Transcription
Okay, everybody's finding their seat. So, we're all going to lean into this collective effort in essence again, and we we'd love to everybody have everybody that's here, even the industry sponsors and everyone also join groups because you bring value, valuable opinions as well.
Over here. And I, I see some that have wanting to stand. That's perfect. That's great. So, just make sure we stay interactive. Again, part of this opportunity, this this patient think tank was an idea of how do we engage you a little bit more? And and one of the things that we've heard is patients love to tell about their stories. And I think that's incredibly important because patients teaching patients is what gets me really excited.
So, what we're going to do is we're going to look at 10 AIH related situations. Now, I had a lot of fun trying to build these. These are kind of experiences that I also collected from Dr. Weinberg and and goal as well to really kind of highlight some of the important questions that we're seeing in the clinic, but also are relevant in the AI space right now, including clinical trials. But there are some mental health aspects here too. So, we're going to try to find a unified response. We don't have to meet consensus on these these these kind of uh challenging situations, but I think it's really going to serve as an opportunity to discuss your opinions. And by the way, we accept differing opinions as well. So, we got to think about problem-solving. How do we approach it? Think outside the box. But ultimately, I'd really love for you to encourage some self-reflection as we kind of think about this as well.
So, I'm going to read these scenarios. We're going to have maybe six minutes or so to talk about each one. Some are longer, some are shorter. Uh, this first one is, you imagine that the National Institute of Health has funding for only one new clinical trial in AIH over the next three years. There are two exciting new drugs being considered as possible game-changers because of preliminary data. So, you as a part of the NIH advisory board need to provide feedback on this one and only funded initiative.
So, you have drug one. This is called Symphoma. It alleviates all physical symptoms related to AIH. But patients must take this in addition to their current standard treatments. So, again, to highlight what I say to patients in clinic is, patients feel great, but they don't live forever because the standard of care unfortunately is not perfect. Still good, just not perfect.
Drug two, you may see where this is going. AI curacef. This stops AIH in its tracks. It reverses liver scar tissue, but it does not change the physical symptoms associated with this disease. Again, patients are probably going to live forever, but they're going to feel the same way they did as when they had AIH as well.
So, the question for the group really is, what drug would you push for and why? So, if you guys can keep it to a low roar so we can discuss, but uh, what, what we'll do is we'll kind of summarize your thoughts and we'll probably review these when we come back from lunch. Okay? So, just generate some kind of discussion.
Okay everyone. So, we're going to switch gears, just with the same theme though, because this person decided to advocate for Septoma. Um, but there's some other decisions that we really have to decide. And from the company, the manufacturer actually makes it in three different formulations. And this is a really important point because we've heard this from our members a lot. There are three formulations.
The first one is 1 milligram, you take daily. The preliminary data says, you know, works good for symptoms, but 15% of patients actually get severe GI side effects, but everything else is better. The second formulation, it's an intramuscular injection. It comes every four weeks. It can be done at home, which is great, but it causes severe fatigue for 3 days beyond the administration. And and then formulation three is an IV solution. You have to go to the infusion center every 8 weeks. It's tolerated well, but unfortunately has this pesky problem of liver toxicity in about 7% of patients.
So, my question to you is, what drug formulation of this drug would you choose and why? So, for the first one, I got a lead, I got a lot of feedback for these, and it sounded like the clinical trial ones were some of the best. So, for Septe, what drug did you choose and why? >> You have the microphone. Can you give it to them? >> Oh. >> You got it. Okay. >> Um, so for Megan and I were um, along with our group, so it seemed like predominantly it was Sima Okilla. I don't know if I said that right. Um, but I think with our group, the consensus was over time, just quality of life was one of the most important um strategies. And so being able to get rid of the symptoms, even though um, you do have to continue on other therapies, standard of care. I know that quality over quantity was what we discussed quite a bit.
>> Any different ideas, Ethan or Parna, in your groups? I think we were actually a little split in our group, but ultimately, I think we decided AIH cure. Am I right? Yeah, we did. Right. I um, we were a bit split initially, and then when we saw the second prompt, we definitely thought not symptom, because, you know, there was still some significant side effects with those with that drug.
>> So, in our group, we talked about having the chance to address symptoms. So, if you're dead with liver disease, there's no utility. So, we sought cure. Again, I'm speaking for everyone. Ethan, was there anything else for you for number one?
