Hey, guys, what's going on? It's Andy Elliott. I'm here with my man today, Alex. Listen, he is blowing up in the industry and building an army. And a lot of people are asking, man, how do I be a part of this? And number one, who is this guy? Where did he come from? And how is he doing it? In this video, you're going to learn a lot about this guy right here. Are you 28 or 29 now? 29. 29, dude. And some of the stuff he's doing is insane. If you're looking for a big life, watch this. You could be a part of it. Burning that bow dance. I like to fire cause it makes hand. I'm not tired. I've been waiting. I'm not forsaken. All right, guys, so here we are. I'm here today with my man, Alex Smith. I know you guys have seen a lot of Spartan army, Spartan solar, and Andy Elliott running together, right? Something that's super important is you need to understand. I called this going to war in 2024, OK? The reason why, because I think a lot of people are losing their edge. I think a lot of people from 22 to 23, they did good in 2022, made a lot of money. But from 22 to 2023, they went backwards. They went down. And when you go down, you need to self-correct immediately. So our whole goal today, and we're going to call this a podcast, a meeting, gathering, a training, whatever you want to call it. Yeah, war room. Well, we're going to back out of the plane crash for a minute. We're going to step out of it. We're going to go 20 feet back, look at the plane crash. We want to say, hey, number one, why aren't people kicking ass? So I'm going to ask Alex some questions, right? I want to talk to you. And obviously, I want to talk about why is Alex growing so fast? OK, like why is he growing so quick? And I want to start somewhere. I'm going to strike him quick. And I want to tell you this, that one of the reasons why he's been able to build so fast in the last 10 months was because you got betrayed. Oh, yeah. OK, listen, by the way, let's not give any names. But I want to talk about how it feels to get betrayed.  Was it when somebody goes, hey, Alex, I really believe in you, man. I believe in you so much. And you're going to do amazing things. Did that make you feel like, oh, man, yeah. All right, dude, I'm capable. Let's go. Or was it when someone goes or somebody betrayed you or said, hey, man, you're not going to make it? And they literally try to dismantle your company, break you down, break your spirit, OK? Which you never let someone ever do. Write this down. Never let anyone break my spirit. I watch people in a basketball game. I watch them. And what do they do when they get tired? They put their hands on their knees. Don't ever put your freaking hands on your knees. Because if I see that and you put your hands on your knees, I'm going to crush you. I'm waiting for you to do that. I'll go 20 times harder when I watch you do that. But you got crushed, right? You got crushed. And let's talk about that for a minute. So someone in your company left. And by the way, tell them what you do. So I own a solar company, CEO of Spartan Solar. I've been doing this for seven years. I was the director of sales of two other solar companies before starting Spartan Solar about two and a half years ago. And along that journey, though, before massive adversity hit, which we've talked about and I've talked openly before, I've started at zero a couple of times.  I put myself in a place of failure. And I had to rebuild from my own doings.  You have to accept it. And you have to move on. Hey, can I say this? He said awareness. Listen, I want you to understand something.  And you're going to need to become aware.  So I'm just wanting to make sure everybody understands.  But then they see it. They know they need to make a change. They don't make a change.  They start letting their self-awareness fade away and they start accepting the reality of whatever is in front of them. And so they stop reflecting. They stop introspecting. And it all becomes whatever else everyone gives them. Yeah, so you basically stop owning your life and the world owns it. And you see when people die, right? A lot of times we hear that expression.  You might die at age 30. Yeah, you're alive, but you're dead. You're not living. And that's because you stop being self-aware. That's that moment that happens and then you start trending downwards. Got it. And so throughout the journey, I started zero a couple of times again, self-inflicted in the beginning, went through some personal trauma, surpassing a lot of death in the family. That caused a lot of a downward spiral I've never experienced before. Rebuilt. So then I realized one thing and you probably experienced this too. When you can go back to zero and you can have everything taken away from you, everything that seemed to mean the world to you, and then you can rebuild it back and you do it better, that builds a level of self-confidence that nothing else can ever give you. That's it. Because a lot of people, they'll hit zero, they hit the floor or even below the floor and then they quit or then they just continue to cascade downward. And when you've never built back up, you don't have this little, David Goggins calls it having the cookie jar. Cookie jar. Right, you don't have that. So I had it there and then I did it again. I started at zero two years ago, two and a half years ago before starting Spartan Solar. So I built another company up, built their internal sales team they didn't have before. I decided I was gonna take a bet on myself and start Spartan Solar because I believed I could do something better. I believe I could do it bigger, I could do it better, and I believe I could be a better leader. Hey guys, what's going on? It's Andy. A lot of you leave comments telling me that you need help. Do me a favor. I'm gonna tell you the best way to get a hold of me. Shoot me a text message right now,<PHONE_NUMBER>.<PHONE_NUMBER>. I'll help you with whatever you need.  Let's get back to the video. In 2024, write this down.  You're gonna put your back against the wall and you're literally gonna say, all right, God, what am I made for? And it's your time to attack, initiate and make that happen. And I wanna tell you something.  I don't care who doesn't believe. The fact is that you believe it will work. Okay, so let's go to that. So in November, you get betrayed. Yeah, lost. And by the way, a lot of companies go through this but I wanna talk about the comeback. Guys, 2024 is about being an overcomer. Okay, go into war with yourself.  This guy doesn't know. Listen, dude, everyday life's a war.  Okay, so, so you get betrayed, right? No, I'm gonna dive into this. So I lost millions of dollars unexpectedly. Everybody is thinking they're gonna get paid because I have to get paid to pay people, right? Because in our company, the reps have always made the line share. So that's just how it works in solar. That's just how it always works. We gotta get paid then we pay everybody else. Didn't get paid, kept promising getting paid, wasn't getting paid. Eventually that company just never paid. And so I sold a bunch of Bitcoin to get the money so I can pay people and money I never got. While that was all happening, I had a leader go behind my back and just plant seeds of doubt in everyone's head as who I was and the way I was operating almost make me look out to be the bad guys if this wasn't actually happening. And overnight stripped away, right around Thanksgiving time. Right around, right now. Literally. One year.  I was on a dock in Tampa, Florida and I got a phone call with one of my leaders, Zach Crotty, and I'm talking to him. He's like, where are you gonna be on Tuesday?  He's like, man, I'm not to tell you this, but I don't think you're gonna be coming back to an office because he had the inside information and he was the first person to let me know what was happening behind the scenes. And at that moment it was like the whole world was shattering. He was like, it's just not Orlando though. It's everywhere else too. Okay, so let's talk about that for a minute. Anybody right now that's ever been betrayed, that's ever gone through something, let's talk about what happened next, what you did next. And this is what I want you to think about. So at that very moment I spent the next six hours on the dock, well there's about, I would say about, I asked him, what should we do? What would make this make sense? How can we build back and build back better? And so we went back and forth and I'm like, dude, I wish you would have said some of this stuff sooner. We could have made some of these changes sooner. I should have been more, I should have asked more questions. I started to take some responsibility there. But right after that phone call, we came up with a game plan of what would work, right? To retain some of the talents.  Because losing all the money while losing all the people is a bad combo, right? And so at that moment then I, so it took that five minutes to like, kind of like cry, right? Like cry internally. I don't think I actually physically cry, but I was internally crying. Either way, it's cool. And I was like, all right, I'm done. And then I started making phone calls. Spent the next six hours calling every single leader in the company, everyone that has any influence. And I started to feel out where they were at. Because I didn't know who was who at this point. I didn't know who I could trust. I didn't know who was with me, who against me.  I just wanted to know who was who. And it was really hard to get to the bottom of that because people always want to tell a story when they're on the phone with you. And so it took six hours to dive deep and felt like I got a good foundation of who was with me. Now it wasn't perfect, right? There was another, I'd say another bomb went off a couple weeks later where other people, again, removed themselves. Yeah, so the company basically got dismantled. You lost a lot of money. You did the right thing. You got people paid. You're sitting here.   Or rebuild it, all right? Let's talk about the rebuild. By the way, can I just skip to something really quick? How do you feel today, a year from when the bomb went off? How do you feel today? Dude, I'm gonna take over the world and I'm on top of the world. Okay, so everybody right now, call your shot. We're sitting here where we're going into Thanksgiving. I don't care where you're at today. Okay, let's fast forward a year from now. What will you be saying?  Okay, because if I would've interviewed him last year at this time, he would've sat here, weeping, whining, complaining, and hey, it's totally cool. And so would I.  