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Take care. 
All right, so coronary artery 

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disease. 
Where are the coronary arteries?

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What did they do? 
Coronary arteries are going to 

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be the arteries that provide the
heart blood. 

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So these are the arteries that 
give the heart its blood supply.

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So, you can imagine how 
important they are. 

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So, what happens? 
Well, we've got some risk 

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factors that can cause coronary 
artery disease and that's where 

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we start. 
Let's start with the basics. 

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What can cause coronary artery 
disease? 

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How about high cholesterol? 
Of course, smoking absolutely. 

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smoking alcohol, diabetes diet 
No exercise. 

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So start by educating your 
patients About the risk factors.

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Because if I am to talk to a 
patient, I'm going to tell you 

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and I'm a broken record when I 
say this, don't smoke. 

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Decrease alcohol, eat healthy 
and exercise. 

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Tell me anytime we say the 
opposite of those four 

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statements, you don't see it on 
the board, select all the play. 

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Choose it. 
It's gonna be right. 

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You're never gonna be like, 
yeah, you know what? 

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Today you can smoke a pack. 
We're okay, no, have a couple 

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burgers for lunch every single 
day we're good. 

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No, no, absolutely not risk 
factors for coronary artery 

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disease. 
So the first step Coronary 

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artery disease is get rid of the
risk factors, educate them. 

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Why put them on any 
pharmacological intervention, or

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do any type of invasive 
procedure? 

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If we can prevent this disease, 
remember in real life in real 

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life, we are now becoming 
preventative. 

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Why? 
Because doctors want to get paid

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and insurance. 
Companies are not going to pay 

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them if they have these 
diseases. 

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If we don't screen them if we 
don't document them they'll yank

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that contract right away. 
They don't want to pay. 

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For the long-term effects. 
So educate them early. 

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Alright, well, let's just say 
it's gotten a little bit past 

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this. 
And now are artery. 

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Has developed a plaque. 
So what type of a plaque is this

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a thorough sclerotic plaque? 
Well, don't use memorize after 

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school or a big plaque? 
Know what it means. 

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The artery is narrowed because 
of a plaque. 

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I throw sclerotic plaque. 
Understand what's going on. 

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So what used to be a nice 
healthy open artery now has 

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diminished blood flow. 
If we have diminished blood flow

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to the heart, We are now. 
Causing ischemia. 

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We are not providing the heart 
with the blood supply that it 

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needs. we have now in farted 
this area, how about? 

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The muscle of the heart is now, 
infarcted myocardial infarction.

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Yeah, we don't have blood flow 
in that area. 

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So of course it's going to get 
infarcted. 

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Of course, it's going to get 
ischemic. 

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So now before we go, and I'm 
going to kind of go a little bit

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more in-depth here because I 
want to I want you to see when 

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an MI occurs. 24 to 48 hours 
after What are we concerned 

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about? 
What are we going to monitor 

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them for will? 
Guess what? 

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In The myocardium? 
We've got cardiomyocytes. 

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What is a cardio myocyte? 
It's a cells in the muscle of 

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the heart cells in the muscle of
the heart. 

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If you come to my EKG lectures 
or you're in the course, I tell 

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people what part of the heart. 
Is controlled by potassium. 

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The ventricles So, if potassium 
starts to leak out, leak out, 

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leak out, this electrolyte 
disturbance can cause one of the

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most lethal cardiac 
dysrhythmias. 

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V-fib. 
So, because these sites have 

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died off. 
They've leaked potassium, 

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potassium can put us into v-fib.
That's why in ask graph changes 

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in potassium are one of the 
eight things that we are 

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freaking out about. 
The next thing is, is that if 

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I'm in farting and causing this 
ischemia, In the heart. 

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Is it now going to be weekend? 
Absolutely do we not kill some 

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of it off, do we not compromise 
the structural Integrity of the 

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heart where it was infarcted? 
Yes. 

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So what can happen if this heart
is beating and that wall is 

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compromised. 
Rupture that heart wall can 

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rupture. 
So, not only are we worried 

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about acutely, what's happening 
to the heart, because we've 

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blocked off the blood supply to 
it. 

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But now we're working 24 or 48 
hours later to make sure that 

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there are no complications like,
v-fib or rupture. 

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I used to try and memorize this 
for my boards. 

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I say, oh, if they have an MI, 
then I got to worry about v-fib 

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and then I got to worry about 
well rupture, but I didn't 

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understand it. 
I didn't realize that the 

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cardiomyocytes had potassium in 
it and they were dying off 

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because we had ischemia. 
I didn't realize that all this 

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could happen 24 or 48 hours 
later. 

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So we were watching them. 
Like why are we watching them? 

