In one of our previous videos we explored the origin of beer from its possibly accidental discovery and its pivotal role in potentially played in the development of human civilization, while also making a few of the earliest recipes from these ancient cultures. Today we explore some of the later developments with beer as we progress now into the early medieval era, a period of time that also coincides with the Viking era. Along the way we've also explored a few other drinks that compete with the potential title of the earliest alcoholic beverage such as wine and honey wine or mead. The biggest change from early historical beers to modern beers is the addition of hops, a bittering and antibacterial agent. But in between these non-hopped and hopped beers was an era when beer used an alternative for bittering and flavoring called Groot. Groot was a collection of herbs used in northern Europe for this purpose and could be a variety of a few assortments of herbs that were available. Eventually hops grew to replace Groot sometime around the 13th century. Chiefly as a way to avoid taxation the feudal lords were placing on Groot, but also because hops contained antibacterial properties. In today's video we're exploring two unique aspects of an early medieval beer, a group beer that is mixed with mead, making a drink called a breggart. The idea of mixing beer and mead dates back to at least 1800 BCE with a reference to it in the Sumerian hymn to Ninkasi. A mixed drink like this would be primed for another culture of the early medieval period, the Vikings. For Vikings ales and beers were very common place, but mead was held at a special place in that culture and religion. And a mixed drink like this forms a nice bridge between them. To help brew this I paired up with a knowledgeable brewmaster from the local Viking reenactment group. The main ingredient for this will be similar to past drinks, barley grown and harvested and left to begin germinating in a process called molding. And honey which we explored in our previous mead episode with our own custom medieval beekeeping masks. But then the new ingredients will be the herbs for the Groot, whorehound, mugwort, yarrow, and common ivy. The drink we're brewing today is an interesting combination of beer and mead. If you want to try other unique drink combinations you may be interested in today's sponsor, shaker and spoon. I've never personally gotten into mixing my own cocktail drinks. It's a lot of work to find recipes and then track down all the unique bitters and then have to have a bunch of them on hand whenever you want to make something. It's a little complicated, but shaker and spoon sent me a few boxes to try out. They make the experience really simple and easy for an inexperienced fixologist like myself. Shaker and Spoon is a subscription service where each month you get a new box that contains all the ingredients you need to make three original recipes paired with whatever liquor that month is for. You'll get syrups, bitters, aromatics, garnishes, and more, enough for 12 total cocktails from each box. That's four drinks for each recipe. Saves you all the pain of trying to figure out a new recipe and then track down all the different ingredients. It's a fun little box to expand your palette and try out a few new drinks. So click the link below and use the code everything at checkout or go to shaker and spoon.com slash everything for $20 off your first box and have it delivered right to your door. That's shaker and spoon.com slash everything or just click the link below and use the code everything for $20 off your first box. It's looking like a fire week in cocoa. So I'm here with Joe who previously helped us with making things like a Viking anvil and a sword, but he also has another skill of brewing and today we're going to brew some Viking Arab beer. I'm Joe, I'm a blacksmith, brewer, and historical reenactor. Today we're going to be brewing a Viking Age bregat, which is a combination of malted barley, honey beverage that'd be fermented historically, and then spiced with commonly found herbs and things that would have been grown locally, native to kind of northern Europe. It's going to be made out of some malted barley, some caramelized rye, and some peated barley, and then we're going to start mashing it over an open fire. So now our kettle has reached strike temp, so that means the water has come up to about 150, probably a little bit more degrees. So what we're going to do now is add our malted barley into the pot and we will let this sit for about an hour, and this will cause an enzyme reaction within the grain to convert all that starch into sugar, and then we will have the start of our bregat wart. Perfect. Make sure there's no dough balls, and which is brew. Okay, there we go. So right now we're doing the mash, which is creating the nice kind of sweet grain water. What we're doing is waiting for a enzyme called amylase that is present in malted barley to take the starches that make up each little barley grain and turn into sugar to create essentially a sugary barley water that then you can add yeast to and ferment it into what we know is beer. Eventually we will separate all of the grain from the wart, which is the unfermented beer, and we will boil that down to our final volume for fermentation, and during that boil down we'll also add the different herbs to turn it into a gruit. Historically humans have probably been doing this for a very long time and probably discovered the process accidentally, but by the time of the Viking Age they would have basically known that taking germinated or sprouted barley, then roasting it, and then doing this process in a mash ton or louder ton would have created the beginning stages of a beer as we know it, and we've just made it more concise and scientific in the modern day, but historically throw it in a pot of hot water and it just sort of happens. Alright, so now we have a collection of herbs I grew to add flavor. We're going to do this without hops. It could be done either with or without. Start off with the Yero, a couple sprigs of that. When do we do the next one? That'll be probably in about 30 minutes or so. Yeah, there we go. Hmm, pretty sweet. I think those turn out pretty good. We've already reduced it down by about an inch. All right, now time for the mugwort. I'm going to cup all those leaves or sprigs. That's enough. Looks perfect. Into the pot we go. It's like making a sacrifice. Yeah. Sacrifice to Govnu. Govnu's one of my favorite historical gods. It's the god of blacksmithing and brewing. Oh nice. So you're good to your guy. Yep, indeed my guy. Now we're going to boil over territory. Oh, the beer. That is the downside of not being able to control the heat super well. Yeah. Okay, let's spill this all over myself. My spoon. So we've definitely made a beer-like thing. So now she feels pretty nice on my hands, considering they're a little cold. It's going to be a little grainy, but you know, it'll work. Yeah, it looks like that was a pretty successful mash, even using very rudimentary tools. It's sort of sticky and sweet, so it looks like we got some decent sugar extraction. So now we have the last two flavoring ingredients. We have poor hound and the ground ivy. The ground ivy, I didn't even actually grow. It just kind of grows everywhere here. So you nicely get rid of some of it. Nice. Now we're cooking. For the next ingredient, honey. So