After a wild divisional round of the playoffs. We are set to have a couple of conference championship schemes this weekend That's set up pretty well We got the chiefs facing the Bengals the Rams against the 49ers a lot of fun a lot to break down from a DFS Perspective to get you set for the final Multi-game slate of this NFL season Let's dig in and try to win some money one last time welcome on into the heat check fantasy podcast powered by Number fire that's right here on the fan dual podcast network in number fire calm My name is Jim Sonnis. I am a senior writer and analyst for number fire calm Joined here as always by Brandon gandula. He is the managing editor of number fire calm Brandon bills cheese lived up to the hype other games that weekend I Think got a little bit overrated in retrospect, but honestly like that bills cheese game made it irrelevant So I'm feeling good excited for the games this weekend. How you doing today? Yeah, I'm good You really can't complain about the games we got last week It does kind of feel just being pragmatic here being a little bit realistic But that these games this week just kind of can't live up to the hype I agree with you where some of the games were a little bit just because the game ends with a field goal Doesn't mean it was a great game Like you want to watch Ryan candle throw three picks and go bro get Zach nine times Do you want to watch no offense? Do you want to watch a guy with a bad shoulder and a bad thumb win a game because of special teams?  That's fine. No, no offense. I agree We want but like where we're coming from is we want points. We want to see good offensive plays I I get in the playoffs that, you know It's engaging sometimes if there's an offensive struggle, but there's a difference between good defense and bad offense and I always think back to that Rams Patriots Super Bowl And a lot of people are like, oh just because it wasn't like a high scoring game doesn't mean like not ever This isn't fantasy football. It's like that game like the offenses were not good It wasn't really that the defenses were good So like if you give me good defense like making plays like breaking up passes getting in the back like that's cool But just bad offense is not the same thing and I want to just kind of Throw that out there. I agree like not every low scoring game is inherently good And I think that's worth like that Titans Bengals game entertaining at the end, but I wouldn't call it like a good I'm not rewatching. Yeah. Yeah, no, but I'll watch I'll watch Gabe Davis absolutely destroyed dudes ankles for the 13th time we talked about him quite a bit on the stream last week and I Had enough where it went really well But like I feel like so like my thing last week was okay. These are highly volatile slates I should just commit and be okay losing it all if things don't go Well the one place I diversified is with the lower salary guys So while I was overweight on Gabe Davis relative to the field I kind of wish I'd just gone full in on those guys too because if I'd been full in on him Lenny, etc Etc. I would have been a really good weekend. It was a it was a very good weekend regardless, but like couldn't be even better So a little bit of regret there But like hey, you know, I can't complain being overweight on the guy who goes for 200 yards and four touchdowns in the playoffs in a loss by the way, which is wild but Hashtag wide receiver wins, but I think that I want to go into this weekend with the same mindset where I am okay Having every lineup not cash because I want to be committed to the plays I think our best and I also think that there's a very narrow tree of Quote-unquote optimal plays for this week. So that's the way I'm viewing this late generally. What about for you? Yeah, I mean, that's one of the things that we've been talking about more this season And that applies on a full slate with like 12 or 13 games where you know, you can try to sprinkle in shares of everyone But whenever you look at the probabilities of hitting Let's call it even seven of your nine You know, it goes down Quickly the odds that all those guys hit goes down and the more diversified you are Yeah, the higher floor the less, you know, volatile It's gonna be you might have some some min cash sort of lineups, but That also applies and maybe especially applies to these smaller slates where it's like, okay If you had just if you were just overweight on gave Davis and by overweight that means let's say, you know Someone's 20% rostered you have been 25% of your line. I'm sure a little bit overweight on the field You're not benefiting as much as if you went 80% like and and you know that yes, that's a That comes down to how many lineups you're playing and not everyone plays multiple lineups. I get that but like Even if you're playing 10 lineups this week and the the easiest way to Talk about this as always with quarterback, you know, you're playing 10 lineups And you play for my home's three burrow three Stafford like you're gonna have a really hard time Hitting on the perfect combination if your goal is to finish at the top of a tournament If your goal is to make sure that some of your lineups have a chance That's fine But you know going back to the Gabe Davis conversations like if you really took a stand, you know You have a chance if you didn't have Gabe Davis, obviously you had no chance But that's really what it comes down to with these small slates is you got to take a stand Yeah, I think that that's kind of the the way I want to play things here specifically to because like I Know having played enough small slates that like the odds. I don't have the guy are pretty high Even when I diversify so like I might as well just fully embrace Trying to hit the right combination with focusing on key guys We're talking more about that and the games in just one second First a quick reminder to make sure you are subscribed to the number fire daily fantasy podcast feed wherever you get your podcast We're not podcast Spotify stitcher The Google podcast whatever it may be called honestly, I don't know either way We're there find and serve by searching for the number fire daily fantasy podcast feed wherever you get your podcasts We're also up on YouTube up on the the fandal YouTube page So make sure you head over there and check out that we are live on air every Thursday at 10 a.m For these podcasts for the final multi slate one will have a single game preview for the Super Bowl as well So swing back by then to get a breakdown of the single game slate Whoever may be there also of course on the number fire daily fantasy podcast feed We have NHL NBA DFS podcast via Tom Vecchio USC from Austin Swain PGA via the two of us and NASCAR just around the corner as well Also, of course the conference championship DFS slate is posted over on Fanduel We got the Rams 49ers cheese Bengals Fanduel is giving you a chance to get in on the action All you got to do is go to fanduel.com and create your own Daily fantasy lineup for the NFL Sunday million contest play for a chance to win a part of the 1.5 million Dollar prize pool. There are a ton of cash prizes to be had So have heard a fanduel today and create your daily fantasy lineups eligibility restrictions apply go to fanduel.com or download the fanduel app For more details, let's dig in now to the conference championships and get set here with the Bengals at the cheese The cheese are seven point favorites total is 54 and a half The 49ers at the Rams is the second game Rams are three and a half point favorites total There's down to 45 and a half. It was 46 yesterday now down to 45 and a half Totals been going the opposite way or Bengals versus cheese injury notes for this late Darrell Williams was a full participant in Wednesday's practice of the cheese Tyron Matthew did not practice due to the concussion he suffered in the divisional round could still get cleared But that is not the start you are looking for there trip Williams do not practice for the 49ers on Wednesday Curtis ankle in the win over the Packers x-rays there were negative He apparently had an ankle injury earlier on the year and I think there is a legit question of whether or not He goes and not having Williams would be a downgrade for the 49ers for sure Eli Mitchell sat but that's kind of been his typical schedule since he came back from his knee injury So would expect he's limited Thursday in a full on Friday for the Rams Van Jefferson didn't practice Wednesday due to a knee injury He played 90% of the snaps in the divisional round and Shawn McVeigh said largely kind of a rest day So not a high level of concern there Andrew Whitworth got in a limited session on Wednesday sounds like he'll be back this week It's good because Joe notebook his replacement got hurt left tackle Darrell Henderson was activated off IR last week He was not listed on the injury report Wednesday, which means he was a full participant So one extra wrinkle added the camp makers discussion for this place. Let's talk about the sleep, right? I think that to me the Acres discussion is pertinent because There is one