I heard about the plague outbreak in India a few years ago. I mean, is this the same plague that could be used as a VW agent? Absolutely, Doris. Plague is caused by the gram-negative rod, your sineapestis. It's an organism of great historical importance. It's an organism that has this bipolar safety pin staining. You can see that here on the slide. In fact, it has a long history as a biological weapon. Probably the first recorded biological weapon. In 1346, a group of Tatar invaders were besieging the city of Kafa, now known as Fyadosia in Ukrainian Crimea.  Well, the plague struck the Tatar invaders outside the city. And in frustration, I guess, they hit upon the somewhat clever idea of catapulting the dead bodies of their fellow soldiers over the walls into the city of Kafa in an attempt to institute a plague epidemic within Kafa. And it worked. The Genoese merchants inside the city got the plague. They panicked. They fled the city, got on their boats, sailed back to Italy, took the plague with them. And from there, the rest is history. That's how the Black Death got its foothold in continental Europe. We now know that maybe this catapulting of bodies really wasn't the real reason for the plague epidemic within the city. We now know that plague is transmitted by fleas. The fleas are carried by rats. Fleas tend to leave a body as soon as it cools a degree or two. And so, in all likelihood, the bodies that were flung over the walls of Kafa probably weren't infectious. And the real reason people inside the city got the plague was the rats burrowed in and out of the city. In addition to this problem in Kafa, or this use in Kafa, we know that the Japanese in the years prior to World War II had a unit known as Battalion 731 or Unit 731. And they did experiments in occupied Manchuria with probably 20 different pathogens and included amongst those was plague. All right. Well, we now have Colonel Russ Byrne, Chief of Bacteriology at USAMRID with us today. He's going to assist us in discussing the plague. Welcome, Colonel Byrne. Thank you. Don't we have plague in this country too? Plague arrived in San Francisco in 1899 as part of the third pandemic. It kind of settled in the southwestern states of this country, northern New Mexico and Arizona and the Fort Florence area. This country averages about 10 cases of plague per year. There are much larger outbreaks in other areas of the world. I think the first two pandemics are worth mentioning too because they're interesting. The first pandemic of plague was known as the plague of Justinian. And again, this is an organism with historical features that are somewhat unprecedented and fascinating. The plague of Justinian was probably responsible for putting the final nail in the coffin of the Byzantine Empire back in the 500s. And then the second pandemic of plague was that great black death that swept through Europe that involved or that emanated from this incident in the coffin. And how long does the pandemic last? Well, a pandemic can last hundreds of years. And in fact, as Colonel Byrne alluded to, we're in the third global pandemic of plague right now. All right. Craig Levy, an epidemiologist with the Arizona Department of Public Health, has many years of experience with plague out there. So let's listen to him talk about the source of the bacteria in this country. What you tend to see in plague in nature is you have the plague cycling amongst rodent populations through flea bites. Rodents get plague. Many of the rodents die of plague. Fleas move on to other rodents.  If that flea had taken a blood meal from an infected rodent, that flea would have a chance to have bacteria multiply in its gut and foregut and proven triculus. And in the process of feeding, can regurgitate literally thousands of bacteria into the bite wound. This is a flea here that has just taken a blood meal from a rodent. In that big red spot you see in the abdomen is the blood meal that he took in.  And then over time, as this blood meal digests, if the food source was an infected rodent, you'll have plague bacteria multiplying within the gut of that flea and up in the esophagus in the foregut. This is a flea here that has digested much of the blood meal and you see a dark mass in the flea that consists of partly digested and bagulated blood as well as thousands of white pestice bacteria. Now this flea can become blocked, meaning that when it tries to feed that this bolus of bacteria and blood can prevent it from actually sucking blood, and this flea can become highly agitated and start biting frantically and in the process start regurgitating some of this material into the bite. This is a prairie dog which is one of the rodents that is a highly susceptible to plague infection, and generally when plague comes into a prairie dog colony it will wipe out these animals in a large scale. And one of the things that we do in plague surveillance is we monitor rodent colonies such as prairie dogs to look for any signs of potential disease in the animals. You have signs of a diop which may be in the form of just animals disappearing or rodent burrows that show spider webs and so forth in the entrance. That's a good time to collect fleas for the plague testing. Plague outbreaks in prairie dog colonies does occur as episodic so that most, if not all of the animals, will be killed in the outbreak. Pet cats are very susceptible to plague infection, much like people. And when a cat is exposed to the disease, either by flea bite or very commonly by eating infected rodents, they will develop symptoms to it including in many cases becoming infected with mnemonic plague. And at that point a cat can be infectious for humans. They will often have a swollen node or lymph node on the side of the face associated from an oral exposure to plague by eating a rodent.  And almost virtually all of the human cases of plague where there was primary mnemonic transmission of the disease in the U.S. in recent years have been from cat to humans. During a plague outbreak in rodents, you can have pet cats starting to show up sick or disappearing in an area. And when we have cats dying, one of the things we will do is again collect some tissue such as liver and spleen, blood, sometimes even removing a lymph node for isolating the plague organism. Now that we know the cycle between animals and people, what does it do once it enters the body? Once the organism gets underneath the skin that's picked up and carried to the regional lymph nodes where the infection becomes much more aggressive and accelerates, the organism starts producing a capsule called the F1 that prevents phagocytosis. This produces the bubo in the lymph node, the enlarged, tender lymph node that's characteristic of that form of disease. Following this, the infection disseminates. It gets into the bloodstream and sets up secondary sites, particularly in the lungs. This is an inguinal bubo in a young girl with a plague. This probably occurred because of a flea bite somewhere on the leg. If the bite occurs on the arm, the axillary lymph nodes tend to be involved. Plague is a very serious form of disease. Untreated plague has a 60% mortality when it's of the bubonic type, septicemic and pneumonic plague have mortalities approaching 100% untreated. Antibiotic treatment changes that. If antibiotics that are effective are started in time, the mortality can be reduced to about 10%. The key is in time. What is in time? Too late comes up pretty quick when you're talking about plague. I don't have good data for bubonic plague, but it's fairly well established that effective treatment is not started within 24 hours of the onset of symptoms with pneumonic plague. The outcome is going to be very poor. How do people come in contact with the bacteria naturally? There's a couple of ways that one can contract plague. Exposure to infected fleas is the most likely route of exposure.  That's a good way to get plague. To get plague is to be exposed to the respiratory droplets of an infected animal or of an infected person. Once exposure has occurred, there's an incubation period that's 2 to 10 days for bubonic plague, 2 to 3 days for pneumonic plague. The different forms of the disease are manifest by different signs and symptoms, bubonic plague being manifest mainly by the bubo. As I mentioned, they tend to occur in the area, draining the flea bite. This is an axillary lymph node that's become infected probably from a flea bite on the chest or abdomen or the arm. Are there systemic signs of symptoms occur, fever, chills, headache, overall prostration? All right. How is it... Is this how it would be disseminated as a B.W. agent by fleas? That's probably not as crazy as it sounds. That certainly probably wouldn't be the most efficient way of disseminating plague. Japanese, again, in Unit 731 in the years leading up to World War II, did attempt to disseminate plague this way. They dropped millions of infected fleas over occupied Manchuria and did start a bubonic plague outbreak in an area where it hadn't been seen before. Again, today, probably most terrorists or belligerent states out there are going to try to disseminate this via aerosol. That would cause the more deadly form of plague, the pneumonic form. Cough, chest pain, hemoptysis, and severe systemic symptoms. The chest x-ray would show a number of findings. It could show cavitation, apache, bronch, pneumonia, or franklobar consolidation. As we can see on the chest x-ray here, this is virtually opacified. Other laboratory data that would be observed, the white count is going to be elevated 20,000 or higher. The bands are going to be increased. The carbon degradation products may be identified indicating the patient may go into DIC. A liver function test, the AST and the ALT, may be elevated indicating that there's involvement of the liver. DIC, Ted, describe it. DIC Doris is disseminated in revascular coagulation. Basically, it's a clinical state where the clotting system has gone haywire. You start to develop microclots in the small blood vessels, typically in the fingers, the toes, et cetera. When you see this in plague, you start to see some of the hallmark findings that are associated with plague. And here you can see in this shot, necrosis of the tips of the fingers in an unfortunate gentleman who contracted the septicemic form of plague. And I think we have another shot that again highlights this devastation. You can see this gentleman's probably going to lose several fingers. Maybe the tip of his nose, maybe his lip, because of the disseminated in revascular coagulation associated with septicemic plague. Now besides clinically, how can you diagnose the plague? Well, diagnostic tests would include staining a gram stain or wastes and stain of fluid that ought to be sterile. There are ordinarily plenty of organisms there to see. A lymph node aspirant might reveal the organism. Sputum gram stain may indicate that it's there, the typical bipolar staining, gram-negative conchalbacilli. Obviously, gram stain, the spinal fluid that's positive for these organisms would be a serious concern. A gram stain of blood can even shell organisms. Patients can have tremendous back to reamings during the course of this disease. Once a gram stain has identified an organism, this can be confirmed with a direct fluorescent antibody test that's performed at the Samrit. A polymerase chain reaction can also identify the organism. The F1 antigen that I mentioned can be identified by an ELISA capture assay. What about cultures? Yosinia pestis grows up pretty well on most culture media. The problem is that it grows up a little slowly. It may take two or three days to complete its biochemicals. It wouldn't be surprising to be involved in a case of plague and not have the diagnosis absolutely confirmed until you're 48 or 72 hours into a course of treatment. Now, Ted, you mentioned before that people can get pneumonic plague from respiratory droplets from another person, but does this mean that plague is contagious? Yes, it does. In fact, that's a very important point that we need to understand concerning plague. Again, we said earlier in the broadcast that one of the few bits of good news about these biological agents is that they're not contagious person to person in many cases. But this is one of the exceptions. Plague and smallpox, pneumonic plague at least, and smallpox can be spread person to person. So proper precautions are necessary. And in the new terminology of the CDC, that would be droplet precautions that one would utilize. Plague has the potential for person to person spread, but it tends to be pretty close contact. And this contact can be limited by appropriate respiratory precautions and the disease can be controlled with prophylactic antibiotics. It's not nearly as contagious as some of the other organisms that we've talked about earlier today, or nearly as contagious as some of the common viral illnesses, such as influenza or measles, where you can acquire the illness from somebody you haven't even seen. Well, we have an interview with Dr. Dave Dennis from the CDC in Fort Collins, Colorado, discussing some outbreaks of pneumonic plague and risk factors for them. Let's take a look at the video. The history of pneumonic plague outbreaks with the third pandemic since the beginning of this century is interesting. There were huge outbreaks