But now, you're stronger than ever, okay? Let's talk about your mindset. How's your mindset today? It's become bulletproof. Okay. I keep an edge every day. How's your physical condition from a year ago to now? Man, if we could throw some pictures up right now on the podcast, the show, before and afters, I'm gonna throw them up. It's insane. Okay. It's drastically different in every way. Okay, good. Isn't that crazy? Okay, what about your team? What's the loyalty like? We don't have people that aren't trustworthy in leadership roles anymore. The same leaders we bring in the last leadership retreat are gonna be on the next leadership retreat. We don't have a retention issue anymore. Yeah. We found our core. And by the way, listen, you guys speak direct in your company, don't you? Oh yeah. Okay, what about the sales people, the team? How are they compared to the last team? I would just describe it like this. The team we have now is selling more solar than they've ever sold before personally at any other company if they were with another company. And for me, I just know that we have a team that excites me, enthuses me, and I know they have everyone's best interests at heart. Like it's a team that all want the same thing. They all believe the same things we believe. They're going to the gym every day. They're doing the Murph on Sundays. They're working hard. They're early to bed, early to rise, work like hell, advertise. A lot of them are stopping drinking. They're not taking drugs. They're doing all the right things to feel good and I just feel better because I know who they are. And I don't have anyone in the company that falls into the category of, he's a little suspicious. Like I just don't really like the way he moves. I don't really trust him. I don't have any, I don't think there's anybody in this company that operates under that guy. So basically Alex, what you did, and then let's talk about how you started to build this, okay? But you basically went from having a normal solar company with systems, processes, hire anybody who's willing to work hard. The leaders were people that were good at selling solar. They weren't necessarily great people. They were people who were good at selling solar because we needed to make money. Right, but you needed to make money though. You went from literally the we need to make money aspect to I'm gonna hire people that I believe in and I'm gonna self-invest in people. I'm gonna self-develop in my people and I'm gonna grow my people. And you took people that are us, that are you, that are like-minded, hungry people all around the world right now. And guys, by the way, if you're watching this right now and you're like, man, dude, I'm looking for a new opportunity. I wanna be very, very clear, okay? How many states are you in? We're active in 30 states and we have high-level leaders in about six states. Okay, so listen. You said- And we need more leaders and we need more core. Right, so you need to understand this. The opportunity, you guys are building more leaders right now every single day, am I right? Yeah. Okay, so the level up, the opportunity to grow in your company is massive. Big picture shoes for anybody. By the way, when all that adversity hit, one of the biggest things that I changed was the entire business model. Most companies are built to create these huge stacks of people that get paid before the sales rep. The new person coming in gets paid. We wanted to figure out a way to start everyone at the floor so they can offer the best experience, the best price, the best everything to homeowners, the customers- Yeah, can we talk about that real quick? So you guys have, you guys are one of the top solar companies in the world becoming one of the top solar companies in the world. And I wanna say this, can you talk about that? You know, one of the things that you talk about a lot is that customer service is number one, right? You talk a lot about, hey, the solar space has been full of amateurs for a long time. People have gotten misinformation, they've gotten misquoted, they've gotten lied to, and you don't stand for any of that, am I right? Yeah, there's so many companies out there right now. Even some of the bigger ones, and I'm very aware of how they operate, but they're under this impression, they accept all business. They accept all business as good business. When you look under the hood and you see how they do business, they just mislead a lot of clients and they're still trying to prop up those numbers if they're real and tangible. Let's talk how you do it. Because your people love working for you. I get on the meetings with Alex's guys and there's a thousand of them and they're sitting here saying, I love the leadership, I love what we do, I totally stand behind the process, our customers love us. It's amazing and they're getting paid really well. So let's talk about that for a minute. And by the way, so good job, totally recreation from last year until now and then let's also talk about like, where will you be next Thanksgiving?  By the way, what does this mean to you? Well, number one, sometimes I like to listen to someone talk about their life.  And by the way, you started coming to training events all the time. You started bringing your people and dude like literally start self-developing and not only did you find the right people, but dude, you believe, which is what I love, that you can build anybody. If you wanna do the right things, if you're a good person and you wanna sell solar, which solar is great for every homeowner in the world and you wanna sell it the right way, it's heaven on earth, you can get paid great and you can work for a great company.  I don't want my guys drinking. You go, I want my guys to have good families. I want my guys to go into bed on time at night. I want them waking up early and hitting the gym. Dude, it sounds to me like really all you wanna do is make people greater and give them an opportunity to build a lifestyle they could never have. Well, I'm just realizing there's a lot of weak men getting created in society right now and it's not even their fault. It's just, it's actually what's pushed as being good as being weak. So do you? I wanna course correct the world as much as possible right now and bring people in that are, they haven't found their home, they feel a little lost, they haven't figured out exactly what they wanna do in life. They aren't dialed in physically or mentally. So it's a massive mentor. It's a massive mentor. I wanna shift everyone into a strong, I wanna create strong men and women. And when you create strong men and women, guess what? They can do the same. When I started really taking care of myself, you asked how I was a year ago, I wasn't taking care of myself like I am today. I don't lose my edge. Monday through Sunday, I keep my edge. On Sunday, everyone's off day, I have an edge day and that's when I do a mirf and I do a challenge.  So once I started to really take care of myself, it became very easy to take care of other people. It came easy to take care of my leaders, to take care of the company, to take care of operations. But I didn't have this much time invested in myself previously. I didn't realize how important it was to never lose your edge. I used to think off days were a good part because it starts to get preached that you should take time to rest and there is a place for rest but I don't like defining anything as an off day.  I would rather keep my edge seven days a week. Especially when you're building a new life. And not in the build phase. Not if you want something new. If you want the same thing, you don't need an edge. But if you want something new, you wanna create something no one's ever created before. You wanna give someone something they've never had before. It is your responsibility to keep your edge for them. I have to do it.    You have to kill the going out. You could keep doing all that stuff if you don't want that though. But I don't think anyone I work with wants to live that old life. They want the new life. They wanna recreate themselves. Something you talk about all the time that's implanted in my guy's heads every day. And that was daily recreation. Yeah. And by the way, how important is it? And listen, you're all leaders. Everybody watching this right now, you are all leaders. Just so we're super clear. And now that you're deciding that I'm a leader, which some of you are badass leaders and some of you are becoming new leaders today, you must hold the standard for your team.  That's why I'm here right now. Yeah, right. But I'm just saying like that's a big key deal.  Super important. You talked about like helping people. Not everybody is lost that comes to work for you, but it seems like you believe a lot in people that have been through adversity, that have had struggles, that have gotten betrayed, that have gotten burned and they're looking for loyalty and they're looking to not be lied to. And they're looking for a home and a place to be accepted in and join. And that's why you call it an army, right? Like your shirt says Spartan soldier, right? Yeah. Can you tell us, men and women? Oh yeah.  And then also, how can they join you? So the biggest thing I'm looking for is full alignment. And what I mean by that is I wanna work with people that believe the same things we believe. And how do you know if you believe the same things that we believe? Watch our podcast. Watch the way we communicate. Watch where we speak. We have a Spartan Way podcast where we talk about everything we believe and everything we do. We show it on social media. Sometimes people think social media is a facade and it's putting on a show. That's not us. This is the same inside of it. Yeah, I'll tell you, this is how he lives. You're the same way as well. And so if you can believe our message, which I think people need to become physically dominant. I think people need to take care of themselves. I think people need to go deeper and take care of what's getting put into their body. I think people need to take care of what's getting put into their mind on a daily basis. I think that people need to start taking care of other people more. And you always bring this up and it's ingrained in my brain now, which is you gotta out-care the competition. I want people that care a lot about themselves and then they're gonna care a lot about everybody else. And if you have full alignment with our beliefs and what you say, think and do, and one of our expressions we bring up every single day, which is early to bed, early to rise, work like hell, which is you gotta go produce. You can't just, you can't live this Fugazi, Fugazi, I'm an advertiser, I'm gonna show you how great of an influencer I am in the world. You have to go produce. 99% of the world. You can't, everyone skips this step. They wanna go straight to, I'm gonna advertise how great I am and talk about how I'm a guru. They're like, no, no, no. We need, and you told me this one thing and it stuck in my head. There's perception as reality. We're gonna always be bigger than we are, right? Everyone's gonna see how big we're bigger than you can imagine. But then there's the truth, which is one, which is black and white and that's results. We have to have results and then you can go advertise. I don't want anyone on our team or anyone in the company to advertise their way. And by advertising, I don't mean saying, hey, come sell solar with us.  Show the way you work out.   And treat your family. Show how you're with your family, with your team. And if you can live by that alignment with us and then you're internally engaged, there's two other categories here. You're highly internally engaged, meaning we have a company chat that blows up every single day. Everyone is firing up for everybody else. And it's really cool to see because people are just celebrating their own wins, right? People are just celebrating just their teammates' wins. They're celebrating every team's wins within the company and they're allowing everyone to co-collaborate and cross-pollinate, which makes everyone better, faster. So you gotta be internally engaged and then the advertising side is the external engagement. You have to be engaged with the world. You have to, and that shows me that you're proud of what you're doing here. If I don't see you engaged on social media with what you're doing at Spar and Solar and what you're doing in your own life, I don't even think you'd like your own life. That's facts. Hey guys, what's going on? It's Andy. A lot of you leave comments telling me that you need help. Do me a favor. I'm gonna tell you the best way to get a hold of me. Shoot me a text message right now.