running back. I feel good about that guy is Joe Nixon Eli Mitchell Not a ton of passing game work left tackles banged up his role during the playoffs has been good but not great and Then you've got acres does he get a scale back to the fumbles Do we see Clyde Edwards E layer eat more into Jerick McKinnon's role does Darrell Williams eating the bats does Darrell Henderson factor in here. So I think to me the two Key discussion points first are we do with the cheese backfield the Rams backfield? Let's start things off here with the Rams Cam Acres, what is your confidence level on him if we assume Darrell Henderson is active and we don't get an additional word on What each guy's rule will be going into Sunday Yeah, confidence is a key word here Because we talk about this a lot where you have to balance what we know and what we are trying to project now I've seen some tweets this week talking about Cam Acres workload being really good and Basically showing his upward trajectory since returning and yes, that's absolutely true, but he fumbled twice As you pointed out Very key situations. Yes, as you pointed out, so any Michelle played on the final drive Now the head coach Sean McVeigh has said quote He's got tremendous faith and confidence In acres despite the two fumbles, but that doesn't He could have said he's our guy still which he didn't I'm not saying that tremendous faith and confidence doesn't mean he's their guy, but he could have just said like no, he's He's our guy Which he didn't that's really something so confidence level not as high as it should be For like making Cam Acres a locked-in play like I had him last week, I Don't want to overthink it But what are your thoughts here on Acres? It's complicated because I kind of want to know how the field will handle him because I Think to me There's a lot of risk and if people are not accounting for that risk Then it's situation where okay, we get people being overconfident in the role. That's where it is Advantages to deviate and if I get the read that Acres is going to be popular Despite the fumbles that situation where I am okay Maybe being underweight on him and by maybe I mean being underweight on him not maybe I think cuz Just I think he'll be popular at 6200. I agree. I think he will be too, which is why I Would be interested in being underweight for this week I think that there's a lot of shakiness in his role. The problem is where do I go if I don't go there? And I think that that's a key thing, too So I think to me the way that I view this is I think the most likely scenario is that Cam Acres is still the lead guy. I Think that the burst he has shown has been very good. I think that they have shown to us They Believe he's better than Sony Michelle The fact that he was still in there after that first fumble at the goal line Which is also a pretty big fumble that says to me they think he's the guy who gives them the best chance to win I think that they will go back to him as a result of that But there is a lot of uncertainty so I'm not going to make him a priority play for this week and that's gonna lower things pretty soon to him I'm not gonna use Sony Michelle. I don't think I think that's all right. I think that I'm not gonna be Henderson either I think that the most likely scenario is if they don't trust Acres fully They would rotate or they would use Michelle in like goal line situations and like that can be enough on a two game slate, but I don't I don't know. I don't think he's gonna burn me for not using him and I also don't think the floor is great either so With Henderson it he was benched for Michelle before his injury. So like I don't care too much about him honestly. I Think Acres is most likely gonna be the guy Let's talk to you about the chiefs because if we are not going to Acres if we don't want to be commit to him too much if we I have concerns about Mitchell a little bit The other place to go be the chiefs So we have this situation where it's Jarrett McKinnon and Clyde Aries-Elair If they were to maintain the same usage as last week McKinnon be awesome because in that game He has just burped in the microphone Sorry It is January McKinnon last week ten carries seven targets 78 yards of scrimmage. He had 39% of the teams Red zone chances CEH seven carries two targets 69 yards 15% red zone share if we were to get that same usage McKinnon would be amazing for $6,200 I'm skeptical we get that because if you look at the distribution by quarter First quarter McKinnon 100% snap rate CEH is zero second quarter 60 McKinnon 40 CEH Third quarter 70 McKinnon 30 CEH fourth quarter 64% McKinnon 36% CEH over time 50-50 Clyde Edwards-Elair actually started over time McKinnon got a screen and did well with it so I Think the baseline expectation for me is that CEH takes away some of the early downward McKinnon still gets the passing game Work because in overtime he ran six routes or sorry four routes He only played four snaps he ran four snap four routes on four snaps McKinnon or CEH ran one route on his four snaps so I Think they split things where CEH is the early down guy McKinnon is the the passing game back And that makes both them have paths to being okay for a two game slate, so I'm okay having a little bit of both Probably prefer McKinnon because the passing game rule is pretty valuable And I think that he is pretty locked into that but what's your read on them and how does it differ from mine? Yeah, so McKinnon played 69% of the snaps last week ran 72% of the routes I know that we have to kind of Do what you did and look throughout the game see how things progressed, but you know overall that's a pretty good workload and even the like fourth quarter stuff just kind of makes me think that McKinnon is going to be as involved as CEH and it's very ironic because CEH was drafted to be like what Derek McKinnon currently is but Derek McKinnon still should profile as being the Pass catching back and as we know you know, thanks to you On Fandle a target is worth twice as much as a carry on average before running back So even if McKinnon's workload gets scaled back He had a good red zone workload last week. He's going to be the priority in terms of targets out of the backfield And within the context of this whole slate if Joe Mixon doesn't really go off And and if the offensive line situation just Jimmy Garoppolo's health caps Eli Mitchell's upside You're not gonna need twenty five points from a running back because nobody's gonna get there So I would have McKinnon ranked over CEH. I think CEH is in play but then the question really becomes Derek or Can makers that's basically what it comes down to is where are you going there? I Don't because most likely we're starting our life right most likely we're playing Joe Mixon at running back and a lot of our lineups and while You and I roster a running back in the flex almost always So they're not the right play to force it in a spot like this and on two game slates historically optimal lineups We see tight ends. We see receivers there. You don't have to play a third running back So let's say we're starting with Mixon Then we got a balance Eli Mitchell versus Jerick versus Cam versus maybe CEH So, how are you viewing this mixing? Mixing and mixing I think is the strategy for this week And I agree that you were probably gonna skew heavily towards Why to save or slash tight end in the flex this week and I say tight end intentionally because I think that Higbie Kelsey is really enticing to me given their respective salaries. So I Think it's mixing and mixing where I commit to mixing and I want to talk through the reason why I'm doing that quickly here So I'll tell Mixon and then Mitchell and then I'll let get your thoughts The reason I want to commit to mixing is because the Bengals have in their higher leverage games So looking end of the season and during the playoffs Joe Mixon has been Very heavily involved in the passing in here has passed four target totals six eight five seven That eight target game came against the Chiefs back in week 17 They've been throwing more, but they've kept him on the field I know there was that weird like some Ajay Pirine like yet There was a pick when he's on the field and they're down that was the exception Not the norm last week for the Bengals Mixon has been heavily involved looking at the games 17 games from with a full snap rate 46% red zone share for Joe Mixon Nobody else in the slate comes close to that and they're most relevant sample 98 yards and scrimmage per game It's amazing relative to the other guys. So Mixon to me is the I Have to add lineups in order to not have a hundred percent kind of guy like that's where I'm out Joe Mixon Mitchell seven thousand dollars. That's a good salary for his workload However, I see some paths to destruction here if you're trying Williams can't go because that is a pretty big downgrade Mitchell Has some work in the passing game, but it's not like the most creative kinds of Targets like he lost 11 yards on one of them Drag against the cowboys in the two playoff games 78 yards to pitch per game He has half the red zone work, but that's on six plays They've run six freaking plays in the red zone in two games. They've won bold.  