the honey will add a little bit of extra fermentable sugars to it. Also a nice kind of sweetness and body to the final bracket. That is thick. So we did the last step of transferring our wort into, this is not the last step. So we did the next step of transferring the wort into the fermenting vessel. Now all you have to do is add the yeast and let it ferment. So traditionally they probably would have just let natural yeast get in and ferment it. But we have a few more options available and you have a very specific yeast you brought with. So this is a yeast that's a Norwegian kveik yeast. Kveik yeast is really cool because they are wild yeasts that have been cultivated in Norway for all of these like farmhouse beers that individual families would have been making. And it has been recently sort of commercialized and become available here in the United States for the home group market. And so this yeast is fun because it's kind of an old wild strain that we can now use to create kind of an approximation of a viking age bracket. And it should be nice and quick and clean fermenting and hopefully will produce a really nice historical beer. Okay, so we've been waiting outside in the cold long enough for me to throw a coat on. But now I think the wort is finally cool enough to actually pitch the yeast in and let the fermentation start. I'm excited as y'all this turns out. Yeah. Pretty good. All right, so it's been a couple weeks. It's a little bit colder out and I'm back here with Joe. Any about a few other people from his group. We've got Ashley and Josh and we're going to try some of this beer. So we're the North Star Vikings and we're a viking age reenactment group based out of the Twin Cities here in Minnesota. We focus more on the daily life aspect of the viking age, making our own garb, making our own weapons, doing viking age cooking, viking age beer, that kind of thing. You know, make all of our own stuff and pretend to be vikings to the best extent that we can. Some of the garb that we're wearing, it's stuff that, you know, we've made ourselves and it's very different than what you might see seen, you know, portrayed in modern media portrayal of vikings. We are all portraying wealthy people with lots of silk and lots of silver. It's all mostly based in Birka, Sweden. Birka in Sweden, it was a very big trading port. So this is a hat that is an Eastern style hat. This is what they were wearing in Sweden during the viking age. It's very Eastern influence. You have your weapons, your pouches, and they were much smaller than something that you would see like in the movies or even at the Renaissance fair. The pouches that they had were very, very small to carry something larger. You would have a bag, tunics and things like that. They were imported from the east based out of Birka trading. This is also an Eastern style kaftan. All of the buttons are hand cast based off of an Eastern style button by Joe, but they're based on like more Slavic influences because they stretched all the way over into Russia. They did a lot of the plates that was a way to show your wealth. And then on mine, I have the tortoise brooches, which are the basic piece that would hold a lot of the Viking women's clothing together. And then you would also have your various daily implements that you would wear hanging from your brooches.  I got a little knife here and then silver and gold foil beads as a sign of wealth as well too. Rich traders. So this beer has been fermenting for about two weeks. Mash was extremely successful. We ended up creating what we think is a pretty high gravity beer. This could be anywhere from really low alcohol to up to probably like 14%. I'm guessing probably it'll be about 10% alcohol. Wow. We're not going to have any carbonation in it. So it's going to be relatively flat. When Vikings did it, would they have tried to chill it at all? Is it just always room temperature? Probably would have been room temperature. If it was colder out, they definitely probably stored it outside. Also, beers historically were generally drank pretty quickly. They weren't aged for a long time. They didn't have a lot of good sealing vessels that they could have held it in. Fermenting is a little bit different than how you normally do with modern equipment. Do you think that's going to cause any interesting flavor? There's a little bit more of an avenue for spoilage with this type of fermentation. So it could be a little sour, but which would have been perfectly normal for historical beers. As modern beer drinkers, we're not as used to that because we have modern sanitation and like glass and stainless vessels. But historically, almost everything they would have fermented would have had some bit of sourness to it just through the nature of them not understanding germ theory and lactobacillus loves to live in wood and other things that they would have been storing their alcohol in. But drink fresh, it would have been less sour and the sour character will definitely expand over time. So I'm guessing it's going to be reasonably alcoholic with still a little bit of residual sweetness and we'll get that nice kind of herbaceousness from all of the grew-it herbs. So I'm excited to try it. Should we try it? Let's do it. I'm so excited. Mm-hmm. It smells so good. There, right down. Right down the hatch.  I think that a lot of that color is the peated barley. Yeah, definitely not, um, clarified at all. Definitely smells like it fermented. Skull. It's like a brown beer. Very sweet and smooth. Very tasty. A British brown ale.  Oh, yeah. Mm-hmm. That fermented well. That's alcoholic. That's really good. That's very alcoholic. Um, I would guess just tasting it, that is probably in the like 11-12% easily. Yeah. I could get used to this. Nice job. Oh, that's real alcoholic. It's so good. Also, there's some of that smokiness I think that we pulled from, pulled from the fire. Like it's peaty, it's like peaty. Yeah, it's got a little bit of that peat character. Um, you can definitely tell that the honey fermented in there. So it's got almost kind of some mead notes to it. Mm-hmm. And you get those herbs. There's a nice bitter backbone to it that's definitely like the yarrow and I think the whorehound. And then you also get the kind of herbaceousness from that, uh, mugwort and the, uh, ivy. It's, it's quite good. Like, I think it balances out the sweetness. Yeah. Yeah. I like it. It's quite drinkable. Yeah. That's good. That's a good beer. Yeah. We did good. Excellent. We made beer. Alright, so we used some modern equipment with a hydrometer to measure and figured out we got about 10% alcohol, which is about what you estimated. Uh, so that's a pretty strong drink and I think it turned out really well, a lot better than I was expecting. Mm-hmm. And uh, yeah. So thank you and the North Star Viking group for joining us and uh, to all of our patrons. Thanks for watching. I'm pretty damn proud of that. It's a good result. Mm-hmm. Haha, we did it. We brewed beer over a fire. Cool. That's very alcoholic. Like, you get that, that ethanol bite. I was gonna say it's warming. If you enjoyed this video, be sure to subscribe and check out other content we have covering a wide variety of topics. Also, if you've enjoyed these series, consider supporting us on Patreon. We are largely a fan-funded channel and depend on the support of our viewers in order to keep our series going. Thanks for watching.


