Home › Nicholas Myers › Posts

Posts by Nicholas Myers

1304 posts shown.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · Jun 23, 2021

Excuse me,

In your previous posts, you mentioned hypertension and tinnitus, which suggests there’s more going on here than just a low white blood cell count. We aren't going to get very far if we just keep digging through old data points. In my view, a rheumatology consult is necessary to rule out systemic rheumatic diseases. Before that appointment, you should definitely have your complement levels checked (C3, C4, CH50) and test for antiphospholipid antibodies (aCL IgM, IgG, LAC, beta-GPI). If you've only had protein electrophoresis, you'll need to check your IgA, IgM, and IgG levels as well. Make sure a full biochemistry panel is completed if anything was missed, along with a urinalysis to check the protein-to-creatinine ratio and an eGFR calculation.

Do you have the fluorescence pattern results if the ANA was determined via IIF? And was an ENA screen performed—was that negative as well?

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · Jun 23, 2021

Sandra Vaughn82 said:No issues besides low white blood cell counts—sitting at 2.8 for about a year now.

If memory serves, didn't you mention some musculoskeletal issues that require NSAIDs? So, there's more to the story than just the labs...

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · Jun 22, 2021

Sandra Vaughn82 said:I'm wondering if elevated immunoglobulin (31) and ANA (1:2500) levels are linked to antibodies appearing two weeks after the first dose of Pfizer. Everything else looks normal.

You had leukopenia, didn't you?

It won't be from Pfizer's vaccine. In your case, this points toward systemic lupus erythematosus (given the hypergammaglobulinemia and significant ANA titer) or perhaps another type of systemic connective tissue disease. Are you experiencing any symptoms? Is the leukopenia still present?

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · Jun 11, 2021

Brenda Alvarez24 said:Felix, thanks for the reply.
Yeah, I've been dealing with some SLE issues lately. 🤦
I have a few questions, so maybe we should move this over to the SLE thread? Don't want to hijack this one...

By all means.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · Jun 10, 2021

Brenda Alvarez24 said:Unlike the last two times, I also had some drinks this morning...
But this isn't just once; it's the third time levels have been elevated.
I used to be anemic and took Iron Mountain, which I stopped once these numbers started climbing.
The elevation isn't massive, but it's there.
Timeline:
https://iili.io/Bb7CmX.md.jpg
https://iili.io/Bb5civ.md.jpg
Started taking Iron Mountain in March 2018
https://iili.io/Bb7oIn.md.jpg
https://iili.io/Bb7xXs.md.jpg
https://iili.io/Bb7zLG.md.jpg
Stopped Iron Mountain in December 2020
https://iili.io/Bb7TBf.md.jpg
https://iili.io/BDTVzx.jpg
https://iili.io/BDuaQR.md.jpg

Still, my immunologist-rheumatologist referred me to a hematologist.
( Dealing with SLE & APL Sy )

Dear Nicholas Davis4,

Generally speaking, polycythemia is considered when hemoglobin exceeds 160 g/L or hematocrit rises above 0.48.

The values you provided are borderline. From what I can see, hemoglobin was only above 160 g/L in a single test.

There are numerous reasons for results like this. It is more likely a secondary cause—meaning it isn't a primary blood disorder, but rather linked to oxygen deprivation (hypoxia) or increased erythropoietin production.

Given the respiratory symptoms you discussed extensively in the lupus thread, and considering your underlying condition (SLE), the first priority should be ruling out pulmonary pathology.

Your MVP reading isn't significantly high. In clinical practice, values up to 11.5 fL are still considered normal. That said, patients with antiphospholipid syndrome often show higher MVP levels. Elevated MVP can also be seen in lung disease.

Since the list of potential causes is quite long, given your specific symptoms, I would rule out respiratory issues first before looking elsewhere.

Looking for a specialist... in Health · Jun 6, 2021

Kimberly Ward said:Just relax. ☕ When someone else suggests the same clinic without even knowing the doctor's name, nobody cares. See the previous page for the post by mistyjackal842.

Dear Brandon Newman95, I’m going to ask you to stop recommending private clinics when it's clear you have zero personal experience with them. Your suggestions basically boil down to one thing: never suggest a public institution, only private ones.

Thanks, message received. Now, please refrain from repeating yourself if you don't have anything new to contribute.

