The following is a presentation of TFNN. Time to talk about your health. Living a primal lifestyle. You know, we have Tom from Tampa on the phone. Hey, Tom, good morning. It's bright and early now, huh? Hey, thanks. How are you guys doing? Good. Good. Hey, your news player's outstanding, man. I'm telling you, man, he's outstanding. It shows the vulnerable edge. I love that stuff. I'd never be without it. I mean, I've been on it now. I'm 34 months, man. I mean, it's just, I can't get over how good I feel. Primal edges, you know, people are raving about it. People who are trying it, they know because you can feel it. We'd not be without it. Call now. Toll free at 1-877-927-6648. Now, your hosts, Niko Dahan and Paige Clark. Good morning. I'm Paige Clark, and welcome to Living a Primal Lifestyle, where we explore a return to a more balanced, natural and wild world. To recover our natural health and regain our rights and freedoms. And I'm Niko Dahan. And it is kind of a stormy day on the way in here this morning. 80 degrees, though. 80 degrees. Kind of balmy, kind of our typical August weather. Hope you're having nice weather where you are. And make sure and pick up our Health Signals newsletter. The Health Signals newsletter comes out twice a month. Yeah, on the 15th and the first. Delivered into your inbox. Yeah, and we've got a new one coming out next week or actually later this week. And we'll put a lot of links that support the show and things we talk about, things we don't quite get to. Yeah, sometimes that's true, too. And this week we start off with the antibiotics, the side effects, and alternatives that you can use. Real good article. And please pick up the primal edge, our one-shot wonder, over 310 organic cell ready liquid ingredients to make it easier to take. Tastes pretty good, too. Kind of earthy taste. And it helps get the good stuff in. And the bad stuff out. And you can use your tiger dollars.  Yeah, we just had a big sale on those and we have those a couple times a year. So that's a good opportunity to pick up the tiger dollars and then use them for the stuff that makes you healthy and keeps you going. That's right. So join the conversation if you're up and at it,<PHONE_NUMBER>. All right. And I kind of wanted to talk a little bit about the words ancient and primal. That's what our show is about. And this headline came across from New Atlas that we had actually discovered, an ancient body clock was discovered that helps to keep all living things on time. And we're big proponents. You and I both know the importance of getting our circadian rhythm in sync. Yeah. Well, we know that nature has all these different cycles. We go through the summer, winter, spring, fall, things like that. We have a daily? We have a daily one, monthly cycles, well-known, especially with women. And here they discovered a little timeline and this is up on the illustrator. It shows when things are waking up and going to sleep and when things are active, how, where is the chance that your highest blood pressure is and maybe that's not the time to take your blood pressure, highest body temperature, your fastest reaction time. Surprised it was that late for me. I'm doing jiu-jitsu at noon usually. It'd be nice to know I was faster then. But this is the way the body works naturally. Yeah, you postpone your jiu-jitsu a couple hours and you'll be a faster guy on the mat. Well, you know, when I was younger, it was easier to do it at night. As I'm getting older, then the body just doesn't stop moving. So by the time I go to bed at 9 o'clock, I'm still moving around and that's not good. See, that's really good. Do you notice that the timeline for melatonin secretion is 2100, which that is, is that 9 o'clock? No. 2100, yeah, 7 o'clock. 7 o'clock. So you already start to secrete the sleep hormone at 7 o'clock and many of us are staying up and looking at these blue screens and this is not good for our sleep. Well, because it actually interrupts that cycle. That's correct. And it's interesting that the melatonin secretion stops at 7 30 a.m. Your lowest body temperature is at 4 30 a.m. Your bowel movement likely is around 8 30. There's the highest testosterone secretion at 9 a.m. And you're more alert at 10 a.m. than you are at any other time of the day. So really, he might want to take a look at this and get an idea of what you're really in sync. But let's learn a little bit more about it. There's a group of Cambridge scientists that have successfully identified the mechanism that drives our internal 24-hour clock, worst circadian rhythm. It occurs not only in human cells, but it has been found in other life forms such as algae. Everything has a sink. Everything, yeah. Everything's on a time clock, so to speak. And it's been dated back for millions of years. And what this research is promising is a better understanding of the problems that are associated with shift work and jet lag in changing time zones. This mechanism has also been proven to be responsible for sleep patterns, seasonal shifts, and even the migration of butterflies. Yeah, and this is important because we know people that do shift work are less healthy than people who are following the circadian rhythms of natural work. Well, that's really Jack Cruise's whole premise. Get in sync with nature, see a sunrise, see a sunset, and go to bed and don't have these bright lights at the hours that you're not supposed to, and you will be healthier. Your body knows what to do. Listen to this. The study from the Institute of Metabolic Science at the University of Cambridge discovered that it's actually the red blood cells that contain this 24-hour rhythm. And in the past, scientists assumed this rhythm came from DNA and gene activity. But unlike most cells, red blood cells do not contain any DNA. No, they're in the white blood cells. During the study, the Cambridge Science has incubated healthy red blood cells in the dark at body temperature for several days, sampling them in regular intervals. And that's when they discovered that these proteins that are produced in the blood are underwent like a 24-hour cycle. Virtually all organisms contain these proteins. That's right. It's called a paradoxidens, peroxyredens. That's a tough one. I didn't want to attempt that one. I forgot my wax and my gaps this morning. So, guys, many of you may know I'm doing this orthodontical work to reopen the extraction spaces. And the wax, now it's a little hard to talk. But we'll get through it as part of the process. You're doing fine. Anyways, what are the implications of this research that they found out? According to one of the lead authors of the study, we already know that disrupted clocks, for example, caused by the shiftwork and jet lag, are associated with metabolic disorders, such as diabetes, mental health problems, and even cancer. What do we see an epidemic of in this country? Those exact metabolic disorders. And by furthering our knowledge of how the 24-hour clock in cells work, we hope that the link to these disorders and others are going to be made more clear. And this went long-term lead to new therapies we couldn't even have thought about a couple years ago. Hey, I wonder if someone has a metabolic disorder, a blood transfusion of someone who's got a good circadian rhythm? Well, it might help a little bit. But of course, we've always exchanged blood with other, even organisms and other people. And those things do help. This research shows that body clocks are ancient mechanisms that have stayed with us through billions of years of evolution. And most things that are living on Earth have these things. And it just makes a lot of sense that our body would have a type of clock that keeps us healthy and keeps us on track. Yes, right. Because we want to be awake at the right time and not at the wrong time. And it just makes a lot of sense. And a lot of times you can feel these things happening. You can feel, like at 4.30 in the morning, if I wake up, I can feel that I'm a little bit cooler and that blanket that I tossed off at midnight, I want