>> Um, ours was ours was split, and [clears throat] it really depended on whether someone was having symptoms or not. Uh, we didn't come to a consensus. Um, but we had people who wanted the second one and some people who wanted the first one.
>> So, in that sense, then too, Ethan, maybe you could talk about the formulations. Was there one that was preferred over another and why? Um, again, I think people liked the second two. Um, formulation two or three. Formulation one, people were lukewarm about, but it was really split on formulation two or three. And it depended on uh, really where someone was, I think, in what they do um, and how it might affect their life. So, for someone that um, uh, is concerned more about their liver or maybe has more advanced liver disease, number three was out of the question. But um, for someone that is really active or maybe they have young kids, number two would be out of the question. So, in our group, that jump in front of you, Aarna, was the idea of having an option if something that came to the market was a, a novel administration as opposed to standard of care oral therapy, was looked upon positively, at least.
>> You know, the, I think at the end, we, we thought number three was the best, but didn't actually feel like any of them were great. Um, but that being said, the flip was number one, there was this sentiment that, well, I can just take another pill. I already take enough pills already. I'll just put another one in and deal with the symptoms if I have them.
>> So, I don't think the pill burden was quite the concern. I think it was more actually that there were still significant symptoms potentially associated with these these medications.
>> Right. >> That's true. >> It's supposed to be seven. Sorry. Does 4% matter? >> Is that it? >> I think it did. >> Okay. And by the way, the audience, if you feel very passionate about one of these, please raise your hand. I'll I'll run to you. Naughty. Anything else about >> Yeah. I think one of the important things that our group mentioned was the fatigue component. And a lot of people said, "I already live with fatigue day in and day out. If it's just three days that I have to struggle with during the entire month, I would actually rather take that um than the long-term chronic fatigue that I live with now." So, I think majority were um going with number two.
>> Plan things around. They can do plan trips. They can plan everything around that fatigue.
>> So, that was a similar theme for us. You said the planning trips because, you know, >> plan around that fatigue. So, they knew that these are the three days that I'm going to have fatigue, and they could essentially kind of plan their life around the fatigue, and it was less impactful um than it would be now when they don't know when it's going to happen.
>> Because the fatigue it now is very heterogeneous and variable.
>> Those are all really good points.
>> All right. So, I tried to instill some of my personality in these slides. So, because of your intense research and with the support of your closest circle of friends, a respiratory therapist, an OB nurse, and a coffee barista, you come up with the realization that you adamantly disagree with the management of your disease. And your doctor believes your treatment response over the past two years is perfect. There is nothing else he needs to do for you. He just wants to get labs on you every three months. He says, "You know what? I'll see you in a year." Anybody have that? Okay. There's a lot of arms. Okay.
So, however, you, you made it clear to him that you're, you're wrecked with fatigue. The joint pain is really most days of the week. You also, your most recent lab show an ALT of 52 and an IGG of 1600. And you're 100% compliant. You take your 50 milligrams of aothoprine and 5 milligrams of prenizone every day. Reminding you, you've been taking this for two years.
So, how do you approach your doctor when you disagree? How about problem doctors? Handling big differences. This doesn't happen in my clinic ever. Just kidding.
>> Um, big differences in opinions with your doctor strategies.
>> Ours was very strong. Find another one.
>> So, bail.
>> Very strong opinion.
>> Bail.
>> How about Aperna and Ethan?
>> Similarly, fire your doctor. Get another opinion. Um, I, I did hear a lot of fire doctor, but I also, you know, part of it was that you've been with this doctor for two years. So, maybe there's a relationship there, and maybe they can learn from you too. So, particularly if the doctor is, there's a lot of room to go up on the medication, and if the doctor wasn't well-versed in how to treat autoimmune hepatitis, would be the opportunity for maybe a patient to be able to teach the doctor. So, we got into the point of how do you share information with your doctor to convince them, as if you have to.
>> Um, but there was a one, uh, who was it that sends papers to their doctor through the portal before and said, "Hey, I'd like to talk about this as a point." So, I think there are strategies to engage your doctor a little bit more. And again, this is personal preference. And again, if it's not working, and it's, if it's, it's really challenging, I think it's probably clear cut bait. But we're also, as you said, two years in, and you may be in a small town. Another discussion point was, this is all I got. So, how do you optimize relationships that are probably subpar? You may have to, based on just limitations of resources. So, a lot of things to think about.
