Thank you for taking the time to educate and explain the complex things in rheumatology. My daughter was recently diagnosed with Auto-Immune SEL and I find your videos so positive and helpful in understanding the different diagnoses, treatments, understanding labs.
Thank you for posting these videos, in the past 3 months my 32 year old son has had DVTs and a PE and diagnosed with lupus I sometimes feel as if we're swimming in quicksand.
Oh boy this one really has me confused! I have RA, but sometimes the doctor calls it polyarthritis. I’m wondering if she thinks I have some thing other than RA but my meds are a straight or a regime. I have binge watched your videos all afternoon and evening today! Love, love, love them. I have learned so much even though I’m not at all new to medicine or to RA. Thank you so much for the depth and detail to what you’re going. Absolutely wonderful info! Now I wish you would dig deep into our a management in sequelae and things that we find ourselves faced with down the line after diagnosis and after we’ve been on meds for a while. It would be really interesting to have you do a deep dive for us. Thank you! Kudos! You’re making a huge difference❤🎉😊
Dr. Ortiz is the beautiful magic fairy, the compliments are Pinocchio (and his nose) and Jiminy Cricket is the antibodies.. They're all a part of Gepetto when he's having a flair and can't make or fix toys. I'm too distracted by sudden overabundance of Sjogren's tears to add Figaro and Cleo! Tagging another autoimmune patient. Great video. Wish I could explain ANYthing this well. Thank you 💌 @Connected Rheumatology
This was explained so well! Thank you for truly breaking it down in medical terms in a way we can all process! I understand the complexities much better after watching this.
Thank you for your vids. You've been more educational than my own Rheumo who when I ask about tests and what they mean , he doesn't answer. so this means alot.
Thank you Dr., I recently joying your channel because I have auto immune disease and my doctors don’t say very much about it. I actually learned more from their PAs. I was told I was in the 10% of people whose blood work does not show lupus. I’m wondering if that test they talk about is the dsDNA. My C3 and C4 blood work is always being taken. I am enjoying your channel, and glad I found you. Thanks again.
I'm glad you are getting something out of it! I suspect they are most likely talking about the ANA blood test, as that is what most people mean when they talk about the "lupus blood test" being positive or negative. Don't hesitate to ask the clinic for a copy of all your results, they are yours, after all. Good luck!
Thank you for this video! Question, so how does ch50 tie into all of this? My c4 was low, c3 was normal and now my ch50 is >60… trying to understand what that means lol
Wow I learned so much like never before has anything been explained so well. I appreciate you believe we should understand our disease. I wish I could see you I would learn so much. I watch a lot of your videos. I was recently diagnosed with EDS, UCTD and possibly MG. I didn’t have any inflammation markers I don’t think. Now I have high CRP level of 12. I’m thinking it should help differentiate the UTCD. I believe I more fit in The MCTD diagnosis. I matched my symptoms before I even saw a Rheumatologist and from watching your videos and studying my symptoms online that I felt I had all these except I feel more like it’s MCTD. I was just happy to finally be diagnosed and I hoped with time the Dr would learn me better and choose a better diagnosis for the UCTD if that makes sense.
I'm one of those 50% that had normal complement at the point of first diagnosis. I have ESL and Sjorgen's, no organ involvement. I was prescribed hydrocloquine 400mg per day. Labs have been good. I decided to change doctor, hydrocloquine was causing dark skin and vision problems. I just had labs done by the new doctor. Labs are good. Sed is at 22. C4C complement is normal. C3C complement is 205. Would you shed some light why c3c complement would be high?
Thanks a lot for educating us which helps us to improve our health. I have lupus/sle c4 complement is 10 at first doctor visit.that time I have symptoms of losing hair, fatigue. Started taking medicine Hydroxychloroquine and been 1 yr. No symptoms but still c4 complement is same 10. Which is concerned to me and to my doctor. Dr thinking to change medicine to benlysta(I think it is shots) because no change in c4. Am bit concerned. What else can you suggest me please. Do you have virtual appointments? I really need your help. How can I get your appointment? I appreciate your reply
What do you do when you get sick 😷 from a treatment and the Dr won't talk to you you can't breath 🫁 heart feels like it is going to smashed by your rib cage
Keep asking dr. Set an appointment for asap! Call the dr office and ask nurse. Switch Dr if they don’t answer ir always give you a hard time. You don’t have a good dr patients relationship and need to find one. Good luck! You deserve someone who will answer your questions and take side effects more seriously!