it back on just for that last hour. And I've noticed these things happening in the last maybe decade or so since we've changed our diet and changed our way of thinking. And it's just an interesting process to go through. I thought back about 12 years ago when we really changed our diet, even though I think for the last 20 years, we're very conscious of eating healthy food and not GMOs. But getting more towards the fats and then that whole progression is so interesting to me. In fact, I've got to talk next year and I'm going to be talking about this whole progression of how my wife and I went through this and what we found. So it's an interesting thing to me and this just substantiates what we've been saying all along. That's exactly right. Take a short break. Stay with us. That's why we need Primal Edge Daily Nutrition. It includes a special blend of ionic, soil-based vitamins, minerals, fatty and amino acids in an easy to use liquid form. Primal Edge is powered by highly concentrated folic and humic acids. Nature's preferred delivery system. They've been called miracle molecules because, like sunlight, air and water, life cannot exist without them. That's right, Paige. They ensure we receive all the nutrition we need to be healthy and thrive. We take it every morning. Primal Edge. Formulated and approved by Niko and Paige of Living a Primal Lifestyle. Buy it today for just $89. Click on the Primal Edge banner on the front page of TFNN.com. 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Oh, toll-free at 1-877-927-6648. Internationally at<PHONE_NUMBER>. And welcome back to the show. So, in the chat room, I have Ruby here talking about Smithfield Foods, a line of soy-based meat products. We talked about that last couple of shows ago, yeah. And that Serbia has reported more suspect outbreaks in African swine fever. There's all kinds of swine flu going around, that's for sure. And, of course, we know that they're trying to replace the meat. Yeah, these meat alternatives, for whatever reasons people are not wanting to eat real meat, we kind of wanted to talk a little bit about real meat today. Yeah, exactly. Well, the propaganda is out there, and you can understand from the point of view of not health, but the manufacturing of food, that it's much easier to put a box or some fake stuff that lasts the heck of a lot longer because you don't lose the profit, because you don't have to throw it out after a while because it goes bad. So that's the reason why food companies are doing this.  We know that ancient human beings don't eat mostly meat. Yeah, they didn't have these meat alternatives to choose from. Well, they didn't even have the vegetable to choose from. I really hate them. I get so mad that people think vegetables, and if you look at the vegetables these days, they all come from one plant, which is a mustard type of plant. The kale and the broccoli and all these things that we're eating, and then, of course, we have the new world foods like beans and things that have a lot of protein, unfortunately not accessible to us unless you do many, many things to them. We're going to the most nutrition that we can find in meat and why we're supposed to be eating these stuff. Yeah, folks, when we say nutrient-dense foods, we're really not talking about vegetables or fruits. And maybe not even about muscle meat as much. Exactly, maybe not the muscle meat, as we've shared with you. Seven nutrient-packed animal organs. This is where the nutrient density is in the animal. And unfortunately, I think many of us can admit that we really didn't grow up eating these foods. I think it was something that our grandmothers, especially, it was part of their diet and day, and they viewed it, and I think it became a lost art. I think some people, you had some. From my standpoint of myself, if I go back two generations, we're eating food that is nothing like the food we're eating today. I think this applies to the most people that are in their 50s, 60s, and 70s.  Yeah, when you really think about it, I'll tell you when you realize this. I've been going to an old bookstore, and I look for old cookbooks. And old cookbooks. The ingredients are not all these packages, and what they use. Betty Crocker's book, yes. That's when baking started. The generation of baking started with Betty Crocker. Exactly. Let's talk about these nutrient-dense animal foods. Like I said, we've heard of superfoods, and a lot of people believe that nuts and tropical fruits are super-dense in nutrition. And they are. They're filled with a lot of light, actually. Really, nutrition is a substitute for the word light. That's what we get when we get in our food. But, you know, there's really power-packed nutrition in the ancient, the enjoyed animal foods. And let's talk a little bit about this. And if you go and look at Nature and look at some of these shows that are filming animals feeding in the wild, then you're going to see that the animals go straight for the organs in the brain and everything else. They even eat some of the stomach contents of animals that have eaten meat, but they will throw out the stuff. And the vultures come for that. Exactly. It's very interesting that the animals thinkively know that these kidneys are very, very important, and they go for that first, and then if there's any muscle meat left, maybe they scavenge the rest of that. Yeah, because the organs offer some of the densest sources of nutrients, like our B vitamins, iron, phosphorus, copper, magnesium, and the rich with the most important fat-soluble vitamins, vitamins A, D, E, and K. So, you're really on the cutting edge of nutrition if you actually deploy organ meats into your meals, or stealthily you need to do that. Because I think many of us don't have that acquired taste. We didn't grow up having it. Well, it's the icky factor. Yeah, I think so, yeah. But, prepared right, they actually are very delicious and very healthy for you. Some ideas that you know, There are some recipes here, so let's go through those. Yeah, there's the big hearts. And I don't need a lot of hearts, and they're a little snappy, I would say. Mm-hmm. Kind of cool feeling in your mouth, too. You have to really get used to these types of... I mean, when you put liver in the mouth, there's that dry feeling. When the hearts, I feel the snappy, and the gizzards snap a lot, too. And they're a little bit chewy. That's another thing. It used to be that turkeys had all the organs inside the neck when you buy a turkey for Thanksgiving. You don't even find the neck anymore. So, since it's a muscle meat heart, it shares many similarities with steaks, roast, ground beef, and it's less expensive. And most of these cuts are less expensive because they're not in demand. So, this is a good way to supplement your income in a way. Instead of buying that ribeye that costs you $40, you can buy some hearts and some gizzards and some liver on the cheap and probably half the price and probably twice as much. You know, all of us are buying these products like collagen and CoQ10 and the B vitamins and the iron and the copper and the zinc and the magnesium, but these are naturally found in these kind of foods. Maybe, when we changed our diet and we no longer ate these foods, it's when really a lot of these deficiencies show up. Well, that's just one of the reasons that you and I really wanted to come up with a one-shot wonder, something that you take every day because the missing ingredients are right in these organ meats and they're right in the primal edge. Well, because those animals were eating food that grew in a soil that was replete with the... Yeah, so from the salt we use from the way we cook things and from the way we take our supplements, like the primal edge the reason we're taking it because this is missing from our diet, we know this and even I don't eat enough liver. I think if you wanted to be eating this stuff, you probably do it two or three times a week and I'm lucky if I do it two or three times a month. And I'm conscious of this. Right. That's very true. You