involving tens of thousands of persons, of person to person pneumonic plague, primary pneumonic plague, that occurred in Manchuria in 1910 and 1911, and again 1920, 21 and so. And that was peculiar circumstances where there were people, large numbers of people, crowded into very small spaces into railroad cars, into small shacks. Plague had been brought into these populations by people who were hunting infected marmots for their skin. I think marmot skin hats was, something was popular at that time. Not only were the pelts infected, but people skinning it got infection through cuts in their skin and developed the plague and then the plague became pneumonic plague and then it rapidly spread person to person. The circumstances that we think that were favorable to it, rather than just crowding, was that it was very cold and very humid and the plague organism is very susceptible to dryness and to heat. And so in normal circumstances, the plague dies very quickly when in the ambient temperature and environment. But in those cold, human circumstances in Manchuria during the winter time, and those crowded conditions spread very quickly and with extraordinary high fatality amongst this group. We don't know everything that we would like about the dynamics of its spread. In some circumstances it seems to be able to spread quite easily and others it isn't. But we do know that plague pneumonia is so severe and so dramatic that patients are seen early and once they're hospitalized and put under isolation with respiratory precautions the transmission stops quite quickly because the organism does not aerosolize such as measles, virus, smallpox virus or tuberculosis bacteria. And it is only spread by those respiratory droplets. So it spreads to persons who are in close contact with someone who is coughing generally the organism in the early stages of the disease. It's a manated person to put under isolation with respiratory precautions. The way to prevent the spread obviously is have good surveillance to detect cases in the early stages to put them quickly in isolation under respiratory precautions to identify all contacts and those that had close contact put them under antibiotic post-exposure prophylaxis with all antibiotics, cycling, chloramphenicol for all antibiotics. Sometimes the person who is allergic to medications cannot take them because of age and whoever can be treated with prognathoprine so from the boxes all as they prevent it. Yes, and of course early treatment of the cases themselves can't continue to spread the organism. I would think that treatment of the case brings about interruption of transmission within 24 hours in most cases that perhaps even shorter than that. Well Russ, Dr. Dennis mentioned several antibiotics actually that were useful in the prophylaxis of plague. What would you recommend? Doxycycline, 100 milligrams twice a day for seven days or as long as the exposure lasts. Now I assume the treatment of the sick patients is also important in decreasing the spread. Well that's right, Doris. Treatment of sick patients certainly is important and the recommended drugs in this case would be streptomycin. Streptomycin would be administered in a dosage of 30 milligrams per kilogram per day. It would be given infromoscularly in two divided doses and you'd probably want to continue that for at least 10 days. Streptomycin is obviously difficult to procure in this day and age. Acceptable alternatives to streptomycin would include doxycycline. You could give that at a dosage of 200 milligrams initially and then 100 milligrams Q12 hours again for 10 to 14 days. In those 6% of plague cases that would be expected to develop meningitis you would want to use chloramphenicol since that's the only drug that reliably treats your cine infections in the central nervous system. It's important to remember to start treatment very early. It needs to be started within 18 to 24 hours after the onset of symptoms if you stand a decent chance of salvaging the patient. Colonel Byrne, maybe you can enlighten us as to whether there are new treatments that one could consider besides the drugs I've already reviewed. Well, considering the limited availability of streptomycin, genomycin is usually used initially and that's not a new drug obviously. There's evidence to suggest that the chronolones would be effective. There's in vitro evidence and there's evidence in lavatory animals. There's evidence of any human data to support them. There's evidence to indicate that the penicillins and the cephalosporins are not effective and I believe that they're actually contraindicated in the treatment of plague based on certain animal studies that have been done. What if people were exposed and they don't have symptoms yet? Well Doris, in that case I'd use the same treatment that we discussed for healthcare workers namely doxycycline prophylaxis. Is there a vaccine for plague? It's licensed in this country. Three shots are administered over a three to six month period. It has an acceptable side effect profile. It's not the easiest vaccine that we have to get but it's not the worst. The majority of the patients have some local symptoms and perhaps 10% will experience systemic side effects. You know, I think it's... I'd like to point out here at least. We've heard a lot about anthrax vaccine and we hear a lot about anthrax vaccine being the first anti-biological warfare vaccine. And yet there's this plague vaccine that's been around for a long time and again we've used it in Vietnam etc. So the question is, what's up? Well, I think the answer to that question is we've never thought of the plague vaccine as an anti-biological warfare vaccine. In fact, when we administered that vaccine in Vietnam it was to protect against endemic bubonic plague not against biological warfare, pneumonic plague. The vaccine really as far as animal studies revealed to us doesn't seem to work against pneumonic plague, against aerosol plague. And I wonder if Russ, you had any more comments about the vaccine, its availability, and issues like that. Well, outside of the military the plague vaccine is a very limited market in this country. There's only a single manufacturer of plague vaccine and the existing stocks of vaccine become outdated before the end of this year. Currently there are efforts underway to get the new lots of the vaccine licensed. Since this organism is contagious are there any additional decontamination methods that you need to use? Well, Russ, besides strict adherence to droplet precautions for the pneumonic form of plague you would want to administer antibiotics, obviously, as indicated, and for the first 48 hours of that antibiotic treatment you would continue these droplet precautions. If you then subsequently confirmed that in fact you were dealing with plague you would continue those droplet precautions until sputum cultures were negative. You have to remember that if someone has recently been exposed and they're not yet, and the person they were exposed to is not yet coughing, is not yet generating secondary aerosols, then they're probably at very little risk and just soap and water or dilute bleach for decon, et cetera, would be effective. So I think you have to take that into account. Okay, well I think most people remember an outbreak of plague in India a few years ago and as an example of some of the fear of this disease and to emphasize some of the epidemiology information we covered earlier, let's go back to Dr. Dennis and hear about his experiences investigating that outbreak. We were first made aware of an unusual situation in India in September of 1994 when we had requests for large, lots of reagents for the diagnosis of plague and when we queried the WHO office in India about this, they got information from the Ministry of Health that there was a suspected outbreak of plague occurring in West Central India. It was the worst case scenario from a public health standpoint in Surat. It was the city of about 2 million people, many living on the edge of the poverty, many people who were transient coming in from the rural areas to find work and living in slum areas, shantytowns and extraordinarily poor sanitary and hygienic measures in place. The garbage was littering the streets so the rat population undoubtedly exceeded the human population and when the word got out that plague was occurring the government was putting into place plague control measures and they were very efficient at plague control measures. They could mobilize large numbers of people to go in to identify people who had fever and hospitalized them to treat people with antibiotics to provide antibiotics for prophylaxis to put up free suppression measures. They were quite good at that but anyway when the word went out that they suspected plague people still had a memory of the outbreak of plague that occurred in the 30s and the 40s in the early 50s terrorized the population and of course they wanted the exodus and tens of thousands of people anyway and in the press it was reported hundreds of thousands of people left the city of Surat and spread themselves out in other areas of India. The panic was so great that physicians and nurses and other healthcare workers deserted their posts and so that further decreased the confidence in the public that the government was able to manage the situation. Fortunately we have no evidence that there was spread of plague to other large cities or other areas in which there was inhuman to human transmission. We did identify one person in Delhi with a confirmed human plague from a laboratory standpoint who had been living in rural Maharashtra and had traveled to Delhi at the time he was incubating the disease but there was no secondary spread of course in this person that was the chronic plague. I don't think there was any way to really determine quickly what the evolution of the outbreak was and it certainly could have been an unnatural event as far as we know especially the situation in Surat where there was an amount of plague cases what happened was there was an explosion over a period of a few days of about 100 cases of severe pneumonia with respiratory insufficiency, homoptices and rapid death and the high fatality in persons who weren't treated quickly in fact there was about 40 deaths of 100 cases that occurred in the first few days. The thing that was unusual about it was there had been no antecedent plague in Surat for decades. There was no known cycling of plague in the rodents and their fleas in the city.  There were no bubonic cases which you would expect to be very much greater numbers than the mnemonic plague cases than the perceived mnemonic cases. That was not in place. So I mean in actuality it makes a very good scenario for an accidental or a determined event. We still don't know really what happened but the best conjecture at that time was that someone had come in from the area where they had reported the outbreak of bubonic plague in the countryside in Surat at the time that they're incubating the disease developed secondary mnemonic plague and then there was a burst of cases arising from exposures to that and secondary cases accounting for those mnemonic plague cases and deaths that occurred in the city and then it quickly died out and without evidence of there being rat plague or bubonic plague cases occurring there what is needed to respond to a plague case or plague cluster of cases or an outbreak is a multidisciplinary team in effect a SWAT team and that really is what was needed in India. They needed a team of epidemiologists who understood plague including clinicians who could determine whether or not the clinical signs and symptoms really were compatible with plague they needed a microbiologist that had a mobile laboratory at least to have the reagents and to have the materials to do a presumptive diagnosis of plague and they needed to have the entomologist and the zoologist the utologist that understood the natural cycle of plague and how it could have spread to the human population and if they'd had a team of those people they could have gone in and made sense out of that outbreak in Surat in 24, 36, 48 hours but they missed the boat. Now as I recall there was a lot of international fear that this plague could have spread around the world. Conor Byrne? Well the severe form of nature of the disease requires effective focused containment measures there's panic associated with it and justified it so international regulations allow a quarantine of up to six days of individuals suspected of having a significant exposure to mnemonic plague and that was the justification behind the cancellation of flights and holding planes on the runway and stuff like that. The key point is significant exposure that requires household contact or possibly workplace contact or face to face contact like you and me right now. Certainly a lot of these issues that we're talking about here call into mind the importance of epidemiology and of conducting a good epidemiologic investigation as we talked about earlier on the show. Alright, why don't we move on to another bacterial agent the one that causes tularemia? Okay, tularemia doris is a disease that's primarily zoonotic in nature. It's a disease of rabbits, hares, ground squirrels, muskrats, beavers and the like. As a disease of rabbits it's often known as rabbit fever. It's transmitted