Elevated heart rate can make you feel like you can’t breath, however a medication causing such high heart rate or difficulty breathing is should not be taken.
I'm blessed to watch your channel. What measures do ypu do for a very high ANA TITER? The blood rrsult came 1:4000 from the normal of below 1:100 supposedly. What are the management for such a very high ANA titer with only a dip in the C3 conplement of 3 points lower and a C4 complement of 2 points higher from the normal result? The patient is on Reconil 2tablets daily with no symptoms of pain, diagnosed with MCTD with only Raynauds Syndrome and hair loss that all came back now. What can we do in this case?
I want to know as well for high levels. I was diagnosed with mix connective tissue disease 4 years ago. And 5 months ago, I was diagnosed with lupus. My health started to decline after I had a laparscopy surgery I had after my son was born. I had seizures, body pain, and migranes, and I was also diagnosed with SIbo for over 3 years. I was on the strongest antibiotics that you can imagine. Through the years, I had early menopause. Age 38, and I'm currently 41 and 1/2. But I will always say. My health has declined after all that Gi surgery. The gut is the key to so many autoimmune problems. Currently staying positive. I started Benlysta infusions for my lupus. I'm praying it works. Wishing everyone good health. And always listen to your body and get second opinions. 😢I got misdiagnosed. I'm great full o followed my gut and found a great rheumatologist.
I have low c1 and c4 and be have Hereditary Angioedema. I just had my c3 levels done and they too are low. If c3 and c4 are responsible for inflammation is it plausible that it is a contributing factor for obesity? Is it possible to have Lupus and Hereditary Angioedema?
I cannot get doctors here to help me enough to figure out what is wrong. I have low C4, low C3a, high IL-6, high IL-10, high ANA, high SSA-Ro (yes suggestive of Sjogren's - but have not had lip biopsy - rheum recommended against it), and said not confident it is SS. So where do I go from here at this point is my question? I'm so tired of being sick and tired. I have other autoimmune conditions - Grave's Disease, Ocular Rosacea, etc... also have Osteopenia, small fiber neuropathy (suspected to be autoimmune fgfr3 related), and more. If I were a friend, what would you tell me to do? And thank you for being a doctor who believes that patients can be educated, and are educated, as well. That is a very much appreciated trait that you have.
@@soundsrelaxing888 I have medicaid. I recently was able to go see a different rheumatologist. That rheumatologist said I needed to go to a place like Mayo, Cleveland Clinic, or Vanderbilt. With Medicaid, you have to have a separate referral for each specialty you are going to see. My primary care doctor said I just need to give up and accept things as they are. I did not like that response whatsoever. I cannot write my own referrals. I am so tired, and I cannot begin at the beginning yet again, with yet another new doctor....
My Ana was. 1:160 and speckled..my rheumatologist thought because of my compliments being normal that I don’t have a auto immune problem. I’m miserable and I don’t understand. I do have fibromyalgia and osteoarthritis. I’m so upset. I’m not sure what else to do. My complement 3 was 161.
Hello Dr Ortiz. Thank you for your excellent video. I'm just wondering if complement levels will be abnormal if someone has one of the Autoimmune Paraneoplastic Syndromes? Thank you very much.
Depending on the type of paraneoplastic syndrome the person is having, yes, complements may be low. But there are so many varieties or flavors of autoimmune paraneoplastic syndromes that it's hard to generalize.
@@ConnectedRheumatology Thank you so much for your reply. Is it a neurologist who tests the paraneoplastic antibodies or does a rhumatolgist also test for these? Thank you again.
I know your channel isn't a replacement for a medical appointment, but what if someone doesn't have a diagnosis but their labs say they have a positive ANA, normal C3, and slightly low C4 (9, when the low normal is 12).
Dear Dr i have beem diagnosed with Rheumatoid arthritis..pain in my hands and my fingers become stiff and its difficult to make a closed fist...its both hands. I also have pains in my arms both sides..between the shoulder and the elbow. Especially in the morning. My left knee also pain and both feel knees feel soo stiff before getting up. Please advise the type of medication or pills i must take. I only take 2 pain pills and 1 tramadol. Kind regards Lochline Kensley..Cape Town, South Africa.