I don't know whatever anyway He's losing some work to Debo I know we still had 22 carriers per game But like I think that there's a lot more fragility in in Mitchell and not in the positive sense I'm looking at some initial like roster rate projections and They have Mitchell lower than I would have expected. I'm guessing that will change throughout the week I Don't know it. Maybe it won't but if Mitchell comes in where he is currently projected to come Maybe I'm more on him than I thought I was but I think that there are very obvious paths to failure there So that's why I want to go the mixin and mix it strategy We'll rename it on the fly mixin and mix it strategy at running back So give me your thoughts of mixin Mitchell and overall running back Yeah, so Joe mixin is Like he's the best play. We don't have to you know say a whole lot more than that My my early simulations have him 42% likely to lead all running backs and in Fando points on this slate That's really good. Just pretty pretty high floor high ceiling. We know what we're gonna get from Joe mixin I think that I'm a little bit higher on Elijah Mitchell than you are we've seen The 49ers just commit to the run Because they have to their pass rate in non garbage time situations Since Jimmy Garoppolo and Elijah Mitchell came back 43.9 percent In week 10 and a week 18 combined against the Rams their pass rate was 14 percentage points below Expectation based on game conditions. They're gonna want to run the ball that might not make them efficient But Eli Mitchell should still factor in pretty heavily From a floor perspective and we don't care about floor But I think floor can go a long way and I've already gone through I can build mixin in in Mitchell lineups and still feel pretty good with what else I have It does come at the expense of the receivers And then the conversation is and you have to do this with every position this week is if you're Allocating one place you're shorting another place If you're playing mixin and Eli Mitchell, you're saying, okay Cooper cup isn't really gonna get there for a 9700 salary on this small slate Debo might not be a hundred percent They're gonna get kind of stifled because Jimmy Garoppolo just can't really move the ball, you know Tyree kill is just okay. I guess Jamar Chase doesn't really erupt. They find a way to limit him. That's basically what you're playing I think there's a case for that lineup that being said Just going over those receivers. I'm much more terrified of not having as much Jamar Chase Tyree kill Then I am having like Eli Mitchell. So Realistically, I'm still going mixin With the mixing in like you said the mix it But it does sound like I'm higher on on Mitchell than you might be. Yeah, I just see like I Don't know. I'm not as high on his floor as you are I think that your point about floor mattering more is pertinent and I agree that I'm just not as high on his floor because It takes a lot of opportunities for him to rack up points because of the lack of passing game involvement Like he hasn't had more than 20 receiving yards since November 28th That's that's kind of tough for me So like I am okay with him and like again if he comes in with the projected roster 8 at Where it's at right now relative to cam acres, then I will jump ship and be higher on Mitchell So I think that's kind of the key decision point is is keeping an eye on projected roster 8 for him seeing where he comes out there and Kind of reacting to that appropriately. I think that's the way I want to do things here as far as the other guys. So Not going Mitchell. Where do I go between the others? I Feel like I have to go acres, but I also am okay If acres is definitively ahead of McKinnon in terms of roster rate I am okay jumping over to McKinnon and going that way instead mixing in some CEH But I think that to me Having mix and be the staple rotating through those other four guys between Mitchell acres McKinnon and CEH. I think that's the way I want to play things I will have lineups where I have a running back in the flex if I decided just because I need some salary if I go acres and Like CEH or McKinnon. I think that like, you know those guys compared to the Low 6,000 receivers assuming I already have Teagan's in there. I think they grayed out pretty well. So like I was building one which was it was a lineup with Mahomes and mixing and I had like 6400 for the for the final slots and I could go with like Odell or acres or McKinnon I did wind up going a running back in that in that lineup over Odell, but I'm not actively seeking them out I think that's you know, I'm trying to get stick to two if I can Yeah, I think the the main reason to go away from running back in the flex is To get a Mitchell mix and stack Or to play acres plus McKinnon Or acres plus CEH and then try to get an extra stud receiver Which again if this were a main slate that wouldn't really be at the forefront of my mind But on this particular two game slate and on two game slates in general I'm there. Yeah, okay. So let's talk about receiver here I think we ran through running back actually let's do quarterbacks that will kind of inform wide receiver to me I know this will be consensus. So Chuck baby, I Think that the quarterbacks in the first game are standouts and I like both Mahomes and borough more than I like Stafford Again though like if Stafford projects to be low rostered. I'm okay pivoting to him given the You know, I do think that there is some appeal there the reason why I'm so high on Bengals cheese The first time they played those two teams were slinging it. It's not just a total It's also the philosophy they had in that game The Bengals had a 76% early down first half pass rates The cheese were at 67% the two matchups for Rams and 49ers Rams were at 52% early down first half pass rates 49ers 37% so more passing volume Um, I think that both these guys are pretty easy to stack obviously to between Mahomes and borough So that's why skew towards both Mahomes and borough above Stafford, but again, I mean as Stafford winds up Being much less popular. I'm okay pivoting to him. So I know that's like feels like a cop out But I do think that's an important way to view things to see what's your view of quarterback here Yeah, but I mean, we're not we're not here to say like we don't give our locks and like ignore everything else Don't exist. Yeah, that's not really how it works on this show. Um For us, it's more just talking about a lot of game theory, especially on these two game slates and um My slate simulations have Mahomes roughly 50 likely to leave the quarterbacks in Fandall points borough about 22% Stafford about 20% so that's actually pretty close And then garoppolo just kind of gets um About 5% whenever everything else goes Goes in the dumpster for all these other teams and so if anyone's, uh, wondering If garoppolo makes any sense to play You are asking yourself what the odds are that Mahomes borough and stafford basically all stay below 15 Fandall points I think in garoppolo gets you about 10 On that gap narrows then and and then you can allocate salary for the receivers or to get the travis kelsey Um, that's really what you're doing with with garoppolo. So I kind of want to at least address that and not just say Not a chance for me. I'm not going to play garoppolo. Um But that's what you want to think about is You know, what are the odds that this chief's bangles game is? Bad offensively. It seems pretty low. Um, so Yeah, we've got a question about Weather in Kansas City on twitter, which is a good question Because one game is indoors and this game is not luckily for us 44 degrees three mile per hour winds sunny I'm very jealous and I would like to be there. Um, but that helps a lot for the paths of destruction in that game One less path to being bad. Yeah. So to get back to it Um with quarterback, obviously my homes should be worth the salary in terms of projectability the ceilings there Uh, the I don't want to say floor, but like the floor is there if you look back at that first match up, um Daryl Williams had two rushing touchdowns. My homes went for 259 and two I give him an extra touchdown. We see my homes Run the ball plenty himself now. I mean a two for 25 with a 17 yarder in that first match up I think that that gives my homes an element that It's something that he can do but has he doesn't have to do Um, now he's open to doing it and we saw what that could could lead to so Um, my homes is easily my number one. I'm with you with burrow over stafford. Although I will just mention that I love love the idea that both, um, jerry mckinnon And cam makers are the same salary and that joe burrow and matthew stafford are the same salary because it really makes you uh, bear down and and kind of Think about what you want to do. Do you want to duplicate those lineups and do the the one for one swap? I think that's not bad if you have a core and realistically you're going to have players from You know the rams and the bangles in