are. You are very conscious of it. So the supplements are very important these days so the primal edge is something that really if you're not eating any of this stuff you need to pick up the primal edge folks and if you are, I would recommend doing it anyway because it's probably the sources are not as good as they were 20,000 years ago. Naturally, we need that extra boost. And that's a great point. So a lot of people feel more energy when they eat organ meats and many times they'll eat them well any animal food that's raw has that energy. You know, like I love steak tartare. And it's not an organ meat but it could be. Yeah, it could be. You know, if it's made that way. But let's show them a picture of liver. You know, I don't know if you like liver. You'd be sure not to overcook liver too much. It's very dense. It's very dense so you have to cook it a little bit more. Chicken livers go pretty fast. So if you're doing those just be careful. You want to be able to see the shine a little bit in the center. I think not so much the way it's prepared here. Although the good compliment here is the onions. They add a lot of flavor as well as the parsley. Right, exactly. And then the olive is a little sour so that helps digestion. Yeah, for sure. So when you pair things, think about the reason our ancestors paired things with food and mostly they were herbs because we know that the bad part of the plants, all the defenses are in the stem, the stock because that's the last thing that gets torn up. When a cow eats the top of the thing, it's because the toxins aren't there yet. Those are sprouts. We know the sprouts don't have the toxins. Very good point. We'll be right back after this break. Pick up some primal lids while you're at it. Yeah. The personal training studio that Niko is the owner and coordinator of performance training. Since 1998, Niko has trained individuals and groups to improve their health both mentally and physically. 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For more information just click the Think or Swim banner on the front page of TFNN.com So Niko and I have been talking about nutrient dense foods and to many of your surprise the most nutrient dense foods that we can have are actually organ meats from animals that are eating in their natural food and living their natural life. And they're not in jail. Right, exactly. Not, you know, confined animals in the industrial food system. We talked about heart. We talked about liver and brains. Some people eat brains. And also the kidneys and sweetbreads, which are neither sweet nor bread, they're actually the pancreas of animals. But this is, we're going to kind of segue into why we're talking about this. Traditional people ate the animal-based foods, but today in natural health we know that using these substances can be part of a healing regime for people. For example, if you have liver issues glanular therapy is a big move for those of us that are in natural health. It's a resonance. And, you know, one of the things I'm just going to digress before we go into this Dr. Marshall, Premier Research Labs, you know that's a product line I use. That is a vegan line. And there's reasons I use both. However, he really studied the resonance. What is the frequency that is in those animal foods?  Well, one thing about, I can say about the different types of vitamins and so we're using a lot of plant-based vitamins. And the reason is modern medicine has a way of extracting the amino acids and the other vitamins and isolating them in a really good way so they're healthy for us. So it's kind of like it's gone through the animal. This is what the animal does for us. So now we can do a lot of that in the lab. This is not to say that these burgers that they're coming out would have any of this type of therapy in it. They don't. But there are. Yeah, it's a beautiful cow. So we have this different kind of glanular therapy that's going on. And a lot of it originated from 100 and gather societies that were eating the whole animal's nose to tail, so to speak. But I want to make that point too that glanular therapy was big in medicine, even in traditional medicine, 1700s, 1800s. Yeah, and if you were a hunter and gatherer this was a natural process for you. You were already doing this naturally. So because we got away from it because the food was gone, the large animals were gone, and we had to use starches to kind of extend the food, now we have to go back and use therapies like this. That's exactly right. And when it comes to the matter of endocrine glans and the hormones they produce, modern medicine has done well in isolating and synthesizing in the lab, the very hormones we produce in our bodies, whether it's like insulin, for example, injected by type 1 diabetic or the testosterone cream applied by a lot of men today. Or estrogen.  Hormone preparations help keep us healthy, sane and strong. Okay? But what would happen if we were actually eating the foods, the actual animal sources of these products? Yeah, the spectrum between being okay and needing a pill, patch, cream or a shot of hormone is broad. What happens when you're not quite functioning normal and not quite struggling enough to take these things? And this is really the state of the human being in modern society today is that we are not getting the hormones we need because we're getting all other hormones. We're being filled with these GMOs that give us different hormones that we're not supposed to have. We call them Xenoestrogens. They are cheap and fostered. They're synthetic. And they're imposters. Xeno, they appear like an estrogen. So what happens is they block the estrogen receptor, for example. And we need estrogen. We get more than enough estrogen. But we do need some of it to activate and get into the receptor. Another important part of hormones which is a little bit... Well, it's easy to understand because this is the way the body works. It gets very complicated because they all kind of work in unison. There's a squirt here, a squirt there and they all come together and that is very, very healthy. So doing individual hormones may boost that hormone for you and give you a good reaction but it may not be working together with all the other things. And it can also interfere with the feedback loop. And then it's almost like your own production shuts down. The body reads this and says, hey, I've got enough estrogen or testosterone floating around. I don't need to make my own. So either way, nutritional therapy, supplemental hormone therapy or whatever, dietary change, exercise, stopping, smoking, taking herbal medicines, these can all be helpful. But another strategy of great value is that of glandular therapy also known as organotherapy which uses the entire gland of an animal to support the corresponding gland in a human instead of extracting just a single hormone. Glandular therapy delivers the hormone precursors and other nutrients associated with the gland to gently and holistically tonify the body. So everything works in unisons like an exercise regime. You're not just doing one exercise and you're going to pump your arm, just the right one. And you're much better doing a push-up because you're isolating all the muscles. If you do the whole thing but if you're just doing one arm then you're kind of unbalanced. So the use of glandular preparations has become commonplace in conventional medicine and in recent decades however research has switched their attention to isolating them. They want to find a more profitable way that we call them petrochemical nutrients. And this is the reason for this I believe is the advertising is much easier to have a baseball player or a football player saying hey guys, take this if you want to make your woman happy and you feel better and you're stronger. Exactly, you're right. But like I was saying organotherapy actually originated in hunter gatherer societies in which the eating of the animal glands were observed to have beneficial effects and the role of animal organ preparations and healing are well