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We aren't they already had the 
heart attack, but now I had to 

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go back and understand it in 
order for me to pass my boards. 

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So this is how I did it. 
I broke it down to a point where

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I understood it. 
All right, so now we've got 

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these plaques well their 
cholesterol plaques. 

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How can we treat this? 
How are we going to treat 

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hyperlipidemia statins first? 
The question was, how do I treat

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hyperlipidemia? 
So, remember when you're taking 

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your board exam, look at what 
they're really asking, that's 

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why I say, put it in your own 
words. 

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So statins simvastatin 
atorvastatin or rosuvastatin. 

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All statins. 
What are statins going to do? 

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Well, do can work on our lab 
values. 

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They're going to decrease our 
total cholesterol, they're going

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to decrease our triglycerides. 
They're going to decrease our 

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lousy cholesterol or LDL. 
They're going to increase our 

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happy cholesterol or our HDL. 
The rule of 50s for a rough 

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estimate of where the normal 
values lie. 54 HDL. 104 LDL. 

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154, triglycerides and 204 total
cholesterol. 

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But watch this. 
This is where students make 

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mistakes on the boards. if a 
patient's cholesterol, Went from

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380 to 340, but normal is 200. 
Is this medication working? 

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But, but it's only it's at 3:40 
and normal is 200. 

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That wasn't my question. 
My question was, is a the lab 

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value normal? 
My question was, is this 

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medication working? 
Yes, it is. 

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It dropped from 380 to 340 it. 
Did its job. 

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Have we reached our optimal 
results. 

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Not quite dose adjustment. 
So will increase it if we are 

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going to educate this patient 
about when to take this exam or 

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when to take example, what exams
when to take this medication, 

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when are we gonna give it to 
them? 

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Okay, okay, okay. 
Okay. 

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See, I see different answers in 
here at night. 

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Time is wrong. 
I bet time is correct. 

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Look, I live in Vegas, bedtime 
here, varies. 

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People were graveyard shift. 
Nurses work, twelves. 

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So look for those little tricks.
Look for the board's to trip you

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up. 
The correct answer is I bedtime 

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because that's when we go into a
fasting state when we're in a 

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fasting State, we release 
cholesterol. 

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When we release cholesterol, 
perfect time to try and attack 

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them. 
Prior to administering this 

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drug. 
Look at the word I used prior. 

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To those little words, change 
the hole. 

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Question, or the whole answer 
prior to giving his medication. 

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What are we going to check? 
Check your liver function tests.

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Alt AST. 
I look Foss prior to does it's 

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no good if we check after takes 
away our Baseline. 

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There is a side effect that 
we're concerned about. 

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And the side effect that we are 
concerned, about is my APA thie.

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Myopathy is muscle pathology. 
There's something wrong with my 

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muscles and the specific 
myopathy that were concerned 

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about Is rhabdo. 
Mayo. 

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Lysis. 
The rabbit emir's of my muscle 

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are being sliced or broken down.
My muscle is breaking down. 

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Well, what is muscle made of 
protein? 

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Think about it. 
If I go to the gym and work out 

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and I want to get all buff, I'm 
gonna go and get what a protein 

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shake because I want to get big 
muscles. 

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Makes sense, right? 
Go. 

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Workout Core. 
Workout Core workout. 

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Would I need protein. 
I need my muscles. 

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So I can get all the hot ladies 
but if you break down your 

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muscles you're breaking down. 
What you're breaking out of 

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protein. 
Protein is going to get 

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dispersed and try to get 
excreted, and it's going to clog

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our glomeruli. 
All this access breakdown is 

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going to clog our glomeruli and 
we will develop acute kidney 

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injury. 
And if we do not aggressively 

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Hydrate with IV fluids, this 
acute injury will lead to acute.

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Renal failure. 
How's the patient going to come 

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in with Rhabdomyolysis? 
They're not going to walk in and

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say nurse I think I got rhabdo. 
It would help us a lot but can't

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do that. 
Yeah they're gonna come in with 

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some muscle pain, muscle 
tenderness muscle weakness. 

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If a person's on statins and 
they haven't done anything 

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extensively and they're 
complaining of muscle cramps, 

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muscle tenderness muscle pain. 
It should be a red flag. 

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What's going on? 
You were just fine. 

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Oh, it's presses on Statin. 
Let's get some blood work. 

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Let's check your kidney 
function. 

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And how do we check that be in 
creatinine? 

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You got it. 
Hey guys, dr. 

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Deshawn here. 
Thank you so much for joining us

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00:14:24,700 --> 00:14:26,800
on this podcast. 
Hope you guys enjoyed it. 

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00:14:26,800 --> 00:14:30,400
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good one. 

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