<PHONE_NUMBER>.<PHONE_NUMBER>. I'll help you with whatever you need.  Let's get back to the video. Because I think if you're excited about what you're doing, you just want to share it because you know it's infecting you in a positive way. That's right. So if you can do all that, guess what? I'm gonna have a high level of trust to work with you and anybody have a high level of trust, I know I can move really fast. And if I can move really fast, speed and trust, right? Those are our words for this year. I need to have a lot of trust so we can move really fast. If we can have both of those things, we'll turn you into whatever you want. We'll make you go from broke to a millionaire in a year. That's something we can do.  Then I don't have any friction in my heart and I'm excited to work with you and I can pour everything I have into you and soak in my leaders. Yeah, and your leaders operate the same way you do. Oh, all day. Which is why I love it. And you got one of them here that's a badass. He follows just like you. He's put on like 25 pounds. Yeah, he looks like a different animal. Anthony looks like a killer. Okay, super important. If somebody wants to join, if they want to join, they can go to your Instagram, right? And there's a link that's in your bio. Is that correct? And also there's a link in my bio but there is a link in your bio. And tell them how that works. They click on it, they answer some questions, send over a 30 second video and then you'll reach out to them. How does that work? So you can follow me, it's Alex H. Smith. And if you go on to my Instagram, you'll see it in the bio. All of our guys have it in their bio too because we wanna bring people into the army that follow exactly what I just said. Once you fill it out, there's gonna be a video with me and Andy talking a little bit about what we're doing here and we kind of went into that for a second. But once you fill out the questionnaire, there's gonna be a part where you have to attach a 60 second video. This is where, and I'm looking at all of you guys right now, you really gotta sell yourself. Like the way we watch these videos and we send these videos around to one another and there's some videos that are a joke and you're not even gonna hear a response from us. But then there's the videos that people are like getting after. They're in the gym, they're talking to us. They're speaking the way, they have high energy. They come prepared. They come, what feels like, ready for war, right? And since 2024 is that we're going to war, I need you to sound like you're ready for war. And if we see a video like that, guess what, you're gonna get a screening call. That's a call where we're gonna have someone on the backend team, maybe myself, reach out to you and just see if you're the right person just out the get go.  And after that, you're gonna get an interview if you pass that test. There's a few tests that you have to pass because again, before like you mentioned, I used to bring in everybody, but now I'm so freaking careful. You guys vet, by the way, only good companies vet. So careful. Okay, any place that you can go and show up and you're breathing and got a pulse and you can get a job, you do not wanna work at. You want it to be a vetting process because your team, they trust that when you bring someone onto the team, right? That it's someone like-minded to like them. They trust you guys and that's why this process is so cool.  Am I right?  Like you don't have to be selling solar to come work for you. You can literally be a responsible person that is ready for a new challenge, that's ready for a new life and maybe if they don't do all the things that you have talked about right now, but they are ready to do that. You have to want to do it. Yeah, yeah. But I think deep down everyone wants to do it.  Yes. And if they're ready, there are leaders that will help them develop all of this. All of the training. And the cool thing I love about your company, the way that you have set up, really nobody even sells anything. It's really just helping people.  But anyways, as you got betrayed, you literally went back, you rebuilt.    Yeah, at that time. So this is the crazy part. So come January, it's just 30 of us. So kicking off January the new year, I'm at a low, low in my life. I go out and blitz with some of the teams, go out selling with them on the doors, take an Airbnb and just what blitz is basically when you work around the clock, morning till night for 10, 20 days straight, because we have to create momentum. Yeah, it was grind time. It was grind time. Created some momentum, started seeing some success. We really figured out who was all in. And that was just 30 people in January. In June, we were at 86. Now, flash forward to today. We're at about 400 people. But not just 400 people. The thing that happens during adversity and a big challenging moment like we had before, I like to look at it like this. So when you bring out someone, and I already knew some of these people should have been removed from the company, but I didn't ever take action on it because they're still there. I don't know what it is.  No, no, it's a, I call it avoidance because it's a fear making a mistake. Because inside internally, you think you can fix everybody. That's a good way to look at it. Yeah, yeah, I call it avoidance.  So like, you're like, I can fix anyone. And the fact is, is that, bro, you can't fix everyone. I'm sorry to realize that. Yes, and listen, and if they're not like minded and they're not like you and they're not doing the stuff, then the fact is, is that there's a good chance that they're probably not happy and they're probably tainting the rest of your team and they're probably being cancer to the rest of your team. So you must let them go. How I explain it is that, do listen, I want to be happy and you want to be happy too. Okay? I need you to work here to be us. Listen, listen, there's us and then there's you.   I need you to be us.  And that just opens that up to your team saying, hey dude, we don't tolerate people who aren't us. And it's, hey, and it's not that you're not bad.  It doesn't mean that we're better than you. What it means is that we hold ourselves to a level of excellence that we're not gonna tolerate it. And by the way, isn't it cool to be positively peer pressured to be better? Like write this down, positive peer pressure.  Dude, listen to me. You don't have to do anything. Okay? You don't have to stay attractive. Okay? You don't have to have a lot of money in your bank. You don't have to get financially free. Okay? You don't have to care. You honestly don't have to do any of this because honestly, 90% of the world doesn't. And the fact is, is at the end of their life, they're gonna be sitting on a bedpan saying, I wish I shoulda. So we're not. And so that's the reason why like, I love that we get out there and say, and by the way, you know what's cool about this podcast, like us talking, is that people can make a choice right freaking now.  But if you're watching this right now and you're looking for an opportunity in 2024 to destroy it, if that is the case, you need to go find Alex right now on Instagram, AlexHSmith, and literally go into his bio and go through the questions, which are very easy. It's just we wanna understand you and literally make a video. And when you make the video, the eyes of the window to the soul.   You can just tell if there's a level of care in which when they made the video that they want to be with you. They want to be a part of you. Not they have to, they want to. Most people feel like they have to work. You want people who want to work, right? And that's it. And by the way- We don't micromanage so- Oh yeah, that's what I was about to say. What I love about your company is that you always say this, I'm not a babysitter. So like, if you're wanting to win and you wanna be the badass you always said you do, we're gonna give you an opportunity to do it. Now the one thing that I wanna say, this is super cool, is you give your people the tools and the resources to become great, right? Can you go into that? Like what kind of resources do you give people when they join you? Not just the opportunity. I'm gonna touch on two notes. Okay, let's go. So one, and you brought this up and I wanna clarify it. Like a decision happens in an instant. A decision to make a change happens in an instant. Now it can take you six months, a year to make that decision to change, but a decision happens in an instant.  So a good example of this, if you wanted to stop drinking, and this is what I did when I stopped drinking over two and a half years ago, I knew I wanted to stop for a while, but the decision happened one day when I was like, I can't do this if I really wanna become who I wanna become. I can keep making about a million dollars a year at this level when I'm drinking. I was like, that's not for me. And I was like, I'm no longer gonna be the best leader for a lot of people if I continue this. Even if it's just once a week, it just can't happen. So on that decision, it happens in an instant. Same with like deciding to make a change physically.  That's an instant. And when you make that decision in an instant, the next thing you have to do is you have to start rewiring your brain. And so for me, for drinking, for example, I rewired my brain to feel immense pain every time I saw it. If I saw someone drinking, if I saw someone, even if I was around it, because I still wanted to be around it because I didn't wanna shelter myself from reality, I would look at that and just feel the pain they're gonna feel the next day. And basically put yourself in their shoes. I just put myself in their shoes and I felt the infliction and it's just like, I can never do that. So you need to rewire your brain after you make the decision.  You have to see pleasure in not pain in it because a lot of people will continue to feel, oh man, I gotta do this, I gotta do that. But no, you have to just course correct your brain. Find joy in being different. You gotta do that. Yeah, like, hey, and I wanna say this to a lot of you guys. Because then you can walk in and keep going. That's right, like, dude, I walk into an airport and I see 95% of the people look the same.  You know what I mean? And like, that's my point. Well, they're walking through the airport with you. Even if people don't know who Andy is, it's bizarre. But him and Aaron, I think maybe the bald heads. But when they're just walking around. Well, my shorts are so short. And then Aaron's so big. They're like, dude, where are these guys going? These guys gotta be doing something big. People just stop them for, they have no idea who they are. They're like, I just feel like you're somebody. And I'm like, that's how I wanna be perceived everywhere I go. So I'm gonna change my life to where, and now it's happening. When me and Anthony are walking around, we get people stopping us now. We're wearing the same gear. We're looking different.  