So, you come across this social media post from a prolific AIH patient. This posted on the AHA Facebook website. This is from Jessica, the AIH healer, and she says, "AIH warriors, amazing news. I just got back from a spiritual trip to Arizona, and I met this incredible health guru. He, it changed the way I think about healing. On this journey, I focused on nutrition with a goal of beating AIH. And guess what? I think I've done it. Following a diet of ancient grains and lean means, my energy's returned, my labs are normal, I feel better than I have in years." I know it might sound too good to be true, but I promise you, if you consider eating this way, you'll be able to stop all your medicines and those exhausting doctor visits. If you have any questions, you know, reach out. [snorts]
So, where do you turn for reliable information when it comes to this disease? And how do you even decide what to believe?
>> Turn to this organization.
>> Yes.
>> And it is the one.
>> The social media posts from Jessica the AIER. Reliable information. I, I told everybody in my group this was self-serving. I just wanted to hear it was AIA. So, we are the best. Obvious no. Uh, so it was reassuring to hear that a patient group and a patient le organization has some of the best information. But where, where do others get information from? We heard also, uh, Mayo Clinic has a great website um, people would look to, or other academic sites uh, for blanket statements on autoimmune hepatitis.
>> Um, Google. I think that everybody when they first are di, not everybody, but I think a lot of people when they're first diagnosed will turn to the first browser and search, and that's often the first place they go. Um, and then everything else.
>> What is your guys' approach when you have patients coming in with Google searches and in other strategies?
>> Yeah. Know, I, I warn against that. There, you know, it's a very biased place to look, and you're going to see everything from the scariest scenarios, and you might not hear the truth of how the disease manifests and how we manage it and whatnot. So, I, I turn patients to to your website here, to American Liver Foundation, and then I give them some um, resources from online as well. So, I try very hard to steer away from just the Google searches. Um, I wonder if I can still do that with Chat GPT and other other >> Yeah. Nobody said Chat HTTP or AI.
>> I know. I mean.
>> I guess that's built into the web browsers now. Maybe.
>> Right.
>> Yeah.
>> Because we, we have had instances using Chat GPT to write summaries and things and making up references and things of that nature. I don't know if you've seen this or not, but Nadia, was there anything else that >> No, we had the same AIHA, a lot of AIHA and Google initially.
>> Yeah. So, deciding what to believe or what you want to believe, are there things that are just too good to be true? And where do you draw the line? Again, I, I have a lot of patients that want to try things. And I think that's part of the human condition. I'm not a psychiatrist, but I think it's a sense of control. I, I applaud that. I want proactivity. But again, where is that bar, and what do you guys practice, or what did you guys hear from your group?
>> Our group also talked about sharing within like the support group or sharing among like a larger reliable group. So, maybe not just like the full Facebook page, but maybe, or maybe it's the private page or something along those lines. Like, if you feel comfortable already with that support group, then you find that material a little bit more reliable from somebody within that group.
>> Got it. Okay, that was a good one. Let's uh, wrap up to the next question again, to make sure we're going through.
>> So, you are an AI patient for the past two years. You just came from an incredibly relaxing vacation in the Caribbean. This is just what you needed to recharge your batteries because you were just zapped. Past few months, you had some challenging work deadlines. However, on your first day back, you tell one of your closest friends who doesn't know about your diagnosis, by the way. You'll meet them at a restaurant, and I, you've been dying both to try it. However, you know what that feels like. You hit your couch. You get home. Oh my gosh, I'm exhausted. I, I, I just can't get off the couch. And th, this conversation ensues. I'll see you at seven, right? It's going to be a great night. Listen, I'm really sorry. I'm just not feeling up to it. Uh, the idea of you're cancelling again, and just disbelief, right? You never do anything anymore.
So, I'd like to hear kind of interactions with patients saying how do you handle these situations? On top of that, which is again, an extra level, is how do you decide who you tell about your disease, and how do you even explain it to them? This is a big one. The friend that doesn't get it, how do you handle these situations? Naughty, what's your group say?
>> Wait, what's that?
>> The spoon theory was one of the, which, if I, if I'm honest, I don't know what that is.
>> Spoon theory.
>> Yeah.
>> Does somebody want to highlight?