Please stop commenting on this moderator warning within this thread; follow the instructions provided.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · May 20, 2021

Chris Chase4 said:Could someone who understands blood work explain why my MCH and MPV levels would be low when everything else looks fine?

Here are the basic values and the reference ranges in parentheses:

WBC 8.4 ( 3.4 - 9.7 )
RBC 4.88 ( 3.86 - 5.08 )
Hemoglobin 133 ( 119 - 157 )
Hematocrit 0.410 ( 0.356 - 0.470 )
MCV 83.5 ( 83.0 - 97.2 )
MCH 27.3 L ( 27.4 - 33.9 )
MCHC 327 ( 320 - 345 )
RDW 12.6 ( 9.0 - 15.0 )
Platelets 245 ( 158 - 424 )
MPV 6.2 L (6.8 - 10.4 )
Lymphocytes 40.7 ( 20 - 46 )
Monocytes 7.1 ( 2 - 12 )

I previously had an episode where I essentially "overdosed" on Vitamin B12 after breaking my arm—I experienced numbness in my hand and face, along with some chest pain, because I was taking B-complex vitamins daily alongside a standard diet. That mild tingling still happens occasionally, and it seems to trigger whenever I consume B12 through multivitamins or foods high in it. As for my heart, everything seems fine since I’ve already had an echocardiogram and a Holter monitor test.
I assume these numbers are negligibly low, but I'm wondering if this could be a result of that B12 spike or perhaps my daily fish oil capsules over the last two years.

Hello,

Since your hemoglobin and platelet counts are normal, the MCH and MPV values in your report aren't particularly meaningful; in fact, they are practically within the normal range. Regarding whether you overdosed on Vitamin B12, I can't say for certain, but it doesn't seem likely.

Regarding how Vitamin B12 and Omega-3 fatty acids affect MCH and MPV, here is the breakdown. In individuals without anemia (which you do not have, based on these results), the influence of B12 levels on MCH (average hemoglobin per red blood cell) is minimal. Generally, there is a positive correlation: as B12 rises, MCH rises. However, even an increase of several hundred pg/ml in B12 concentration might only bump the MCH by about 1 pg. Theoretically, if someone has very high B12 levels and no anemia, we would expect a higher MCH, not a lower one. Therefore, an MCH at the bottom edge of the scale doesn't align with high B12 concentrations.

As for the effect of B12 on MPV (mean platelet volume), an increase in B12 concentration typically leads to an increase in MPV. Again, this is the opposite of what your results show. A lower MPV suggests smaller platelets, which can sometimes be seen in various inflammatory conditions. However, that isn't significant unless there is also a concurrent abnormality in the actual platelet count, which isn't the case here.

Looking at the impact of Omega-3 fatty acids from fish oil, they don't have a significant effect on MCH, nor do they affect MPV in otherwise healthy people—though they can lower MPV in diabetics.

Based on all of this, it appears that your MCH and MPV parameters are not significantly deviating from the norm and, in your specific case, shouldn't be linked to your B12 supplements or fish oil.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · May 12, 2021

Richard Anderson53 said:Nicholas Myers, what's your take on my cholesterol (link 1) and hormone levels (link 2)?
View on imgur
View on imgur
How does one lower Estradiol? Is it strictly diet, or more about lifestyle changes?
I'm assuming cutting back on dairy helps too?

First, we need to pinpoint why your Estradiol is running high. What are your actual numbers? Height, weight, current symptoms—essentially, why did you get these tests done in the first place?

Living with Antiphospholipid Syndrome in Health · May 11, 2021

Dear,

Regarding the lab results you shared, I have to point out that having both MPO and PR3 antibodies present at the same time—as seen in your case—is quite unusual. When results look like this, we always have to rule out an underlying infection or certain medications that might trigger such a pattern. To be honest, I’m pretty skeptical about this being ANCA vasculitis, though I can't rule it out entirely. As for antiphospholipid syndrome, my stance remains unchanged: seeing only positive antibodies isn't enough to confirm that diagnosis.

I see you've also had coagulation tests performed, specifically checking factors VII and X, along with Protein C and S levels. Those levels are low, which makes sense given that you're taking Warfarin, as indicated by your INR. Since Warfarin works by blocking the production of factors II, VII, IX, and X, it's expected that these levels would drop while on the medication. I’m not entirely sure why these specific tests were requested. It would make perfect sense if factors VII and IX, or Protein C and S, had been tested *before* starting Warfarin—that's how you determine if there's an existing risk for clots or subsequent embolisms. Your entire clinical picture seems centered around clotting and emboli, yet you haven't mentioned them, and thrombosis or embolism isn't listed in your diagnoses. That's a bit confusing.