that lineup, so You don't have to swap things around so i'm very open to being pretty even on burrow and stafford But that does go against the idea that I need to pick and choose My quarterback so for right now I have my homes expected to be in about That's a 75 percent of my lineups. Um, and then about 25 left for burrow or stafford Realistically, I think I would take a stand with just joe burrow, but i'm not against that You know sort of the one v one swap that I advocate for a good bit Yeah, I think that stafford is very interesting Which is why I am kind of hedging a bit because like in a vacuum I prefer burrow because I just like that game more in terms of the game environment But also like stafford's playing indoors um He played very well the past two weeks. I think that's encouraging as well um You know it is a good defense and stuff like that, but I'm open to him for sure. Yeah, and for me. Um, I know stafford's like if you look at the box scores and stuff And i'm not talking game film because i'm out of my element when it comes to game film But you were grinding tape with uh, what was it? Who were you? Some cd lam some dax got throughout the year But even like stafford's big drawback in recent games was just a lot of picks But he was actually decent from an expected points model either number fires or Others that you can look at He was actually pretty decent despite interceptions and interceptions kill Your epa or you're passing that expected points and What that meant to me was that perception was going to be lower on stafford than it should have been Um, and that's basically been the case now. I will say that It's hard to look at someone and and and say 29 24 fandal points doesn't really have the ceiling But he had rushing touchdowns the past two weeks and he got to 20 but basically 25 and 30 Before that even like with those picks. It's kind of what i'm what i'm getting at is like It's a little bit hard to to narrow down what we're going to expect from stafford He's not like a 25 point passing only kind of Quarterback at this point If you take away the rushing touchdowns, which isn't fair to do The the ceiling's not quite there. So really for me to play stafford. You're you're betting Specifically against mohomes and burrow and in that case then if i'm like no I'm gonna play stafford because I think that the Cincinnati, kansas city game Isn't as good as the over under suggests I would be actually very heavy on stafford because that that to me Is the real case to make for stafford if you're saying well Mo homes is going to be great and stafford is going to be good. You're basically saying burrow is going to be terrible, which It can happen, but the correlation is not quite there. So yeah, realistically I think that's why I might have very minimal stafford because I don't want to I want to keep my exposures tight Oh, I think that makes sense and that's a good thing about it too. Okay. Let's move to wide receiver and tight I'm going to lump them together because I think they do tie in pretty well here Let's start with the value because we need mixon or I think we need mixon at least Um, you're individual which means we need to find some values somewhere My guy is uh, well guys are brandon. I you can tee higgins I know if you are a regular listener to the podcast shocker I mean back half of the season on those two guys first half is a little different story Is that a genuine shocker because like We've been talking about those guys a lot. Yeah, you has you specifically did not like tee higgins early I said second half of the year. I've been very into the second half of the year. Yes. I just wanted to clarify. Yeah Yeah, second half of the year I've been very into the reason that I think that I you can higgins are like the two Sorry, you can yeah higgins Higby and higgins is like in my brain and I can't like get out of it. Anyway, okay The reason those two guys are the focal points are because they both still get good workloads I know how you can the playoffs has been rough Last week He only caught one ball. It was overturned. He fumbled it. That's not great. Uh, but overall We played the games since george kennel returned And with debo samuel nila michael healthy Are you because it's 68 yards per game doesn't a lot of red zone work which is limiting But he's down to 5600 dollars I think that is a very good number for someone with his workload tee higgins in the games He's played with jamar chase since chase's return 23 target share a 31 deep 19 the red zone and People just saw jamar chase Absolutely shred this defense a couple weeks ago I think that if they go to the Bengals, it'll probably be via Mixing via chase Higgins will still be popular to do the salary. He's not going to be like Given the twitter discussion around odell. I'd assume odell gets more attention in the low six thousands than Higgins does so I think higgins is very interesting Final guy here to mention as far as values higby. Uh, tyler higby has a 19 percent target share in games with odell beckham since the buy Um, 13 deep and 11 percent of the red zone which is not I like huge But He did a two touchdowns versus the 49ers thinking he had eight targets total in that game And I can use for another game too. Oh, did he okay? Cool. Um, so he's I can use him without limiting myself with kelsey because I could just use both and I'm Probably gonna like I think it's single entry. I'm pretty likely to have two tight ends Like decently likely which feels weird, but I think it's probably the right way to play things this week. Um, So higby iuk higgins the guys that stand out to me. What about to you? Yeah, I mean, I think the the obvious The jump to mine one name. I wanted to figure away Uh Salary Okay, so that I think could factor in from a pivot away from is spiral A salary seven gyms making a face. I'm not watching but So in in Is at 80 percent not out rate. Oh 71 out rate Pringle the seven game iuk three and a half. You know, one team is going through the ball plenty the other team is trying not to ball one team is Team total seven five other team in this conversation 21 um That's what 10 point seven five points. Um nine point seven five, I guess so I think pringle deserves to be on that list Attached to my homes, especially because he helps my homes uh be you can play my homes and One touchdown for even 20 yards for from pringle um within A stack is pretty solid. Yeah, I mean like he's just so like In the games with kelsey and hill since they're bi-week Like I've heard people cite pringles target totals over the past month You have to keep in mind that kelsey didn't play one of those games and hill Was active but banged up But if you look at the games, he's played with those two guys being like full goes 13 percent target share nine percent deep 17 percent red zone share percent. Yes percent. I get it volume though Like I use market shares are gonna look good. Also. I reference just the pat like the playoffs No, I wasn't talking to you. I was talking to the Okay, the broader republic.  So talking about the republic. Anyway, uh, I uke 5.4 targets per game Did you want to look since the the in the split I mentioned before? He's a 3.5 in the playoffs. So fair, you know, uh, that's very fair to mention that his overall numbers have not been great But I just think the yardage upside is better and Like I don't know It's just so hard for me to get over the mental hurdle of using a dude who's like gonna max out it at 40 yards and over the guy who his like betting prop is 49 and a half Like yeah from a probability perspective the odds that Pringle out scott scores. I uke are decent but like I just think that like I'm betting on the wrong Stuff when I go with Pringle in that scenario Sure, uh Sure seven targets, uh in each playoff game from my homes or Three and a half in jimmy grapolo. Yeah, like There's more to it than that. Yes Yardage upside wise I think makes sense. I don't know if the yardage upside is really there and at this moment Because of what this team is doing.   