>> Anybody that practices spoon theory?
>> So, if you go to the website, but you don't look sick.com. Uh, it'll explain the whole spoon theory. Somebody with lupus started it. She said how she describes her fatigue and um, you know, need to cancel appointments and whatever with people um, is that she starts a day off with a certain amount of spoons. Getting out of bed might cost her two spoons one day. Taking a shower might cost her one spoon. Making breakfast is another two spoons. Like, then by the end of the day, she's left with one or two spoons, and she has to decide how she uses those spoons. Is it going out with friends and then you're drained, or just sitting on the sofa and chilling out? Keep her spoon.
>> So, I've, I've seen this more in PBCSC. It's applicable here. We've talked about the, the battery monitor in terms of percentages and things as well. And I think it comes down to coping. And actually, in our group, uh, I forget who said it. Yeah. So, the idea that I wouldn't have made plans early in the day. I would have waited till later in the day to make plans. So, maybe some coping strategies that we can do better. Um, just adaptations. Who do you decide to tell about your disease?
>> So, I think for our group, one of the things was, like you said, Dr. Layart, planning around their fatigue was something that a lot of people noted. Um, most patients, sorry, people said that um, they try to tell most everybody in their lives, people who are they're closest with, at least, so that they do have that support system, so that they know that if they are going through, you know, [snorts] a harder day, more fatigue, then they feel comfortable um, speaking to those people and knowing that they'll understand. Um, and then having a group like this as well, so you know that you're, you know, sharing in your um, symptoms or fatigue or whatever that situation may be.
>> Yeah. And maybe, can I ask a patient to give me your best elevator speech? Does anybody have a good one for AIH? Anybody willing to say it? I practice with patients in the clinic.
>> Okay. I don't think we've practiced together, but usually [clears throat] we talked about in our group too, like the word hepatitis can sometimes get in the way of people understanding, or it has stigma. So, I often say, I have an autoimmune liver disease, or I have an autoimmune disorder where my body attacks my liver. Um, and that would be the very short elevator speech for it. But then, if there's interest there, I can go.
>> Tell me more. [laughter] [gasps] Um, [clears throat] yeah, so then perhaps explain like some of the treatments, like what is the goal? Like, this isn't something at this point that we can cure, but it's something that we try to manage, usually with steroids and immunosuppressants, which can then also help them understand, okay, maybe this is why you were more careful during COVID, or like, tailor that to the situation um, or dig into symptoms a little bit, like, yeah, you just said I look great, but actually, like, what you look like on the outside isn't really necessarily what it feels like all the time, and try to let them into, like, fatigue that can come and go, or those symptoms that are invisible, which is going to be different for each of us.
>> Anything else?
>> No, but perhaps. Well, yes, a few things. One is, there's a big challenge in younger people that are recently diagnosed, and sort of the strain it places on social relationships, especially if that involves going out to bars and, you know, socializing, going on dates and stuff. And when do you start to um, share your underlying liver disease with some, with with your friends, and kind of building a network that you can start to trust, and having other friends sort of filter out if they're not going to be supportive. Um, this is an opportunity to rename the disease, apparently. So, right, liver disease is really good about renaming itself. We renamed NASH, we renamed PBC. Maybe this is our opportunity to rename autoimmune hepatitis.
>> Yeah. So, that's been mentioned before, and again, I think the challenges have present there. That could be a target, but not in the near future. So, the next one, you've lived with this disease now for 10 years, and despite taking multiple medications, your disease is not fully controlled. Your lab tests still show ongoing inflammation. You have a fiber scan that we'll talk about tomorrow, has increased up to 10 from six over the course of the past three years. Here's the twist. You feel awesome. You are living life, working, spending time with friends and family. You're going to dinner. You're meeting your friends. Everyone loves you. From the outside, nothing's wrong. And you actually feel great, right?
So, your doctor tells you about a new clinical trial. He says, "Actually, it's a chance to try to get a medication that may actually control your liver disease, but there's some issues." So, these requirements, you have to have a biopsy within three months of start, and you must complete it after a year. You also have to get rid of your current treatment over the course of the first few months. You must be seen at the trial center every two weeks for up to an hour at a time for at least a year. And there's a 50% chance that you don't even get the new drug because it's done with an equal number of patients that get placebo.