Furthermore, some genetic testing was done, though not for antiphospholipid syndrome as I suspected, but for thrombophilia. You were identified as a heterozygote for PAI-1, meaning you have the 4G/5G genotype. The highest risk for thrombosis lies with those who have the 4G/4G genotype; for someone with your 4G/5G profile, that risk is significantly lower.

I also noticed testing for the I/D polymorphism in intron 16 of the ACE gene. In individuals with the homozygous D/D genotype, there is a link to higher blood pressure and thickened vessel walls. What's puzzling here is that the report lists "I/D homozygote," which is a contradiction in terms. A homozygote is either I/I or D/D; I/D is a heterozygote. This suggests either a clerical error or an incomplete result.

Additionally, there was testing for a Factor XI polymorphism. Being a C/C homozygote is linked to a higher risk of venous thromboembolism, but your results show you are a heterozygote, which would mean that specific risk doesn't apply.

All in all, as I've said before, this is a complicated situation. We have a mountain of data but no way to review the full medical history or complete physical exams. Without the full picture, we're just spinning our wheels, and we still don't have a definitive answer as to what is actually happening.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · May 9, 2021

feralcobra3 said:Hello,

Thanks for the response. ESR wasn't part of the panel. Unfortunately, my labs don't list absolute values for albumin or other proteins—just percentages. However, total protein is 80 g/L, so I assume those percentages are derived from that total. If that's the case, here are the numbers:

Albumin - 49.29 g/L
Alpha-1 globulins - 2.48 g/L
Alpha-2 globulins - 5.6 g/L
Beta globulins - 6.64 g/L
Gamma globulins - 15.36 g/L

During the biopsy, they didn't actually take a tissue sample. I assume the doctor decided it wasn't necessary since everything looked "clear as day."

For celiac disease, they were supposed to run tTG IgA, but since my IgA levels were low, they ran an anti-DGP IgG test instead. The result was
I went in for blood work today, and three things came back abnormal:
Bilirubin is at 41 µmol/L (normal up to 30)
Conjugated bilirubin is 3.7 µmol/L (normal up to 3)
FDA - 31 U/L (normal up to 27)

AST, ALT, ALP, and kidney function are all normal.

Hello,

Regarding the bilirubin, you likely have Gilbert's syndrome, as I mentioned previously. Some people with Gilbert's describe symptoms like fatigue, abdominal pain, loss of appetite, or bowel irregularities alongside occasional jaundice, though those issues aren't strictly linked to the syndrome—especially if they are pronounced.

In your case, I would suggest adding an ESR to your routine testing.

The lab results you provided don't show any major red flags. However, given that you are experiencing involuntary weight loss—which is always a concern we take seriously—it would be wise to follow up with a gastroenterologist. They should re-evaluate the situation and potentially consider an endoscopy of the lower GI tract.

Constant burning, pain, coldness, and muscle spasms... help! in Health · May 9, 2021

Hello,

The sheer number of symptoms you’re describing, coupled with that prior knee injury, fits the profile of complex Regional Pain syndrome quite well.

Based on what you've shared, I wouldn't expect to find evidence of a systemic rheumatic disease, though it’s impossible to say for certain without a formal evaluation.

There is some excellent literature available on complex Regional Pain syndrome. One of the more comprehensive resources is this: Patient Caregiver Education: Complex Regional Pain syndrome.

Regarding the changes noted in the CCT, the question is whether we are actually looking at Raynaud's, since that disorder can present with similar findings. If you do have Raynaud's, the real question is whether those CCT changes suggest a primary or secondary condition, or if they are simply inconclusive. Given that your ANA came back negative, the likelihood of secondary Raynaud's is slim.

Taking all this into account, a rheumatology consult likely won't lead to a diagnosis of systemic rheumatic disease, but it is still important to follow through with it.

