whereas COPD a lot of the times involves the actual lung tissue. And asthma, most people have a tendency for a hyper-reactive reaction. So they are inhaling some sort of an irritant that they are basically allergic to and that causes a very abrupt change in the otherwise healthy looking normal airways where suddenly the airway tightens up. The muscle around the airway also gets tight and the mucus glands can acutely start producing mucus. The symptoms could be quite similar. Once the patient is in an asthma attack, they will have shortness of breath and coughing and wheezing and chest tightness, but it has a more transient nature and has a very strong association to exposure to the irritant. So in between times the asthma patient may feel completely fine. Has the treatment of asthma changed over the years during your practice years? So in the last few years, major changes have happened in the asthma care initially by the recognition of these very specific allergy mediating cells in the blood called eosinophil cells. That patients who have a large number of these eosinophil cells in their blood, they tend to react much more abruptly to exposure to inhaled irritants and cause severe asthma flare ups. And so now if we screen these asthma patients and find that their blood has a lot of these eosinophil cells, there are injectable asthma medications that came on the market about probably at this point eight or nine years ago. Some of them are once every two weeks. The other one is every month and there's one on the market that is once every two months. But basically the bottom line is that these medications block these allergic cells, these eosinophil cells in the blood and with that they make the patient much less prone to severe abrupt asthma attacks. They tend to work very well for the right patient. They also tend to be very expensive. Is that true? They are expensive. There is a lot of... So the insurance is pretty well recognized the value of these medications in keeping people away from having bad enough flare ups that land them in the emergency room in the intensive care unit or God forbid on a ventilator. And also these medications decrease the need for taking steroids like prednisone on a long-term basis, which have a lot of long-term side effects. So keeping people healthy enough not to have to do that overall is a major healthcare saving. So I think that insurance companies by now fairly well recognize that and they usually cover one or the other medication. They may not cover all of them. And most of the drug companies have also have some patients assistance programs. So for the right patient, if the financial constraints are an issue, our clinics are definitely well worth to help them figure out a way to get them to one of these medications. Sounds like with COPD we've made some progress, but with asthma we're probably making even more progress toward controlling the symptoms controlling the disease. I think that this is true that I think that these injectable medications were groundbreaking. There is another big new change coming in the asthma world. Also the national asthma guidelines and the GINA guidelines, which is basically the two big guidelines of our therapies are now have changed and they're kind of getting into the pulmonary and primary care communities basically starting these what they call smart asthma therapy. And it's a huge paradigm shift in the way how we think about asthma and how we think about asthma care. So I think it's going to take some time until everybody will be comfortable with that mindset. But basically what we used to have controller inhalers that the person had to take every day, no fail all the time. And then we had Albuterol which was what we called an rescue or emergency or as needed inhaler. The new guidelines are especially for mild to moderate asthma are really prioritizing using one specific maintenance inhaler that has a combination of a steroid and a long acting bronchial dilator to be used on an as needed basis, which was never before kind of the mindset. So this is going to be very interesting. So let me ask you this, if a patient whether either asthma or COPD is seeing their primary care provider and they're still experiencing some difficulties, when would be a good time for referral to pulmonologists such as yourself? So I think that if, first of all, if there is a question about whether or not we have the diagnosis right or wrong, it's always a good time to refer because we have more tools to try to really make sure that the person who's complained was coughing and shortness of breath and was labeled with asthma actually has asthma and we're not missing some other diagnosis. I think if the person has like a mild intermittent asthma, very seldom has flare ups. Generally is in good control. I think it's appropriate to stay with primary care. If there is frequent flare ups or a feeling that the current medication regimen is just not controlling the asthma well, it would be a good time to refer to pulmonology. And I think that sort of the same holds true for COPD is if the treatment regimen has to be escalated and even that's not working well, it's not a bad idea to kind of have a referral. Let us see the patient will give treatment recommendations or will co-manage with primary care, depending on a lot of the different variables, how far the patient is coming from, how comfortable they are with taking back the management or how much they want us to co-manage. I'd like to move on to talk about sleep apnea, which I know you're very involved in. You run the sleep lab at Rutland Regional Medical Center and have done some special training in sleep studies. It's a very common problem. We see it in primary care quite a bit. Certainly as the population has gained weight over the years, that has exacerbated the problem because often it's associated with overweight. Can you talk a little bit about what is sleep apnea? How do you diagnose it and how you treat it? So sleep apnea is a very common problem and it's becoming more common in a pediatric population as well. So we're seeing both adults and kids with sleep disorder breathing in our clinic. In terms of sleep apnea, there is actually two different kinds of sleep apnea, but when we say sleep apnea, we just mean what's actually called obstructive sleep apnea, which is about, I would say, 90-95% of the people with sleep apnea. But there is this minor group that is a central sleep apnea, which is a completely different disease and treated differently and has very different risk factors. But since that's a pretty small portion of the pie, I would focus on the obstructive sleep apnea just right now. So that is related to the upper airway getting actually obstructed by either the tongue pushing back or extra tissues around the neck, just the weight of the tissues as we fall asleep kind of falling on the main airway or the jaw pushing backwards and again obstructing the upper main airway. And that is what results in snoring. And when the snoring ceases and the actual obstruction happens, that's when people have the apnea, which is a pause in the breathing. And the main danger of that is that when somebody is not breathing for 30 or 40 or 50 seconds, there is no oxygen coming to the body. And from there, since there's no oxygen coming to the lungs, there's no oxygen going to the blood system and to the heart and to the brain. And overall, this could be very damaging to our vital organs. And how do you diagnose sleep apnea? The sleep apnea is diagnosed with what's called a sleep study. There is basically two ways of doing a sleep study. The gold standard being an in lab sleep