documented. They were even parts of rituals preparing women for childbirth. Well they appeared in writings too Aristotle in 384 Pliny the Elder? Yeah, that was 29 AD I mean these were people who were ancient and already knew about this stuff but where along the line we got lost maybe in the dark ages I'm not sure. Yeah here's an MD Henry Harrower he was an early endocrinologist who authored several books on the topic and he described the concept of like healing like we talk about kind of the doctrine of signatures, we'll talk a little bit about that before the show ends but this is actually very much the premise of homeopathy Yes it is. So how the substances are taken in a supplement fashion may support a gland that will be deficient or I like to say it reminds the body or the gland what to do it's there to help remind our bodies how it was supposed to function and hopefully get back into homostasis in a way. So you might say why should we do this Nico instead of pharmaceutical hormone therapy? Because the reason I think we do it because it's kind of like a multivitamin it's a whole food it's nicely balanced and all the other things are going to go along for the ride and everybody's happy. Yeah because unlike hormone therapy these you know which will use synthetic and naturally desired isolated hormones glandular therapy is always naturally derived from the tissue of other animals a perfect example that a lot of people would know is many people have a thyroid issue and their doctor puts them on levothyroxin or synthroid which is a synthetic thyroid. Well that's a very isolated synthetic man-made chemical where something like armor thyroid is the natural hormone from the pig. Let's continue with this. Yeah this is interesting stuff we have to take a break. Stick around folks and it's a good time to take a couple minutes to pick up your problem. You know what's cool? Taking something that's good for you. Something specifically formulated to help with weight loss, better sleep stress reduction and the need to detox. Nicar hunter and gatherer ancestors found all their nutritional requirements for health in their wild environment but today our food sources no longer contain the vitamins, minerals and nutrients our bodies need to stay healthy and strong. That's why we need primal edge daily nutrition it includes a special blend of ionics oil based vitamins, minerals, fatty and amino acids in an easy to use liquid form. Primal edge is powered by highly concentrated folic and humic acids. Nature's preferred delivery system. They've been called miracle molecules because like sunlight, air and water, life cannot exist without them. That's right Paige, they ensure we receive all the nutrition we need to be healthy and thrive. We take it every morning. Primal edge formulated and approved by Nico and Paige of living a primal lifestyle. Buy it today for just $89. 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Go to tfnn.com and hit watch Tiger TV. That's tfnn.com and hit watch Tiger TV for the latest market information. Lanier therapy, why do I like Lanier therapy instead of using the synthetic man-made things because clearer therapy helps to restore instead of just replacing? Yeah, the gladiators are thought to provide growth factors that stimulate regeneration of similar tissue and also contains the enzymes that they secrete. So in other words, glandular liver products are going to help deliver healthy. And a precursor that we talk about in vitamins that produce another vitamin and this is what this type of therapy does so it makes a lot more sense. Caththymus has been shown to prevent respiratory infections and treat asthma, hay fever, food allergies in children. So I think we can take pause here for a moment and I think so many of us, like I just used the example that we could take a liver glandular to help heal the liver but most of us immediately think, oh, we need to take turmeric or we need to take milk thistle for our liver. There was just a plant solution. These can be helpful too. Possibly maybe some of both is the thing to do. I would start with the animal. I'm with you. I'm kind of coming back around and I think we've ignored a lot of these really ancient healing tools. It's just the fact and this is coming out more and more.  And that's the cool thing Niko. Good point supplementing with animal tissues or eating these animal foods, they come complete with the package. All of the nutrients found within that gland organ, for example if someone took a product that was a brain tissue or ate some brain from an animal, these include and this is done by the way for a lot of physiological conditions. They are replete in the numerous fatty acids and the derivatives required to repair damaged nerves and regenerate the damaged myelin sheaths of the nerves and so this is an important part of healing. Given your body all the tools to make it happen. And it's interesting because when you look at nature, we have things that happen in nature that give us clues to what we need and we'll just switch over to this. And of course we want to source these well, you know and I think we should put this in the newsletter so people can read. It's got a lot of great references for sure. Yeah, we can go through the whole thing but you'll definitely be able to read the whole thing. I talked about the doctrine of similars and that they know like cures like homeopathy. I mean this is all coming together and we've talked about different foods and I really love to remind people of this. We've covered this before but nature does give us a clue of things that can be healthful to us and we talked about using the organ glands but also things from the plant kingdom, correct? Yeah, well one of the things that I remember one of the first shows we did you talked about things that are good for us are shaped in nature like the things that are shaped in us. So we look at nature and a lot of this thing is kind of interesting because when I look at the galaxy here or we look at the hurricane or we look at the shell I see Fibonacci numbers. Right. Something that we use here in the market also. Yeah, exactly. You see the the math, the maker's math so to speak. Yeah, exactly. So let's talk about this. Here's something that Oscar Wilde said nature which makes nothing durable always repeats itself so that nothing which it makes may be lost. Yeah, very wise guy. And you know if we really look at it it's an unmistakable fact the natural world does tend to repeat itself. We see this in this picture here and early physicians took note of this natural phenomenon and they created a pharmacopia that's centered around the concept that like affects like. And I mentioned here the early physicians but I would go even back farther and talk about the medicine man. These are the things that they knew and found it. Right, and they called this the doctrine of signatures as I said credited to Renaissance position alchemist Paracelsus. This doctrine contends that the earth is governed by the microcosm macrocosm principle as within so without as above so below and herbal pharmacist took visual cues from the flora, you know. That's right. And if a plant resembled a part of the body that was an indication of a healing property for that body part similarly I want to make the comment that those of us in natural medicine say we need to build a whole flower we need to build a whole person. So for example if we're making a remedy or we want to help heal someone we'll use the flower of that plant, the stem of that plant the leaves of that plant. Yes. Or we'll take a flower stem root of three different plants to make the remedy. Yeah and I remember in my childhood in Holland my grandfather taking me out for a walk near the farm and then showing me different mushrooms and different plants and explaining what they look like and why. Now he didn't tie it to nutrition but I imagine that our ancient ancestors did this. They took the kit along and the medicine man is showing the guy who was interested in medicine this is what this does and this is