Yeah Like I'm not out on a yuke, but I do not think that he is As high of a play as like t-higgins or titer higgie. Well, no, I think he's below higgins. Um, I think higgins is a great option um, but like Realistically if I want to get to Nixon, I'm gonna need guys in the 5000 range and I get to check that so so it's pretty But like I mean counterpoint Let's say I go my homes. I want to get in Tyreek and Kelsey That means I have one more slot for a chief like we're gonna work it up against that cap at some point this weekend Do I go pringler? Do I go with a running back? Probably going running back because you know Although pringle did get a pringles endorsement this week. So You know, there's that maybe that maybe that tells the scales. Um, and then While we're here hyper focused I I know probably how this is gonna go but tether boy 58. Oh, no. I actually like boy. I was gonna bring it up I'm not typically a huge boy dude, but like I think he makes a lot of sense this week Looking at the games with higgins since higgins came back 15 target chair 16 deep 12 red zone if the discussion were Will you pivot off of iuk for tyler boyd? I would have said yes, that's fine I prefer boyd over pringle by a pretty decent amount actually. Um, I'm glad he mentioned it because I might have forgotten to Talk about him, but like I think that he is the better player between the two I think I've been pringle for this year fact of being tied to the better offense with the higher touch and expectations Pringle is not going to score in every single game. It's not going to happen but You want efficient efficient passing that should be this week. You want red zone chances red zone targets available Um, and I think really what it comes out Pringle's scoring not because he's like converting these As gym would be first to point out like these 50-yard touchdowns because the yardage isn't there for a 50-yard touchdown But it's literally not there. He's not at 50 yards in the game with hillar kelsey They were with hill and kelsey both being like fully healthy since the buy But how many touchdowns you have in the playoffs while teams are trying to limit What teams are trying to limit tyler kill travis kelsey stop everyone in the red zone Touchdowns are the most stable thing in fantasy football to bet on I agree. Um, okay, so you know what you know what You know, I might be stable seven targets from Patrick. Well seven targets 29 yards He needs 15 targets to get to 50 Okay, I think let me read you.  Therefore. I like him more than I like Iron Pringle Okay, so now we're on boyd, but if we lump all three together are we certain the 49ers will Run a red zone play this week. Are we certain that they will score a touchdown this week? I you might I'll score pringle with no touchdowns The chiefs are probably more likely to score four touchdowns than the 49ers are to score like two That's right about even Get out of here. Um, okay. I think boyd's actually a good play I think I think that I think the place to be the line most is on boyd being yeah being relevant Yeah, so like if if we get the read that iuk will be Which I don't think he will be given they donated last week. Does that show up in his game log? I don't think it does because player card. Yeah, I'll get a turn Like I like iuk and I've been I've been advocating for him for a while, but They don't want to throw the ball. They especially against the rams. They've shown them. They don't want to throw the ball Corral is very hurt. We have all these reasons to believe that a one target no catch games Possible again, so I just don't want to be overexposed Yep I mean, I think that I would I think that like I agree with that. I would just rather differentiate with with boyd than pringle He scores three touchdowns again. Cool. It burns me. It's fine I will use him to be clear, but I am much more inclined to go I uke and boyd As I said it right sort of the way tony romo says I uke It's I uke. I looked it up because I was freaked out by the way. He was saying it. He was saying he says like I uke It's I uke. So I uke or I uke. There we go. He's messed me up. We're almost in my head. Anyway Let's talk about the studs reason we're talking so much about the value plays is in order to give us access To the studs and by studs.  I want to say cooper cup But the salary makes it unlikely that he'll actually be the person I have the most exposure to So I'm most likely going to be heaviest on tyrie kill because I'll be heaviest on patrick mahomes Um, and I can I can play tyriek with t higgins. I can play tyriek with tyler boyd. I can play tyriek with Um, joe mixon as well. So if I'm gonna play a lot of mahomes, I just want to be realistic here I'm gonna play a lot. I'm gonna be overweight on tyriek and calcy and Pringle um, but But I think that it really comes down If I'm being pragmatic, uh, it comes down to chase and hill Is the top plays and for me it's gonna be hill I think I probably agree with that Because like I think about receiver mostly in terms of game environment and the game environment's better here Which puts hill and chase above cup and samuel What? Don't that doesn't but that doesn't apply to it. It applies to boyd 50 5600 always a lot different than the 97. Okay, okay Okay, uh I think it's really tough to decide between hill and chase Because I do objectively think that chase is like Kind of on that level because we've seen the bangles more willing to go deep recently than the chiefs, which feels wild to say If we look at jamar chase In the games, uh, the typical sample I go to here 42 of the deep targets 23 red zone share He's been kind of netso during the playoffs too. He's at a 116 and 109 yards He's at 100 plus and four the past five the one game where he didn't get there is a game where joe burrow didn't play um He's kind of stupid in the most positive sense My worry is that people will go there because of how much he shredded the chiefs and leave higgins more so in the dust so Like if I get a read that chase will be less popular than I think he'll be I'm very okay going with him over hill my baseline assumption is that like In the hill went nuts last week. I think cheap people will go to chase because of the performance that he had versus the cheese so The side between the two I'm leaning Towards hill right now, but I am very receptive to chase and just being in on both them pretty heavily So it sounds like out of the top. Well, I guess we're throwing in kelsey out of the top five our top two are Tyree so has chased number two for you out of the top five then Think so because he is for me. So then Then who's who's third kelsey? kelsey, okay, because Basically what I was getting out was like where are you with debo because you've been much more Intuned with what to expect from debo samo than I have And I often let what you tell me dictate what I do even if I fight back on it a little bit Yeah, so like the reason I like chase is because of yardage. He's had insane yardage totals and He can translate that into touchdown because he's an absurd player Debo during the playoffs 10 carriers per game three and a half targets per game 97 yards per game He's had two out of two out of six red zone chances. So 33 percent But whatever If we look at the larger sample of the the one I typically go to with the four owners 97 yards per game 29 red zone share his red zone share slash Red zone share is better than than jamar chases but I think that like just again game environment that I think the yardage looks better for chase. So that's why I go chase I would go Samuel is $1,300 lower than cup and that's a big difference if I want to get to mix in so like I might go Samuel over cup But it's hard for me to get to him above chase given game environment given yardage expectations, etc, etc Yeah, um, I'm with you. I think I'm gonna be low on debo. Uh, just as a result because I can't play everyone I'm just not gonna play that way this week and We talked about chase going off against the chiefs. Debo has had really good games against the rams Um, I think about 27 fandal points per game against them. He scored. I think a rushing touchdown in each Uh, a receiving touchdown in the first match up and then had four for 95 In the second match, I guess I could pull up the player card. I was doing it a different way, but uh Um I think that that's gonna factor in. I don't know what his health is. He's probably gonna be He was a phone. He was not even listed on wednesday. So that's good.  Yeah, he'll practice through dings and dems. You're right So he might not be at max efficiency, but again, it comes down to the just sort of expectation of game Output and again, I have nothing against anyone who says You know what? Everyone's gonna play bengal's chiefs because it's got the higher over under it makes the more Most sense. I'm actually gonna focus more on rams 49ers Play the angle that that bengal's uh chiefs is a little bit underwhelming. I get that like i'm far Or you could just play the angle that ran 49ers goes nuts, which could happen. Could it? Yeah, I could Could it? Yeah I mean, it's maybe if I'd spread One of the teams is very fast You know, I think that it's indoors. I think there are paths. Do I think they're the most likely paths? Oh, well, I'm gonna go chiefs bangles, but like their paths Yeah, and if debo is quarterback and because he threw that touchdown against the the rams as well That 24 yards or so about that So what i'm what i'm getting at is like With jimmy playing the way that he's playing which and and maybe we're maybe we think about this completely differently If his receivers caught some of those passes in the the first half Um, you start off what 0 for 5 over 4 with like every pass being dropped No, no with every drop back being a sack He was 0 for 5 on like 15 drop backs because he just kept holding on the ball getting sacked because That game is miserable So, I mean look i'm not actually saying that there's no chance that this 49ers rams game goes over but You really need it to be You need long plays I think you I think you're the the sort of a realistic path for this game to play Better than than chiefs bangles is the 49ers get Quick touchdowns maybe with a long debo touchdown. I you obviously have the yardage upside Kittle has the run after catch ability Maybe a special teams score to put pressure on the rams to throw the ball a lot but if The 49ers play from behind I still think that they're going to be playing slow playing their game try to run the ball slow things down and it's Sometimes I see like I think about these games in terms of like, okay I'm gonna look at it on the tv And the clock's gonna tick to zero at the end of the first quarter is like I see the the the overlay being like rams 3 49ers nothing I think there will be one score in the first quarter. I don't know what that one score will be And it's like and it's like, okay did it really Was the theory there was strong enough to prioritize this game? and again The the probabilities are out there that this game is better And you just have to think about that and I think that it's far enough a way that that's why I'm Totally fine ranking uh the top five pass catchers to be hill chase kelsey Uh, I guess debo and then cup gives the salaries way up there.  