from animal to animal or from animal to person sometimes by the bite of various vectors. The deer fly, for example, and in that sense it's often referred to as deer fly fever. The disease tularemia is caused by infection with the gram-negative cacobacillary organism, Francisella tularensis. Tularemia is interesting in that it's found naturally only in the northern hemisphere. Alright, what are the ways people are infected? Well, there are several ways that one could be infected. One is through inoculation of the skin or of the mucous membranes by the blood and tissue fluids of infected animals. So if I skinned muskrats as a hobby or for a living, that would be a good way to contract tularemia. Another way is, again as I stated earlier by the bite of an infected deer fly infected mosquito and infected tick. Rabbit hunters are at particular risk. So if you want to get tularemia that's a good way to do it, be a rabbit hunter. Less commonly infections can occur by inhaling the contaminated dusts of areas where animals have frequented by ingesting contaminated food or water and the like. The organism is rather stable. It can remain viable for weeks in water, in soil or in the carcasses of those animals that we've discussed. Does the stability make it a good BW candidate? I'll let Colonel Byrne answer that. The stability makes it a good BW candidate along with the fact that it forms aerosols naturally and then it only takes one to ten organisms to initiate infection. The Japanese studied French cellularensis in Unit 731 and the United States weaponized this organism in the late 1950s and early 1960s. Is the disease fatal? Well, Doris, we used to consider tularemia a lethal agent back when we had an offensive biological warfare program. I think nowadays with modern medicine, modern standards of care, good antibiotics most of us would consider tularemia an incapacitating agent. Most naturally acquired cases in the 1990s have a fatality rate of only 5-10% actually without treatment. If you were doing biological warfare, you may be able to select out a more virulent strain and it may be a little higher than that especially given that what you're going to see in biological warfare or terrorism would be primarily the septicemic form of the disease. But with appropriate antibiotic treatment basically the case fatality rate should be 0. Okay, so but if a patient is exposed, what do they experience? Colonel Bernardo, you could probably answer they may have seen more tularemia than I have. Well, it's an incubation period that can range from 1 to 14 days. It's usually 3 to 5 days. Then the clinical presentation depends on how the infection was initiated. The most common form is the ulceral glandular form and that produces an ulcer at the site of inoculation. Now also associated with this are regional lymph adenopathy and systemic symptoms such as fever, malays, chills, so on. I think we have a case here that we can show you, give you a feel for what this looks like. In this case there was a woman who was treated by my partner George Christopher at Scott Air Force Base. This woman was apparently bitten by a tick and she came in complaining of a two-day history of fever and debilitating malaise. You can see the ulcer that has formed at the site of a tick bite on her scalp. She was treated, she did fine, she lived happily ever after. If the ulcer was not present then you would basically have a syndrome that we call glandular tularemia. There's also a syndrome known as pharyngeal tularemia and there's an ocular glandular tularemia and basically the only difference is that there the conjunctiva is the portal of infection. All of these syndromes can progress to a disease which we often refer to as typhoidal tularemia. That can also result directly after the ingestion or the inhalation of Francislla tularensis. Okay, so which is the most likely form in a BW attack? Well, assuming a biological warfare attack would probably be that the bad guy out there would aerosolize this stuff. We would inhale it and the form of the disease we would get would primarily be typhoidal tularemia. Typhoidal tularemia presents with fever, you may have respiratory involvement with some sub-sternal discomfort and a non-productive cough. The pneumonic involvement is not always present though, even after an inhalational exposure. Here is an example of a good pneumonic tularemia case and you can see the infiltrates on chest x-ray. Respiratory symptoms sometimes may be the predominant manifestation of illness though. Okay, Colonel Burr, are there any other ways to diagnose tularemia? Unlike plague there are usually not a lot of organisms to see on stains. Staining sputum or lymph nodes is usually not very helpful. The organism can be cultured but it's difficult because it has specific growth requirements and it's also a little bit dangerous to work with. There have been a lot of laboratory outbreaks of tularemia in people who work with this organism. The laboratory ought to be notified if you suspect tularemia so they can institute appropriate BL3 containment measures. This is usually established by acute convalescent to antibody determination in serum. Ordinarily these are agglutination tests. There's also an ELISA available. Lumerous chain reaction has also been used. If organisms are identified in tissue there's an indirect fluorescent antibody that's used at UCM-RID that can confirm the diagnosis of tularemia. Alright, well since it's not usually fatal, do you really need to treat the disease? Well do as you do. First of all it can be fatal and again belligerence out there could pick an especially virulent strain that can be fatal up to 30% of the time. And even if it's not fatal it certainly is not a pleasant disease. People can get pretty sick from tularemia. We usually consider it an incapacitating agent but again not a pleasant disease if you get it. Both streptomycin and genomycin are effective in treatment so we have good relatively inexpensive therapy and certainly I would use that if I had a case of tularemia. As you can see here the recommended therapeutic regimen would be streptomycin 1 gram every 12 hours given intramuscularly over a 10 to 14 day period and alternatively one could use genomycin that would be given 3 to 5 milligrams per kilogram per day intravenously again for a 10 to 14 day period. Tetracycline and chloramphenicol can be effective but they're associated probably with a higher relapse rate than the immunoglyphosine. What about contagion with this agent? Do healthcare providers really need to worry? Although laboratory infections are a real problem, human transmission is very unusual and standard precautions with respect to secrecy are all that is necessary to prevent transmission in the healthcare setting. Okay now if you've been exposed is there anything you can take to prevent infection? Well Doris antibiotics are very effective in preventing disease after aerosol exposure. We know that from a lot of animal data. Two week course of tetracycline or doxycycline is what we would recommend and you can see here the recommended regimen with respect to doxycycline would be 100 milligrams orally every 12 hours for a two week period. Is there a vaccine? A live attenuated vaccine is available as an IND product. It works quite well in preventing laboratory infections and in preventing infection by aerosolization and human volunteers in old studies. As with most vaccines all vaccines that I know of the detection can be overwhelmed by very high inoculum of organisms. At present the vaccine is only used in laboratory workers. The vaccine is an interesting history as you're aware. Right, the vaccine actually was given to us in 1955 at the very height of the Cold War by the Soviet Union. It came from their Gamelia Research Institute and we refer to it as the Gamelia Strain. We're using that at the exact height of the Cold War we would get this from the Soviets. Exactly. Well, tell what, let's start on our last disease of the day, brucellosis. And before we get started I'd like to welcome our last guest expert for today, Colonel David Hoover. Colonel Hoover is the scientific coordinator for the Brucello vaccine program at the Walter Reed Army Institute of Research. Hoover, can you describe to us some of the background of Brucellosis? Brucellosis actually has a long history associated with the military. It was first described in 1861 by Marston in British troops who were stationed on the island of Malta. And then studies in the late 1800s by Bruce and Hughes define the clinical spectrum. It's actually quite prevalent in the developing world, but there are less than 100 cases per year in the United States. It's an important cause of abortion in large animals, especially large food animals, and it's naturally acquired by contact with infected animals or their products. There are actually six recognized species of Brucello. Four of these are pathogenic for humans.  Followed very closely by Brucello suis, which is a pathogen of swine. Brucello abortus is the primary cause of infection in cattle and Brucella canus in dogs. You know, there are some pretty interesting ways in which one can become infected with the Brucella. As Colonel Hoover stated, these are common pathogens of certain farm animals, and so if one were a rancher or worked in the animal husbandry industry, for example, that would be a good way to contract Brucello suis. Brucello suis is essentially a venereal disease of animals. It's present in the gynecologic tract of cattle, of sheep, and of goats, and so if you were a rancher assisting in the delivery, for example, of a pregnant cow and you weren't wearing gloves or you had a tear in your glove, you had a tear in your skin, that would be a good way to inoculate oneself with Brucello suis. It's present in the milk of many of these animals, as well Brucello suis is, and so, for example, on the Mexican border, goat's milk cheese is a common delicacy and it's often unpasteurized. So to go down to the Mexican border in south Texas, for example, and sample the unpasteurized goat's milk cheese, a good way to get Brucella melotensis infection. In south Texas they're fond of hunting havalina, these wild boars that are found in far south Texas and those are good animals to transmit Brucella suis infection. And finally, in Saudi Arabia where Brucello suis is very common, there's a very interesting habit, shepherds in Saudi Arabia, as part of their payment when they deliver their sheep to market, the sheep are slaughtered and they're given hot right out of the animal the caudate lobe of the liver and it's customary and it's considered a delicacy to eat that raw caudate lobe of the liver. And a lot of Brucellosis cases emanate from that very interesting practice. So this is a disease that's highly infectious by aerosol but it's got a long and variable incubation period. So the fact that it's highly infectious makes it somewhat attractive as a biological weapon, but the fact that its incubation period is so long and so variable to track somewhat from that Doctor Hoover, tell us what a typical case of Brucellosis looks like. It's a little hard to define a typical case because of this variability in presentation, but Brucella can either present as an acute febrile illness with fever and sweats, headache, arthralgias and general malaise, and these kinds of symptoms can go on for weeks or months until the disease is diagnosed or it actually can present as a more insidious illness with anorexia, weight loss, difficulty concentrating and depression. About a third of patients develop spread to the bones and joints. And younger people, sacroiliitis is the most common joint infection and this is typically a non-destructive infection. But in older patients, as seen in this photo here, you can get vertebral osteomyelitis and here the disease starts in the intervertebral disc and spreads to the adjacent vertebrae. In addition, you can get chronic genital urinary tract infection, particularly epididymitis. And you can also get meningitis or endocarditis, which are the main causes of fatality, although fortunately these are very rare. I've actually seen a case of Brucellosis. Before I joined the army, I worked for a while with the public health service in Barrow, Alaska, this remote Eskimo village and we had a gentleman come in and was ultimately diagnosed as having Brucellosis and he had hunted a polar bear and had eaten raw polar bear meat. We presumed that that was the source of his Brucellosis although that's not the most typical animal to harbor that disease. But I can tell you from experience, a very difficult disease to diagnose. It took us several weeks before we finally came up with the proper diagnosis of Brucellosis in that case. Those patients who have respiratory symptomatology often have normal chest x-rays. Some patients have a paddle splenomegaly, some patients don't. So you can see it's tough to diagnose. For those patients who do have joint involvement, CAT scans, MRI scans, plane radiographs, bone scans may be helpful, but again very tough disease sometimes to diagnose. So how do you confirm that it's Brucella causing all the symptoms? Well, culture is actually the most reliable test of either culture of blood or suspected infected body fluids. And although it's considered a slow-growing organism, 95% of those cultures that will