Food coloring, food coloring, or color additive, is any dye, pigment or substance that imparts color when it is added to food or drink. They come in many forms consisting of liquids, powders, gels, and pastes. Food coloring is used both in commercial food production and in domestic cooking. Food colorants are also used in a variety of non-food applications including cosmetics, pharmaceuticals, homecraft projects, and medical devices.


Thank you very much for having me. It's a delight to be here. I'm computer phobic, so that explains why people are helping me. I'm in private practice in New Jersey. To me I try to always be the advocate for the patients for whatever disease they may have. I have the privilege to be in a large group that affords me the time to be taking care of patients with the GU emergencies and I think it is an evolving disease over the last few years that we've been blessed as medical oncologists to be able to offer patients treatments where we did not have that opportunity 10 years ago and kidney cancer is the prime example about how the evolution of science and research has allowed us to offer patients therapy in a disease as you heard before that offered a limited amount of options. So I'm gonna give you a brief overview. I try to make it brief because to get into formal detail it becomes very I guess boring but more importantly I think it's gonna lead to a lot of opportunity to ask a lot of questions which I think may be applicable to applicable to some people. So this is meant to be a small overview and hopefully you can stimulate more questions afterwards. Broadly put there are two main opportunities to treat patients with kidney cancer. You've heard Dr. Wang speak about surgery and I think that is the integral part of that when one has a malignancy that could be respected but that is the ideal therapy that one should try. But when it comes down to systemic therapy when the cancer has traveled outside of the kidney and requires therapy for disease that traveled to other regions like lymph nodes, lungs, even other organs we do have therapies. So dating back to before 1992 there was really no FDA approved drug. Immunotherapy appeared to be the therapy that was studied most. Dr. Dutcher is one of the leaders when it came down to the data that was published early and I think the immunotherapy science really is that it's able to attack cancer cells systemically throughout the body. It's an intravenous therapy. Sometimes it's subcutaneous but it does train the immune system to recognize and target only the cancer cells. So it has this ability of really being primed that it's gonna probably help kill the cancer cells. It does have some effect on other parts of the body and we'll talk about that shortly. But the main launch category in the therapies that we've evolved over the last nine years has been the targeted therapy and these therapies actually target and interfere with the growth of cancer cells at a molecular level. It focuses on specific pathways to inhibit cell growth, replication, and really disrupt the blood flow supply to the cells. And when you look at the main categories that's listed you have immunotherapies. There are two drugs. There's interferon alpha and then there's IO2 or into looking to and then there's the target therapies and we're gonna break them down a little bit. And again, I don't want to get into details about each one specifically and we're gonna not to talk about the data. How about it's FDA approval? Well, we can sort of left it. We have a very broad but these are how when you see a medical oncologist is how we think we think about opportunities. We have what therapies are best to be used. First we try to think about the sequences of therapy and there is sciences behind it. There's many different conflicts how one should think and I think it's important to definitely hear the conversations that you hear from the physician. But this is all stemmed from a multitude about of conversations and data that's been published over the course of the last eight years. When we assess patients, Dr. Wong spoke about the surgical approach about how patients are evaluated. We have two prognostic risk models that we've utilized over the course of the last few years. The second one being the one on the right by Dan Heng. The one that's been used over the last 15 years was based upon the let's call the MSKCC or Bob Motzer. They actually utilize this data based upon use of interferon and surgery and they came up with how we should assess how patients should predictively be doing from when we start seeing the patients upon disease progression. So looking at Dr. Moters, I'm gonna start on the bottom of Dr. Moters criteria, there actually is two parts to it. The early 1999 analysis actually looked at patients who had prior refractories to presection of their cancers. And then what we use is Karnofsky performance status. It's really the patient's functional performance status and there are criteria by that. Looking at the hemoglobin, the calcium level and the LGH is a blood test. So in essence every time we see patients and medical oncologists, we should have the category pretty much in our head by the first visit because a lot of these blood tests have already been done. We've assessed the patient. The Dr. Moters criteria did change a few years later and they took out the first pregnant refractory and they actually used the criteria of the interval of time between when the patient had their surgery to when they presented to you as a need to start therapy. The difference between Dan Heng and Dr. Moters criteria is really on the last bullet point. There are times of LGH, which could be a marker for the burden of cancer. Sometimes it's normal and therefore it's a sometimes an inconsistent study. So they utilizes the neutrophil count, which is a white blood cell count and a platelet count, which sometimes can be elevated with inflammatory processes. Sometimes that number can reflect a true volume of cancer predictor. So you see a shift every time you read these articles. They talk about usually it still goes back to how we've always dealt with the MSKCC criteria that Bob Moter, but Dan Heng's now the criteria is being utilized a little bit more. So when we look at these risk factors, it's not just one of those. We just see the patient's data and we just see how their risk survival is going to be. It does actually allow us to see which therapies may be best. A lot of times if someone has a favorable risk factor, it actually would be an excellent candidate to go for surgery, for side-inductive nephrectomy that Dr. Wayne pronounced. I shouldn't be discussed. And then sometimes even for the intermediate risk, it may be a benefit to have these patients undergo side-inductive nephrectomies as well. But based upon these risk categorizations, we're able to sort of feel which therapies may be better for patients. We'll talk about how poor risk did come about based upon that categorization about the approval of one of the drugs that are used for kidney cancer. But for the most part, every physician should try to believe that their patients should fit a criteria before you come up with a decision about how to take care of these patients. A little broad discussion on immunotherapy. Immunotherapy really just boosts one patient's own immune system to sort of recognize and attack cancer cells. It activates and increases the number of immune cells. It activates these immune cells again to recognize and kill cancer cells. The death of the cancer cells slows or halves the tumor growth, possibly leading to tumor destruction. For the most part, for kidney cancer, we try to slow down and stop growth of disease that are times we are able to be successful, that we can actually reduce them and the tumors that is and they can go away completely. But for the most part, our goal when it comes to patient care and survival is actually slowing down this disease and sort of halting the growth. Kidney cancer as well as melanoma are one of the two therapies that actually respond quite well to immunotherapy. Specifically for interferon alpha, this interferes with the life processes within the cancer cell and it prevents the growth and making it more susceptible by other elements to be destroyed by the immune system. Typically, this is medication that's given subcutaneously. It's