I feel like you're somebody. I'm like, oh, we're doing something right now. Cause people that don't know us think we're somebody. Can I ask this question? If somebody's watching this right now and they're like, dude, all right. How do I get everything that you're talking about? When you join Spartan Solar. Tools. You provide them training. Oh yeah. And obviously I train all the guys as well in the leadership, but you also provide them exercise programs. Am I right? Yeah. Okay. So there's a few folds. When you come in through onboarding. Let's talk about the self development Spartan Solar offers people. So the biggest thing, most companies when they're trying to scale, especially a lot of the sales companies trying to scale, they just try to throw anything at the wall and see what sticks. And that approach can work, right? To a certain degree. We want it to take a very different approach where that's why we're thorough with when we vet people to see if we want to bring in the company. Cause if you are a good fit and we're not even good fit, we're just excited to work with you. That's what it comes down to. We need to feel excitement because we're then going to pass you on to our leaders and you're not going to be just told what to do from afar. They're going to be physically with you, teaching you. So not only are you going to get all the tools, the technology pieces to scale, right? You're going to get the technology pieces to get better, the training platforms online. You're going to have the stuff you need so you could do things at home, right? Which is an important part of learning. But I think one of the biggest components is you're going to be with leaders that actually care. They're hands-on. Leaders that are going to take you out on the field. They're going to show you exactly what it is you need to do so you can get your language right. Cause once you learn what to say, like solar cells itself, it is very easy to start. Yeah, can we talk about that new guy the other night? You sent me a picture of. Oh, which one? Brand new, the guy that he sent the video in, filled out the questions, right? And then went through the vetting process, right? You said he was fired up, ready to sell. He goes, I love Andy Elliott, ready to win. He's like, dude, just tell me what to do. You guys brought him on, first day one, tell him what happened. So day one, he was out. I mean, this is what happened. So I want you to understand day one. He took action. So he took action. That's the thing, though. Some people can come into any company, and the company can't just make you successful without you wanting to do it, right? Right, but our people know that. Yeah. They're hard workers. Anybody that's watching this that will go fill that out is ready to go work on. You're the hard worker, right? So you come in and just do what the leaders say to do, right? So guess what they did, and he did. Me coach him. He went out into the field with the leader. The leader's showing him what to do out there, communicating with clients, communicating in the comb with the clothes. Everything they need to do, he was just there and put himself out there and did not pause. He just immediately attacked. And day one, he's out with Nick Murray. Day one, he gets a sale with one of his leaders. And the leader's hand-holding him, right? So he's doing a lot of the work for him, helping him get paid right away. Because our leaders care, right? Because he could easily say, this is all me. Yeah, and so what could a guy get paid on something like that? Customers are happy. I just want to ask. And give me an average. I mean, if we're a good job, customers happy, right? Leader helps him. He's training, self-developing. He's in a great company now. Day one on the job, roughly, what will that guy make? Day one, if you're coming in brand new in the beginning, you're a setter, right? So you have to learn every part of the job. So day one, you're going to be making about $2,000 to $3,500 a job as a setter. OK, so that guy made anywhere that guy was out in the field for a couple hours with a leader, hands on, and made anywhere between $2,000 and $3,500 for that. I mean, they can make up to $5,000, $6,000. But I'd say average we're looking at, probably $2,000 to $3,500. But my point is, is that look, how many days do you want to work a month? OK, $20,000. Let's just use an example. Could you work hard with a great team? Give it all you got. In 20 days, 20 days times $2,000 on the low end average, or $3,500 on the upper end on average, is $40,000 to $80,000 a month if you could find a sell every day. Which there are guys who find them every day, because whatever you're looking for, you'll find. I want to tell everybody that all I care about, and all I've lived for since I started my training program, was finding people who want to win, and then training them to crush it and kill it, and whatever it is they're going to do. But never have I really opened up opportunities for people to join. And that's why I want to tell some of you right now. If you're in a great place, if you have a great company, guys, do what Alex is doing in his company, and go kick that ass, OK? We love you guys. And also, if you're wanting to do this, or if you know you're the right person, but you just don't have the right company, because I don't want to call this recruiting. I'm telling people what's available. You're right. He doesn't recruit, which is what I love. Everybody's always like, I don't recruit people. No, dude, you want to find your people. Guys, there's 9 billion people on this planet. You don't need to go work somewhere where you don't like the kind of people that are there. If you go work for Walmart, there's 90 million different kinds of people.   One's super nice. But really, it's just a mixture of everything. You're showing up. You're getting paid. And you sell your dreams for a salary. Jobs like that, unless you own Walmart, are made for people with small dreams. And I'm not being disrespectful. Well, there's categories. And I think Patrick McDavid talks about, right? And you're close with him. You know, there's the entrepreneur, right? The person that's going to create the opportunity. There's the entrepreneur that builds the opportunity within. And then there's just the workers. And the workers, we don't have workers here. We really don't. We just have entrepreneurs, people that want to build within an organization going somewhere. And that's what I want to hone into. I want to hone into the entrepreneurs. If you're just a worker that needs the clock in, clock out, this is not for you. Straight up. And you need more leaders. Because you have so many people joining. How many people do you think will be sitting out at the end of 2024 in Spartan Social? We're shooting for 10,000. OK. I want you guys to hear that. 10,000. Now, in 10,000, are we going to need leaders? Yeah.   Hell, yeah. Now, listen, I know that there's some people that are watching this that are like, oh, man, I love Andy. But he's always trying to recruit my people. You're so lost.  I hate that. Dude, listen to me. I hate that your perspective is always someone's trying to take something from you. You need to understand this. If you have something great, nobody can recruit your people. You can't recruit anybody on my team. I know I can't recruit anybody on your team. Nobody can recruit somebody who's happy.  These are the guys or they've been in sales and they've gotten betrayed. Like one of the things that I love, why a lot of your leaders are so loyal to you is they are very good at selling solar, but they have been burned over and over and over.  That's if I lie to you. So your accountability with your team is so high that your standard is if I ever lie, cheat or still me. If I ever do it, you guys all abandon me immediately. Have you seen me even stop living the way I say I'm living?  Because I'm not gonna keep growing. I love that, man. I gotta keep going. Yeah, and by the way, so you're 29 years old, right? Is that right? Oh yeah. I live in Florida. Yeah, Miami. Little Miami. Yeah, and he's going to be living part time in Scottsdale, right? Oh, walking in. Okay, and guys, he's starving for the next generation. Okay, what does that mean? If you're 18, if you're 25, if you're 40 years old, if you've got a family, if you don't have a family, if you're ready to change your life and you're looking for the right opportunity, not only to just have a great opportunity to be around great people who wanna watch yourself develop and become the man or the woman that you always wanted to be, but also really help you get paid really well and have a good life.   He goes, we run such clean deals in our company. Your software is so, it's so highly developed. It's very expensive. You have your own in-house coders, the way they built it. That honestly, like you said, you're not really selling anything. You just need to be coachable. You need to become a good person and the leaders are gonna do everything to help develop you. And then the systems take care of the rest. The systems and software take care of the rest. The complexity, you know, we always talk about this in our company, which is kind of like a motto, especially with operations, which is complexity is the enemy of execution. So we need to keep everything extremely simple and by keeping it simple, we don't mean it's not built out. We don't mean it's not, we don't mean it's not an intelligent system. We mean that it's so simple that you don't have to really think it's intuitive for you to do. We created systems that are super intuitive so you can get the result at the end of the day without having to get lost in the weeds. And we wanted to create an environment where systems allow us to scale because we can't manage people at 10,000, but we can manage systems. And that way, you won't be a leader, too.  And do, listen, I'm a salesman. So at the end of the day, I've learned there are CRMs that I love and there are CRMs that I hate. And if a company brings in a bad CRM, no one will use it. If it's a confusing CRM, no one will use it. But if it's easy- Even a bad group chat, right? Yeah, yeah, a bad group chat. I mean, anything, right? And that's what I love about all your stuff is that you're so young and innovative, but you really have like a 50-year-old brain. You have like an 18-year-old energy, you have a 50-year-old maturity, right? But then at 29 years old, you're in your youth, you're in your prime, and dude, you don't judge anybody. Everybody needs to understand this, okay?  All we care about is who in the hell do you want to become. Am I right? And dude, and listen, I'm an overcomer. I've made lots of mistakes, man. I mean, God, dude, I don't know how I got here. But I got here because God is good, and he gave me a second chance, or really two million chances. And I want to tell some of you, one of the reasons why later in my life I really blew up and started doing some big stuff is because I was always around the wrong people. The proximity of being around a guy like Alex and his leaders and his team is priceless. Being around people that will develop your life is priceless. It's priceless. It literally, you can't put a dollar amount on it. And now, if you can have that priceless development and be around good people that want you to become a good person, like just imagine what the future of your life looks like. Imagine that.   