become positive become positive in seven days. It's still recommended to hold cultures for up to two months if you really suspect the disease. And culture of bone marrow can increase the yield substantially over blood culture alone. You should warn the laboratory, however, not to subculture the bacterium unless they have BL3 capability, since this is actually one of the most common causes of laboratory infections. Most cases are actually diagnosed by serology. The gold standard is a tubal glutenation test. You have to worry about cross-reactions with Francis L. Tullarensis and patients who have cholera or vaccinated with cholera. PCR is actually useful for speciation, but it's not very useful clinically at this point. Well, it sounds as if this could be a very prolonged illness. I mean, can it be treated? Well, of course, it's actually not too difficult to treat. There's some good news and there's some bad news attendant with treatment. The good news is that the treatment regimen is the standard regimen. There are actually several regimens one could use, but the most commonly recommended regimen is doxycycline plus rifampin. And the good news here is that both of those can be given orally, and both of those can be given once a day. So I can give you one pill a day of doxycycline 200 milligrams, one dose a day of rifampin 600 to 900 milligrams. And again, pretty easy to administer that therapy. The bad news is that you need to continue therapy for six weeks. And the literature is full of cases of relapsing brucellosis where the clinician didn't treat the patient for a long enough period of time or where the patient stopped taking the antibiotics. What do you do for severe disease? Well, you might want to add an aminoglycoside like genomycin. And for endocarditis you should certainly consider valve replacement early in the infection. You have to remember that you don't really need to isolate these patients since it's not transmitted person to person. Is there a vaccine available? Well, Doris, there's a great veterinary vaccine. In fact, there are a couple of great veterinary vaccines available and those vaccines have greatly decreased the number of cases in animals. And that's led to a decrease in the cases of human brucellosis. It's still important to emphasize though that you need to avoid the consumption of unpasteurized milk and cheese, the goat's milk scenario that I alluded to earlier. And it's important to know or to realize out there that there is no human vaccine currently available. But studies are going on? Yes, we do have some publishing animal studies going on, but vaccine is a few years away for sure. All right. Well, that about covers the bacterial agents and I guess it's time for our local activity number two. A recent vote of no confidence has led to parliamentary elections in Krasnovia. Control now lies in the hands of the hardliners who immediately after assuming power signed a mutual defense pact with Saracen and withdrew support for UN peacekeeping forces. Elite Krasnovian special forces plus three parachute infantry regiments have been deployed to Saracen despite vigorous U.S. and U.N. protests. In response the United States has moved the 18th airborne corps to staging facilities in Europe.  The 28th currently occupies the old U.S. air base at Zweibrucken, Germany. In addition to the heavy workload and anxiety associated with site preparation, you are burdened by an unusually high number of sick call patients from your own unit presenting during the past 48 hours. Most of these patients have complained of fever, headache, fatigue and cough. Yesterday your partner wrote 43 azithromycin prescriptions for what he assumed to be walking pneumonia. As you come on duty you are surprised to see that half of those patients are back and that many new ones have arrived. What is going on? Hey Sergeant Walker, Sergeant Walker, who are the soldiers? Hey sir, it's been like this all night long. We've had about 20-30 patients all night not including these ones we got here. We're all complaining of the same thing. Headache, fatigue, tightness in the chest and a little bit of nausea. I don't know what else we can do with it. We've got vital signs. Alright, alright, who sick is? Well, he's sick, but we can start over here trying to get some vital signs. We've got a temperature on her. It's about 101. What's bothering you? I'm really hot. My chest hurts. Okay, great. Let me take a listen to you. Take a real deep breath. Okay, deep breath. Deep breath. You guys get x-rays in any of these? I tried to get some x-rays late last night, but the x-ray machine was down. Alright. She doesn't sound very bad. I don't hear any wheezing or anything. Who's next? This guy here. Same thing, tightness in the chest and coughing. What's bothering you? It's hard all the time. Let me take a listen to you. Take a deep breath. Deep breath. Just breathing normal now. I don't hear any rails or wheezing. You got somebody else? Well, this one over here he's been pretty sick. What's bothering you? What's bothering you? Are these folks in the same unit? Same unit, sir. Let me listen to you. You sit up a little bit. Take a deep breath. Sergeant Walker, you need to send somebody down to X-ray. You got to go right now. Yes, you do it. You need to go down to X-ray right now and get that portable down here ASAP. Okay. Let's go to CBC. All sides of some of these soldiers. A few hours later, an hysterical soldier runs in screaming that he just found his buddy dead in his bunk. Come on, soldier! One, two, three, one, two, three, five, I found him in his bunk and he's dead! You got to come! The X-rays you requested that morning finally arrive. Specialists, I need to check these 558s. There's too many similarities here. Have you noticed the vital signs? Everybody's got over a hundred and one temperature, a hundred and two temperature. They're all complaining about chest. Something must be going on. Whoa, whoa, whoa! This is the MT-1. What are you guys doing here? I'm listening to Colonel Messon from the 257th Company. Yeah, I'm Colonel Messon from the same company. We're dead, so we just arrived here. We're looking around and we wanted to see what was going on. Well, you're busy here. I'm not quite sure what it is yet. Well, we noticed a lot of spraying going on outside. It's truck driving around spraying something in. We're thinking ticks here. We're thinking maybe we need some tick-borne and civilized vaccine. Well, I don't know anything about that. My whole EMT is loaded with patients. I've got some serious problems here, okay? And you guys may have walked into something that we may have to call a quarantine. As a matter of fact, you're quarantined right now. Well, we can't do that. We can't do that. I've got radios. I've got landlines. We've got a real mess on our hands. I've got one medical doctor. I've got 20 patients out here. Why don't you guys give me a hand and a dentist? We have to be quarantined. You're sure we have to be quarantined? Well, I think so until we get to the bottom of this. Why don't you guys just give me a hand and you take these half over here and Doc, you take those half. Well, we have to. Sure. I've got medics working with them and they'll give you a heads up as to what they're seeing, but I think what you're going to see is you're going to see a lot of high fever here, 100 and 102. There's a lot of respiratory distress or at least they're complaining about tightness in their chest. Nobody's come back. I've listened to a couple of tests myself. I haven't really heard much activity. They just feel loud. Okay. Well, pretty frightening scenario, I think you'll all agree. What I want to do is very quickly review some of these questions and then we'll take it back to Doris and we'll take some more questions from the studio audience. First question. You saw that the physician who had been on the day before had started a lot of people on azithromycin therapy thinking that initially these may have been cases of walking pneumonia. What do you think about that? Would you continue the azithromycin at this point? Well, I'd certainly reconsider the antibiotic choice based on the fact that I've got so many troops coming back who are sicker on the therapy and I'd be rethinking my initial diagnosis. Good, good. And that's an important piece of epidemiology that you allude to. You need to take into account what's going on here. If it doesn't fit what you expect, these patients are starting to get sicker than you would expect the average case of walking pneumonia to be. I think you need to reconsider your diagnosis. So initially I don't have any problem with this diagnosis but now that patients are coming in sicker, I think you can see that you've got to rethink your diagnosis. Any tests you would want to do? Is it important to do any test? Of course it is. What kind of tests would you want to do in some of these patients? Well, again, at this stage of the game you're rethinking the diagnosis and gathering more data including initial vital signs. They already mentioned chest x-ray and these patients who are having significant respiratory symptoms, getting to include culture, maybe a gram stain if you have facilities to do that and some CBCs, things of that nature. Good, I agree with all of those. Now, in the case of blood culture it's going to take a couple days to get useful information out of blood culture but a chest x-ray ought to give you some useful information right up front. And I painted a pretty realistic scenario here, the x-ray machine's down, et cetera, et cetera, but I think it's very incumbent upon you to press for that diagnostic information that you need. So you eventually got that chest x-ray and what did you see on that chest x-ray? There's a widening of the mediastinum which clearly indicates that it's probably anthrax. Absolutely, so widened mediastinum almost has to be anthrax and the teaching point here is there isn't too much in the world of human medicine that produces a widened mediastinum like that. There's not too much that causes hemorrhagic mediastinitis and in fact the only battlefield relevant injury I can think of other than anthrax is a bullet hole through the mediastinum. So if I have patients with chest x-rays like that and I turn them over and there's no bullet hole there, they must have inhalational anthrax. So pretty easy diagnosis to confirm in this particular patient. I think you all realize this guy's probably not going to do very well but your job as clinicians is not necessarily to save that index case but rather to very rapidly learn from that index case and use that knowledge to hopefully save a lot of other people. Now the issue came up about quarantine for these two dentists who entered the picture. Anyone agree with that? Disagree with that? Do you quarantine these dentists, sir? That was, I think, overreacting since the diagnosis was made of anthrax then since there's not person-to-person transmission you wouldn't need to do that. Good, good. And if this were an unknown, you might approach it differently. For example, if pneumonic plague was still high in the differential diagnosis, I might think a little bit differently although even with that, these guys just stumbled in, they really haven't had time to be coughed on. Chances are that even with pneumonic plague they probably wouldn't need to be quarantined. But with anthrax, which doesn't have the possibility of person-to-person transmission, certainly those people don't need to be quarantined. Good. Okay. What do you want to do for these ill patients? These patients who are starting to clutter up your treatment facility who are coughing, who are febrile, who are ill? Anybody have any advice regarding therapy? Kent Lee? Well, if you have enough antibiotics you could try to start them all on antibiotics and then if you have a vaccine that you would also want to start them on the vaccine to pick up any of the latent spores that might still be in any of the individuals. Good. Good. So this is a triage issue and we've said throughout this course already that if you wait until patients are symptomatic to treat them, chances are they're not going to do well. So many of these people under certain circumstances might be categorized or triaged as expectant. But on the other hand, if your resources permit it would certainly be reasonable to try to treat those people with antibiotics. Now what about those people who are not yet ill? Patients who may not yet have shown up at your treatment facility but who were in the same geographic area as these sick patients? Dr. Bellin. You would still want to start them on antibiotic treatment and if they haven't been vaccinated to start them on the vaccination. Excellent. Excellent. So in this case the antibiotics could be oral and you would be given them as prophylaxis rather than as treatment. We discussed the dosages, etc. throughout the course and for those of you students out there in television land if you need the dosages, they're in your little blue books. In fact, that's why military BDUs have these hip pockets there to hold our little blue books. So you would look that up. And again, good prophylactic regimens are available and certainly they would need to be coupled ultimately with vaccination. Well, you guys have done great and I think there's again no sense trying to test you any further.