given several days a week. It depends on how it's administered. It's got a lot more headlines over the, since 2009 when Vastin got FDA approved. The Vastin was FDA approved with its usage with interferon. But it's because of its benefit with the Vastin, the use of interferon as a single agent has gone down in regards to its usage. The over response rates is, it looks small. The problem when it was actually analyzed in the interferon, the criteria about how to analyze the data was different back then. The use of response criteria was a little bit different. So the rates may be smaller than actually what we see. But again, the best candidates are patients who have good performance statuses prior to nephrectomy. So Dr. Wang showed the data that was published in 2001 as well as disease that's primarily in the lungs. And again, the response rates talked about not just how patients do, but just the reduction of the cancer by 50% or more. So the stability of the disease is not reflected by the data that's presented. Again, these therapies usually work by regressing the tumor slowly. It's not a therapy that's going to be initiated and start reduction of cancer within the course of weeks. Usually it's several months before the disease actually responds. There is a multitude of side effects. I always tell the patients it's like having the bad flu. A lot of times these therapies are given three days a week. So sometimes by the time your body gets better from the symptoms of the toxicity of the therapy, you get an injection all over again. And based upon the dose, you can actually predict the side effects. Of course, every patient for every disease, for every therapy are different. So a lot of times you have to unfortunately administer a therapy at a dose that offers a higher risk of toxicity before you find a dose that actually can be utilized and adjusted to the patient's success of tolerability as well as efficacy or efficient ways of treating the disease. Another form of immunotherapy, IL-2, proloquine is a therapy that's been FDA approved since 1992. It's genetically engineered to a product that once body owned makes, everyone has IL-2 within their own self. It does allow the stimulation of T cells and natural killer cells. This is a therapy that can be given subcutaneous as well, has a lot more success being given intravenously. There are I think between 50 and 70 centers in the United States that actively utilize this agent in the way of using it as a high dose therapy. There have been studies comparing high dose to low dose or subcutaneous doses. Still, I believe most patients are receiving this therapy in the high dose setting that are before it's these high dose centers became more comfortable with these usage. It was just given with a low dose in the office, sometimes combined with interferon, but the toxicities were vast. So the most success has actually given us a high dose. When you are in the hospital for five days of IL-2 therapy, given a dose every eight hours for 14 doses, you have a five day rest. I'm sorry, I'm sorry, you have a around anywhere between a five to 10 day rest and then five days again back in the hospital. We've learned over the course of several meetings that there must be 50 different ways how to give high dose IL-2 as a high dose. So you find that there is a lot of variability how people are administering it these days, but still a very successful therapy. It is the only data I think Dr. Dutch is going to show you a slide that actually has therapies that are given to patients that can put these patients into not only complete remissions, but durable remissions. These are therapies that if given and if it works, you don't always have to have a complete remission to have a cure. You can always have a therapy that can be working partially, can stabilize the disease. The benefit of these therapies can actually be where you're postponing the inevitable next dose of therapy. If one can actually be on this therapy and being able to possibly slow down the disease that you don't need to get any further therapy, I think that's the ultimate goal when it comes down to trying to treat patients and the fact that one's able to believe that over the course of a lifetime, if one's going to be exposed to many medications, then limiting the amount of therapies to patients is going to be probably most beneficial for patients quality of life. The side effects for high-dose IO2, unfortunately, are difficult. I think that, again, in the trained center, and as much as I think that we know how to do it, I have to value my nurses and the nurses to have on the hospital floors because they pretty much are beyond diligent how to monitor these patients and avoid any worsening of the toxicities. But there is a phenomenon called capillary leak syndrome with the capillary leak in essence, if you remember the old-fashioned biology between your arteries and your veins, every capillary fluid drifts out, and because of that, you have a multitude of side effects, that being lower blood pressure, you have kidney dysfunction, blood tests can be a ride, and even says good old-fashioned hallucinations. The patients go through bad rigors, I describe as good old-fashioned earthquakes from California, but they're very terrible. The great thing about this therapy, the adverse effects are predictable, they're manageable, and they completely resolve upon completion of the therapy. So best spoken to by a person who got IL2, but I can tell you that these therapies not only offer a therapy to benefit for the immediacy, but also possibly long-term. And then we talk on the targeted therapies. So there are three different categories, one's called TKI's, Tyrosine Kindness Inhibitors, and these are anti-androgenous agents, they inhibit vascular endothelial growth factors and platelet-derived growth factors to block the growth of new blood vessel formations in tumors. Simply put, cancers need blood supply and built its own blood supply to build a bridge between the tumor and an existing blood vessel, so these therapies actually have the ability of not only inhibiting the growth of these blood vessels, but also having the ability of disrupting the blood vessels that are already formed. They do work in different pathways, the word multi-kindness just reads, there are different pathways that these work by, we'll break them down a little bit, but they're really, as I said, designed to slow down the tumor growth, possibly even shrink to the existing tumor. I do set goals with my patient when we start our discussion with therapy, is that my goal is for them to tolerate that therapy and live as long as possible. We as medical oncologists, of course, like to believe that we understand what it's like to be a patient, that we want the cancer to go away, there are times if we stop the growth of cancer, we are very happy with it. Shrinking it as a blessing and going away completely is sometimes great hope, but we always believe in everything we do, so a lot of times we talk to patients about that the tumors are not growing anymore, that is a success. The common side effects with tyrosine kinase inhibitors, they put them up here because we can talk about them individually with each drug, and they have some variability amongst all of them, but for the greater good fatigue type of rash, we'll talk about that, the diarrhea and high blood pressure seem to be the most, there are some that have different within each other, and we'll talk about it. Bleeding, clotting, and wound healing is part of the VEGF pathway, and I think when you have all these drugs that have part of the VEGF pathway, they're all going to have issues that way. Next of our was the first FDA approved drug, I can't tell you why I know, but December 20th in 2005, nothing else to do today, so with that, again that was the first drug and then literally five weeks later, January 26th, 2006, Sutton gets FDA approved, and I think within the course of five weeks to have two drugs that worked very well was really, I mean beyond the blessing, I know we've seen articles that talks about the embarrassment of rashes, and I think that's something that applies. Next of our got its FDA approval based upon its patients who received the prior therapy, then we see this as a second option of therapy, and this did improve the median time for the tumor to grow