I just like his dislike his salary like he's amazing He's absurd and if you know my previous sentiments towards cooper cup, you know that that is me being genuine I would I would not lie to you. I will tell you what I actually think about him Um, he's great. So this is not that something odell quick 63 to dollars I think he's overrated in terms of dfs relative to Higgins and like the value guys because This is just based on like twitter People think odell beckham is like going bananas with the rams. He has not had more than 70 yards since december 13th He has not had more than 80 yards Since his second game with the team the yardage upside has not been there the touchdowns have Now the touchdowns have been there because they are designing stuff for him near the goal line and he's converting on that so i'm not saying that's fluky but like He's kind of like adam thielen except people think about him better And he's also lower salary than adam thielen I guess we're gonna go that way too But like he's kind of feeling esk where I think that higgins has Much much much better odds of dropping a hundred with a touchdown on our heads. Um, so that's why I prefer higgins I think he's kind of in like the The voidish range without the similar sentiment a little bit better volume than void, but the yardage is like kind of similar so That's where i'm at on odell. What about you? Yeah, I mean if you told me that like t and odell would be at it's not roster rates I'd go t all you know every day, but I don't know if that'll be the case correct. Um So, I guess realistically it comes down to And this is something we haven't discussed yet, but just I don't want to say wasting salary, but leaving salary on the table Are you willing to build lineups and have 63? For odell beckham, but instead you play tetherboard I think I would yeah I don't I think that's something that probably doesn't get talked about enough is like, yeah, everyone's like, oh If you want to differentiate leave some salary there, but it's like okay if you have 60 64 in a lineup and you Are already playing a lot of t higgins like would you just waste all that and play tetherboard sometimes like Maybe I think I think higgins is a harder sell than beckham. So if you have 63 like Yeah, I don't think that The gap is massive enough between boyd and odell, especially because odell is very touchdown dependent. Um Like odell or pringle who are both touchdown dependent like I was gonna say I'd stop myself Like I no I get the case fancy Byron pringle.  Hopefully the it's a joke. It's in the clip before I get roasted onto it's a joke I'm gonna clip this one up for you, but but so I mean, realistically the receiver's come down to two tiers. It's the studs and then it's everyone else Um, I think that we're we already touched on the top five. I think the t higgins is clearly the number one uh non superstar salaried uh pass catcher No pushback there from you. No um, and then it realistically comes down to Uh boyd pringle beckham and iuk. Can you rank them? So I know pringles last. Yeah by marg why margin if you look at yardage props over at fandal sportsbook hashtag plug um hashtag company boy um iuk's at 49 and a half Beckham's at 50 and a half uh kiddles at 52 and a half. We even talked about him Yeah before we close up. Um, and then uh for the bangles guys Uh pringles at 37 and a half under um Higgins is at 70 and a half my goodness. Um boyd is 39 and a half So I'm okay kind of ranking him that way. Um using that as like the guiding light iuk one I'll go Boyd two that's due to roster rates straight up for beckham, but like expected roster rates I think he will gravitate towards beckham. Uh boyd two beckham three Pringle four, but also my Lack of enthusiasm for beckham also ties into our discussion before about if I had 63 left I might just go acres and mckinnon as like the if it's like for the final slot I can just go in the receiver. Yeah. Yeah. Yeah, exactly. Yeah, that's kind of tainting or going to that too Let's have a george kittle uh 5800. You can put tj uzama in here too if you want. Um, because honestly he has had a legit role I've talked a lot about higby kelsey as being a combo. I like in the same lineup I do think there are paths to kittle being really solid here. Um You know in in the the first or the second rams games are the more relevant one He had seven targets. He had 10 yards on the seven targets. So that's you know, that's that but also like He is kind of the type of player you want to use against his defense so He's 5800 dollars. He is a talent where if he gets targets, he can convert on it That's not enough me to put him above higby but it's enough to say where Even though he doesn't project very well, even though his like game log isn't very good I'm still okay getting to him because I know it's within his range of outcomes drop 120 and two touchdowns on me And I think that's worth considering here because not a lot of guys can do that on two games late. So Even though kittle is not going to like From a data perspective look great And that's the reason why i'm not enthusiastic to use him. I do still want to use him What are your thoughts on kittle and you can talk about hizama too if you want? yeah, so I've been having a hard time with kittle. Um, I took his under on catches last week at four and a half And he had four but he had that I mean he had one fantastic four and a half again this week And he's at four targets per game. I think during the playoffs. He's at four and a half targets for you during the playoffs so That's You know that's basically been again that applies to the iu conversation is it's really hard for me right now to look at What these guys are capable of and they've they've done in the regular season and apply it to right now Because of the way that's off ends is operating and maybe All of a sudden jimmy garoppolo is just way healthier and starts You know throw on the ball again. He had some good throws in the first quarter last week Maybe that continues. Maybe he builds on that and then You know shocker the 49ers pass catchers have a lot more life But as it is now i'm not really seeing it that way. So i'm a little bit lower on uh, george kittle No, it's at the point that I won't play him. Um, because he has yards I have to catch upside all you know All it takes is one is much more in play on these two game slates All these playoff slates than it is on a on a full slate, but kittle simultaneously has like I won't call it volume upside but market share upside like he he could get 35 percent of the targets and that makes sense Um, that's not going to translate into 12 targets or anything unless this game just gives a blow out from the start um, my question to you Is I know If we're talking flecks and you have 62 left you're you're gonna lean toward the running backs If you have 61 left so you cannot play, uh, odell backham, uh, jerek mckinnon or cam makers Are you playing george kittle? Are you playing higby cju zama?  