So, how much of these requirements reduce your likelihood of participating? And how would you adjust the requirements to increase your chance of participating? Again, remember, you feel great. It's just your liver doesn't.
>> Um, so maybe the next one, um, clinical trial requirements. So, again, [clears throat] a lot about clinical trials, trying to think about how much these requirements reduced your likelihood, or what you would change about a trial to increase. Remember, you felt awesome on standard of care, but your disease was getting worse. Ethan, did your group have anything to say about those inclusion criteria?
>> Yeah. Um, we had an excellent conversation about this. So, of the four criteria, the least controversial was the liver biopsy, which if you ask practitioner, if you ask doctors, they will tell you that, and if I ask my colleagues, they'll say, "No, the liver biopsy, no one's going to want to do it because of a liver biopsy." That was actually the least problematic one.
>> Um, there were concerns about the frequency of visits, every two weeks. That was a little too frequent. Um, and one of the strategies we talked about was, what if we had home visits instead? People liked that, particularly if you're working um, that would be helpful, or having you have children, it would be difficult to be able to actually participate in a study um, with all these other obligations. Um, I forget number two. Well, there was standard medication off, and then >> Yes, there were also concerns about flaring when you remove the medication, and so that was another big concern. Um, and then we didn't touch too much on the placebo, but people in general were not excited about a 50% placebo.
>> Yeah, Aparna, was there anything else?
>> I think similar sentiment. There were no concerns about biopsy, which actually really surprised me as well, because that is one of the concerns that I feel like our patients have. So, it was great to hear. Um, the idea of getting off of your standard of care of medications was not, was probably the most likely reason why someone wouldn't participate. So, having to withdraw something that was potentially managing the disease. Um, and then knowing that you're going to flare was, was sort of the, the biggest challenge. And a 50% placebo was sort of, you know, there brought out some hesitancy. And ideally, you know, more like 66% 33% was more favorable.
>> How about Megan and Nadia? Was there anything else that we haven't mentioned?
>> I think with our group, just a couple people mentioned not wanting to undergo biopsy, but it was just, you know, the risk of disease progression, not being on your medication, and then only having the 50% chance of actually being on trial um, therapy, which led to mostly nose.
>> Quite a bit of hesitation. Okay. So, for this one, Samantha is 42 and she's lived with AIH now for a decade. She has this great caregiver. His name is Mark. Uh, he's, he's been there for appointments. He helps her through flares, picks up slack at home, and the fatigue really takes over. Lately, Samantha notices Mark is withdrawn and exhausted. He skips his basketball games. He doesn't talk to his friends anymore. And and he even himself says, "I feel burnt out." She wonders, "If the person who supports me begins to run on empty, how can I thrive?"
So, again, a little bit more of a touchy-feely one, but how do you best ensure, in a weird one at that, but how do you best ensure your support of the person who gives you your support? How about supporting your caregiver? This was taboo in our group. However, we had one member said that this is very similar to her current situation. What do you guys do to support your support? We saw heard some interesting things in terms of communication, and if one care provider is on 10% and the patient is on 10%, it's a, I don't want to quote wrong. It's, it's a Netflix night, right? Maybe just Netflix, not Netflix and chill. So, the [laughter] any other strategies that you can do to support, again, this is a, a seldom discussed topic, at least in the world of chronic disease caregiver support.
>> Um, in our group, we had the suggestion of um, maybe was it Mark or Brad when it would go for a weekend golf trip or something?
>> What was it? I'm sorry.
>> Uh, we had the suggestion of like sending your caregiver to do something that they enjoy. Oh.
>> Like a weekend getaway, or even trying to reduce um, just not for long, but just, you know, maybe a few days, reducing.
>> [snorts]
>> Um, a little bit of the AIH talk, maybe, you know, just kind of giving a little bit of a breather, but not.
>> Space.
>> Yep, just a little bit of space.
>> That was more or less.
>> Yeah. Ethan, Aparna, anything else?
>> I don't think that our group loved the way this question was phrased, where the responsibility.
>> Yeah, we don't, we, our group didn't love the way that this question was phrased, where the responsibility of the caregiver's well-being fell on the person with AIH. So, it is important for the caregivers to develop their own support system, to develop their own interests, to nourish their bodies, their souls, find fulfillment, but that shouldn't fall on the responsibility of the person that's suffering with AIH.
>> Got it. No, that's good.