by double, and I think that's sort of got the foot in the door and students got its FDA approval based upon two phase two studies. Shortly after they did release data on a phase three study and Sutton pretty much became the drug of choice for kidney cancer, it definitely had the best favorable response, it reduced the disease and a third of the patients by more than 30%, and for some time that became the go-to drug for patients who had metastatic kidney cancer. Three years later, similar pathway, Voltrient or Pizzatinib gets FDA approved, given once a day, it's side effect profile, a little bit different, and you have to watch the web of function tests almost every two weeks for the first three months, it can affect your electrolytes, so again monitoring with that seems to be very important. Again, something we instill into our patients, we do ask patients to sort of follow through the way the protocols were done, and I think it sometimes we do see patients that we have to adjust the therapies because of these side effects. In LIDA, or I said it was the one that's most FDA, most recent FDA approved two and a half years ago, it too has its own set of side effects. Horseness seems to be something that we see, and actually they started utilizing, can we start predicting who should be doing well, and they started to use a biomarker, even just using high blood pressure, sometimes within LIDA, and now with Sutin, we're going back and sometimes recognizing that patients who have started these therapies and have high blood pressure, they sometimes can predict that they may started having a better response than others. The other target therapy is the mTOR inhibitors. These inhibit the mTOR stands for mammalian target of rapamycin. It's a protein that controls cell division and survival. Taurus cell and Affinitor are the two drugs that fit this category back in the day, and even now, if you look at the mTOR and Taurus cell and Affinitor, they actually incorporated the mechanism into the name of the product. Taurus cell is an FDA approved drug in 2007. It's an IV formulation, and it actually got its FDA approval based upon the poor risk categorization. So in patients who have Sutin and Nexavar, its first FDA approval, these were for clear cell renal cell cancers. Taurus cell sort of fit the need of what wasn't being covered. So patients were not eligible for those studies because of their poor risk categorization, if they had looking at the MSKCC criteria, or if they actually had non-clear cell patients were getting Taurus cell at that point, and its FDA approval was based upon those categories. So its FDA approval was not based upon the fact is that it can be taken care of patients who have clear cell, but actually non-clear cell or patients who have clear cell at poor risk. So it gave us an opportunity to treat these patients where data was not offering us that knowledge when it came to Nexavar or Sutin.  The side effects appear to be similar. It happens to be an oral drug, taking one today, has a little bit more pathway inhibition, even angiogenesis, or again the same pathways that the VEGF incorporates. It's there again, the side effects between both agents are relatively similar. I'm not going to go through each one of them. You do find with Affinitor you do have more of a mouth infection risk, and sometimes you can actually develop an inflammatory condition in the lungs that are, it's readily reversible steroids. Again, two agents that have actually fitted quite well to our armamentarium. The last one is the pure VEGF inhibitor, that being Avastin. It got its FDA approval for kidney cancer in 2009. Avastin is FDA approved in other malignancies, given intravenously once every two weeks. Again, its FDA approval is within deferron, but there are times where it actually can give Avastin by itself, and it too has the common side effects of the high blood pressure that had it in the fatigue. I think it was Mike Atkins back in 2009, actually you came up with this first roster about how we should be thinking that when it comes down to patients, and this list has grown over the course of the last five years, and when we go through experience, when we go through the NCCN guidelines, when it comes down to data, this is how medical oncologist should be thinking. This is kind of the playbook we have in our head when we see our patients. It's relatively easy, and it really is important to try to incorporate our therapeutic interventions when it comes to patients, because it's not just about what the doctor feels. This is gut feeling. There's a lot of data that supports that hopefully they're gut feelings. Now, first line and second line is really the first agent they receive. Again, I still think surgery in my ideal scenario is the best thing, and sometimes as Dr. Wang was saying, you can actually go for surgery and actually do absolutely nothing afterwards. And there's a period of time where you can just keep valuing the patients doing cat scans or MRIs ever so often to feel that the disease is truly a almost a typical kidney cancer where it is a slow-growing process. You can actually be living with cancer and do nothing for it and actually not have to be involved in any of these therapies. But when these therapies are important to be utilized, we do have pathways to think in our heads about based upon the data of how we should be thinking it. And again, I'm not going to go through the list on each individual one, because this also is a subject for discussion just because when it comes down to our oncology meetings, everyone has a reason why they use one drug for the other. The future where it is going to be discussed probably in the next nine minutes, but more for how the data is going to evolve over the next two years. The science has now evolved to new pathway. The new pathway is PDL1, which is a program death of Lycan1. These are expressed on tumor cells and tumor infiltrating immune cells, where these are normal pathways that suppress the T cells. So these are inhibitors of those suppressors of the T cells. So our T cells that are normally used to incorporate to help boost our immune system, these are therapies that are now able to sort of inhibit the blockage of our normal immune system to fight cancers. These Ketruda and Urvalli are FDA-approved drugs, as these types of therapies for melanoma. They're being studied extensively. Again, those three bold points at the bottom are active studies that are a lot of centers across the United States, even in this region. And I'm going to weave that part of the discussion up to Dr. Dutcher. So to sum up, gamenotherapy is still the main state of therapy for advanced kidney cancer. The FDA-approved drug, Progokin or IO2, appears to be the best drug if one wants to sort of over, I guess, to undertake a therapy that can be toxic temporarily but reversible with its toxicities, but possibly be able to be on a therapy and then have a long, durable response, remission, for the therapy possibly postponing inevitably maybe having to get another therapy, possibly postponing any other therapy that you may require for advanced kidney cancer, targeted therapies for the last nine years has been a breath of fresh air for our patients in regards to options of therapy. They do have a set of toxicities and I think that when I talk to patients about therapies, it's about the tolerability of the therapy as well as the efficacy, but in that order. And that applies for the TKIs as well as mentors as well. As to how one approaches therapy, it really comes down to the patient's presentation, their quality of life, their extent of disease, their goals, our goals, and really one always tries to apply the risk categorizations of prognosis to find out how the patients should be able to be given the therapy form. And again, the checkpoint inhibitors again is going to be a new science that's going to be incorporated into our practices definitely within the next five years. A new way of taking care of kidney cancer patients, allowing us to do what we've done over the last nine years is give them therapies that we're not able to give them in the past. So with that in mind, I think I have five minutes. We'll just go into the next one because we're going to have a question and answer period after the break and ask questions at that time. So I thank you for your time.