That's my situation, as well, and I can't find any answers to that question.....and it's going to be a very looooong 3 weeks until my Rheumatology follow-up.
My complement is high and it's stating my C4d is high..... My test is showing a high red. I read it's dealing with my kidneys... I have skin issues and low iron
Hope you can give your opinion pls, my primary dr did an ANA test wich one of them come positive and she told me I have lupus she told me to go to a specialist rheumatologist so they can treat me so I went to specialist and I show the Anna test and the rheumatologist told waiitttt a min!! Not because you had an Anna positive means you have lupus that's my job to tell you not your primary doctor so she ask me some questions like if I ever fevers, a butterfly like rash on my face or if my joints hurts and I say no then she told me I will run some test to make sure you dont have it so she did the test where I saw c3 and c4 and dont remember the other one but everything came negative and she told me see I told you, you dont have lupus and i went back to my primary dr for a follow up to see what the rheumatologist told me and she said nope those test the rheumatologist did is not for lupus go to another rheumatologist because once your positive on anna test is positive what should I do??? Pls help
Your primary is wrong It's honestly insane that they would tell you you were positive just because you had a positive Anna does not mean you have lupus honestly I've had several positive and several negative as well Unfortunately they come and go they can change quite quickly depending on your symptoms if you're in a flare it might be positive or if you're not it might be negative do you know what your score was was that would be interesting to find out and also your primary is not the person to diagnose you if you did have lupus that's a rheumatologist's job I really wouldn't recommend listening to the primary if they tried to say that you had it if you didn't if the doctor did all your tests in your test were negative and you're not having the symptoms and I wouldn't really worry about it
Go to another doctor. You won't have every symptom. Lupus goes Positive and then negative. I had pos and neg. No dsDNA but titer 1:80. Tested again all came back neg but the compliment is in the red it isn't low and it's saying I have an autoimmune disease...... It's might be pointing towards kidney damage or something with my kidneys. I go to a Rheumatologist doctor soon. Go to a hematologist as well. Don't stop at one doctor
@@soundsrelaxing888 thank you I went to another rheumatologist and everything came normal I went to neurologist it came everything good I went to neurologist and everything came good as well 🙏
@@JamiesLife thank you for replying Jamie I went to another rheumatologist they run all the test and they came negative I also went to the neurologist and some other everything came good thanks God I only have allergies 😅🙈😁
Primary should know that making a lupus diagnosis is not that simple, & should have referred you to a specialist for more definitive testing & diagnosis. Hope your primary simply wanted to minimizei the hassle for you.
Just like having low complements can be associated with some autoimmune diseases, having persistently elevated complements can be seen in others. And just like with low complements, high complements have to be taken in context of the bigger picture: what are the other lab findings? what are the symptoms?
Thank you for taking the time to educate and explain the complex things in rheumatology. My daughter was recently diagnosed with Auto-Immune SEL and I find your videos so positive and helpful in understanding the different diagnoses, treatments, understanding labs.
Thank you for posting these videos, in the past 3 months my 32 year old son has had DVTs and a PE and diagnosed with lupus I sometimes feel as if we're swimming in quicksand.
Hang in there!
Excellent video, I learnt a lot of information for dealing with my Lupus.
Thank You for explaining so we can understand what is happening to our bodies
Oh boy this one really has me confused! I have RA, but sometimes the doctor calls it polyarthritis. I’m wondering if she thinks I have some thing other than RA but my meds are a straight or a regime. I have binge watched your videos all afternoon and evening today! Love, love, love them. I have learned so much even though I’m not at all new to medicine or to RA. Thank you so much for the depth and detail to what you’re going. Absolutely wonderful info! Now I wish you would dig deep into our a management in sequelae and things that we find ourselves faced with down the line after diagnosis and after we’ve been on meds for a while. It would be really interesting to have you do a deep dive for us. Thank you! Kudos! You’re making a huge difference❤🎉😊
Dr. Ortiz is the beautiful magic fairy, the compliments are Pinocchio (and his nose) and Jiminy Cricket is the antibodies.. They're all a part of Gepetto when he's having a flair and can't make or fix toys. I'm too distracted by sudden overabundance of Sjogren's tears to add Figaro and Cleo!
Tagging another autoimmune patient.