Oh boy, that's a good question I think i'm gonna face that a lot this week probably uh in initial builds I have so yes, I'd agree that If i'm going six Six thousand or lower I'm taking a very long look at kittle. I would say If I don't have higby I might just go higby too. Um Yeah, that's he's involved in this. Yeah, so I think the tight ends are hyper hyper involved in this discussion Is what I would I think that's a big takeaway I think the kittle is someone where kind of someone acres. I'm okay letting sentiment dictate where I go if kittle's gonna be Super popular. I think he's the worst player in a vacuum than higby and I just go higby Like if higby is going to be a lot less rostered and so I look at roto grinders, uh, rostery projections I know people We're talking a lot about them. So I should probably say where I'm looking at them I look at roto grinders typically Um frustrating thing with these is most rostery projections are paywald. So You know, it's kind of a bummer. We want to make this like accessible to everyone. Um, I lean on their stuff a lot though If you're wondering where we look for this stuff, um You can find a lot of places though But they seem to think and that there's this like heavily database I know the way that like they're the process is very good. Um, and it has Kittle being pretty popular in that scenario. I would go higby for that final slot Maybe void I'd give consideration to void too. Maybe I just like probably more than I thought I did Yeah, I don't know sounds like yeah Huh, what about you? What would you do in the scenario? So I was gonna kind of do a little bit of a cough out and it's going to depend on the game I'm stacking and realistically I'm gonna be stacking Chiefs bangles primarily because I'm gonna again, I'm gonna have a lot of my homes and going back to the staffer conversation like The the reason to play Stafford is you think that he contends with my homes and if that's the case Um, then you're saying he's gonna out square burrow at the same salary Then what you're saying is the chiefs bangles game is either super run heavy Or just doesn't have as many touchdowns as we want a lot as much yardage So I'm gonna lean towards someone like uh cg ozama tyler higby's kind of Independent of that because I don't need him to to be part of this back-and-forth game I think higby's the best process-based play. Yeah, um But I think cg ozama tyler boyd and byron pringle would would take precedent over someone like brandon at uke for sure Pringle win, but the rest might I I can I know c e h kind of be yeah. Yeah c e h is in that discussion too. Oh, yeah, I guess I we didn't I think he's in that discussion, but sure, you know, okay Chips are on the table. Who are your top priorities across any position? Uh for the sunday slate Patrick my homes in the sense that I'm going to be way heavier than What I think the field would probably be I would assume Usually like my slate simulations are roughly decent with like How popular guys are I would expect them to be about 50 percent, especially looking at things last week Um, so I'm going to go like 75 percent. So I'll call him a priority Joe mixon And then tyree kill I think and t higgins would be my four top priorities I think like top top top top top priority for me is mixing like If I am filling out a lineup realistically, he might be the first guy put in Just because I want to allocate that salary towards him and there aren't I don't want to use two other running backs like again I've had the situation the past couple weeks were like I look at my you know, again plug for roto riders their uh, their extension and you can look on your fandom browser and see roster rates for your exposure levels for each god. I see oh, no, I've got a hundred percent Darrell williams and I had to Had to like change things up. Thankfully, uh, it's like get off of that And I think that mixon if I like refresh the upcoming tab and like look at my exposures Nixon will probably be 100 off to like find ways to like lower that a tiny bit not too much though I'm okay being very close to a hundred. So mixon is the top priority higgins probably too, which means I'll be heavy on bangles It's just fine. No objections for me. Um The more I think about tight end the more I think that I I need to make helsea a priority whether he's a tight end or a flex Higby's kind of close to that too so like Honestly, I wouldn't be shocked if I'm like 60 40 at tight end versus receiver and the flex I could see myself having a tight end in 60 percent. Maybe I won't but I'm not I'm not opposed to it I mean realistically we have four tight ends in play like yeah, we do Yeah, and we have three value tight ends in play And it's weird that george kiddo is in the conversation with cg uzama and tether higby but It's it's just like you're asking Him to be hyper efficient on five targets Yep Which he could be and he that's that's the scary part exactly exactly So I think that's where i'm at t against the receiver priority again So I think that's where i'm at for right now All right, uh any final thoughts for you before we send off the good people to fill out those sick sick lineups Um, I think I got to say everything I wanted to say I really I really wanted to make the point about like Think about why you're playing Matthew Stafford and what that does like you don't want to I'm not I'll say I'm not going to stack Matthew Stafford with like a full chiefs Bengals sort of stack like if I'm doing that I'm probably going to be lower on Jamar chase tarry kill and get up to cooper cup, which I know sounds obvious But like yeah, it can be easy to lose sight of who's actually in your lineup when you're playing the best plays And then you're like well, I'll just stafford over borough because it'll be less popular like Really look at every single lineup you're playing even if it is and I guess especially if you're you know using an optimizer Before you submit those look and see if this those lineups make sense because on a two game slate sometimes they won't really add up Um, so that's one thing I would throw out there We're just built in my hand To do it that way too That is all that we have here for today for the conference championships But as mentioned we'll be back with you for the Super Bowl Probably the Thursday or the Wednesday. We have not talked about this. So I don't know. We'll figure it out then We will be with you The week before the Super Bowl to get you set for that That'll be on the fandal youtube page live at 10 a.m Most likely whatever day it may be super detailed analysis there But of course we also have our pga podcast every Tuesday 10 a.m on the fandal youtube page If you're watching youtube right now a thank you Be hit subscribe Uh c hit the like button too because that does help us out a bunch Also, make sure you are subscribed to the number fire daily fantasy podcast feed for nba nhl usc pga nfl nascar podcast all in the same place All of wherever you can get them each time they are posted brandon If people have questions for you on twitter, where can they find you there? I'm at gudola 13 gd ula 13 and i'm at jim sonnis j i m s a n n e s You can also follow the fan dual podcast network at fan dual podcast big Thank you to everyone for tuning in forward today. Good luck to you with your lineups. Enjoy the football We'll talk to you once again in the coming weeks to get you set for Super Bowl 56 ish I believe we'll talk to you then this has been the heat check fantasy podcast powered by number fire You


A war has broken out between FSB and Defence Ministry in Russia. A war has broken out between Vladimir Putin's Federal Security Service, FSB and Russia's Defence Ministry after the Wagner Group's mutiny, Kiev has said. Andry Chernyak, a representative of the main intelligence directorate of Ukraine's Ministry of Defence, said mercenary chief Yevgeny Prigozhin's short-lived revolt over the weekend revealed the weaknesses of the Russian president. This, he said, has sparked an open war between the so-called Towers of the Kremlin, headed by Russian Defence Minister Sergei Shoigu and FSB director Alexander Bochnikov, and that liquidation of each other's officials was likely. The Defence Ministry and the FSB headquarters are located just three miles away from each other in Moscow's city centre, according to the Daily Mail. Kirill Budanov, the head of Ukraine's intelligence directorate, added that Prigozhin is also in the FSB's crosshairs. We are aware that the FSB was charged with a task to assassinate him. Will they be successful in doing that? We'll see with time. As Russian Army units refuse to fight in Ukraine, it appears that volunteer fighters are continuing to sign up with the Wagner Group in spite of Shoigu's recent decree that all volunteers must sign contracts with the Russian military. Reports from Medusa media outlet suggested that Wagner Group recruitment hotlines remained open as of today, with Russians continuing to sign private contracts with the Group in defiance of Shoigu and the Russian Defence Ministry.