Morning Chevy morning Chevy. Oh, thank you. Thank you for the morning kisses. Thank you. Good boy Do I get morning kisses for everybody this morning? No, just Chevy. That's cool with me. All right Forget how I open these things now. How's it going people? We're uh Just into Wisconsin from Illinois.  The trip in total was 2700 kilometers all together Let's say I'll do the math today. I didn't do the official math with you yesterday because I was outside So it was about 2700 kilometers divided by 1.61. It's oh, I Told you like 2,500 miles yesterday.   Oh, well at least I corrected myself, right? the next day I'm just gonna leave that in there. I haven't edited yesterday's yet. I'm just gonna leave that in there and see how many of you Caught that So I'll show you the load real quick if you didn't watch yesterday's vlog I encourage you to go back and watch it that way, you know how we got here, you know My whole vlog channel is a story of my life day by day. They're all numbered for your convenience so you know what order they're in and I've been doing this since 2011. I have about 2400 over 2400 videos on the internet for you to enjoy So there's a lot for you to catch up on if you're new. I'm glad you're here Don't forget to subscribe. That is the most important part. That is the most important thing to this channel We're getting very close to 100,000 subscribers very excited Exciting times and if you want to help us get there All you got to do is hit the subscribe button and it's free Doesn't cost you anything if you want to go one step further You click the little bell beside the subscribe button and that'll send you a notification every time I upload a new video Because it's sort of at a different time every day. I try to do it about midday But that way you get a notification sent to you and you can either log it away to watch it later Or you can watch it right then at least you know that there's a new one and you don't don't miss it All right enough of that Let's go see the load Here at the scale just into Wisconsin Somebody got in trouble over there for parking on the side of the road I'm not supposed to park on the side of the freeway people I know you probably can't see it because of the fisheye lens, but Place officer over there is Upset at the person parked on the side of the freeway because it's illegal. You're not supposed to park on the side of the freeway It's a danger Okay, here we go. This is the load with the smoke tarp on the front. I explained that yesterday And it's a very very light load. I believe it's styrofoam the whole thing I keep joking around saying the whole thing weighs like Five pounds It's really not that heavy at all So with that being said We're gonna get excellent fuel economy. We're planning on it anyways Can get as far as we can today. We won't get quite into Canada We're gonna be crossing at North portal North Dakota North portal Saskatchewan from portal North Dakota Crossing the border into Canada there and then going through Saskatchewan into Alberta to Calgary I don't know where I'm going from there yet, but This is gonna keep us busy for the next two to three days, so let's give her let's get out there I'm just gonna look up the actual weight. Oh, yeah, I gotta send these papers in anyways for border clearance. Okay Let's do that right now the actual weight Shipping weight. Oh, yeah, right Says the actual weight is five thousand six hundred and eighty eight pounds. Yeah, right I literally it feels like there's nothing on the trailer if I wouldn't have mirrors. I would think the trailer was empty It is so light There's two thousand three hundred and four individual pieces that weigh a collective five thousand six hundred eighty eight point nine eight nine pounds or two thousand five hundred and eighty point four eight zero kilograms So it really isn't that heavy five thousand pounds to a big truck like this isn't anything at all, but Like I said It's gonna be great fuel economy Our favorite season is finally upon us once again Construction season Looks like we're just getting out of it right now, but all the way from the Illinois border all the way out to here Where are we? What mile marker headed north on I-94 or is it it's technically west, right? It's sort of heading northwest through Wisconsin All construction It's not that bad. It doesn't cause any delays or anything They've left two lanes open. They're just working on the median, I think for the most part We're here at exit number our important me mile marker 169.6 and We still got the cones on the side of the highway. So maybe it'll turn back into another construction zone It's sort of been on and off But that season is now upon us The season we've been waiting for all winter We missed it. I know I know you missed it just as much as I did Construction season. It's always a fun time to be on the road. I want to be on the beach. I Always love these rocks off to our right here That looks so cool Not sort of like what you would expect to see in like the deserts of Utah or something except there. It's red We're trucking along And commenting on current events because my videos are behind and by the time you hear what I have to say about it it's It's already a long pass you guys have moved on but I just want to put my two cents in that I think it's absolutely tragic to hear about the Notre Dame Cathedral fire As you know from my videos I am I value history a lot. I value our European history What we have accomplished and built and the buildings like the Notre Dame At its current state it took 300 years to build to get it to that point. I mean construction started in what 1162 The two towers were completed in 1240 to 1245 I think somewhere around there And it's been standing through wars the world wars it survived through a revolution And so many significant historical events have taken place there and it's a symbol of our history our heritage and Our ability To engineer and build that that was a huge feat of engineering at the time like those eight or eight hundred years ago And it used to be the tallest building on earth at its fire Absolutely tragic. I was so sad to watch that happen You know, it's amazing that after the fire the cross and the altar survived and we're still standing Inside the building and the structure seems to be all right. I hope they can rebuild it But you know, it'll never be the same Because the structure the stained glass some of the stained glass of the building was original Original stained glass and its housing was lead so the lead can melt and the stained glass is obviously susceptible to high heat And they don't know yet how much of it was damaged. That was original from the 11th 1100s and 1200s Burnt to the ground and there's been several attempts to burn it down in the past decade But I won't go into my thoughts on that here on YouTube Let's just say that I question What they're telling us happened I question it It happened right before the holy week of Easter Couple days after the last person who tried to burn it down was sentenced in prison There's a lot of things that are just I understand. We're all the what they're calling conspiracy theories come from but You know, the official report isn't out yet at this time of filming and when it does come out I don't know if I'll believe it. I'll just say that I don't know because No one knows what to believe anymore these days. All I know is that I believe it's a tragedy and absolutely It's infuriating Whether it was an accident or not. If it was an accident. It's infuriating that someone was so careless And if it and if some people did that it's infuriating That they did that So either way, I'm upset. I'm sad I'm not even Catholic Well, that's my thoughts on that When I release this video, there may be more information out there.  