Living with Antiphospholipid Syndrome in Health · May 9, 2021

Donna Lopez79 said:Thanks for the response.
I was discharged from the hospital about a year and a half ago. At that time, my RF and CCP levels were elevated, and the doctors kept leaning toward Lupus. The whole team worked me over, but I left the hospital without a definitive diagnosis—just a carotid and vertebral artery dissection, a prescription for Warfarin, and orders to see a rheumatologist. These specific diagnoses were added later based on follow-up blood work they performed.
Due to the chaos with COVID and the shortage of specialists, I didn't actually see a rheumatologist until March of this year. She ran some labs, and those diagnoses were already sitting there in front of her. They told us they would call to schedule an appointment. When we didn't hear anything, we called them, and were told that from a rheumatology standpoint, everything was fine—that I didn't even need to come in, and that she had sent my results directly to my primary care physician.
Now I'm back at the Coagulation Clinic getting blood drawn again, but looking at a few of the replies here, I'm starting to realize these results aren't going to change.
If you'd like, I can send over the hospital blood work and the subsequent labs that led to these diagnoses. And if anyone has any advice, please, let me know. I feel like I'm just spinning my wheels.

Many thanks.

Ma'am,

With every post, you bring new information that flips the situation 180 degrees. Your case is highly complex. You've seen many different doctors and have a mountain of medical documentation; frankly, you won't get a concrete diagnosis through an online forum.

I'm not entirely sure I follow. You mention a rheumatologist, but looking back at your posts, it's still unclear whether that specialist actually sat down and performed a thorough physical exam. It seems like the conversation keeps circling back to paperwork and lab results being shuffled between doctors while you're simply being scheduled for more blood draws.

A diagnosis for rheumatic diseases—whether it's Antiphospholipid Syndrome or Vasculitis—cannot be made solely from lab reports and paper trails. You need a comprehensive clinical evaluation, a deep dive into your medical history dating back to childhood, and beyond just blood work, various imaging studies and, frequently, a biopsy.

Furthermore, it is highly unusual—almost contradictory—that your treating neurologist is noting suspected Antiphospholipid Syndrome and Vasculitis, while you're stating that from a rheumatological perspective, everything is perfectly fine and the results have been passed along.

If everything is fine from the rheumatology side, why is the neurologist adding new suspected diagnoses instead of clearing them?

As I've noted before, based strictly on what you've shared, I don't see sufficient evidence for Antiphospholipid Syndrome (a positive antibody test alone isn't enough for that diagnosis, and I must reiterate: you cannot diagnose rheumatic disease from paper alone). As for Vasculitis, I wouldn't bet on it; even with positive ANCA antibodies, large vessel dissections are rare, as those types of vasculitis typically target smaller vessels first—though I recognize there are documented cases of carotid dissection in patients with ANCA Vasculitis.

Then there is the lingering question regarding Lupus, which comes up constantly. Based on RF and anti-CCP findings, though in this diagnostic context, ANA is the much more critical marker, not RF or anti-CCP...

Living with Antiphospholipid Syndrome in Health · May 7, 2021

Donna Lopez79 said:The diagnoses are:
1. Suspected secondary Anti-phospholipid syndrome (APS) with positive Anti-cardiolipin and anti-β2-glycoprotein I antibodies (both IgG) at
2. Suspected systemic vascular disease (e.g., Vasculitis) given elevated RF and high ANCA levels
3. Hyperhomocysteinemia
4. Dissections of the carotid and vertebral arteries

In layman's terms, they explained that I wasn't born with this. I have no complaints about their work—they truly went over me with a fine-tooth comb in the hospital. MRI, color Doppler, lumbar puncture, they even did an echocardiogram and an abdominal MRI. They were likely searching for any other dissections. Everything seemed standard. My RF and CCP levels were high, so they kept leaning toward Lupus. It didn't make sense to them why these dissections happened while I'm still young (35 years old).
Today, my neurologist told me the therapy will be lifelong. And I’ll be repeating those blood tests at the Coagulation Clinic at the start of July.

Oh, and because of diagnosis number three, they added B-complex and folate to my regimen. I'm also taking Iron tablets and Vitamin D.

Just a brief comment.

Based strictly on what you've shared so far (noting that I haven't seen your full medical file), you don't meet the criteria for antiphospholipid syndrome. Having positive antiphospholipid antibodies just once isn't enough for a formal diagnosis.

Elevated RF and CCP aren't definitive indicators for Lupus, though they can show up there too. Given the other details you mentioned, I'm actually somewhat concerned that the doctors treating you might not be specialists in rheumatology.