So I could go live and FaceTime someone right now or Skype someone and I could show them a beautiful view but to the extent that my call brings someone pleasure or a family member or a friend, wherever they are in the world, 98% of the pleasure of the call will come from me. It's not going to be the beauty of standing here on top of Los Angeles looking out at the Hollywood sign. So I love Sydney, I love the beautiful beaches, I love Los Angeles, I love San Francisco but the overwhelming meaning of these places comes from the people I know there. I would much rather be in a drab, boring environment with people I love and be in beautiful places with people I don't love. So I remember in the year 2000 I went on a Jewish singles trip to Israel and I just had a blast for two weeks. Then I went on my own to Greece for a week. I went to Mykonos and Santorini and Athens and it was just such a let down. It was just not nearly as exciting. I did it on my own as compared to the trip where I went with a group to Israel and I liked the people I was with and we had a blast. So it's all about who you're with, it's all about the connection. The natural beauty can be a cherry on top.


Christian scripture is largely a collection of stories. Stories about this profoundly messed up family trying to figure out how to live with one another. Stories about a young nation trying to find its place in the world. Stories about suffering and anger and betrayal. Stories about comfort and love and hope. Stories about a man who himself told stories that confronted previous theologies and invited a new imagination. Stories about a man who lived and died and lived again and in doing so changed the way we read all the stories that came before and shaped the stories that have been told the sense.


What's up, good people, and welcome to SPM bars. My name is Miss Kithingi, and today I am on location. As you can see, I'm very comfortable in Mekaribishwa. I am here to meet someone. I'm sure you're interested to know who they are. This is Samuel Njao Gishiru. This is the former president Moaikibakiz Lukalaek. Tumefika kwa ke na tunataka kumungelesha. Alafu menebene, itwa a.k.a. Uncle Sam. Uncle Sam? Yes, please. Abarriako. Sorry, Sana. Tumefika kwa kumetukaribishwa. Sana? Karibu Sana. Tumekuna, you've become an internet sensation overnight to learn a small snippet of video views. And I was so interested to know, who is this person? Wunendelia Vizuri? Mimina Idelia Vizuri. Majinayaguni Samuel Njao Gishiru. Yes. Mimu muzariwa waga tondo. Okay. Karibu na uhuru kenyata. Okay. Hapu apu tukaribu. Yes. Lakin nika hamia kiyabu. Yes. Mia kaishireni. Oh. Nikona bibi. Yes. Piya na itualuse. Okay. Hala. Na Piya niri wahiku pata accident rekifanya campaign. Oh. Nikawa kwa huyo sutia. Oh. So. That is too much resemblance and coincidence rather. That's a lot. I mean coincidence ya the late former president. Now Samuel ningetaka kujua. Ulyanza kuhu any watua mikununa, FaNana na kibaki? Ni niably многоha kiyuuku kwenuna, FaNana na president. Hama watua, lianza kukudia? So wahiki to iritokia wakatua covid. Mimu makuwa, nirikua na nniorewa nnioree tangu, m'n yakayaguyu yote. Kwa yubi waku na mtu triki watu, FaNana. Lakin wakatua covid, tukau nnioru sana, sana juu yakutoka injke, kwa da kuni nniorewa. Diyo ni kalei aniwere, eka tokia hiwa. Ah, okay. So that's when people started seeing you look like I know the former president. Yes, there is a time I was at a supermarket. And then I found out that there was a point. So I went to Moai. Moai is doing it. Kutoka upon Kanzapu, I went to Moai. Kitu kama hiwa? So far we've seen any mistakes and identities that you have to tell me. Diyo. Saigi na watu ananiwena wana toroka. Niliye da kununua mahariku aduka. Nika wana misutia na mesewa. So ni kashidwana miimi. Na wakate niliyansakuskia wana sema Moai Moai. Ni kajari buko ugia kamaia niliwena kama na eza ko ugia. Wana takakuskia. Wachana jo. Wata zamaji wana ngojia. Ata before miimi, you know the former president. I would also like to know how old are you as Samuel? Ukonami akangapi? Sometimes it's confidential but I have to tell you. I'm from 55 to 60 am there. Approximately there. Alright, alright. So a view by any chance you know interacted with the former president in the past? Ushia interactu naia ya kweni? No to president kebaki. Jomokinyata ni mewahi kumusarimiya. Namkono. Baba Moai ni mewahi kumusarimiya namkono. Uhuru tuikua tunachesa naia ni kiyomu dogo. Uko nyubani katodo. Tuikua tunachukuriva kwa tauni ya katodo tuikua vijana. Tuna perekwa ishaveri. Tuna eda tunachesa naia ya. Ali kua very smart boy. Tuna viatu. But he could freely mix with us. He has been a good man throughout. Tuikua tunachesa naia ya lafu. Pa le mishoetuna pewasoda ya fantana. Iri kua tamusana namkatu nusu. A very big treat. Wow and that is so surprising now. You've met all the presidents and the person that you actually look like. You haven't met until you know the pastor. I was not lucky to meet him. How did you feel when you got the news of his passing on? Well, that is good because when you receive a good person, that is okay. You feel good. It's like the spirit of Erija in Elisha. One spirit coming from one person to the other person. So I felt good because it's a good man who have done a lot of good things for our nation. I was very excited. Do you have a memory of Kibaki that you remember and you know when I remember the former president, this is what I remember of him. Kibaki has done a lot of things for this nation. If we have to write a book, suji tutajasafitabu gapi, kutokea mazomo, hospitali, mabarabara, kufugwa ekonomi and so many other things. Ia ni kamaedie ameweka foundation on which all the other president that will come will have to built on. So that is really something we can remember him for. Yes. Now Samuel, I'm sure that you know the people are watching and really cannot wait to see, to hear now you mimic the president because already I think they can see you already look like him but now they want to hear you mimic the president. Do you have some famous words of him that you can actually just enact? Yes. Igawa, mengi alikuwa ni mabaya kuchikeza. Abali zenyu. Mkosalama. Ntaka kusemasiku yaleo, ni lazima tufanya kazi kwa bidi maana kamaa tufanya kazi tuta kua buri. Ntaka mawere kazi ako ita kua niku kapa rena kuku nyu wa pomba pasweo ta kua buri. Ntaka mawere ni binanda maina ya mavia kuku na tunata kua tuku kushike na tuku kamaa te tuku eke dani maana huna maana kabisa huna maana. Guys, what do you think about what Samuel has done? I think he's doing a pretty good job. Now, Uncle Sam, nulize, did you just learn this, wakatiwa covid, how to imitate the former president or ulu kua najiwa? Sikuwa najiwa. Lakin wakatiwa tuwa miasa kusima moiki baki na tunajiwa mire na ungea vizuri maba ya kuchikeza ni kajari buki dogo, ni kaona ni naweza. Kwa maana, ni mutu ari kua nauna beri na kamaa ufanya kitua na kwa bia hapo hapo akuna kitua na kuficha kwa hivyo trikwa tu na mpeda hivo na najiwa kiramutu. Watoa mi pegasimu sikuia leo drwa uti sijuini ni niwa miona lakin hiwa ni sawa. Kwa hivyo ni mechukuru na hivyo mi fika hapa na tunatarajiwa mungu atatupatia president after president who will be like kebaki because kebaki wa not sure fish. Kwa merete maba ya fish on twenty thirty na hiwa hiwa na husu ya ya siyamenda na metu bachia hiyo na hiwa tu tafrahia na hiwa merete freedom katikainchi etu kwa ni ni kitu iginaga ni murikua muna takahini. Akuna.  So ni kwa vikiri wacha ni hede ni oni. Niage muze. So ni kwa eda palesi kwa na matraji kwa na maneno. Sasa kufika pare na oni kila skari ya na rudi nyuma kido kwa kisegenya na kwa rain. Ni kashidua. What is this? And then when I went inside to view the body of our 8 president, all the cameras were on me. And even after that everyone would want to take a photo with me. Until that time when the police said, no, we cannot trade this anymore. And that is the time I went out. Then on arriving home, kira mutu anaseyama yo tu me kwa na kwa TV. Naseyama ni kwa na fanya ni ni kwa TV. So the story started like that until midnight people were still calling. Okay. Which is okay. Adam happy about it. Very true. Na kitu nige sema, tuigemfano wa presidentu etukebake. Na wale wote wa takuja wa fanya ibo. Na kira mutu wa fanya kazi ya baya wa taku bukwana yo. Kwa mano e ukisha eda uta ku bukwana ni ni. Na kituigina muhimu. Ni uju e dunia hiu me kuja diyo fanya watu kazi. Siyo kuji fanya. Na kujita arisha. Yo ita kuwa bule manayo. Tetu ta iwa chapa dunia ni. Yoko na masuari nyi ngire yo. Hehehehe. Jus, laziba tukunu e. Laziba tukunu e Jus. Now atatuki malizia Samuel. Nne, une, these are time you know the president, the former president, the late president, Moiki Bakia had gone, you know, Kwa press conference akambia watu ni kona bibi moja. Seju kama uliwona yo, yo, yo news. Ehe, sasana bibi ake lucia li kuwa palia, mesi mama palia Anatangaza e only have one wife. Seju kama wewa ni kitu ambatio na eza fanya just to acknowledge your wife and how, what do you think about what the president did then? I think what president did, I was good. Because niye ni muna takaku jipede sasana kuwa watu kusama mi ni bibi afrani na furani. Maybe it was very right for the president. Thank you very much. I want to make this one very clear that I have got only one wife and she is called Ruse. And nobody else should come and say other things. Kwa maana mwenyata se maivo. Na wale wana se maivo. Seju yo manenu ametua wabi. So I want to introduce my wife as Ruse Kebake and no other wife. Coincidentally, my wife is also called Ruse. And the other thing is I also had an accident when doing a campaign for the consular seat and I was on wheelchair for six months. So he mamba ya kufanana iko kera mahali. Do you ever feel like and if you look at my children are very happy about me. Maybe you can have a look at that. That is me with my grad child. And whoever comes to me unauna ni yangariya mara ya piri una shidwa ni mi ini shidwa ya watu. Di unika kuja kujiwa kuna kitu nani kusawa sama mi mi. Does it cross your mind that the two of you are related somehow? No. If I look at my background I know my father very well. And by the way we look alike. If you look at the picture of my father I can show you it's right there. I look like my father and more like my mother.  