why it's shaped that way so you can look and it's very easy to identify. Make you strong like bull. There you go. And our modern approach to medicine does not really allow for this I call it the creative art and science of healing this intuition and it doesn't acknowledge the power or philosophy of spiritual beliefs and healing which is something that I do really want to see instilled in us that we really are active parts of our own healing but let's look at some of them. There's one of my favorite, the pomegranate. Take a look at the pomegranate. It's awesome. Yeah. Here's the cells. That's right. The benefits for epithelial tissue are on display. Another thing is as we say the pomegranate is the second ovary. Now what does it ovary have? Lots of little eggs, right? And that's because pomegranate has some estrogenic properties but it's a deep red astringent sweet fruit the astringent nature of the pomegranate is a good blood cleanser so we like to use it in that way and they're also known as a symbol of fertility. The color reminds me of like cranberry and cranberry purifies the blood too so there you go. Flax seed is another one here and even though we say if you're going to be eating seeds you really need to do a few things to them like soak them for a long time throughout the water, get clean water in there maybe let them sprout a little bit maybe even let them sour or ferment but you can see that the similarity is there. They look like the tissue that they heal. That's exactly right and you know we have been consuming the key is that we need to remember the traditional art of preparing them all these foods.  Right. That's a really good picture right here because instantly you can see this looks like a brain. And it may be the most poetic of all signatures because it resembles the part of the body that they nourish this one really hits it on the head for sure. Yeah. And you know it's high in vitamin E which is protective. Omega-3s. Yeah. And they also but again these plant foods also contain receptors and nutrients that are needed. It is a whole food as well. Yeah. So much more so than something you'd buy that's chemicalized and synthesized like what you see on the commercial. Famous herbalist Matthew Wood said signatures represent configurations of energy or patterns in plants and they correspond to similar patterns in people. That's exactly right. We'll be right back folks. I'm certain you are one of the best of the best at everything you do in life. It's the most common trait that we tigers and tigers share. If you're looking to become the best of the best when it comes to managing your money let me teach you to do what most wealth managers tell you can't be done which is how to time the markets. I'm Steve Rhodes author of Mastering Probability and for the last 12 months Timer Digest has been tracking my newsletter signals which have earned me the ranking as their number one market timer six and three months. Timer Digest also ranks me as the number one market timer for gold as well. The fact is markets can be timed and I'll teach you the exact set of tools that I use that has transformed me into one of the best at what I do. Sign up for Mastering Probability today by clicking on the newsletter tab on the homepage of TFNN.com and get immediate access to workshops where I take you step by step how to use an extraordinary set of tools as well as provide great market calls too. Sign up today. Hi folks, Tom O'Brien here. If you'd like to get my daily newsletter, Market Insights then now is a great time to sign up for a 30 day free trial. Every morning by 9.30 I send out my morning letter to subscribers with market commentary on a variety of markets, currencies and commodities to keep investors up to date on the day's trading action. Included in Market Insights are specific buy and sell recommendations for stocks, ETFs and even options which stops and price targets included in my newsletter. If you'd like to try my newsletter risk free for 30 days then head over to the front page of TFNN and you'll find Market Insights under Trading Newsletters. I use my years of trading experience to bisect and dissect the market every morning and give my subscribers the most important information they need to know for the day ahead. I even issue afternoon updates for my subscribers whenever warranted with important market action. I'm always scouring the market for the next great trading opportunity. Sign up for your 30 day free trial on Market Insights today by visiting the front page of TFNN.com Well, go get them folks! TFNN has put together the best lineup of live content for traders by traders every market day featuring some of the most knowledgeable and respected minds in the business. TFNN broadcasts 5 days a week live from 9 a.m. until 5 p.m. Eastern time. We have live programming every market day during market hours. Every morning Larry Pezzavento kicks off live at 9 a.m. and breaks down the opening bell with trade what you see. At 10 a.m. Tom and Tommy O'Brien host the TFNN Bull Bear Trading Hour followed at 11 a.m. by the team at TD Ameritrade and Thinker Swim with Fast Market. Basil Chapman host the Tiger Technicians Hour at noon Steve Rhodes at 1 p.m. with the Trader's Edge Dave White at 2 p.m. with the Power Trading Hour and Tom O'Brien anchors the daily lineup from 3 till 5 as host of the Tom O'Brien show. Tune in to TFNN's Tiger TV on your computer or mobile device and you can always find us streaming on YouTube. TFNN.com Educating Investors.  You don't have to do it daily. I don't think that hunter-gatherers were lucky enough to find food daily, you know, like that. They would have the organs, they would eat them, and then they'd use the bones. If you're a small family, you have a big animal that lasts quite a while, but if you're part of a village, then the big animal doesn't last as long and you have one heart and you have one liver, you have two kidneys. So there you go. So, maybe this might be a solution for you. I really like this company, Ancestral Supplements, makes a grass-fed beef organs combination. So what's included is a way that you can nourish your way to health and happiness with grass-fed beef organs which includes the liver, heart, kidney, pancreas, and spleen. So, the way I teach the people that I coach is that they might want to choose to buy this and twice a week take 10 or so capsules. That's like they had an organ meal. They don't have to do it. I know people get overwhelmed with taking two to four capsules a day. Instead, do it, treat it more like it was a meal that you had. And these are capsules, so you can actually open them up and put them in a drink or you can put them on your food. They're pasture raised in New Zealand. This company. I also buy from Vital Proteins. I buy the liver alone. But it's grass-fed and grass-fed. So these are animals that are grazing the way we want them to. No hormones, pesticides, or GMOs. In New Zealand, thank goodness, there's one continent there that really has no pesticides, no GMO at all anywhere in the country. Beautiful. And they use no fillers or flow agents and that's one of the requirements I have for many of the supplements. And there are some companies that tablet that I like, standard process. They use tablet, they're glandulars. However, I really look to not have these flow agents that really don't do anything. The name of the company is Ancestral Supplements. Of course, this goes right into the newsletter and we have talked about this company before. We really like their products and the source is really important, like we said. Remember, we talked about the guy who did this company. He has a whole nose to tail philosophy. Yes, he does. And that's becoming more and more prevalent. I've been watching more and more YouTube videos of people talking about the carnivore diet and talking about supplement with organ meats. So it's definitely a good trend. Well, hope you found some stuff today that you can use to stay healthier. We'll see you next show. Have a wonderful day. Take care. Bye-bye.