Great video. Wish I could explain ANYthing this well. Thank you 💌 @Connected Rheumatology
Thank you so much for sharing your knowledge.
This was explained so well! Thank you for truly breaking it down in medical terms in a way we can all process! I understand the complexities much better after watching this.
Thank you for your vids. You've been more educational than my own Rheumo who when I ask about tests and what they mean , he doesn't answer. so this means alot.
Excellent explanation, thank you. I have antiphosphospholipd disorder, not active for most part, can you do a video on that?thank you
Thank you again for another informative video!
Thank you!!!! So informative and helpful ❤
what about high complement level? complement B and complement I is elevated
Thank you so much for explaining
this to us.I have always seen it on my blood form.
Thank you Dr., I recently joying your channel because I have auto immune disease and my doctors don’t say very much about it. I actually learned more from their PAs. I was told I was in the 10% of people whose blood work does not show lupus. I’m wondering if that test they talk about is the dsDNA.
My C3 and C4 blood work is always being taken. I am enjoying your channel, and glad I found you. Thanks again.
I'm glad you are getting something out of it! I suspect they are most likely talking about the ANA blood test, as that is what most people mean when they talk about the "lupus blood test" being positive or negative. Don't hesitate to ask the clinic for a copy of all your results, they are yours, after all. Good luck!
Thank you for this video! Question, so how does ch50 tie into all of this? My c4 was low, c3 was normal and now my ch50 is >60… trying to understand what that means lol
Wow I learned so much like never before has anything been explained so well. I appreciate you believe we should understand our disease. I wish I could see you I would learn so much. I watch a lot of your videos. I was recently diagnosed with EDS, UCTD and possibly MG. I didn’t have any inflammation markers I don’t think. Now I have high CRP level of 12. I’m thinking it should help differentiate the UTCD. I believe I more fit in The MCTD diagnosis. I matched my symptoms before I even saw a Rheumatologist and from watching your videos and studying my symptoms online that I felt I had all these except I feel more like it’s MCTD. I was just happy to finally be diagnosed and I hoped with time the Dr would learn me better and choose a better diagnosis for the UCTD if that makes sense.
Great video, thank you !
Thank you!
I'm one of those 50% that had normal complement at the point of first diagnosis. I have ESL and Sjorgen's, no organ involvement. I was prescribed hydrocloquine 400mg per day. Labs have been good. I decided to change doctor, hydrocloquine was causing dark skin and vision problems. I just had labs done by the new doctor. Labs are good. Sed is at 22. C4C complement is normal. C3C complement is 205. Would you shed some light why c3c complement would be high?
That’s what I am trying to find out as well why would it be high
I’m researching this, my C3A is high. I have horrible histamine intolerance and Sibo. I hope someone out there has an answer.
Thanks a lot for educating us which helps us to improve our health. I have lupus/sle c4 complement is 10 at first doctor visit.that time I have symptoms of losing hair, fatigue. Started taking medicine Hydroxychloroquine and been 1 yr. No symptoms but still c4 complement is same 10. Which is concerned to me and to my doctor. Dr thinking to change medicine to benlysta(I think it is shots) because no change in c4. Am bit concerned. What else can you suggest me please. Do you have virtual appointments? I really need your help. How can I get your appointment? I appreciate your reply
Is there any concern if complement levels aren’t low but on the lower side? For example: mine is 22 when low is 19 on the scale of the test I took.
What do you do when you get sick 😷 from a treatment and the Dr won't talk to you you can't breath 🫁 heart feels like it is going to smashed by your rib cage
Keep asking dr. Set an appointment for asap! Call the dr office and ask nurse. Switch Dr if they don’t answer ir always give you a hard time. You don’t have a good dr patients relationship and need to find one. Good luck! You deserve someone who will answer your questions and take side effects more seriously!
Elevated heart rate can make you feel like you can’t breath, however a medication causing such high heart rate or difficulty breathing is should not be taken.
I'm blessed to watch your channel. What measures do ypu do for a very high ANA TITER? The blood rrsult came 1:4000 from the normal of below 1:100 supposedly. What are the management for such a very high ANA titer with only a dip in the C3 conplement of 3 points lower and a C4 complement of 2 points higher from the normal result? The patient is on Reconil 2tablets daily with no symptoms of pain, diagnosed with MCTD with only Raynauds Syndrome and hair loss that all came back now. What can we do in this case?