If you look at them there is one who is still alive. If you take a picture of him he really looks like muaikebake. So watu fanaana. Natsia na sisi ni Bin Adam na tumetoka ku Adam na kebake na mi mi tumetoka kuakikuyu na mobi. Kwaivi yoku fanaana yo ni kawahida na ni mabaya mungu. Na kuna shidwa kuahiyo Na kuna unaka kama mstiania mingini tu dikuana fom 1 Na ni kuana muaigariya saana Wakati umetokia ni mi yonaka maniiaiaia. Tata yo ni kumanisha ni kuna miakangapi Samuel. Ni kumadogo? Na mi piya ni kumadogo? Oh ok. Nyukweli. My last question Samuel I would like to know if you had the chance to meet the former president muaikebake what would you have told him? If I was to meet him I would congratulate him for the job he has done for Kenyans and I would tell him we are all happy and I would personally tell him I'm happy to look like a person who is excellent in life and who is successful in his life and who have moved this country to greater heights that would be my words Ha kuna kitu iginana eza kumuambia maali ya keni ya ke na maali ya wa totoa ke na ya wa totoa wake na mi mi anguiko katondo na ni na tosheka na iyo Asanti. Na josai zunaju uko nama fans the people that are watching you are your fans now Please tell them something Jambo Imi na itwa angkosam ni na wa salimia sana na ni watakia mema na na takakuabi ya wakatuwa uchaguzi me wacha kupiga mu domo kise mahuyu na huyu kira muntua kuna raitiake na tutajiwa yure tu ta pigia kura kwa hiwi yuwek usue kaziaku kutoka zubuini siyasan pakajioni hapana panya kaziaku na munguata kubariki kwa iya jia utaeda na ni razima utafa uru lakiniu ki kapare chinia tista iyo iyo akuna kitu utapata kwa hiwi yo na watakia mema muena skujiema na muederekuji enjoi na mi mi nedereku pumuzika na mama hiu kwa gawa pekiya chai nini mo genia biya muna kuja sawa sawa That was Samoe Onjao Gishiru Very calm and collected just like our late former president Muai Kibaki mehi sol rest in peace was indeed a great man Now we are done talking to Samoe Please leave a comment down below on the comment section How do you think he did at the mimiki you know mimiki in the late president Let us know down on the comment Thank you so much guys for watching SPM Buzz My name is Miskithinji Until next time Keep it SPM Buzz Thank you See you later See you Miskithinji Miskithinji Miskithinji


This looks a little bit complex. Service members deployed to Camp Lemonnier recently participated in canine tactical combat care training, camp veterinary services, and combined joint task force, Horn of Africa's Civil Affairs Veterinary Cell, teamed up to instruct medical personnel on the basics of treating an injured military working dog. Combining classroom lecture with hands-on training, service members were given tools to improve their medical skills. Increasing awareness and also improving the skills that some of these medics know they have but how it translates to an animal, to a canine specifically, definitely improves readiness. During the training, service members were advised on how to properly approach a working dog, safety measures to take when handling them, and steps to triage and implement life-saving measures when necessary. Hands-on training gave participants an opportunity to become familiar with basic canine anatomy while performing a general exam on a live working dog. Realistic training aids provided opportunities for participants such as practicing bandaging wounds, splinting fractures, CPR steps, and inserting intravenous catheters. Military working dogs are key to a dynamic team, playing a vital role in support of the warfighter. Reporting from Camp Lemonnier in Djibouti, I'm Air Force Master Sergeant Sarah Madison.


And, and this has been hard because I grew up with, in a household with a scarcity mentality instead of an abundance mentality. So that's another one of the things that I'm trying to rewire in my life is being able to say, yeah, there's plenty for everybody that I don't need to be a squirrel, you know, hogging all of my nuts. It's okay to share them. And I just said share my nuts on a podcast. That is, that is not what I meant by that. So I'm trying to rewire from going from a scarcity mentality to an abundant mentality. And that's not that's not easy either. Yeah, it's staying in your lane. Yes, is what I'm hearing. The comparison is the thief of joy. They say that for a reason. I think with us too, we're on social media, we're constantly seeing people that have more followers that have bigger gas that are doing bigger things. And it's the, Oh, well, they're already doing it. So why would I even try? And that's the opposite. So yes, you working on an abundance mindset. What are those practices, those tools that you have to help you switch your script? Well, it all comes back to awareness and it comes back to patience. So I have to be aware of when I'm living through a scarcity lens. And then just say, all right, you don't have to view it this way. You know, it's it's life does not need to be zero sum. You know, just because they chose you to be the keynote speaker instead of me doesn't make me less than unless I choose to make me feel less than. And that's the other part of me in the speaking industry in general. I mean, I think in Vegas alone, they're like 6000 speaking events in any given year.  So while I'm over here in my feelings crying and worried about one event I didn't get. There are literally tens of thousands of other events that I can get.  And you don't get one, then you're like, okay, well, now I guess I'm in a little bit of trouble. That's not the case. You know, we talked earlier also, I know I keep referencing that we had a wonderful conversation in the car at 515 this morning when these ladies picked me up. But like looking, you know, at the dating world and same thing. So you meet someone that checks all the boxes and you think would be an amazing partner. And then for whatever reason they're not. I have difficulty thinking, well, that's okay, because there's going to be somebody else out there that can still meet like there's no shortage of people that I believe I could be a good fit for. And I don't mean to go down a tangent, whether someone believes in soulmates or not, that's fine. I don't believe that there's one, I believe there's plenty of people that could be a wonderful partner for me moving forward. But that's where that really is where it triggers for me. So I'm in a relationship, things go really well, and then they don't go well. And now I'm thinking, Oh my God, did I should I be sacrificing who I am and what's important to me to make this work, because there might not be another person out there that's good enough. That's that slippery. So I'm trying to rewire myself. Absolutely. So I'm trying to rewire myself and and and not to not to dehumanize anyone.  And that is not to compare young ladies to buses, but just simply say that if it doesn't work, that's okay. But then but then this is where all of these things start to trigger, because I still have the temptation to when you meet someone, you want to put your best foot forward, you want them to be impressed by you.   So I've learned to be comfortable just being me right from the beginning. And that's the ultimate qualifier. And if me being me is not the right fit for you, then that's okay. And if you decide that it's the not right fit for you, it still might sting. I still might like you and kind of want this to work out. And then when it doesn't, it's a gut punch. But then I move to the next play. I give myself 24 hours to binge watch Netflix and think, well, is me, but then just wake up the next day and say, all right, well, let's give this another go. So the dating world is the ultimate EQ laboratory for me to work on all of these things. So it's, it's been good practice to say, but it's good practice for anything for business being aligned with what you want and what your business stands for as you build it. Like if people say no to us, whatever, we're staying true to what aligns with us, or as you're making a friend and you're trying to impress a random friend with these cool stories, just like be yourself because eventually they're going to see who you really are. You can't sustain that game. Honestly, I feel like this, that could apply to anything. And yeah, dating's got to be so tricky. But I think a lot of people feel that way. Like, you know, there's the timeline of, okay, but I want, I don't want to wait five more years. You know, like, should I just settle because they're like kind of okay, but then you're sacrificing who you are, which is going to lead to resentment. And I feel like that can literally be applied to any part of your life and just how important being authentic is and being alignment is. And that's a huge part of your book of sustaining your game is like, if you're feeling burned out, you're probably not aligned with what's important to you. So can you kind of speak to how you can get realigned or like even start with alignment so that you don't burn out? You just said you teed it up perfectly. So burnout is misalignment between the sacrifices you're making and the hours you're putting in and the meaning you find in the work that you're doing or in the relationship that you're having. It's not just for work. So if you don't find meaning or purpose in what you do, you're at risk for burnout. If you are not curious by or fascinated by what you're doing, you're at risk for burnout. If what you're doing is not in alignment with your core values and your deepest held beliefs, you're at risk for burnout. If you don't believe the work you're doing is contributing to something bigger than yourself and you're making a difference, you're at risk for burnout. So it's not just from long hours that that is a contributing factor, but we all know someone.  I mean, you've got full-time jobs and you're working on the side to build this business. You're putting in a lot of time, but you find so much meaning in what you're doing that you guys are so vivacious and so alive and so into this, as soon as you would stop finding meaning at that, that's when you're at risk. So it's not just the long hours because you can balance long hours if you take care of yourself physically, mentally and emotionally. I mean, so you're capable of working 60 hours a week and not getting burnt out if you love the work that you're doing, but that's the key. And not a lot of people love the work that they're doing for the long periods of time in the long haul. So that's when you have to look to make some tweaks. If we just use a generic example, you're working in a typical corporate structure and you've been there for 15 years and you're starting to feel some burnout. Ask yourself, first of all, what has changed between now and when I started? Maybe they moved you to a different department. Maybe you used to have a work BFF, but they went to a different job. Maybe your role has changed and what you're being asked to do. Maybe you have a new boss. Like a lot of these things could have changed and that could have thrown things out of alignment. So you can look to tweak some of those internal things. You guys will see today during the keynote, that's one of the things I talk about is finding meaning in your work and deeply connecting to the why you do what you do. Why would you work 60 hours? If the answer is for a paycheck, that usually does not require the meaning to sustain that. If it's because I believe what our company does is making a huge difference in people's lives and I actually get to see the lives that we have a chance to