Sometimes less. Oh, sometimes less, but I want anybody watching this right now and to know that going to war in 2024, this is your year, okay? I don't care what happened in 2023. I don't care what happened last year. I don't care what you did before.  I don't care who burned you. I don't care who you burned. What I care is, is 2024 gonna be the year that everyone talks about on your deathbed. That that was the year that you cause, you know, not say market disruption, but total recreation.  I mean, just think about it like this.  I lost millions of dollars. I lost over 70% of the company I poured everything into to build. My bank accounts also got hacked. I lost my relationship right before that too. So, you know, it was like, I really needed someone to talk to when I was going through it. I had no one to talk to. And so all of this stacked up at one moment. It was within a few weeks, all of that happened. And then a year later, we're in contention to be the top solar company in the industry. And we're gonna be the top solar company by the end of 2024. But that's just one year and a lot of adversity. So my point is if you're going through a lot of pain and adversity, you're having challenges in your life, whether it's financially, physically, mentally, like it can all change really fast, but you have to find the community and brotherhood that all are in that boat. You can't do it on your own. You want to do it on your own. We all want to do it on our own. You got to have a family. It's just a shortcut. And it keeps you there when you don't even want to be there. And then you look up a few months later and all of a sudden you're on top of the world and people ask you how you're doing it. And I'm like, dude, I'm in heaven. I feel like I'm in heaven on earth every single day right now. And I'm around the people that inspire me, that fill me with joy. The people I spend the most time with are the people I work with right now. Because guess what? They all feel the same way I feel. And how special is that to know that the people that you get to spend all your time with want the same things you want. So guess what? You're gonna get what you want out of it. But in a year they all can change.  We're gonna have 10,000 people. We'll be the top solar company in the industry. Everyone will have to go to us if they wanna have an experience. And everybody matters. Everybody matters. Everybody matters in your company, which is cool. Everybody's a part of the family. Everybody's a part of the love. Everybody's a part of the brotherhood. And by the way, women do really well in your company too. Yeah, so we don't have as many women in our company to be completely transparent. But women are really dangerous. But the women that we do have in our company that ourselves, they just have an edge. Yeah, they're killers. There's an edge out there because they're not, most of the time it's a bigger approach. Well, number one, women are very good. They are. And they seem to be very coachable and can learn very quick. So I just wanna say, when we say like band of brothers and a brotherhood, it's because us being guys. That terminology. That terminology is there's a lot of men. But the girls are really good, man. And they make a lot of money. And it just seems like they're growing like crazy. So I just wanted to say to everybody, hey, number one, we're grateful for you. We're going into Thanksgiving week. It's Monday, right? We smashed the freaking gym this morning. We came into work. We got big stuff going on. He's flying back out to Florida here in a little bit. And I just wanted to shoot a little quick podcast with him and or even just a talk, right? Just to sit down and say, guys, let's get ready for 2024. I wanted to talk about where he was last year and where he's at now. And I hope that it inspired a lot of you to really look at your situation and say, you know, listen, man, like, okay, talk's cheap. Okay, talk is talk. Like how many times have I said I'm gonna do this? And then that year didn't happen. So I just wanted to make two last statements.   And I love you and stay close to me. Stay super close. But if you don't have the place and you're looking for that, all right, where do I belong? Where are my people? I love this, Andy. How can I join? Very simple. Go to Alex Smith, okay? Go to Alex H Smith, right? On Instagram, you're gonna see his face. It's very simple. You click on the link in his bio and it will say, go ahead and fill out some questions, send over a video. When you do, it's very easy.  You will be a part of the team. They'll talk about what relocating looks like if you need to, they're in a lot of states. Some people move, some people don't. There's leaders everywhere. You can decide what that looks like on the inside. But most importantly, you're gonna plug into everything that we talked about on this podcast. And all that I pray is that all of you have this opportunity to live your best life and be happy as hell in 2024. Make a lot of money, help a lot of people, make impact on the world, be around a great team and obviously just overcome anything in your life. And if anybody doesn't believe in you, dude, we believe in you. It's the truth. So let's get ready for war.  I mean, the last thing I would say is do whatever you can to keep your edge. Whatever company you're with, you're happy, everything's going great, great. Keep your freaking edge because other people are going to have an edge and they're always gonna keep killing it. They're always gonna keep going to war, especially if they're around other people going to war on a daily basis. So when Thanksgiving comes up, when Christmas, when New Year's comes up, don't wait till New Year's to become different. Don't wait till New Year's to make the change you need to make today. Make it today and at New Year's, you should be that new person already. Yeah, New Year changes never works. Yeah, it never works. And I know you've heard that message a bunch, but I just want you guys to figure out how to keep an edge.  You usually gotta do something physical to keep an edge. You usually gotta do something mental. Mental, you usually gotta be around other people and the last thing I would say is, besides keeping your edge, because I just want you all to keep it because it's a powerful thing when you go into a Monday with an edge. Most people do not. Most people are just restarting on a Monday.  From heart attacks, that's just what happens. So keep your edge. Don't have off days, have edge days. I want you to transition over that language because when you start communicating that way, that's what's gonna end up becoming the way you operate. And there was a second part, but I forgot it when I got in my tangent. Hey, doesn't matter dude, we covered a lot of stuff, but I wanna tell you, I love you, bro. Hey, we're family for life.   By the way, long-term guys, okay? Make a commitment for the next couple of years to really dig into something and become great and totally self-develop and recreate your life. This is your opportunity. So much love guys, have a blessed day. If anybody needs anything, you can always text me. I'm gonna drop it here, but my cell phone is<PHONE_NUMBER>. That's<PHONE_NUMBER>.  Love you, bro, appreciate it, man.  See ya. Let's go. This is my curse. Hey guys, that's what I tell you. You're the true one percenters. You made it till the end of the video. Do me a favor, share it with the friend that wants to go to another level. Make sure you like the video, comment below so I know who you are. Set your notifications and then subscribe to the channel. We got daily sales training videos dropping. I'll see you soon.


My work here on YouTube is supported by viewers. Please take a look at the link in the description below and visit my page at 50th Street where you can become a sponsor. I've shown you videos of the largest bookstores I've ever visited and now I want to tell you about the most interesting. Almost a year ago I visited Seattle for the first time to conduct an interview with an acquaintance of mine and after we were done I Noticed this place a few doors down. It's called Ada's technical books and cafe and I very quickly decided it was easily the most interesting bookstore I've ever discovered it happened to be women's history month when I was visiting there So there was a lot of feminist literature on the shelf here, but you can see what caught my eye There at the end of the shelf. I am Princess X Which turned out to be one of my favorite books of the year last year? It's a small place In fact, it's a tiny place But it has the most well curated collection and most thoughtfully curated collection. I've ever seen you've got antique science books right next to contemporary graphic novels Small but very thoughtfully curated collections science fiction Shoulder-to-shoulder with science and real science too Every time I turned around I found something interesting enough for me to point the camera at every shelf space was well stocked With stuff that I felt was worth reading and the space was interesting too The tables themselves acting as display cases for antique technical instruments science toys everywhere Posters memorabilia handmade jewelry. You'll see that in a minute When I took this video a year ago, they were just finishing work on an addition Which would include a lounge and bar One of the walls Incorporating a giant periodic table of the elements Just a super interesting place my intention is to return soon and Conduct an interview with the owner For my 50th Street tour over at the 50th Street channel, I'll include a link Thank you for watching Please subscribe to my channel here on YouTube and please be sure to press that thumbs up button That's how videos get recommended and seen and please take a look at the link in the description below and Go to my 50th Street page where you can become a sponsor