study where the patient comes in, spends the night in the sleep center and we monitor 18 or so different parameters, including brain waves and breathing and oxygen and respiratory effort and heart and limb movements and all kinds of different things. Short of that, for the right patient in an appropriate setting, there is also something called a home sleep study that can be done, which is kind of a little bit more rudimentary assessment. More specific to just sleep apnea does not really assess for any other sleep disorders. But again, for the right patient, it could be a little bit more expedited way of getting a diagnosis and moving on to treatment. So that would involve the patient thinking. And let's talk about treatment. Once you know that someone has at least moderate to severe sleep apnea, what are the treatment options? So for severe sleep apnea, really the best treatment option is to use a positive pressure machine, either a CPAP machine or a BiPAP machine, which basically generates an extra force to the air, which is that goes through a mask and it basically keeps the extra tissues aside and serves like a pneumatic splint. It splints the upper airway open. That is what's approved for severe sleep apnea. Now, for mild to moderate sleep apnea, the CPAP machine will still work just as well. But for those folks, there are other treatment options. So weight loss definitely helps. But for the patients who are not overweight, who do not have too much extra tissue around the neck, there's also something called an oral appliance, which is a dental device made specifically by sleep dentists. And it's something that the person only wears at night. It fits over the teeth and it basically gently incurs the lower jaw to the upper jaw and jaw from flopping back. For kids especially, but some adults, tonsillectomy could make all the difference, especially if we see children with very large tonsils and some sleep apnea that could solve all of their problems. The uvula resection and pharyngeal aplasty is kind of falling out of favor, not great results overall for adults. But then under commercials, I'm sure your viewers are seeing all the time about the Inspire device, which is a nerve stimulating device that is almost like a pacemaker built into the right side of the chest wall. And the pacing wires are going to the nerve that innervates the muscle that holds the jaw in place. I certainly know from my experience in primary care that when people have their sleep apnea effectively treated, they feel so much better. They have more energy during the day, they can concentrate. A lot of things improve. This is one area where definitely I would think people should be seeking out a specialist so that they can get diagnosed and treated appropriately because most primary care providers are not set up to necessarily diagnose and treat sleep apnea. Let's talk briefly about lung cancer. This is lung cancer screening month, traditionally November, although it should be year round. What are our screening options now? Who do we screen for lung cancer and how do we screen it? The lung cancer screening guidelines changed just within the last few years. But the idea is that patients who are smokers, active smokers or who have quit within 15 years should be screened for lung cancer. Based on the new guidelines, this is now age 50 and above, active smokers and people who have quit within 15 years. And the smoking history also has changed, but basically the equivalent to one pack a day for 20 years is the new guideline. So if somebody either smoked in the past, one pack a day for 20 years or two packs a day for 10 years, they would qualify for the screening. The screening is done with a CT scan, which is a picture of the lung, a little bit more sophisticated than an x-ray, but doesn't take a whole lot longer than doing a chest x-ray. And in fact, the radiation dose used for this particular CAT scan is not a whole lot more than a chest x-ray, a little bit more, but not a whole lot more. This does not require contrast shot or contrast administration, so this is a non-contrast CT scan once a year. Our insurance companies, under the guidelines you just talked about, are insurance companies, most of them covering this now? Yes, so this is mandatory coverage by the Affordable Care Act, and this is part of just like our mammograms and colonoscopies that are mandatory covered for the right patient, and it cannot be counted against the person's deductible either. As we know, lung cancer remains the number one most common fatal cancer in the United States, but the numbers are improving. Certainly a lot of that has to do with far less people are smoking or smoking heavily in the United States now, but is some of the difference you think from the screening? Absolutely. So I think that the difference comes from two major improvements and major advancements in lung cancer care in the last 10 years. One is the widespread availability of lung cancer screening. We're actually finding much smaller cancerous tumors when they are surgically resectable and curable, and the other advancement is just in the surgical techniques and the radiation techniques that we use now. The survival rate for small cancers has improved a great deal. And some of the chemotherapy is becoming much more specific for the kind of cancers that people often have. In the remaining time we have, let's talk about COVID. You've taken care of people through the COVID epidemic, and it unfortunately continues, although perhaps not as severe as we saw in the first year or two of the epidemic. In terms of people's lung function and pulmonary function, how is COVID changing? And also, could you talk a little bit about long COVID and how that affects people's lungs? During the acute COVID infection, some people, as you know, get through it very quickly and without much problem with a little bit of a runny nose.  It's still difficult to tell or predict who is going to do well or who is going to do poorly. But certainly, immunization against COVID has made a big difference in how well people did overall when they got infected. The people who do end up in the intensive care unit or on the ventilator tend to have the COVID lung infection involving more deeper parenchymal tissue of the lung, causing a lot of inflammation, kind of swelling inside the lung tissue. When that heals, it can heal with scarring, and that could be a permanent damage to the lung tissue and make the lung kind of more of a stiff, rigid organ and not be able to process the oxygen so well. So that could be a long-term sequelae of having severe COVID lung infection. When you see a severe form of the COVID that's affecting the lungs, are there any, aside from the couple of the IV medications or Paxlevid, are there any specific pulmonary interventions that you think can prevent this scarring? So there's very specific, so it depends on how sick the patient is. But for very severely ill patients, especially on a ventilator, there are specific ventilation strategies that we use for COVID. One of them is using the prone positioning while the patient is ventilated and changing the positions, using some IV steroids as well as the antiviral medications. Well, it's been a learning process for everyone, obviously including the pulmonologist and critical care specialist such as yourself. We've covered a lot of topics here in a short period of time and really only scratched the surface, but I want to thank you for being here. It's been really helpful. Dr. Veronica Jodlowski is the head of pulmonary care at Rutland Regional Medical Center. Thank you so much for being here. Thank you for having me.