Over the last few months or so, I've noticed that Firefox is broken, so I've had many problems over the last year with Firefox in general, the way they run their business, the way they deal with the money coming from Google, all this stuff, I have a problem with it. And as anybody who's watched the channel for long enough knows, you know that I've been searching in vain for an alternative to Firefox. But for the most part my criticisms of Firefox really haven't been with the browser itself. The browser has always been fairly fine. Little slow, but mostly fine, definitely usable enough that I still use it. But recently I've been noticing so many more problems, and this has nothing to do with the update that just came out. I personally think it's fuggly, but whatever. I use the user chrome.css stuff and make it look the way I want to look, and I'm okay with it, whatever. What I'm talking about is actual rendering of the internet. So over the last six months I've just noticed more and more websites just don't work well in Firefox.  There are certain parts of Patreon that I just can't get to load. For whatever reason half the time when I upload a video, the percentage that counts up to tell you how long you have until the video is uploaded just doesn't work. And it works fine in a Chromium-based browser. I've tried it in Brave, I've tried it in Chromium, it works fine. So what I think is going on is that Firefox has such a small market share. Web developers have no incentive to code for it. And the way Firefox handles its engine and stuff in the background is definitely different than the way Chrome does it. And Chrome is the internet. All developers develop for Chrome. Web developers develop for Chrome. They have no reason to develop for Firefox and their little minute changes to the way they render the web. And that causes things to break. And for a while it wasn't a big deal because for the most part those little minute differences in the way Firefox does things didn't really affect that many things. But it's getting worse because it's like spreading out to more popular websites like the banking websites like Patreon, like YouTube. Now obviously the Google stuff is more anti-competitive. They have a very good reason not to code stuff to work well in other browsers. But things like my bank and Patreon and Facebook a lot of the times, they have no reason or no incentive to code for Firefox because nobody uses Firefox in the grand scheme of things. So my quest to find a different browser is beginning again. And it's going to have to be a Chromium based browser. So this is just kind of a really short video but I wanted to know if in the comments below, let me know in the comments below if you've been having the same experience with Firefox because it's possible it's just a few websites that I use every day or whatever that are having the biggest problems. Maybe it's I'm the only one that's noticed it but I'd love to hear about your thoughts in the comments. Make sure you like and subscribe and all that nonsense. You can follow me on Twitter at linuxcast. You can support me on Patreon at patreon.com slash linuxcast. Before I go I'd like to take a moment to thank our current patrons, Devon, Marcus, Megalyn, Donnie, Sven, Meese, Coach, Webb, Merrick, Camp and Mitchell. Thanks everybody for watching. I'll see you next time.


Ladies and gentlemen, I extend my congratulations to MasterCard and the Boulder Institute of Microfinance on this important event. I regret that I cannot join you in the beautiful city of Cape Town. As representatives of financial institutions and researchers, you are truly on the front line designing, testing and implementing what really works. Your focus on client needs is of utmost importance. For many years, providing financial services to the poor was not widely recognized as a matter of major concern. That picture has changed. In September, an ambitious new global development agenda was adopted by 193 countries. While leaders have recognized that providing the poor with the financial tools they need will contribute powerfully to sustainable development goals such as ending poverty and hunger and creating gender equality. It months ago at the World Bank, a group of public and private leaders including MasterCard committed to reaching universal financial access by 2020, a powerful commitment that many of you are pushing forward. This is a major step, but we all know that access alone is not enough. We have to provide people with financial products and services that are really suited to them, tailored to their specific needs. And we have to invest in financial education, otherwise the promise of financial inclusion is left an empty shell. Our work will be supported greatly by new research initiatives such as the Insights to Impact Data Hub announced here yesterday. This will provide valuable insights that can guide the creation of new products and services. I cannot thank the Billum and Nuggets Foundation and MasterCard enough for providing a public good of this kind. By focusing on the real needs of customers, you can translate financial access into life-changing gains, making it possible for people to afford food, medical care, education for their children and a roof above their heads. This is what we are all working towards, offering people the opportunity to create a better future for themselves, their families and their communities. I am deeply grateful for your commitment and contributions. Thank you very much.


Our next speaker is Dr. David Ladder, and in the ongoing game between Toronto and Montreal, Dr. Ladder is a home run for Toronto. He graduated from McGill University in 1982 and completed residencies in general surgery and CBT at McGill, a clinical fellowship in thoracic transplantation at Stanford. He was on staff at the Royal Victoria Hospital in Montreal from 1991 to 1996. And in 1996, he was appointed to a position at the University of Toronto's St. Michael's Hospital Division of Cardiac Surgery. He has been a professor in the Department of Surgery since 2015. So during his many years at the University of Toronto, Dr. Ladder has held various positions. I'm just going to pick out a couple of them. Chair of the Royal College Examination Board, Program Director of Cardiac Surgery, Acting Chair of the Department of Surgery. He's currently the director of MD admissions and student finances at the University of Toronto. Dr. Ladder specializes in adult cardiac surgery with a special interest in micro valve surgery. And the title of his presentation is surgical decision making during tricuspid valve surgery. David? Thank you. Thank you, Michael. Who's going to advance my slides for me? Will that be you Fatima? David, you can go ahead and share your screen and that should give you control to advance your slides as well. Perfect, okay. So I'm just going to share my screen, right? And I'll just give this talk here. Okay. Sorry, excuse me for the delay. So thank you very much for having me. It's a pleasure to be talking to this group and it's a wonderful meeting organized by my colleagues across the city. I'm very appreciative to be here. I don't have any conflicts of interest. And these are the objectives for this 20 minute talk. Hopefully it will be on time. And we're going to just review some of the issues of regarding decision making in the operating room about tricuspid valve surgery, the indications, and of course some of the techniques that we use. So let's minimize this. This is just something I think you all are aware of in the AHA guidelines of 2020 talking about the severity of TR. And we've changed the name over the years. We now call them stages and C and D are severe TR. The difference, of course, is the presence of symptoms or not. So C is severe without symptoms and D is. And that's primarily where we do most of our interventions on tricuspid valve. It's when they're severe except sometimes when we're doing left side of heart surgery, we may intervene on a patient with only a stage B severity of TR or what we used to call moderate MR. This is the current guidelines, HA guidelines. And I just put this up here as the start of this talk to point out that really there's only one class, one indication, and that is to address severe TR when we are in the operating room doing something on the left side, usually the mitral valve, but it can occasionally be on the aortic valve or even bypass surgery. But that's a one A indication. The other indication that we do in the operating room is really this one here who have stage B, but they have a dilated annulus. And some of my previous speakers, some of the previous speakers have talked about that and I'll address that a little bit more and about where that