I have the pleasure of introducing Dr. Jeremy Larson. He has joined City of Hope Phoenix in November 2022, where he serves as the assistant clinical professor in the department of hematology and hematopoietic cell transplantation. He is involved in patient care and clinical research for multiple myeloma, lichen amyloidosis and related disorders, and he has served as a primary investigator for numerous investigational studies for multiple myeloma and AL amyloidosis. He graduated from Creighton University School of Medicine and completed internal medicine residency and hematology oncology fellowship at Mayo Clinic in Rochester, Minnesota. Okay, well thank you very much, and yeah, packed house, I'm delighted to see this, and so I think this is a good sign that we're starting to move the needle in the right direction in terms of awareness and obviously excitement about amyloidosis. So, you know, as a hematologist the disclaimer is when I use the word amyloid I'm likely referring to AL unless I specify otherwise. So, you know, we're going to take you through a few clinical cases today. I will feel, I would say, I feel like amyloidosis is a disease that some of the, you know, the troubleshooting that can happen in these kinds of talks is education. We kind of need to know what tests to do, but I think also as kind of engineering the system, you know, from a nomenclature standpoint of the testing, I'll try to clarify some of this, because I think we all, you know, I need to order an SPEP, I need to order a free light chain, but it turns out there are lab orders for total light chains instead of free light chains, and so there's lots of little little snags that we'll kind of try to highlight as we walk through this, so making sure we're getting the right testing at the right time. So, a few disclosures listed there, so we'll walk you through a common clinical scenario where screening would be indicated, we'll talk a little bit more about the options for testing, and then kind of go through that algorithm when amyloidosis is suspected. So, as many of you are aware, you know, MGUS, or this monoclonal gamopathy of undetermined significance, that mouthful is extremely prevalent. So, depending on the patient population you're screening, older patients, 65 and above, anywhere from 3 to 4%, and if we go into patients of African descent, that may actually be as high as even 6 to 7% incidents. So, extremely, extremely common, and when we talk about the kind of slice of the pie here, you know, it's hard to give you a specific number, but you know, at least probably 3.5 million and above, you know, with MGUS, many of those patients are unaware they have it, whereas we talk about kind of the end organ, you know, complications that develop from a disease like multiple myeloma, that's a tiny slice of the pie. And as hematologists, I think we all have a little bit of, you know, I'd say, I guess, blood on our hands from a perspective of the late recognition of AL, I can't tell you how many times in my not that long of career that, you know, patients are followed for years in a hematology clinic, and they're tuned in for looking for crab symptoms, the hypercalcemia, you know, the anemia, the bone lesions, and all the time this patient has ongoing nephrosis, nephrodic syndrome, and nephropathy, et cetera, and so kind of being tuned into, you know, these other complications from plasma cell disorders. So, not going to obviously belabor, you know, the plasma cell in great, great detail, but I think some knowledge of what we're kind of talking about, you know, can help, you know, really be aware of what the cell we're dealing with is here. So, a plasma cell, as you may recall from early, you know, education is essentially a B cell that's sort of gone to postgraduate school. It's a B cell that's been activated by some form of exposure. It's saw an antigen, a T cell activation. I kind of sometimes joke that sort of, you know, plasma cell development is essentially nature's first two-factor authentication. Essentially, it gets exposed to something, a T cell activates it, and so we're now using that technology, but this is something, you know, our bodies have done for a long time.  The plasma cell is a perfect example of that. So, you may recall this kind of pale area right outside of the nucleus. We call it a half. It's loaded with Golgi apparatus and endoplasmic reticulum. These are pumping out proteins, immunoglobulins, or the other term that you're probably familiar with would be antibodies. So, the structure of an antibody, and I'll get to why we're talking about this in just a second, is this Y-shaped construct. And at the kind of business end, the arms of the Y is the antigen binding site, and that's, you know, really designed to recognize millions of different antigens. So, that's something that's variable, and then that's attached there to the heavy chain construct.  And so, we have five different types of immunoglobulins. You probably remember this from boards as well. So, the key things we see clinically, as you heard earlier today, IgG, IgA are the most common variants, but we actually do see rarely IgM-related amyloidosis. It has a little bit different phenotype, and I think that's in large part due, when you see this IgM pentamer, it's a gigantic protein construct. And so, we tend to see more incidents of, especially those profound neuropathy complications in our IgM amyloidosis patients. So, many of these patients also have Waldenstrums, for example, a little bit less tendency for cardiac involvement, but definitely more soft tissue, neuropathy, and often times renal involvement. They can be very challenging to treat. So, we'll kind of get into the business here and make it real for you. So, you know, we'll kind of put on our clinician caps here, and so, you know, we're walking into our first patient of the day. So, in this example, gentlemen, very, very, I would say, representative of our patient population.  When you look at some of the symptoms, he's got mild grade one, distal neuropathy, primarily in the toes, little bit of the balls of the feet, you know, going up a couple of flights of stairs or up a hill, he is short of breath, no chest pain. CBC is unremarkable, he's got maybe mild renal impairment, trace microalbuminuria, TTE is done, grade one, diastolic dysfunction, EF looks normal. So, the question is, is this the patient that we need to go down this diagnostic pathway? And I would argue, obviously from a, you know, utilization standpoint, there's gonna be a lot of MGUS screening for this type of patient if we were doing that. So, you know, as you heard earlier today, you know, some of the patterns that we're gonna talk about, it kind of, you know, depends on the severity, depends on if there are other clinical factors that could easily explain their neuropathy. So, in this gentleman, you know, we have diabetes that can likely explain his trace microalbuminuria and, you know, some of the other changes we're seeing here. So, I would argue that's probably not the patient that needs screened. So, we'll walk to our next door neighbor here, our second patient of the day, we're feeling good after the first one. So, this is now an 81-year-old woman, very, you know, high functional status, but has developed somewhat unexplained edema of the lower extremities and also now is starting to have kind of a weeping ulcer over a right lower leg. She's kind of a second opinion for you. She's already seen a vascular specialist. They've worked her up for PAD. They've looked into possible IVC compression that's negative and so, she at this point is now a year into this. She's gone through wound care, et cetera, et cetera. This keeps happening and she's on diuretics, but the edema is not going away. And so, in this example, you know, we're gonna kind of walk six months forward now. We won't say what was done then, but six months later, there's now a TTE that's updated and she has a new pericardial effusion. So, as you heard earlier today, that should probably be a red flag. She goes through a pericardiosynthesis, cytology is negative for malignancy. So, we're happy about that. The TTE outside report is unrevealing as it's kind of carried forward in the progress notes. Turns out, you know, she had been sort of labeled with half-pef, essentially. And a well-intentioned provider says, I'm gonna screen for amyloid. So, good, they thought about it. They did that first step, bravo. Second step, unfortunately, is where they got tripped up. So, they ordered an S-pep. And as you heard nicely earlier today, that's not enough. But unfortunately, they anchored to this. They said this isn't amyloid, her S-pep is negative. So, six months pass by, symptoms continue to get worse. This is actually where I met the patient two years into her journey. At this point, she has profound peristegias of the feet, painful neuropathy, autonomic dysfunction gets dizzy and falls when she stands. She was previously independent, she was a widow and she is now in a care facility because she's unable to care for herself. And with even walking to the bathroom, she's short of breath. And so, I actually met this patient in the hospital because she had new oxygen requirements. Those were what her legs looked like. So, not good. And so, the diagnostic testing that then is carried forward, this is kind of textbook AL. And unfortunately, this patient is way too far downstream where 24 months before, we probably could have done a lot to help this woman. She has all the classic manifestations, low voltage, QRS. Her TTE at moderate to severe, concentric increased LV wall thickness. She still has the pericardial effusion. She's anemic, she has renal impairment. Her albumin is low and she has predicted about four grams a day of albuminuria. The SPEP, still negative. And actually, in this case, the serum immunifixation was also negative. Sometimes that will pick up kind of dimerized light chains. So, it's not uncommon to see a monoclonal Kappa or a monoclonal Lambda on immunifixation. We'll talk a little bit more about what this test is. But in her case, it was the free light chains that really were kind of what gave us the diagnosis. So, her Lambda free light chains were quite elevated. And not all patients will have light chains to this degree. So, in this case, 32.4 milligram per deciliter. So, that's about 15-fold higher than normal. Her ratio is suppressed. If you want to flip that, as a hematologist, we often times think about what we call the DFLC, the difference between the involved light chain, which in her case would be Lambda minus uninvolved. So, if you subtract those two, 30.7. That's very high. Her bone marrow biopsy is done. She has a plasma cell dyscrasia, 9%, Lambda restricted. Her fish is positive for one of the most common cytogenetic abnormalities we see in amyloid patients, which is a rearrangement of the 11th and 14th chromosome. And this also highlights what we heard earlier as well, that the bone marrow biopsy is not the end-all be-all for screening for amyloidosis. So, her report was read as equivocal. But it highlights, and I think you're gonna hear more about this in the next talk as well. But from some of our internal data, we would suggest that roughly about 50% of patients with AL amyloidosis may have a positive bone marrow. But on the other hand, that's gonna tell you're gonna miss 50% of the patients, if that's what you're anchoring your diagnosis on. So, in her case, we also did an abdominal fat aspirate, and that was positive for what should be Congo red stain, and mass spec confirmed an amyloid subtype of Lambda type amyloidosis. So, we have a diagnosis. So, in this case, the patient was profoundly symptomatic, and actually after long goals of care conversation, she decided to go to hospice and passed away about six or seven weeks later. So, this is an egregious example. Obviously, way too long went on without people kind of looking into the diagnosis in the first place, and then obviously, submit opportunities with the testing. But this really just kind of goes to highlight all of us, I think, our job is to really recognize these patients, ideally, far more upstream. And cardiologists in the room, you guys are huge gatekeepers for this, but our GI docs, as you've kind of heard a moment ago, with patients get EGDs, colonoscopies, for diarrhea and malabsorption, and still see all the time that Congo red stains aren't done. Have seen a couple of examples now of someone who presents their ENT doc with macroglossia. They get a tongue biopsy, and we're applauding because no carcinoma, but they didn't do Congo red staining. And so, you know, I think there's lots and lots of examples of these kind of things, but I'd say if there's one thing we can really do better as a medical community, would be early diagnosis, because therapy really can change these patients' lives. But as you're kind of heard, once the kind of cat is sort of out of the barn, that's not their expression at all. But, well, I'm gonna coin a new one here. We're gonna go with that. So, you know, obviously there's sometimes limited therapy of what we