    [Speaker A]: How are you?

    [Speaker B]: Hi. All good.

    [Speaker A]: Since our last visit.

    [Speaker B]: Oh, asymptomatic. All good.

    [Speaker A]: Yeah. Good, good. How do you. I know we were kind of talking about, you know, the pantoprazole and so on and you know, I know like you had mentioned sometimes you felt like it was harder to remember to take the evening dose. Has it been. You felt like it's been easier to remember to take it lightly or.

    [Speaker B]: Yeah, yeah. I mean, are just set up an alarm so I've just been taking it more regularly.

    [Speaker A]: Okay.

    [Speaker B]: Yeah.

    [Speaker A]: How often do you feel like you've been taking it? Twice a day.

    [Speaker B]: 100% of the time. H. 100% of the time.

    [Speaker A]: I'm so sorry, I couldn't hear you.

    [Speaker B]: 100% of the time.

    [Speaker A]: Okay. I think that's really good. Excellent. Okay, great. And I know you're feeling well before too. So, you know, you know, I think, you know, it's just a question of like what we could do is I guess we last spoke, it was a couple weeks ago, so I guess for about two weeks now we've been doing it 100 of the time. So maybe we could, you know, do that for a total of two months, you know what I mean? And then plan to repeat the endoscopy if you would like. And then, you know, I would say, you know, and if at that time if it still looks elevated, then that may give us enough reason to think about switching to dupixent. Right. What do you think about that?

    [Speaker B]: I actually did my research and I think we can go ahead with like switching to dupixent already.

    [Speaker A]: Okay.

    [Speaker B]: Yeah.

    [Speaker A]: Okay. You feel okay with that? Okay, good. Yeah, I mean, you know, and you can definitely chat with your allergist when you see your allergist next, Dr. Silverman, because you know, it can sometimes help with those other issues too. So, you know, with. Maybe. So, you know. Okay. Yeah. If you feel like doing that, then what I'll do is I'll go ahead and send in the prescription.

    [Speaker B]: I think before you do, can you make sure you like send in the pre filled syringe and not the auto injector.

    [Speaker A]: And you want the pre filled syringe because.

    [Speaker B]: Because I heard like, I researched a lot about like the actual injection itself and the reports were basically that the auto injector hurts way more than the pre filled syringe.

    [Speaker A]: If you want to try that, we can do that. It's. Yeah. And it's just gonna be like the 300 milligrams, like you know, once a week and you know, you'll I think the company will contact you actually and go over inject, you know, instructions and stuff as well after the prescription sent in.

    [Speaker B]: Okay.

    [Speaker A]: But you know, you can inject it like on your thigh or your abdomen if you're injecting yourself. And they just recommend to rotate it on look like the location each week. If you don't want to do it in the same place every single week. Because that area will, you know, just get a little temperature probably. And if someone else is administering it for you to do it on the upper arm. But if you're doing it yourself, you know, you could do it in that area and. Okay, yeah, let me just send it in for you. And if there's any issues with the prescription, I'm sure they'll let us know. But you know, feel free to call our office, you know, if there's any issues there. Okay.

    [Speaker B]: Yeah, one more thing, like a couple more things actually. Like how much of it can you prescribe? Like how much? Like since we're probably looking at like two giving this medicine, about six more weeks. Four to six more weeks. Right. So how much of it? Like will it. Will I have to get a refill later or.

    [Speaker A]: Well, I mean I'm starting you on a new medication which is a biologic. So I do want to follow up, you know, within a few weeks to make sure you're doing okay. So I'm gonna send in like a one month, you know, supply for now, you know, and I can put a refill on it. But I do want to see you within, you know, within a month just to make sure you're doing okay on it.

    [Speaker B]: That makes sense. Okay.

    [Speaker A]: And then, you know, and we'll go from there.

    [Speaker B]: Okay, that sounds good. And how much is the like medication usually cost with insurance?

    [Speaker A]: Yeah. So I don't know, like you're gonna have to go. It depends on your insurance company and stuff. So I'm gonna have to run through your insurance to kind of see what it's going to be because it just really varies per insurance. I don't really have any way to predict what it's going to be for you, so. But did you want this to go to the Amazon home pharmacy or do you want this to go to your local pharmacy?

    [Speaker B]: Amazon home's fine.

    [Speaker A]: Okay. Okay, let me just make sure that this is set up. Okay. Pre filled syringe, 2ml subcutaneously. Just make sure.

    [Speaker B]: So the one on Amazon was advertised as I think once in two weeks. So you might have to double the.

    [Speaker A]: Oh, don't worry. We write the instructions like based on what we, you know, what's recommended. So we don't, we don't write it once every two weeks because that's not how it's done for. You're probably looking at it for a different indication for different conditions. They may do it every two weeks, but for eosinophilic esophagitis, they do it once a week. So. So, okay, so I'm going to send in the pre filled to rin does the requested. I'll give you one refill on that and then that's going to the Amazon home pharmacy right now. And yeah, it says it needs a prior authorization. So, you know, our office will work on that. But just give it a little bit of time.

    [Speaker B]: Sure.

    [Speaker A]: But yeah, I think, you know, keep the pantoprazole on board for now though. You know, until you're able to start that medication. Then you can overlap it by, know, a week or two. There's no like, clear thing to say. It's not like when you stop that medication immediately, your symptoms are going to come back or anything. But there is something called rebound reflux that can happen when you stop, you know, a proton pump inhibitor within a few days to a week or so where you can get a little bit of acid reflux. So even if you wanted to take it like every other day for a week or so, you could do that too to minimize risk of that. But you could also just stop it like, you know, just on its own. But just keep in mind that's like a normal physiological thing that happens and it should normalize within a few days if you do notice symptoms every day.

    [Speaker B]: Okay, I see. So what, what exactly are you suggesting? Like, I take dupixent for about two weeks and then start tapering the like, pantoprizer.

    [Speaker A]: You can. There's no clear like, like way to do it, but, you know, if you just want to have it on board. And now the reason I was just saying taper was just because whenever you stop a proton pumping in general, for any indication, like you can get a little bit of rebound acid reflux, which is like a normal physiological thing that can last for a few days. So if you wanted to take it for like every other day for a few days, you could do that if you want to, but you don't have to. Some people would just stop it. You may not even have that. I just wanted to be aware that may happen.

    [Speaker B]: Okay. Okay.

    [Speaker A]: Okay. All right. So I sent that into the pharmacy. I think. Let's just plan to follow up in about a month and presumably at least have been on it for a minute. Hopefully a few weeks, if not a couple weeks by then. Hopefully, they have to ship it to you and everything as well. Right. And the prior authorization to go through and we'll go from there. Okay.

    [Speaker B]: Yeah, Perfect. Thank you so much.

    [Speaker A]: Awesome. Okay, if again, if any issues, just give our office a call and our prior authors. The authorization department is actually really great and, like, really quick with stuff, so they'll they'll work on it as soon as we receive the information from the pharmacy.

    [Speaker B]: Okay, perfect. Thank you so much.

    [Speaker A]: Awesome. You're welcome. Good to see you.

    [Speaker B]: Have a good day. Bye.

    [Speaker A]: Bye.