 We have gone over a little bit, but we still have time for a panel discussion. Does anybody have any questions for our group up at the table? Yes. Let me grab a mic back to you. As we increasingly recognize these patients as potentially having cardiac amyloidosis, we do more testing. After the clinical suspicion comes the testing for monoclonal gamopathy. There are scenarios wherein we don't have your immunofixation, both serum and urine, negative, no monoclonals, and yet you have capillum, the ratios that are high. Their kidney function is okay. So tell me what is happening in your mind and what would be the workup that you would recommend going forward, aside from going for the next imaging test of choice? Yes. Thanks for the question. So great question because it's so clinically relevant, and if you spend any amount of time in the clinic working up these patients, this is a very routine dilemma that we see. In my time at Mayo, I feel like I was routinely receiving emails from our friends in Heart Failure Clinic regarding, hey, what do you think about this light chain ratio? So one thing I would often attempt to advocate for, if you have a colleague from a hematology standpoint that you have faith in, I would never hesitate to run these type of scenarios by them. But I would have an extremely low threshold to refer that type of patient. I think if, obviously, there is something clinically that made you think, I'm going to do this test. And if there's a light chain abnormality, I would say at least lateral that over to a hematologist that you feel like has experience with amyloid to help kind of decide, is this something we need to go on and do a bone marrow biopsy for or further evaluate for. So in that scenario that you highlighted, I think one thing I kind of quickly alluded to in my talk, I would honestly say, so from a hepatic standpoint, so in patients who have metabolic syndrome, you see some, an ultrasound, some steatosis. So that's a very common scenario that we can actually see from a hepatic perspective, this immunoglobulinemia. And so one thing that can reinforce that, if you check an IgG level in those patients, oftentimes it's high, and it just goes along with that they kind of have polyclonal stimulation. Another common scenario is vaccination, so it's not a long-term phenomenon, but a patient gets a booster and their light chains get checked a week later. And so that's a reason to potentially follow it up or an actual infection. So lots of, I would say, nuances to it. So it's a very sensitive test, not a very specific test. Thanks for some great talks. I have some provocative questions, one, and it's sort of in all three areas. So number one is in any patient that's diagnosed with cardiac amyloid who doesn't have a definitive diagnosis of polyneuropathy, should we be referring to neuro, to do EMGs, nerve conduction studies, et cetera, once we've made a diagnosis of amyloid? Second question from a heme standpoint is, from what I understood from the talk and my understanding, you know, obviously if we get a capital lambda, that's a sensitive test, as you said, but not very specific. Is there any reason why we can't just do that as a first-line test and then go to, let's say, immunofixation only if it's abnormal? Is there a reason that we have to do all three up front? And then the last question, I guess, is, I don't think my lab has calcium blue. It seems like it's a really good stain. What's your sense of how many labs actually have it and should we be pushing for that in our labs? I don't know how much it costs or whether it's actually, you know, something that people don't have for a specific reason. Thank you. I can tackle, you know, part two of that question from a testing standpoint. So, you know, some of the data that kind of goes back now, probably 10 plus years, so Dr. Katzman at Mayo Rochester who really helped pioneer some of the free light chain testing in the first place, some very nice papers who kind of look at, you know, these are bona fide patients with known AL amyloid and they screen them, they say if you do an S-pep only, what's your percentage you pick up? You an S-pep plus immunofixation, what's the present when you do, you know, plus all those two and then add a free light chain. And then lastly, if you do all of the tests, essentially five tests. So essentially, if you do all five tests, you pick up 100% of patients. You know, if you ultimately leave out the urine, you're going to miss a few percentage if you've done those other ones. So I guess that's where I would go back to, I'm a realist. I'm, you know, if ultimately a urine test isn't done at the first pass, I'm not heartbroken by that as long as there's a free light chain. So I will say the serum immunofixation, if you were going to really say, gosh, budget cut back, sorry, Dr. Larson, you only get two tests. You know, if you had to do it, free light chains plus a serum immunofixation, you're going to pick up the vast majority of those patients. So it really kind of boils down to a sensitivity. There are patients with amyloidosis who make very few light chains, which I know it's kind of a misnomer. Like it's light chain amyloid, shouldn't they have high light chains? But ultimately that serum immunofixation will pick up some patients, that their light chains kind of look quote unquote normal. And I will tend to see this with the lambdas, since the lambdas are the ones that, you know, if you've got a little bit of an elevation of your Kappa, because they've got some renal impairment, their lambdas are sort of on the upper end of normal, the ratio looks normal. But when you actually treat that patient, you see their lambdas fall quickly. So, so basically, you know, the immunofixation does, does add, you know, some value with picking up some additional patients.