came from. So you may only have moderate TR or what we call stage B now, but if you have a dilated annulus, you probably ought to be taking care of that in the operating room when you're doing left sided surgery. But it's a 2A indication. The other ones that are in this list are functional TR. And of course, there's a couple here that are talking about primary TR, such as this one here. And we'll talk a little bit about that later as well. So functional TR or what people used to call secondary TR. My previous speakers have talked about this. There's lots of different causes. The most common cause of course is left sided cardiac disease, valve disease or LV function. You can't have pulmonary hypertension. What about right particular enlargement? That's sort of the primary etiology that does happen. I've operated on some of those patients. There's different reasons why that may occur. And this one here that I've listed, long-standing atrial fibrillation and annular dilatation. I didn't think that that was a real thing, but it definitely is. And there are a cohort of patients who have long-standing atrial fibrillation. And for reasons I don't really understand, just seem to dilate their tricuspid valve annulus and develop TR. Dialysis as well. Organic or primary TR, these are some of the causes there are others. Endocarditis is probably the most common one. Trauma is not rare, pacemaker is not rare. But if we have different, we have I think a different indication for surgery when there's a primary valve disease versus a secondary or functional TR. So I'm just going to talk about some of the studies that I think are relevant for the discussion. This was a study in the JTCVS of the Mayo Clinic where they looked at the incidence of TR in their patient cohort, depending on what was the, they all had surgery on the left side, usually the mitral valve. And they noted that the occurrence of TR occurring post-op mitral valve repair was not that great. If the mitral valve indication was for prolapse or a typical mitral valve, you know, a mitral valve MR case where we were doing leaflet, mitral valve leaflet and annuloplasty. If it was for rheumatic mitral valve surgery, the incidence of progression of the TR post-op seemed to be greater and significantly greater. And then in the final sort of group of patients, they looked at if the intervention in the mitral valve was due to ischemic myocardial disease, the progression of TR post-op was the worst. So these things are something that we have to bear in mind when we are faced with decisions to whether or not to intervene in the tricuspid valve when we're operating on the mitral system, mitral valve. This is a study that came out of a hair field by Dr. Dreyfus. He now works in, he's a cardiac surgeon who works in Monaco. It was a pretty important paper and it was a group of patients, they took about, I think it was about 300 patients and they decided that they couldn't rely on preoperative echo assessment to really give them information about should something be done about the tricuspid valve when we're doing mitral valve repair surgery. So they made a decision to just and every one of their patients, they opened the right atrium and did an actual measurement of the of the tricuspid valve and they took a measuring tape, a little sterile measuring tape, they put it at the commissure between the anterior and septal commissure and they stretched out the, they stretched out the mitral valve, the tricuspid valve sort of was sort of linear and just measured the distance from here to as far as they could stretch it out and they found and if it was greater than seven centimeters, so this was when we talked about seven centimeters, we're not talking about a diameter, they're really talking about a stretched out length, they would then intervene on the tricuspid valve with typically an annular plasty and that was probably the predominant the intervention, maybe some some minor leaflet work or you know exclusion of some in large commissures but they did routinely did that and the group that had 70 millimeters or more they intervene and the ones that were less they left alone. They use they use almost exclusively size 32 or 34, 32 in women and size 34 rings in men and they looked at the outcomes and it was really interesting that there was clear, clear benefit for the group that had something done to the tricuspid valve, they had less TR and less CHF but and this is probably true I think in all surgical series the survival wasn't improved, it was still the same survival but they did have less heart failure, less TR and this is I think one challenge that we may see in this sort of new era of perc-tase intervention that yes we can do these procedures and take away the TR but doesn't make people live longer and that is a big question. So currently and I just did a little survey when I was preparing this talk, different centers there's still quite of who have reported on this quite a variation in and how what percentage of patients who are undergoing mitral valve surgery have their tricuspid valve operated on at the same time. The Mayo Clinic in Toronto General it's like less than 10%, Mount Sinai in New York this is David Adams group it's as high as 65% and other centers Pennsylvania is very high, Herfield takes an aggressive approach and they're sort of intermediate but that's quite a large variation between you know prominent centers that are doing as low as 10% or as high as 65% intervention rates on the tricuspid valve. So when we decide what we're going to do if we do anything on the tricuspid valve it's really important for us to consider the anatomy and that's why I really appreciated Dr. Vegas's talk and Dr. Armrand where they really talked about the anatomy to help the surgeons make decisions and these are of course really important things. The angular dimension we currently use at St. Michael's and I think most people use preop echo measuring 40 millimeters in the dimension between the middle of the septal leaflet to the middle of the anterior leaflet in biastically preferably in the four chamber view. Perhaps it's more accurate if you used an indexed version of that so some people are bigger or smaller but this is a pretty useful number 40. The RV size is important I don't know any really good measurements of that or even also important is the RV function hard to measure that and get something that we can make decisions based on that with leaflet tethering, commissure and scallop depth. So I'm going to show you a picture where the tricuspid valve is very variable with its anatomy and some of them have really deep scallops in the anterior leaflet that looks like it's a fourth leaflet. The severity of TR of course if it's three plus or more then I think we ought to do something if it's two plus then we can make some decisions and of course the severity of TR fluctuates. It fluctuates preop. If you happen to do the echo on the patient a day when they're well dire yeast you may have much less TR than a week later when they've consumed too much fluid, they've stopped taking their Lasix or whatever is going on and we certainly see that in the operating room where intraoperative assessments of TR are always less than the preoperative assessments. So one of the issues about leaving the tricuspid valve of course and this is what we're really talking about here what is the consequences of that. I don't think there's much different there's certainly no change in mortality in the short term and I think I would I'm hard pressed to find any papers that show a long term difference of whether the tricuspid valve is intervened on at the time of mitral valve surgery that affects survival but we do know the TR gets worse over time and severe TR definitely gets worse and we do know that dilated tricuspid valve analysis lead to TR and that gets worse over time and these factors female atrial fib diabetes they seem to promote progression of TR and again I talked about the mixed rates of intervention and of course the real problem is this last comment here is that if you don't do something at the time of the first surgery and then five years later the patient has had severe TR and is really struggling the operative mortality risk is probably at least 10% on those patients and so that is a significant risk to the patient to start to consider surgical intervention at that time. Um that a paper from Mount Sinai that said that indicated that 65% of their patients that they were operating on the mitral valve or having something done to the tricuspid valve was actually presented at the AATS meeting in 2015 and actually was quite controversial led to a lot of sort of discussion at the time and Tadrone Beva got up and said that that's