In your webinar you specifically refer to complement levels associated with Lupus. What about other diseases such as small cell vasculitis?
What does it mean if your complement is high
Would love to know this! My C3A is high and I have Sibo and horrible histamine intolerance 😮
I want to know as well for high levels. I was diagnosed with mix connective tissue disease 4 years ago. And 5 months ago, I was diagnosed with lupus. My health started to decline after I had a laparscopy surgery I had after my son was born. I had seizures, body pain, and migranes, and I was also diagnosed with SIbo for over 3 years. I was on the strongest antibiotics that you can imagine. Through the years, I had early menopause. Age 38, and I'm currently 41 and 1/2. But I will always say. My health has declined after all that Gi surgery. The gut is the key to so many autoimmune problems. Currently staying positive. I started Benlysta infusions for my lupus. I'm praying it works. Wishing everyone good health. And always listen to your body and get second opinions. 😢I got misdiagnosed. I'm great full o followed my gut and found a great rheumatologist.
What complement levels should be tested for cutaneous vasculitis, on-going for over a year, on methylprednisolone same amount of time.
i have axspa and psoriatic arthritis my c3 c4 and crp are allways high.
Will these compliments also be low for MCTD?
I have low c1 and c4 and be have Hereditary Angioedema. I just had my c3 levels done and they too are low. If c3 and c4 are responsible for inflammation is it plausible that it is a contributing factor for obesity? Is it possible to have Lupus and Hereditary Angioedema?
I cannot get doctors here to help me enough to figure out what is wrong. I have low C4, low C3a, high IL-6, high IL-10, high ANA, high SSA-Ro (yes suggestive of Sjogren's - but have not had lip biopsy - rheum recommended against it), and said not confident it is SS. So where do I go from here at this point is my question? I'm so tired of being sick and tired. I have other autoimmune conditions - Grave's Disease, Ocular Rosacea, etc... also have Osteopenia, small fiber neuropathy (suspected to be autoimmune fgfr3 related), and more. If I were a friend, what would you tell me to do? And thank you for being a doctor who believes that patients can be educated, and are educated, as well. That is a very much appreciated trait that you have.
You need a new doctor asap
@@soundsrelaxing888 I have medicaid. I recently was able to go see a different rheumatologist. That rheumatologist said I needed to go to a place like Mayo, Cleveland Clinic, or Vanderbilt. With Medicaid, you have to have a separate referral for each specialty you are going to see. My primary care doctor said I just need to give up and accept things as they are. I did not like that response whatsoever. I cannot write my own referrals. I am so tired, and I cannot begin at the beginning yet again, with yet another new doctor....
Good Evening. Asking for a family member. Is a C3 169 high and C4 53 high?
My Ana was. 1:160 and speckled..my rheumatologist thought because of my compliments being normal that I don’t have a auto immune problem. I’m miserable and I don’t understand. I do have fibromyalgia and osteoarthritis. I’m so upset. I’m not sure what else to do. My complement 3 was 161.
Plus my c4 was 33
Hey what was your diagnosis?
If your complement c4 is always normal but over a year has been steadily decreasing what can that mean?
What does a high C4 mean
What about a low C3 but high complementary total?
Can C3 and C4 be affected by scleroderma?
Hello Dr Ortiz. Thank you for your excellent video. I'm just wondering if complement levels will be abnormal if someone has one of the Autoimmune Paraneoplastic Syndromes? Thank you very much.
Depending on the type of paraneoplastic syndrome the person is having, yes, complements may be low. But there are so many varieties or flavors of autoimmune paraneoplastic syndromes that it's hard to generalize.
@@ConnectedRheumatology Thank you so much for your reply. Is it a neurologist who tests the paraneoplastic antibodies or does a rhumatolgist also test for these? Thank you again.
Good morning Doctor. Please my complement C5 is very high. My doctor said she can't refer because she doesn't understand what it means. Please help.
How low is low? I have C3 98 and C4 17. I’m being tested for lupus.
Thanks
Hi what does it mean if you have a high C1q, c3 and c4?
I have the same question, why is my C3 211 and they checked for infection which I don’t have. My HS CRP is 10. Why am I so inflamed
I have Sjogren's and my C3 ahs been both high and low in the past, why?