could do. So these are just some of the patterns. We're gonna talk a little bit about this. I highlighted this slide specifically because of that lower panel. I don't know how well that shows up, but the soft tissue involvement, so those ulcerations, those non-healing ulcers of lower extremities, likely we're in part due to the edema, but also, you know, we also will see soft tissue kind of plaques and ulcerations sometimes form. You know, from a GI tract perspective, there's the autonomic standpoint, the dysmotility, et cetera, but also many of these patients have friability, and so we'll see kind of that, you know, the coagulation deficits also can manifest with the easy bruising. You know, in high alkyphos, hepatomegaly, Dr. Rosenthal and I just kind of share a patient who is a gentleman who was having very refractory ascites getting tapped repeatedly, had a hepatomegaly, what looked like severe cirrhosis, and, you know, his liver was chock full of amyloid, and now several years later, that patient's living a fairly normal life, and so therapy can also be extremely helpful for these patients when we recognize the diagnosis in a timely fashion. So, you know, this is just a highlight, you know, there is a disconnect between hematologic response in terms of watching those light chains go down and the time to organ response, and so, you know, Dr. Lerne, who's an nephrologist in Rochester who has really pioneered and has kind of been, I think, a very big advocate for this term, what we'll call kind of delayed renal response, but this is a specific case where a patient who went through an autologous stem cell transplant, that's kind of the time zero on the bar. So, in this schematic, what you're seeing, the dotted, you know, line there is their protein area, so they started roughly around 13,000 milligrams per day, and their serum albumin is a solid line there, so what you can kind of see, obviously as the urine protein levels dropped, the serum albumin rises, but really from a complete organ response standpoint, all the way out to three years before this patient technically, you know, had normalized their protein area, and oftentimes, you know, the NT-ProBnP and the troponin follows a somewhat similar pattern, and it's very common in those first few months of therapy to see cardiac biomarkers actually rise significantly because of, you know, the added stress of the chemotherapy. So, ideally, recognizing those patients earlier on in their journey, that therapy is gonna go a lot more smoothly. So, when to consider, you've heard a lot of this already, I'll harp on just a kind of a couple of things here. So, you know, when to consider screening protein area, obviously, you know, if there's no other explanation, the renal insufficiency comes late, so if you're just waiting for their creatinine to rise, you probably already missed the boat, the amyloid perpura, so kind of termed raccoon eyes, you know, as one of those very pathodynamic things, we don't see it very often, but if you do, you know, obviously, some alarms should be going off. The neuropathy that you heard nicely from Dr. Goodman just a moment ago, the restrictive cardiomyopathy, so this half-path-like syndrome, and I think, you know, with advances in imaging, we're, you know, hopefully labeling fewer and fewer patients with athlete's heart and these types of things, but I would say, as a hematologist, one of the things that, you know, many of us don't do would be, you know, screening cardiac biomarkers, so as part of the routine follow-up for MGUS, you know, we're doing CBCs and metabolic profiles, but, you know, lots of patients who have shortness of breath necessarily aren't getting appropriate testing, so I would oftentimes advocate, you know, to my colleagues, that that is something that could be, you know, especially for those patients who have some of those types of symptoms, and NT-propion P could be extremely helpful, you know, the macroglossia, obviously, and then that hepatomagliate, you know, an elevated alkyphos in isolation without, you know, the other LFTs is also a big tip-off for these patients, so, you know, this is more for, you know, from my standpoint, when we have a monoclonal gamopathy, what are the big things that we're thinking about? As hematologists, we're all tuned in, you know, we're looking for myeloma, but, you know, the periprotein-related syndromes are what I would say we still kind of fall short on, and so, you know, these are kind of the, you know, the big things that as we start this testing cascade we're thinking about, so it's probably once or twice a year that I meet a patient that referred for a stem cell transplant, and I started looking through their records, and it's myeloma, it's myeloma, it's myeloma, and it's because, let's say, they were anemic, they had a bone marrow biopsy, 10% or more plasma cells are found, you have myeloma, we're starting therapy because, you know, you're anemic. No one really thinks about, yeah, I guess I did have some neuropathy, you know, I am short of breath, more than usual, et cetera, so it's very, very common that I meet patients who actually have bonafide amyloidosis, they don't have, they have more than 10% plasma cells, but they have no bone lesions, they don't have the classic renal impairment, and so I put the, you know, the periorbital perpary here as this is a couple of years ago, in my time at Mayo that I met, a woman walked in to the clinic and this is maybe not quite this severe, but profound periorbital perpary had been on treatment that was not going well for the prior three months outside and had never heard the words amyloidosis, she had terrible neuropathy, she had terrible autonomic dysfunction, she had periorbital perpary, but they were anchoring on the fact that she had more than 10% bone marrow plasma cells, so the diagnosis of myeloma versus amyloid really comes down to the clinical phenotype, we know that patients with amyloid with more than 10% bone marrow plasma cells, the prognosis is inferior to those with lower clonal burden, so this is probably, you know, for more directed towards my hematology colleagues, but just kind of food for thought. So you've heard a lot about, you know, the diagnosis, so really this is kind of four essential pieces, so we need a syndrome that we've kind of talked a lot about, we need tissue conformation, and ideally we'd start with some form of staining looking for the amyloid, most commonly congo red, some facilities still do electron microscopy, and then once we find amyloid, the next key step that I would still say the adoption of is not where it needs to be, would be actually doing amyloid subtyping and that mass spec or amyloid protein identification would be the key thing, and then lastly we need some evidence of the monoclonal plasma cell disorder, and so that's usually kind of towards the top in terms of the cascade of this, but as we'll kind of talk about the laboratory evaluation, this is kind of gonna be the first step. So the S-PEP, as we call it, the serum protein electrophoresis is an old test, this is not new, this is a gel agarose based, essentially a kind of a Western blot style test, and so antibodies or immunoglobulins tend to drift into that far right portion of the graph, the gamma globulin range, and so this is a pretty normal example, but when we have a very large monoclonal protein, we tend to see almost a tower or a spike-like presentation, but the hard part with many amyloid patients, they may have a 0.1, a 0.2 monoclonal protein, and it doesn't stand out much on that gamma globulin peak, and so that's where the sensitivity of the S-PEP, it's still a helpful tool in my mind, we do advocate to perform it, because it helps give you quantified information, it says how big is that monoclonal protein, but in many amyloid patients it's small. So a common question is what is an immunofixation? Well, ultimately what it is is it's an immune precipitation, so this is a more of a yes-no test, it's not gonna give you a number, but what it's gonna tell you is what type of monoclonal protein is there, and it's the most sensitive screen we have in the blood, specifically looking for something like a heavy chain plus a light chain, so the IgG lambda, for example. And so what you're seeing in this schematic here, so in the G heavy chain and then the L light chain band, essentially we've precipitated out a monoclonal protein, so we know this patient has an IgG lambdas, you'll see the report come back, I identify in this. So up to the kind of upper right quadrant here is specifically referring to the immunoglobulin free light chain assay, and so there's a number of different proprietary assays out there, the first one on the scene is called the free light assay by a company called the Binding Sight, and ultimately what they're taking advantage of is the fact that I pointed out in these earlier constructs, we have a light chain bound to a heavy chain, and that's where most of our light chains circulate, but we also have soluble free light chains, so as it goes to tell you, there's no heavy chain bound to it, and historically, before about the early 2010s, around that time is really when these assays became readily clinically available, but before that, the way that you needed to find free light chains was, as this term we're probably all familiar with, is Bench-Jones proteins, which these are light chains in the urine, and so the 24 hour urine protein electrophoresis plus the immunification was the way we found free light chains, so now we're privileged that we can actually have a readily available tool from the blood work to identify this, but I would say the downside or some of the hazards of relying only on the free light chain assay is that there are many false positives, so as you heard a moment ago, physiologic increase in Kappa light chains especially is common with renal impairment. The other thing increasingly I'm seeing is I think with the rise of the obesity epidemic, many patients with non-alcoholic fatty liver disease ultimately have what we term polyclonal hypergamoglobulinemia because of kind of the hepatic inflammation, and so we also see abnormal light chain ratios commonly in that population, so it's a very sensitive tool, but it's less specific, and so that's where ultimately the urine immunification is still really, really helpful because what you can sometimes see is a mildly abnormal free light chain ratio, but their urine immunification comes back negative, and that's oftentimes reassuring, and so this is just a schematic that I think kind of tries to illustrate where these ratios are coming from. We all make Kappa and Lambda light chains, they're part of our normal immune system. Normally we have this tight band, and depending on the center that you're at, they'll publish their reference range, but around one and a half is sort of the upper limit of normal down to all the way to 0.5. That renal reference range that we call it can go all the way up to about three to 3.1 for someone who has renal impairment, but if we're overproducing Kappas, we're overproducing Lambdas, that's where kind of that teeter totter starts to shift, and you'll see marked elevation of either your Kappas or suppression with your Lambdas, and I kind of point out, once we have a patient who has known monoclonal gamopathy, knowing what their involved light chain is actually really helpful for monitoring, so especially for our amyloid