To finish things up today, I'm going to talk about a case of optic neuropathy and end stage renal disease and some things that hopefully everyone, at least who's seeing patients with end stage renal disease, which is probably everybody in this room, can think about. So this was a 59 year old man who presented with painless vision loss and dyscadema in both eyes. He had a rapid decline in his vision for about six to eight weeks before he came into Dr. DeGree's clinic. His vision was suddenly very dark and blurry. He couldn't read. He couldn't make out any details and he couldn't do his daily activities. He had an MRI brain which was done about three weeks before coming in to see us and didn't show any new abnormalities. And he was seen by his local optometrist who saw a dyscadema in both eyes and said, I don't know what to do with this. Let's send him to neurophthalmology. So his past medical history is remarkable for a chronic disability, which is mostly accounted for by his mental illness. He's had multiple issues with schizoaffective disorder with bipolar features as well as obsessive compulsive disorder and others. He also has a history of end stage renal disease which arose from chronic lithium use. So the lithium helped to control his psychotic features but unfortunately at the expense of his kidneys and he actually stopped the lithium about five years before this presentation but he unfortunately had suffered long-term permanent consequences. His nephrologist actually had urged him to go on hemodialysis as we typically do with patients who are on end stage renal disease but both the patient and his family declined to continue with hemodialysis for a number of reasons, side effects and other issues. And so actually because he was end stage renal disease and not on hemodialysis he was essentially placed on hospice or given the option to be placed on hospice. He stayed on hospice for about six months and then he really didn't get any worse which was pretty surprising considering all of the things that were going on in his kidneys not working. So they actually took him off hospice just before he came into CS. He also had a history of hypertension, had a prior singulotomy which was done in attempts to cure his OCD which did not work and he also had a long history of chronic knee pain and chronic opiate use which was relevant because he had some changes in his opiate medications prior to coming in for this presentation. On review systems just the chronic knee pain as I mentioned and he had a very poor posture he was extremely kyphotic his head was kind of dropped over to the side and no concerning GCA symptoms and then you know these are his medications pretty standard. On examination his visual acuity was very poor two over 200 in both eyes his pressures were normal his pupils were equal and there was no APD seen and his visual field showed the deficits shown here he had some more in the right than the left eye superior deficits as well as other peripheral deficits really the only quadrant where he could kind of make out some some site was in his lower right quadrant although that was also kind of inconsistent and his extracurricular movements were normal there was no nice stagmus on his slit lamp examination he had dermatoclasis he also had cataracts bilaterally and then the important feature here was the grade three optic discodema which was also accompanied by pallor no-disc heme appeared chronic in nature and obviously with that poor vision he was not able to do much in the way of color vision testing or stereopsis and his neuro exam just showed some decreased strength but otherwise essentially normal neuro exam so i wanted to focus on his optic disc photos here where i'm not sure if it projects very well but you can see there's definitely you know some discodema in both eyes with pallor more pallor in the left eye and then you can also see this uh high watermark line which really tells us that this is chronic and has been there for some time you know probably for at least the six weeks if not you know significant time before that and then his goldmine visual fields were very challenging to uh complete because of his central scatoma and he kept losing fixation but essentially showed altitudinal defects in both eyes and again his oct rnfl just confirms the chronic disc swelling which was observed so our differential diagnosis um i actually put the the thing that we were kind of thinking about the most on top here which is this uremic optic neuropathy which i'll talk a little bit more about it's actually a very rare um cause so we also considered other more common things such as elevated icp which we felt was probably less likely in this case given that his MRI was normal he also had a uh second MRI which included the orbits which again didn't show anything besides a little bit of increased fluid but nothing to suggest markedly increased intracranial pressure we also considered um ai on which again would be more typical to present as a unilateral and then could be sequential bilateral but not typically both eyes at the same time and then an infiltrative cause which again would likely have been detected on MRI and then um uh also because of his kyphosis and he couldn't support his head we were also thinking about things like myasthenia and nodding head syndrome but really all signs tended to point towards this uremic optic neuropathy so i wanted to talk a little bit about ocular complications and end stage renal disease because it's probably not something that we think about all the time but uh something that certainly can come up so uh the anterior segment or surface problems are the most common things that we see and patients come in with red scratchy eyes they've got foreign body sensation they're you know kind of in your typical dry eye patient category and they can also present with band keratopathy and all of these effects are thought to be related to alterations in calcium and phosphate metabolism that happens when you have end stage renal disease and your kidneys are not able to process those uh those materials normally um and then we also have some other effects which are kind of variable so um intraocular pressure can actually increase decrease or might not change at all and so it's kind of variable in the literature as far as what happens with iop um there's also been rare reports of retinal detachments associated with ESRD and this is thought to be maybe due to fluid shift and would probably represent an exudative retinal detachment and then lastly optic neuropathy is um the most likely cause in this case so uremic optic neuropathy was actually first reported in the 1880s uh there was a um a 10 year old girl who came in with a post streptococcal glomerulonephritis who also had non-reactive pupils dyskidema and loss of vision and uh her physician astutely noted that uh when her renal function recovered um her vision recovered as well and so um I don't think at the time he coined this uremic optic neuropathy um and the article was not in English so I couldn't read it but um that was you know kind of what he was getting at um and then uh there's actually really even since the you know since that time not been much in the way of the literature there's been about maybe a handful of case reports and then this case report here this uh by winklemeyer this one actually summarized all of the previous case reports that they could find which were about 14 cases and uh talked about kind of the differences um between those cases and they actually proposed a classification system so in terms of classifying this uremic optic neuropathy um there's the first category which is the uremic optic neuropathy itself meaning there's no other uh other cause or other um etiology that could be inferred and then we also have um uremic we also have optic neuropathy associated with ischemia which could be associated in cases of uremia and then we can also have problems due to adverse drug effects elevated ICP and uh cerebral infarction and this table uh from winklemeyer's article just kind of summarizes those classifications and the types of diagnostic clues that you would look for to lead you in one direction or another and then also the suggested treatment which typically amounts to dialysis and corticosteroids if an infectious etiology can be ruled out again from this article summarizing those 14 cases one of which they had presented in the article the majority of cases did undergo dialysis here and uh about half of them also underwent corticosteroid treatment and about half had some reversibility of their vision loss which brings home the point that this should be recognized early and should be treated appropriately if it is suspected so when do we suspect this any patient that has either known uremia or previously diagnosed uremia who's presenting with vision loss or pupillary changes or both and again the treatment as I mentioned dialysis and then also a corticosteroid oral corticosteroid taper is recommended but we really don't know enough about this condition to say that this is the you know be all end all of how to treat it so if we return back to our patient for just a minute we of course recommended dialysis in our patient but again as he was adverse to dialysis before finding out that his vision was lost we thought he might change his mind but he was not not interested uh we actually referred him back to his nephrologist to talk about some other options but uh couldn't really come up with much there so we said okay next step is to try some corticosteroids but again he's got psychiatric disease that's been well controlled on a number of psychiatric medications we knew that there is a potential to worsen that um so we had a discussion with both his brother who is a psychiatrist here at the university and his um his psychiatrist and came up with a way to increase his psych medications and try to get him the steroid taper so he did undergo steroids for a short period of time but he had no change in his vision unfortunately and he ultimately succumbed to complications of his urenia at two months so that is my case and I'll be happy to take any questions