>> This, this one's a little bit of a downer, too. I hate to say. Uh, this is a patient reflection. So, living with AHC feels like I've lost pieces of who I used to be. I once defined myself as energy and and productivity. Now, it's just survival. Every few week blood draws, every few months, another doctor visit. People just don't see crushing fatigue, aching joints, poor sleep. So, what hurts most is the loss of identity. Now, I hear this over and over and over again. I don't feel like the ambitious, capable person anymore. My days are about managing pain, monitoring labs, and just holding it all together. Despite all the efforts, there's no progress, only maintenance. And sometimes, I don't even recognize who I am anymore.
So, my question to you, and so you can teach each other, what do you do when you feel like you've lost your identity? It's good. How about the, uh, what do you have to say or do, or say when you feel like you've lost your identity? And I, I'll just share from our group. It was trying to find something that you enjoy. And again, it's, it comes down to coping, I think. Again, I'm not great at discussing coping. Um, but I think these are skills that we have to build within this community. Um, again, I hear this loss of self all too often. I think it's actually one of the worst things I can hear in clinic.
>> Sure.
>> Let's move on to the next one. Two more. These are two shorter ones. Your eyes are, you open your eyes and you realize you've been transported back in time, back to the exact day before your diagnosis. You see yourself sitting in that waiting room chair. You're anxious. You're clutching that paperwork. You don't quite understand. But you have the gift of foresight, and you know what's coming. The name autoimmune hepatitis. The years, the of labs and medicines, the ups and downs, the lessons that you learned, really the hard way. What do you tell your pre-AIH self that? And talk about advice you'd give to your pre-self. Was there anything Aarna, Ethan, or Naughty, or Megan? Ours were centered around optimism and, you know, open-mindedness, but things that made their journey better. Find a, a good doctor, someone that's worth visiting, someone that's a part of your team, willing to discuss, um, and just ultimately taking care of your body, uh, listening to your body. Any other attributes?
>> The one that I liked was, don't eat all the things on prenizone.
>> Can you say that in the like?
>> I enjoyed that one. What was it?
>> Don't eat all the things on prednazone when you're on prednazone.
>> Um, I think another one was, uh, just know that you will learn to live with your new normal. That was one of the big ones.
>> Yeah, that's good advice.
>> Oh, go ahead, Ethan.
>> One of the thing was being a, being your advocate was an important thing that, that we talked about was that this, it's a tough journey, and that you need to be your own advocate in order to uh, help uh, with your disease.
>> No, that's that's that's awesome. And I think that does take trial and error. So, the point is, don't underestimate your body. Again, you know your body better than anybody else, and uh, make sure that that message is clear to your doctor. Yeah. So, I think that's important, and those are some of the things that I talk to patients when I first meet them. I'm at least setting that kind of expectation.
All right, last one. These are all hard-hitting. I don't know what your groups are talking about, but this is deep. So, next one, and the last one before lunch. You are an award-winning author. Now, as your career nears its close, and decide your final book, you must make this the most personal of all. It's an unflinching memoir about living with AIH. You reflect on the years of all the challenges, the flares, the invisibility, the small but profound victories that made life worth writing about. This is going to be your legacy. It's your gift to the world. So, you, yet one question haunts you. What are you gonna call this book? And then finally, the title of your book. Do you guys have one? I, I have one from our group. It's a shortened version. It's just F F Ah. That was one. Was there anything else that you guys came up with?
>> I think we had something like, "My Body Hates My Liver." I think someone said that one. Yeah, we had another one about the that harped on the invisibility of disease and living in that journey.
>> Yeah, we had "All of Me" was one, and then there was another title centered on invisibility that I'm forgetting, but I liked "All of Me."
>> All of me.
>> I think we had "A New Normal."
>> Yeah.
>> A new normal. That's what it is. Okay, got it. I think ours wins. Um, so that concludes today, guys. This is, uh, I, I hope you've enjoyed this first session. We, we tried to make it interactive. I think this is really important for this community. Um, I'm going to turn it over to Megan. She can tell you a little about some of the instructions for this evening and afternoon. And we know these are long days. And again, this used to go all day. We've trimmed it back way. But now is the fun part.
>> Yeah. Right. Exactly. But again, lean into the community. I hope you've met some new friends, and uh, keep talking AI, but talk about some other things, too.