My c3 is high but my ana was pos now it's neg with a neg DNA. This lupus is a mess. I have so much inflammation
I know your channel isn't a replacement for a medical appointment, but what if someone doesn't have a diagnosis but their labs say they have a positive ANA, normal C3, and slightly low C4 (9, when the low normal is 12).
Dear Dr i have beem diagnosed with Rheumatoid arthritis..pain in my hands and my fingers become stiff and its difficult to make a closed fist...its both hands. I also have pains in my arms both sides..between the shoulder and the elbow. Especially in the morning. My left knee also pain and both feel knees feel soo stiff before getting up. Please advise the type of medication or pills i must take. I only take 2 pain pills and 1 tramadol. Kind regards
Lochline Kensley..Cape Town, South Africa.
What would you do for a patient with a C7 deficiency?
Can a high C3 indicate encephalitis?
What is high complement mean
Could my low complements be connected to low rdw?
My C3 is 0.84 low. What does that mean? 😔 I’m having so many health issues and pain..
What if your c3 and c4 is normal but ch50 is above the max for your lab?
That's my situation, as well, and I can't find any answers to that question.....and it's going to be a very looooong 3 weeks until my Rheumatology follow-up.
My complement is high and it's stating my C4d is high..... My test is showing a high red. I read it's dealing with my kidneys... I have skin issues and low iron
What if you have high complements
Hope you can give your opinion pls, my primary dr did an ANA test wich one of them come positive and she told me I have lupus she told me to go to a specialist rheumatologist so they can treat me so I went to specialist and I show the Anna test and the rheumatologist told waiitttt a min!! Not because you had an Anna positive means you have lupus that's my job to tell you not your primary doctor so she ask me some questions like if I ever fevers, a butterfly like rash on my face or if my joints hurts and I say no then she told me I will run some test to make sure you dont have it so she did the test where I saw c3 and c4 and dont remember the other one but everything came negative and she told me see I told you, you dont have lupus and i went back to my primary dr for a follow up to see what the rheumatologist told me and she said nope those test the rheumatologist did is not for lupus go to another rheumatologist because once your positive on anna test is positive what should I do??? Pls help
Your primary is wrong It's honestly insane that they would tell you you were positive just because you had a positive Anna does not mean you have lupus honestly I've had several positive and several negative as well Unfortunately they come and go they can change quite quickly depending on your symptoms if you're in a flare it might be positive or if you're not it might be negative do you know what your score was was that would be interesting to find out and also your primary is not the person to diagnose you if you did have lupus that's a rheumatologist's job I really wouldn't recommend listening to the primary if they tried to say that you had it if you didn't if the doctor did all your tests in your test were negative and you're not having the symptoms and I wouldn't really worry about it
Go to another doctor. You won't have every symptom. Lupus goes Positive and then negative. I had pos and neg. No dsDNA but titer 1:80. Tested again all came back neg but the compliment is in the red it isn't low and it's saying I have an autoimmune disease...... It's might be pointing towards kidney damage or something with my kidneys. I go to a Rheumatologist doctor soon. Go to a hematologist as well. Don't stop at one doctor
@@soundsrelaxing888 thank you I went to another rheumatologist and everything came normal I went to neurologist it came everything good I went to neurologist and everything came good as well 🙏
@@JamiesLife thank you for replying Jamie I went to another rheumatologist they run all the test and they came negative I also went to the neurologist and some other everything came good thanks God I only have allergies 😅🙈😁
Primary should know that making a lupus diagnosis is not that simple, & should have referred you to a specialist for more definitive testing & diagnosis. Hope your primary simply wanted to minimizei the hassle for you.
My ch50 is 91 is that high or low?
What about a high compliment?
Just like having low complements can be associated with some autoimmune diseases, having persistently elevated complements can be seen in others. And just like with low complements, high complements have to be taken in context of the bigger picture: what are the other lab findings? what are the symptoms?
Mines high sed rate, high CRP
@@CANDGIRL271I also had high CRP, high sed, and high C3. I hold a diagnosis of UCTD so far. Have you found out more for yourself?
@@Lathilia I have an appointment for Monday and lots of referrals so I will let you know in the months to come
Could you do a video on u1RNP?
My son has high levels in c4
I would like to find out more about genes... there are genes on genes linking them with Lupus.
Thank you 😊
Thanks