impact, then you're at less risk of burnout. So on the shorter end of the spectrum or the smaller end of the spectrum, you can make some tweaks internally. Ask your boss if you can switch to a different department, take on a different role, move your cubicle somewhere else. Like you can try those things. If that doesn't work, then you may need a full reinvention. You may need to leave the basketball space and become a keynote speaker. That was why I left. I started to feel burnout on being a basketball performance coach. I loved the kids I was working with. I loved the coaches I was serving. I was no longer fascinated by sets and reps and designing programs. You know, I no longer found meaning in having kids run faster and jump higher in dunk basketballs. That filled my cup for 15 years and I loved every second of it. But then it stopped having that meaning and I was finding more meaning in leadership, in culture, in communication and the things that I speak about now. So that was why I made the shift. And if in 10 years from now, this is no longer providing meeting, then I'll just shift to do something else. I believe as long as I'm developing skills with high utility, then I can do anything that I want. Leadership has high utility. Communication has high utility. Emotional intelligence has high utility. And those are all areas that I still need to continue to up level. But no matter what, I'll be able to find a home for those skillsets because we need them in every area of our life. I love two things from what you just said that I think are so important at home is that you are consistently aligning with where you're at. And that can change over time. And you give yourself permission to change your mind on what you want to do.  Like for me, I, I tried it and it, it was burning me out because I wasn't getting the value anymore. It was nice when she was a baby, but it should became a toddler. I was like, I'm not the Pinterest mom. I, I don't not getting anything out of this. And I don't think she is either. You know, I think somebody else would be more equipped to do this. And so I think allowing yourself to know that you evolve and then actually tapping into what you want. And realigning like when do you take that time to evaluate where you're at? And what you just said takes courage too. We need to, we need to be able to celebrate the things that we do well. You know, a lot of us have that inner critic that's always telling us the things we're doing wrong. But I mean, it takes courage to make some of these big changes. It takes courage to leave a relationship. It takes courage to leave a job. It takes courage to switch vocations. You know, I mean, these things take courage. And sometimes I don't think we celebrate that enough. We tend to ostracize that. But I think that's, yeah, that's huge. And I've always believed also using another old adage that, you know, you can't pour anything out of an empty cup. So our first rule or our first non-negotiable needs to make sure our cup is always filled. That's how you become the best parent, the best spouse, the best fill in the blank is making sure your cup is filled. So one of the first things I had to do, which is interesting as I told you all for the first 40 years, I was a rather selfish person in general. But I've had to realize that filling my cup first is not an act of selfishness. It's an act of selflessness. Because the fuller my cup is, the more I can share with others and kind of go back to that candle analogy. If my flame goes out, I can't light any other candles. So job number one is to keep my flame lit. And I do that in a variety of different ways. And making sure you are aligned with what it is that you're doing is one of those primary ways and give yourself that grace. Now, this is also not to be confused with a minor slump, like with, you know, I mean, sometimes you're going to go through a few days where work is just kind of a pain in the backside and you're not loving your job. That I'm not saying everything needs to be this massive red flag. But if you're starting to know weeks on end, I'm not looking forward to Monday morning. I'm not looking forward to going into the office. I don't like the then you may want to make a switch and keep those options open. I think what prevents people from doing a lot of these things is we worry about what everyone else is going to say. Generally speaking, I have had tremendously supportive people in my life. I have not had a lot of people tell me you can't do that or you shouldn't do that. And I know a lot of people have an uphill battle because they have those naysayers in their life. So when I said I'm leaving basketball to be a keynote speaker, I had a lot of people ask why, but I didn't have anyone go, oh my God, you're insane. Why are you doing that? You'll never succeed at that. I mean, I had good people in my life, but I certainly had a lot of people say why, like you spent 15 years working towards the top of your like brand recognition and some of these opportunities. Why would you give that up? And the answer was because it's not filling my bucket anymore. That's why and I can't make it. So I enjoyed it while I did it. And I loved every minute of it, but it's just not, it's not doing it for me anymore. And I believe I owe that to myself, but I also owe that to the people I was working with. I don't think teaching and coaching and mentoring and the things that we all do and the playgrounds we play on are things that you can just mail in. Like you got to be all in. I don't think anything would be more disheartening than a half-assed teacher.  That is the future of our world and you're mailing it in every day. That's unacceptable. Now it's completely acceptable that you don't love teaching. There's nothing wrong with that, but you need to get out of the game because now you're having, you're detracting from other people. And that's one of the reasons that I love teachers so much is most teachers, they're in it to win it. They're not doing it for the pay. They're certainly not doing it for any type of accolades or recognition. They're doing it because they believe in pouring into young people. But if you're a teacher listening to this and the moment you no longer want to pour into young people, please find something else to do that can utilize your greatness and don't feel guilty about it. There's nothing wrong with that. Nothing says that when you decide to be a teacher, you have to do it for 30 years. If after three, you want to do something else by all means, knock yourself out. You should. Yeah.  And that kind of leads you to remember the next question, which is what you talk about with the performance gap of the knowing it and actually doing it and talk about the fundamentals or anything in life. I'm curious why you believe there's such a big gap between knowing it and actually doing it because most of the things that we know are hard to do. I mean, if it was easy, everyone else would be doing it and we know that now we chose to find some enjoyment in what we did this morning. There's nothing easy about getting up at 4.30 in the morning and doing the workout that you guys drug me through for 30 minutes. That is challenging to do. It would be much easier to sleep in instead of doing that. We all recognize that. But because we find meaning in it and because it gets our endorphins going and it makes us feel good, like we found weight, but it's not, it's not easy to do. So part of it, I think is just the acknowledgement. But that is where people get tricked up and where people get frustrated. It's rarely from lack of knowing. It's from lack of doing. Even today, later today at the keynote, we could do this survey. We don't have time, but I could say, all right, everybody take out pen and paper and write down the 10 healthiest foods that you know of and everyone would write them down. And I bet you would see a lot of the same foods on the lot of the same piece of paper. And then I could say, okay, how many hours of sleep are you supposed to get every night? Write that number down. Everyone would write a number down immediately. Most of them would write down the same number and then say, how many of you, you know, can you just etch out what you should do on a weekly basis as far as moving your body, as far as physical fitness? You don't, you don't have to design a workout and submit it to men's or women's health. But generally speaking, just what should you do? And every single person would be able to write down what they're supposed to do. And then I can simply ask them, okay, are those the foods you eat consistently? Is that the amount of sleep you got last night? And are these the type of workouts you do four to five days a week? And for the people that are being honest, you're going to see a lot of heads saying no, but it's not from lack of knowledge. They know exactly what to do. They just wrote it down. They're just not doing it. So to me, that's, that's pivotal to my work is, is finding the thorn in people's pause and figuring out how to take that out so that now they start doing the things they know they should do. But some of it starts with the awareness. Some of it starts with, you know, lack of don't self-love and beat yourself up. Don't feel guilty. Don't say, I haven't worked out for the last 10 years, say, but I can work out this morning. You can't change the last 10 years. You'll never get that back. And the more you think about that, then the more the lower you feel. So yeah, you can't do anything about those 10 years, but you can work out this morning and just take it one, one day at a time. Yeah, Brooke and I have a coach and she always has a say up until now, like maybe, okay, it's irrelevant that you were bad at that before up until now. And moving forward, I am a person. I do identify as somebody that is going to exercise five days a week. And I do think there's something about why people have such tough times mentally, knowing that they, they have the knowledge and they're not doing it.  