wondering what you know what do you feel like what are the major changes that are going on at middle of six what is this year looking like what new fun innovative special things are we up to that people should know

about oh gosh man a lot is going on at middle of six last year the I didn't intend it to be a theme, but it fully turned into a theme.

It was actually my annual goal, which was like, I really want to focus on the client experience.

And what does that mean? And what do we need to do? And it just was like brewing in my mind.

But then it became like a rallying cry and everything I was working on and, you know, trickled down to the team too.

So in 2025, I feel like we leveled up a lot of our... processes and tools.

We're in our 10th year, kind of approaching 10 years of middle of six in 2026.

it's going

So how does persistent hyperuricemia lead to monosodium urate crystal deposition throughout the body? And why is that important beyond the joints?

Absolutely.

So when we have a state of hyperuricemia, when we find that there's this high level of uric acid, that it's actually exceeding the saturation limit of the uric acid level.

You know, our body lacks uricase enzyme that can break down the uric acid that normally gets excreted by the kidneys to be safe.

So then in turn, when you think back, if you have a real high saturation level, the kidneys can only excrete so much, you know, what then is going to be that process? You know, we've had that target level of six to seven, perhaps of a uric acid level that is to have been presumed or assumed to be, you know, that saturation level limit of the uric acid level.

So we have greater saturation.

We have to think about what's going to happen to that high uric acid.

So, you know, when gout remains uncontrolled, talk to me about what some of the structural and musculoskeletal consequences that can develop over time.

I would be happy to.

I've got a different background than you probably suspect.

Right out of nursing school, I actually went into labor and delivery.

Did that for a number of years.

Worked across three hospitals, really, because I was one of those crazy people who worked 12-hour nights and was trying to keep my schedule the same.

So I did labor and delivery and some high-risk labor and delivery at a hospital.

Also did inpatient peds.

So looking into our magic eight ball or our crystal ball, what do you think that means, Wendy, for how outpatient surgery and ASCs will continue to evolve? What are some things we all need to be thinking about no matter where we work in terms of that movement of care?

None of this is shocking to me, but I'm interested to see what you say.

Oh, my gosh.

I am busting at the seams completely.

Love this one.

Love this abstract.

Fabulous.

And it's a complete appropriate teaching tool, especially for us in rheumatology as well.

But again, I think it just highlights the importance that we continue to monitor our patients closely.

And you being kind of the osteoporosis guru that I obviously consult all the time when I'm talking about my patients, what do you make of this?

Amanda, this is so appropriate.

I think most perfect timing and...

Definitely something to follow, I believe, as well.

I love this as well for a topic here with an abstract.

I am having more and more patients, obviously, that are on GLP-1s and treating for osteoporosis and questions coming up.

with regards how that GLP-1 is going to affect potentially the outcome of their next bone density, their bone health, effectiveness of the therapy that I am using as well.

And to your point, I think the other thing is, will patients on GLP-1s, you know, should we be more thinking about an injection or an infusion for those patients to try to potentially limit some of these, you know, AEs? Again...

All right, Wendy, I'm very interested to hear what you think of this study.

Absolutely.

And I love it.

I, ever since being in rheumatology, have always realized and recognized that there's patients that we treat, and especially with that use of steroids that we have.

And it is in rheumatology that we do pay attention to steroids.

I know there's multiple other disciplines that have patients on steroids.

Certainly, osteoporosis has not been always on the top of everybody's first checklist to evaluate and evaluate.

Do you want to talk to us about an abstract?