crazy or over-treating. Anyways this fellow Robert Dion who's a well-known cardiac surgeon who works in Belgium now wrote an editorial on the JTCVS and he basically summarized I think the current thinking and gave some recommendations which I listed here so if the TR is greater than or equal to plus you should do an annual plastic at time of mitral valve surgery. If it's greater than two plus and tenting you should do an annual plastic and leaflet augmentation which I'll show you in a minute sort of pictures of that. What if the TR is less than two so you're talking about you know he's talking about modern TR or mild and but they have an annulus that's greater than 40 millimeters he recommends doing an annual plastic and he even goes so far that if it's if your TR is you know like one plus and but your annulus between 3.35 and 40 maybe if you have these other risk factors you should consider surgery as well. This is what I do now I think it's a reasonable approach similar to what the previous slide just showed. Severe TR you have to intervene. Modern TR for annular dilatation you have to intervene. We know TR progresses the incidence of significant TR after MBR if it's left untreated is at least 25 percent in the five to ten year range. The mortality of a isolated tricuspid valve replacement or repair surgery is high especially for redo surgery and there is even though there may not be a survival benefit there is a significant impact on the patient's quality of life in terms of heart failure. So this is the current 2020 guidelines from AHA and I just want to put this up here to point out that the only class one indication is this one which is at the time of left side of surgery if you have severe TR you have to do something. The other one that I think is pretty straightforward again at the time of left side of heart surgery is this other column here which is only stage B or modern TR but with annular dilatation that's a 2A indication so these two I don't think there's too much controversy about. The ones and then these two the one the second from the left and the second from the right these are primary tricuspid valve problems so they have a ruptured cord or endocarditis and they have a hole in the leaflet and I think we really ought to be repairing those especially if you're having a right heart failure and you have primary TR you should have surgery. This one what about this one these are asymptomatic patients they have severe TR but asymptomatic and I think you probably shouldn't intervene on these patients before this progresses to severe in severity or especially with symptoms but it's only a 2B recommendation and then this was the one that's probably the biggest category of them all which are patients that have functional TR secondary TR and they have right heart failure they're sick and what do we do with them so if you don't have pulmonary hypertension then yes surgery seems indicated annular dilatation is easy to fix with an annular plasty other things like tethering or RV dysfunction are much harder to fix in fact cannot be fixed RV dysfunction with surgery and the reason why this third column over here is a 2B is because this is their reops they've had previous surgery and the risk of surgery is higher so the indication seems to be a little less strong. Let's pass over that again this is for organic TR which we do operate on especially if they're having if they're severe and they're having and they're symptomatic these are the different techniques we can use and I'm going to show you some diagrams or pictures of these but basically the answer is you know you fix you fix what's broken so this is the anatomy the tricuspid valve this is a typical surgeon's view I wish it actually looked like this when we opened the right atrium in the operating room it's all nicely labeled this is the coronary osteum so this is a useful landmark for us because we know somewhere around the middle of the septal leaflet to the to the commissure is the conduction system which we want to avoid so we don't ever want to really be putting stitches in here this is a triangle of of cauch, caution there's a tendon here called the tendon of Tadaro which we can easily see and that triangle we don't really want to be putting stitches in so that's why annual plastic stitches we'll start about here and go around this looks very nice three leaflets easily identified no deep clefts it really rarely looks this this neat but that is the sort of the anatomy of the tricuspid valve this is what annulus annual plastic looks like this is some people recommend putting a pledging stitch here this is sort of in the orifice of the coronary sinus does a lot to coronary sinus but that's where it's tethered where or based out of and we're avoiding this area because that's where the conduction system is and that gives a nice closure this is one that looks in the operating room this is an older style tricuspid ring carpaccia which ring the newer ones are a little bit shorter here again you sort of you can see one two three four leaflets you say well what's what well you know sometimes it looks like that it's not doesn't look like this very often it's it can be quite variable in this appearance by cuspidization so if you have a prolapsing posture leaflet this is septum this is posture this is anterior this used to be a technique that was done quite frequently we just take it out of the circuit you know plica it out and some surgeons in the you know early days just left it but most people would put a ring on here now to reinforce that someone talked to Dr. Vegas talked about leaflet tethering this is a very real phenomena when the RV dilates and everything moves away from the tricuspid annulus so we would have to put a ring on there to reduce the size annulus but the deal with the tethering it's been suggested that pericardial patches put in so I take a piece of the of the patient pericardium and just stitch it into elongate the anterior leaflet and and make it and close the commerce close the class to make it the competent this is like something called the clover technique so again it would be with an annual class this is really useful for people with prolapsing leaflets so that's more of a primary cause of tr and you just it's like an alfieri stitch of course it looks similar to the what would be done with clips but with a stitch pacemaker reduced we do these kind of repairs we would move them out of the anterior leaflet if it was stuck there we close it and put it over to the side in the commissure area and this is this is hard to do these are putting artificial cords because the right ventricle is so large it's so dependent on size it's really hard to get these the right length so they're they're kind of hard to do and they can be done if you have to but it's difficult to get them right and this is going to show you a couple pictures at the end of my talk this was the case that we did about a year ago we have a very active a group of cardiologists that put all sorts of devices in and this is an evoke valve that went in that unfortunately had to come out because it embolized it looks enormous looks like a UFO it looks enormous because it is enormous it's like 45 millimeters in diameter and then this is a case my last couple slides is that as a young fellow who is a stuntman who fell falling out of a window I think on a movie set landed on his chest suffered a pretty significant right ventricular myocardial contusion was in hospital for a week or two you know initially had some arrhythmia as they settled down had no rupture to his check up a valve but over the year he developed severe TR and I was I ended up operating this fellow and his because of his contusion from his right ventricle his right ventricle got got larger and everything was pulled apart and dilated and this is his anterior leaflet actually with a deep clef that normally is not a problem with a normal sized right heart but in this patient was being held open and he had severe TR through that area and here's his posterior leaflet and his septior leaflet and you can see almost there's like a gap between the septor except the septal leaflet and the posture leaflet work just can't close so I addressed those things I sewed this up the the cleft the anterior leaflet I placate this out with a sort of bi-cospitization technique and put a ring on there and unfortunately the picture didn't come out very well but it worked very well and that was a successful sort of treatment of what I think is primary TR but really is probably from his right ventricle so thank you for that well and thank you David that is fantastic it's always great to see stuff from the operating room to see what's what's going on so we'll we'll move along