No, he changed his mind. Okay. Yeah, that's right I'm entering the entrance Look at this Ken. No, look at this Peter Bell here on the right That's what I want. That's what I would like Yeah That is beautiful Mandy how many times why I gotta tell you no I'm back in besides Schneider here Walk over to the tire shop. There's room over here somewhere. I Just need to quickly park and walk in You are obsessed with that street No, looks like I could park here. Yeah, I'm gonna park right here. I'm closer to the tire shop Just off to the left There's the tire shop there There's need to do a quick switcheroo with my steers And this guy's gonna walk right through the middle of the lot right through the middle You know, I try to walk along the edges or along the truck so that there's not whatever whatever. It's okay Not a big deal on a big deal Just different habits. I try to be a little more courteous than some people some people don't have a courteous bone in their body That's okay. You see a lot of them at the truck stops Courtesy, what's that? All right, we got told we can pull right on in that's good That's exactly what I wanted so they should only take like 15 minutes to a charude We'll be on our way This is good, then I don't have to do this on my home time I'm sure how far any wants me but stop here for now. I guess I get this done Look at the driver's side steer here. That's what we're looking at here. It's still looking good, right? Here's the passenger side and see that it's wearing down faster here It's because the truck is usually leaning towards the shoulder, right? Get those switched around and That was actually the exit I thought it was the entrance before Sometimes I should just keep a motion, right? Right. That's what I hear in the comment section all the time So we got our steers switched around we just got to stop at a another location to get them retorted for free down the road And hopefully the tires will wear evenly so that by the time I need to replace both of them that they'll both be evenly worn I See we've arrived in Minneapolis, St. Paul Right in the nick of time for afternoon rush hour Wonderful wonderful at least we're moving along pretty good here. I don't know why that guy's in the left lane He's looking at me funny, too Had a cowboy hat on okay. I don't know why he was looking at me. It's actually not so bad You know Minneapolis isn't the worst city for rush hour Not nearly as bad as like Toronto or Chicago, but those two cities also have a lot of What do you call that? Bypass traffic like that's just going through the city not actually coming or going Minneapolis is further up north here. If you're this far in the United States, you're either Canadian or you're from Minnesota All right, because there's not too much population out west that would travel through here You know like North Dakota, South Dakota, Montana most of them if they went to the eastern states or something They would probably take I I 90 or something So not much population out here not as bad Still pretty good though. Look at all that traffic over the left, right? Wow, it's actually quite a bit. It's all backed up on that side here so that This guy beside me can come into the center lane ladies, but no he wants to stay in the left lane See if he gives me a weird look again No, no, he just likes the left lane There he is over there Dude, there's nobody between us. Why are you in the left lane? I don't understand But he has a 1.5 million miles safe driver sticker on the side of his truck, so I guess there's something to being in the left lane that some of us Don't know After that many miles you think you'd know better Don't hug the left lane. Don't sit in the left lane Looks like there's an accident on the other side of the road or something. Can't really see it but it's probably why Things were backed up a little now this side's gonna slow down cuz you know Rubber-neckers doing as they do I Can't even see there's too many trucks in the left lane Blocking my view Just a fender bender nothing to see nothing to show you So I have Five hours 15 minutes or so I'm just a little over five hours left on my day today yet. I'm in Minneapolis I'm probably gonna be able to get past Fargo. I'm kind of hoping I can get up somewhere on us 52 in North Dakota Maybe around what's that town called again? What's the town called it's got like that big Indian chief giving the The the he's giving a Nazi salute. I'll try to remember to show you what I'm going through I can't do it because I'll get in trouble if I do it, but there's a big statue of an Indian chief giving giving the Hitler salute It's in this town, what's it called again? Not Chamberlain, that's the sketch one I'll have to get back to you on that. I've been wanting to show you the statue every time I pass through there But it's sort of on a section where I can't really stop and it's usually nighttime when I go through there And you can't see it, but it's just giant like at least 30 foot statue And he's doing the salute It's got like the Indian headdress on and everything I'm pretty sure it must mean something different in different cultures, but if I do it Big trouble big trouble I Have the wrong skin color to do that one. I'll try to remember to show you it's pretty I think it's pretty funny I don't know I'd like to bring your attention to the small black dots dotting your screen right now Pretty windy out here Those are bugs What's left of them? may Make some of you go you to me It brings joy to my soul Because you know what those are Those are the very first bugs on my windshield of the season Which can only mean one thing Summer is just about here. It's a beautiful sign I guess I got to start changing out my washer fluid for bug washer fluid and not the winter stuff I'm just gonna leave the guts right there for you. There you go. That's a good sign Well, we didn't quite make it to that statue. I was gonna show you but we'll be there tomorrow I just wanted to say good night to you guys. Thanks for hanging out with me for the day We've made it up to Tower City, North Dakota a little ways west of Fargo, so we're between Fargo and Valley City, North Dakota on the I-94 if you're familiar with North Dakota and Tomorrow will be in Canada see how far we can get we have 1,477 kilometers left to go. I'd say