patients who've gone through therapy, seen some patients just recently, for example, their Lambda was their involved protein. They're on surveillance, they're in remission, they get a vaccine, they get COVID, they are dehydrated when they do their labs, and their labs come back and they have a mildly elevated Kappa Lambda free light chain ratio, and they see that number in the portal, and they're panicked, because they're like, I'm out of remission, but knowing that patient had Lambda free light chains, I don't worry if their Kappa Lambda ratio is a little high, because they're Kappas that are up, because I know it's not from their amyloid, it's a physiologic factor, so these are just some of the nuances, it's a test that requires some interpretation, and so that's really where, pairing with a hematologist you trust that it can help kind of decipher some of this. So with the bone marrow aspirate biopsy, I've kind of quoted a roughly 90% sensitivity that might overshoot it a little bit when we combine a fat aspirate plus a bone marrow biopsy. A lot of this comes from older Mayo data that was looking at in-house, the as we so quote unquote called the Mayo clinic experience. I think one thing that is a little bit to me, put sort of an asterisk on this, because these are very experienced pathologists who are sort of, they're all tuned in to amyloidosis, the providers who were doing the fat aspirates are tuned into knowing how to properly get the tissue that's needed. So in less experienced hands, we know that these things, even if the right tests are done, can be missed. And again, I kind of highlighted earlier with the greater than 10% plasma cells is a higher risk factor. We'll do fish testing, and as a hematologist treating these patients in that population that have the translocation identified here, it's a helpful tool that actually predicts therapeutic response to one of the oral therapies that can be used subsequently. Oops, wrong button, sorry. So this is, I guess my plug to sort of know your reference lab. So know what system you're working in as you heard earlier, kind of set up your order set. I think that's a perfect, perfect advice because even in town, I'm just representing two major labs. So in house at Mayo, there is a whole panel, we call it the monoclonal gamopathy diagnostic serum. And what it is, it's an SPEP, it's an immunification, which we've now shifted to a newer form of that. It's also mass spec based, we call it Malditoff, but a little bit more sensitive. But essentially it's an SPEP plus a serum immunification plus a free light chain. So one test, one order I should say, and you get all three of those. And then we also do advocate for doing your own immunification. I'm a realist, and so I know that it's a big ask for my cardiology providers. If you're seeing a patient that's got a mildly abnormal echo, you're concerned about amyloid, but you're not quite sure. It's a big ask for, to tell you to collect a random 24 hour, urine and immunification. So I'm a realist, so even spot protein with a urine immunification, I think that's a good start. You're gonna miss very few patients. If you've done those top three blood tests, very few patients are gonna be missed with just a random urine immunification on top. So that would be a common test panel to order, whereas with SinuraQuest, their nomenclature is a little bit bizarre. So monoclonal gamopathy DX PNL. So I guess diagnostic panel comma AL amy is the test ID. And so with that, you actually get all four. So serum, those three key tests that we talked about, plus urine protein electrophoresis immunification. But it depends on where you're at. We call these same tests different things in different sites. So kind of knowing what your in-house tests are called and then save that to save yourself some pain. So this is a kind of a flow that comes actually off of the Mayo Clinic labs. I like this schematic. And this is something that's online available. And you can actually click into it and it will tell you more about each of these tests. So that's out there for everyone's reference. But in that scenario, you have a clinical pattern that you're concerned. You're gonna initiate monoclonal protein testing. And one of those tests come back with an abnormality. So it's an immunification that's positive. It's an abnormal free light chain. The next step obviously would be to involve a hematologist and in our practice, traditionally we do those two tests listed here.  So in those patients, you have a high suspicion for amyloid. You know, if those tests are positive, perfect. We have a diagnosis, but if those tests come back inconclusive or negative, you know, you see the plasma cells but you don't see the amyloid, that's where as you're highlighting here, our next step would be an affected organ biopsy. And it really kind of depends on how these patients flow into a hematology clinic. There are patients who come to me as MGUS and they're undifferentiated. And that's where I'm the one kind of directing some of this, but I also meet, you know, many patients who've also, you know, they've already gone through this whole pathway or cardiologist, colleagues have handed this over on a silver platter and you guys have already done the work. So it kind of just depends on where this patient enters in. You've heard about this nicely today. I kind of highlight, this is a throwback. So Dr. Gertz and Dr. Kyle, who I kind of think are sort of the mayo goats of amyloid here, you know, at 1987 we're publishing screening PYP scans for cardiac amyloid. You know, the conclusion on this is interesting because ultimately they were saying, they were trying to say, is this a sensitive tool to pick up cardiac amyloid? And their takeaway was no, it's not a sensitive tool, but they were looking primarily at AL patients. But what they could see is that a number of patients with AL will turn positive. So more for historical interest, but as you heard from Dr. Rosenthal earlier, probably close to a quarter or maybe 20% of patients with TTR amyloid may have an immunoglobulin abnormality. So, you know, again, this is one of these big clinical pearls we've harped on so far today is that just because there's MGUS, that does not equate to AL amyloidosis. You need to take that next step and do the amyloid subtyping.  And so that's a story that I think is unfortunately probably very common around the country that we obviously don't want to repeat. So we have the tools to be able to decipher these. And so again, this is the staging. This is getting a little old. But I know there are some efforts underway to likely refine this schema. And I think these overall survival numbers are also very outdated given the fact that ultimately our tools have improved quite a lot over the last decade. But this goes to highlight the more cardiac involvement, the worse the prognosis historically is, and we're still lacking, especially in those stage four patients. So with those two readily available cardiac biomarkers, the NTPRO BNP, the high sensitivity troponin, and then we also factor in their light chain burden. So that DFLC that I referred to earlier. So with those three things, you can stratify this into a four stage group.  So, you know, this would say a patient with stage one amyloid, for example, they have one risk factor in this data, you know, it was saying about three and a half years. I think we're doing a lot, lot better there, but ultimately the takeaway is that the more advanced cardiac involvement, the worse the prognosis is, so early diagnosis again. So my talk today, you know, out of scope to really get into the nitty gritty of detail, you know, a lot of these medicines are borrowed from multiple myeloma, but the big thing that I would point out, especially that red column, the IMIDS, which, you know, two of the medicines you're likely very familiar with. So thalidomide just from obviously, it's notoriety, and then with lenalidomide, which is more commonly used today in the United States, and then a subsequent version of pomalidomide. There are workhorse and multiple myeloma, but in amyloidosis, there are often times not well tolerated, and actually some of the early trials that, you know, in myeloma, lenalidomide dexamethasone was a blockbuster combination that improved outcomes a lot, when they said, okay, how does this work in AL amyloid? The trials were actually shut down early because of excess death on the intervention arm with Len Dex, and it turns out, patients with AL amyloid, especially with cardiac involvement, do not tolerate full dose, lenalidomide and full dose dexamethasone. So, you know, the reason I put this slide in is that there are nuances here, so the hazard of labeling a patient with multiple myeloma and going down that pathway of Revlimid-Velcade dexamethasone, and they're getting blasted with corticosteroids, the wheels fall off pretty fast in those patients.  The reason I kind of highlight this is that hematologic response, essentially everyone has benefit, so, and these are very deep responses. You heard more than half of patients actually get to the point where their monoclonal protein is entirely undetectable, so we call that a hematologic complete response. But the other thing that's really, really impressive is when we actually translate that to organ response, which is ultimately what we really care about. You can see four out of five patients have significant renal recovery, and when we look at the cardiac population, more than half of patients saw cardiac response, and that's more than two-fold higher than what we saw with cyborg D. So just with the addition of a monoclonal antibody that really honestly adds very few side effects, couldn't really move the needle for patients. But again, it's those patients who were detected early on who really maximally benefit. So, you know, with conclusions here, we've kind of harped on this again. The early diagnosis is key, and so hopefully as a medical community we'll continue to improve there. I sometimes think amyloid is the perfect syndrome that AI ultimately will likely help us. I just heard a recent story of a mother. On chat, GPT entering her daughter's symptoms, she had a rare neurologic degenerative disorder and she'd seen countless neurologist neurosurgeons, and ultimately chat GPT suggested the diagnosis after her mother entered this slew of signs and symptoms from her medical report. So I think amyloid in some respects could be similar because it's all these various different clues and sort of seeing the forest in the trees. Screening algorithm we talked about, so the ASPEP, you need an immunofixation of the serum, you need an immunofixation of the urine, and the serum-free light chain, and so if you can do those key tests, that's gonna be huge for detecting these patients earlier on. And then ultimately, you're gonna hear more about the tissue biopsy in a moment, but our pathway is to suggest doing a bone marrow biopsy plus an abdominal fat-pat aspirate. Knowing that a bone marrow with conger red staining is not enough, the fat aspirate will pick up additional patients, but probably close to one-fifth, maybe even one-fourth patients, you'll still need to go on and do targeted end-organ biopsy. So the key thing from a provider standpoint is knowing that if that bone marrow, if that fat-pat comes back negative, to not stop there in those patients with high suspicion. So with that, I will close. Thank you so much.