You know, that performance gap is even worse because you are thinking of the past or you are thinking about what you're bad at. Yes. But if you, if you look at life through the lens of I'm broken, I need fixing and I have to do these things in order to be whole, then you're in trouble. If you can give yourself some grace and I don't like just being able to say, I'm good as is, whether I go for a run today or not, does not determine whether or not I'm a good human being. I'm going to prefer to go for a run because it makes me feel better and it's moving me closer to my goals. But let's, let's not start in the hole of thinking we have to do all of these things because then when we don't do them, that's when the guilt and the shame piles on and the self criticism. So, you know, we're all doing, we're all doing the best we can with what we got. And that's another thing that's really changed the way that, that I look at the world is I try and be, to help me improve my patience and my compassion is, and this can be naive at times, I make the assumption that every human being I meet is doing the best they can with the tools they have and the awareness they have. Now, clearly there's a lot of people that aren't aware and there's a lot of people that don't have very many tools. We got a few people walking around, all they got's a hammer. That's all they have. But if all you have is a hammer, then everything looks like a nail. Like, can you be, how can you get frustrated at someone? They're doing the best that they can. And that's where I've learned to give myself forgiveness because even the previous, the selfish and I'm painting myself like I was a bad guy. I was never a bad guy. I've always been a high character guy with a good heart. But yeah, I had selfish tendencies built out of insecurity. I was impatient. I was easily frustrated, like all of those things. But I forgiven that guy because even me then was doing the best I could with what I had. I just didn't have very many tools then. So now I'm trying to add tools to my toolbox than most importantly, be able to use them. But I'm a huge believer in starting slow and being very strategic. So if anyone listening to this, if you feel like your entire life is a mess and you need to change everything, that is an incredibly overwhelming feeling. Like you feel like you're going to drown. So don't just just pick one thing. Just say, Hey, just starting tomorrow morning, I'm going to go for a walk every morning. That's it. You don't need to change anything else. You don't need to buy a Peloton bike. You don't need to throw at everything from the pantry. You don't need to hire six trainers and four therapists. Just go for a walk and start to make that stick. And then once you've got that habit, in addition to walking, listen to a wonderful podcast like this and add that to the list. And then after you've become, that's become a habit. When you get back from your walk and listening to your podcast, make a yummy smoothie, a shout out to chef Justin for the amazing smoothie this morning and add that to the list. And then maybe after your smoothie, you can take a few minutes to read a few pages of a book that makes you feel good. And you can start to stack these things on top of each other and slowly dig yourself out of this perceived hold.  Like it's, it's okay. So that we just can't start from a place of being a place of being broken. That was so beautiful. I'm so glad you said that because that's what gets Pete. That's what holds people back through self-limiting beliefs and getting overwhelmed by all that you could be doing. It's very overwhelming. Well, if we're just going to keep piling on things that I used to do that I need to do better, the self-limiting beliefs is a major one because I, I used to aim low to increase the chance I would reach goals. I'm, what I'm trying to expand in my life right now is to dream much bigger and because I've put so many self-limiting beliefs on what I'm capable of because I used to look at the world through that paradigm we've discussed earlier that falling short of a goal means you're a failure and I don't want to fail or I don't want to be viewed as a failure, failure, you know. So if I aim lower than I have a higher percentage chance that I'll hit, but you also live a much more tepid mediocre life. So now I'm trying to, to stretch and expand and aim much higher and just realize that I'm not going to hit all of those goals. In fact, most of them I don't, but I still make progress and I still learn something and then I can chase that goal again if I want. So I'm, I'm trying to be much more open to, to stretching and, but, but when you start lining all these things up, like rewiring, going from a scarcity mindset to an abundant mindset is really hard. I still struggle with it. Going from, you know, aiming really low to some grandiose goals and beliefs is really, really hard. 40 years of being impatient and easily frustrated to now just whistle while the slow cashier at target is ringing people up is not easy. So the number one takeaway from this episode, all of this stuff is basic. None of this stuff is easy. So give yourself some patience, give yourself some grace and just know that we're all struggling with this. That's the part, I think what makes everything worse in addition to shame and guilt is feeling like you're alone. I'm the only one that doesn't have my life together. No, I can promise you everyone listening to this right now, including the three of us doesn't have our life together in some area at some time, but some people are making progress and being okay with that. I'm okay with knowing that I don't have it all figured out. You know, I don't, you know, I'm getting better at being able to lean into uncertainty and knowing I don't have the answers. I don't know the way this game is going to play out. I'm just going to do the best I can with what I have where I am. And coupled with that, I'm not going to blame complain or make excuses. I'm going to hold myself fully accountable for everything that goes on in my life. And even that statement, I recognize coming from a middle-aged straight white male, the definition of privilege can even be a turnoff because I know there are people out there that have a much, much, much harder road than I've ever had. I mean, I've been incredibly fortunate to have a pretty awesome life. And even with someone else setting the table for an awesome life, I'm still tripped up and struggling and finding problems with all this. So I can only imagine people that have had much bigger adversities to deal with. So I don't mean to make light of those. And I certainly don't ever want to sound like I lack compassion. I know people are fighting much bigger fights than I am, but you still choose on, you know, you still get the choice on how you view approaching those things and what you plan to do about them. And that's all we can do. And then we can just try to have a sense of community, like you guys are creating and kind of band together and be able to say, yeah, I'm having a tough day today. Yeah, that keynote did not go as well as I'd like. Yeah, I asked this girl out and she ghosted me after a week. Who puts that on social? I got ghosted a couple weeks ago. I'm telling you guys right now, but I didn't lead with that on Instagram. That was a punch in the gut. But it was practice and it hurt for 24 hours. And then I learned some lessons. I sat in my feelings. They were really uncomfortable. I tried not to tell the story of why I thought that it happened because I have no idea why it happened. So it was a good practice. It was a good rep. And next time if I get ghosted, I'll be a little bit better at handling it. I even went into my therapist and explained that to her about being ghosted. I said, this is the first time I've been ghosted. It's a punch in the gut.  You should be very thankful. That is amazing that you've only dealt with this once. So that just reminded me going back to perspective. Her perspective was how fortunate I am that I've only been ghosted once. My perspective was, oh my God, I can't believe I've been ghosted. What did I do? Why am I not good enough? Why am I unworthy? How come she doesn't like me? I mean, and how how petulant are those thoughts? But I had them, but I only had them for a couple hours. And then I pulled my big boy pants up and said, okay. Yeah. Exactly. Next. There's another bus coming around the corner. I missed this bus. This bus didn't come by, but I'm going to find another bus. Yeah. So it's all good practice. And time does heal these things.  Yeah. I think with support to its perspective, being around people, not only is it awesome to not feel alone and to feel like you have that sense of community, but it also gives you perspective of, okay, I am doing okay. I am all right. Yeah.


Well, I called you up to get New Year's gift off of you, and damn, he didn't beat me to it.  I said, do you remember at night, he and Herman Brown came in here? I don't care just yet. No, they got it, and called it to, got a little, got a little blast like on it. But this is where Dick Russell sat the night that A.W. and Herman Brown brought him in, football game. Well, I'll tell you that football game, he'll play football today. Huh? That team, he'll play football today. Is that all right? You remember that night? Not much, by the way. I don't remember much. Well, we just wanted to call you up and tell you that you were very much beloved, man. Well, you make me feel much good, Mr. Brothers. I hope you have a wonderful new year, and wait a minute, A.W. won't speak by half of me and Wesley, and a few of them here, and say hi to you after this girl talks to you. Senator? Honey, how are you? Oh, I'm fine. I'm seeing you with great approval in the views of you and on the paper. There's nobody's approval that I want more than yours. Oh, Lord, what a apology. No one to let a Johnson press. And listen, I just want to say that I hope there were a lot of Russell gathered around the Christmas dinner table and the new year dinner table. We didn't have a party two years, trust me, so they thought I couldn't get in, but we had big time. Well, all my love to you... All my love to the daughters of yours is all my love, and it's Christmas. Yeah, it was... They were together with us at Christmas, and we had all of Lyndon's family at Christmas, and now we're having my family about 15 tailors. But my two children went with their dates to watch the big ball game. That was the terrific ball game that Texas could beat any college team in the world today. I never saw a team play like that, did I? And then they'll be back tomorrow. And I hope that Linderberg's going to come back up there.  She needs to be a better happy daddy. She's a politician.  And here's Judge Morrison. Ah, Senator? Yes, how are you? All right, happy new year to you. Happy new year to you. That's been many of them. I didn't get along just fine. Linderberg reminded me that time, I saw they had disgraced myself over that and you had to take care of me. Oh, hey, he shouldn't have mentioned that. He's just kidding. How'd you like old Texas today? Long ten years I could have whipped in the college football team. It wasn't similar to that. They were working today, weren't they? Maybe they had a good team, but they just looked like high school out there trying to play Texas. Well, you had a nice holidays? We had a good time. Well, that's so fine. You don't get on the day out there. Yeah, we did. We miss you. Well, I wish I could have been there. I hope the President didn't miss him many times. He did that time and treated that shorty group. No, he made an awful good shot yesterday. He shot a deer that I think about 350 yards right through the neck. Well, that's one. He really did. You know, I'm not lying about that one. I'm not lying about that one.