So segue into s- you know, pruritus specifically, when a patient with PBC tells you that they have itching, what's your first step?

Well, first of all, it's a little bit like when I ask you, "Are you itchy?" People will automatically feel a little itchy, right? And so you wanna be careful that you're not, uh, eliciting events that aren't really relevant.

So I usually try to phrase it in a way of, um, not just do you experience itching, but, like, how often does itching prevent you from getting to sleep, or do you find that, that you're scratching your, your back against a wall, or are your palms and soles, like, impacted to the point where you're picking your shoes or your socks differently, or that you are doing something differently, as opposed to, "Hey, are you ever itchy?" In which you're like, "Well, yeah, I think I am itchy." Um, and so that, that's a little bit harder.

Um, I do have people...

Remember, like, a lot of our patients are part of, um, you know, these groups that are support groups which are incredibly important for patients.

But, um, sometimes learning that you are supposed to be tired and itchy also will have a person come in and say, "Hey, listen, I think I'm itchy," and I will ask about, you know, like, fabric detergents and, you know, new perfumes, all the things that you would normally do if a person who doesn't have PBC starts to complain of a new itch.

Um, and then even in your physical exam, if the person's not complaining, if they're covered in excoriations or scratch marks, um, you're really gonna get the sense of, "Hey, listen, are, are you finding that you're scratching all the time?" And even if they say no, sometimes a family member or their spouse is like, "Oh, yes, you're always scratching," and you can see that on their skin.

When a patient tells you, "I'm exhausted all the time," how do you actually approach that?

So segwaying into, you know, puritis specifically, when a patient with PBC tells you that they have itching, what's your first step?

Well, first of all, it's a little bit like when I ask you, are you itchy? People will automatically feel a little itchy, right? And so you want to be careful that you're not eliciting events that aren't really relevant.

So I usually try to phrase it in a way of, not just do you experience itching, but how often does itching prevent you from getting to sleep? Or do you find that you're scratching your back against a wall? Or are your palms and soles impacted to the point where You're picking your shoes or your socks differently or that you are doing something differently as opposed to, hey, are you ever itchy? And which you're like, well, yeah, I think I am itchy.

And so that that's a little bit harder.

I do have people remember, like a lot of our patients are part of, you know, these groups.

That are support groups, which are incredibly important for patients.

But sometimes learning that you are supposed to be tired and itchy also will have a person come in and say, hey, listen, I think I'm itchy.

When a patient tells you, I'm exhausted all the time, how do you actually approach that?