that's 800 miles I better do the math because last time I was way off 1,477 divided by 961 917 miles okay 917 miles to go we'll get as far as we can today as soon as we cross the border into Canada We'll gain an extra two hours Because we're on Canadian hours of service and we'll get there and unload our freight sometime during the day That's tomorrow for you guys so Take care don't forget to subscribe a lot of you who watch aren't subscribed and it helps me out more than you Thank you, if you just go and hit that subscribe button It's free and if you feel like going the extra mile that little bell beside it helps me out a lot because then when I release my video You get a little notification and you don't miss it I'll see you later. Take care Before we get started I want to give a quick shout out to transportation nation network I have partnered with them to bring you the best in trucking entertainment and trucking news on the web Go to their website transportation nation comm and you will find that it is your one-stop shop for Everything trucking there's a lot of great trucking shows and entertainment there as well I encourage you to go sign up on their website and subscribe to their shows You don't miss any I hope to see you there link is down below in the description


Hey, it's KK, the Metal Voice Man on the street. I'm in Old Saybrook, Connecticut tonight with Ronnie Morrow. And you're watching The Metal Voice. Oh, hey, it's KK, the Metal Voice Man on the street. And today I'm on the streets of Old Saybrook, Connecticut. I'm here with Ronnie Morrow, ex-singer from Metal Church, TSO, and various solo albums out. The first time I heard this man was I was working at 1675 Broadway Entertainment Weekly Security and the head of music direction, Tom St. Clair, came down and told me there was a new singer in Metal Church if I wanted the promo to check it out. I listened to it. I loved it. To this day, I love this guy's voice. Ronnie sang for Metal Church in what, 10 years, Ronnie? About 10, yeah. 10 years, he walked away for a solo career. He put out about four solo albums out, correct? Correct. He landed with a band called Peacemaker. Correct. OK, and he's got exciting news, but last year you joined One Machine, correct? That is correct, yes. And can you tell us a little about that? Well, One Machine is Steve Smythe on guitar. Steve was with Forbidden. I think he's actually doing another show with them here in the next month, I believe. Also, he was in Testament, Nevermore, great guitar player, good people, the rest of the guys are out of the UK. I joined up with him about a year and a half ago, right before COVID hit. So that's kind of been on hiatus and doing things of that nature. And then after that, or closely after that, is when Between Worlds came into the year. OK, then that's this year you joined Between Worlds, and that's after Frontier Records. Now, is that more or less a vehicle for you with the various musicians, or is it a full band? Well, it's a band as of right now. We don't have any dates booked. We will, but the actual release date is September 10th. I see Jack Frost is on the album. Yes, he is. Joe Holstra is on the second single Soul Chaser, which just came out last week. That's correct. And the first single came out in June, which is Between Worlds. And the album will be released September 10th on Frontier Records. Correct. And also, a couple more guests that I have on there was Chris Caffrey and Johnny Lee Middleton, both from Savatage and TSO, Friends of Mine. So I asked them if they'd be part of it, and they said, yeah. And they did, of course, a great job. You know, I'm in very good company with everybody on the record. You've worked with Chris before. I have. He played on My Lord's of the Edge record, and we toured together with TSO plus with Metal Church. I was going to say, TSO, how long did you toured TSO? I did two tours, 2011 and 2012. I think I met Joe on one of them. Yeah. And real quickly, back just on Between Worlds, I was approached by Alessandro Delvecchio, the master.  He does everything, and he's really, really good. And I was honored when he reached out and asked me if I wanted to record some songs, some demos. I'm glad he did. He sent the frontiers. Yeah, so am I. And he's got a group of guys along with them that, like Michael Sanon, drums, Alex Jansen on bass, Pete Alpenborg on guitar.  Jack Frost. Yeah, they do a lot of the stuff for frontiers. But these guys did a great job. And Alessandro really delivered some really good tunes for me to write to. You did most of the writing, the lyrics? The lyrics, yes. The melodies and everything? Yeah. Yeah. They did all the writing for the music. I'm looking forward to singing that. I hope you get a tour out of that. And I hope it comes in states. I can see you're hitting Europe. I mean, you'd be big old, huge over there. Yeah, let's hope so. Now, you studied under a very good singer and vocal coach in Seattle, Washington area back in the day? Yeah, yeah. I think that was when it was at in the early 90s. Early 90s, right? Yeah, David Kyle, the maestro, David Kyle. And he's helped. He taught many people. Jeff Tate from Greensreich, Anna Nancy Wilson, Lane Staley from Allison Chains, of course. Terry Young from Rail, which is another great Seattle band that really never got their due. And a lot of people. So I went in and took some lessons from him to work on my breath control and whatnot. And so basically the rest is history. I've been chugging along. And I think he had something to do with Mike Howe, too, right? I believe so. Yeah, I believe he did. Now, you was kind of sandwiched in between Metal Church and Mike Howe. Mike Howe had left. The band had broken up. And then in 2004, you come along. Yeah. And sorry, this past week recently, we've lost Mike Howe. And my condolences to you and the Metal Church family. You're still part of that family. Well, you know, thank you. I appreciate that. What a tragedy. Quick story. I met Mike and hung out with him one time. Basically, I believe it was in 2006. He came out to Reno and we shared the stage and did date with poverty together. After the gig, we went out to a club and had some drinks and just sat and talked shop. And he was a sweetheart, you know? I've never heard anybody say anything bad about the guy. And what a tragic loss, you know? But you never know what's going on with April. And, you know, again, I feel really bad for leaving as a couple of sons and a wife. She's got a family and that's devastating. So I wish their family the best. And I send my condolences out to all Mike's family, friends and fans. Yes, the Metal Voice family does, too. We're all devastated. And it was great talking to you, Ronnie. Thank you for your time.  One machine coming out soon, September 10th, between worlds, definitely coming out. Yeah, pick it up. You can pre-order it now.  I'm all over the place. And just come and say hello. Check out the video and put a like and share it, if you would. Great saying. Thanks for your time, though. You got it, though.