Furthermore, the second diagnosis is much more serious here: the suspicion of Vasculitis, especially with a positive ANCA finding.

What strikes me as odd—though I lack the full picture—is being discharged from the hospital under suspicion of such a condition without a consultation from a rheumatologist. Typically, if there is a suspicion of ANCA-associated Vasculitis, we are talking about severe, aggressive conditions. You need exhaustive testing to confirm or rule it out, and once confirmed, the treatment is "heavy-duty," to put it simply. In that scenario, Martefarin, B-complex vitamins, Iron, and Vitamin D won't touch the problem.

Regardless, you absolutely need to see a rheumatologist for further evaluation as soon as possible. It's surprising to see your care managed by a neurologist consulting with a hematologist, only for you to be released with two potential rheumatological diagnoses hanging over your head.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · May 6, 2021

feralcobra3 said:Hey everyone.

I've been dealing with digestive issues for over a year and a half now. It all kicked off with nausea the morning after drinking at my high school graduation party. Since I’m not much of a drinker, I figured it was just the alcohol. My friends noticed my eyes looked slightly yellow, so I went to see a doctor once I got back home to the States. Essentially, the nausea hits about an hour after eating, though I haven't been able to pin it to any specific food. Some days everything settles fine; other days, it's a struggle. I never actually vomit, but the sensation is incredibly unpleasant. Frequent burping, even on an empty stomach. Then there's the bloating, gas, and occasionally some pain near my navel on the left side, though that usually passes quickly. Occasionally, I get a sharp pain in the upper right quadrant, but that clears up in two or three minutes. My bowel habits fluctuate, but nothing lasts more than a few days. Stools can be yellowish and sticky, though sometimes they look normal. It's inconsistent. What worries me most is the steady weight loss—about 33 pounds over this period. I'm 19, non-smoker, don't drink, etc. I'm 6'3". The latest diagnosis was IBS-C, but I have my doubts given that I'm still losing weight despite eating a normal diet.

My test results so far: Bilirubin was elevated at 42(7 - 30), liver enzymes were normal, CBC was normal, endoscopy was clear, ultrasound was clear... Hepatitis A negative, calprotectin normal. No occult blood, TSH normal. Celiac test was negative. No parasites in stool. Not H. pylori...

As you can see, most things look fine, but these recent values are bothering me:

IgA is low: 0.21 g/L (0.63-4.84)
IgG and Immunoglobulin M are within normal limits

Alpha-2 globulins 7% (7.1 - 11.8)
Beta globulins 8.3% (8.4 - 13.1)
Gamma globulins 19.2% (11.1 - 18.8)
Albumin and Alpha-1 globulins are normal.

I'm posting here and in other subforums hoping someone might offer insight or point me in the right direction, since most of my labs are unremarkable.

Hello,

Was an ESR (sedimentation rate) performed? Regarding the protein, albumin, Alpha-1, Alpha-2, beta, and gamma levels—please provide the absolute values (g/L).

Also, was a biopsy taken during the endoscopy?

Which celiac test was used (tTG IgA)?

The mild jaundice you mentioned could potentially be part of Gilbert's syndrome. As for the slightly low IgA, it shouldn't directly cause your symptoms, but it could cause a false negative on a tTG test.

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · May 6, 2021

Amy Cox79 said:Hi, I'm looking for some advice on which blood tests are worth running if you follow a vegan or vegetarian diet. Thanks. 🙂

Hello,

What kind of symptoms are you dealing with?

There isn't a single gold standard for recommended testing, but if you're looking to get a systematic overview, start with a CBC, Iron, UIBC, TIBC, Ferritin, Calcium, Vitamin B12, Folate, Vitamin D (25-OH D), total protein, and Albumin.

Living with Antiphospholipid Syndrome in Health · May 6, 2021

brightgull95 said:...if the directive is lifelong anticoagulants (Warfarin or some DOAC), then you take them for life.

For patients dealing with Antiphospholipid Syndrome, we don't recommend DOACs. In fact, certain drugs in that class might actually increase the risk of thromboembolic events in these specific cases. To clarify for those following along here: when it comes to this syndrome, the gold standard remains classic oral anticoagulants—specifically Vitamin K antagonists—or heparin. Not DOACs.

Living with Antiphospholipid Syndrome in Health · May 6, 2021

Donna Lopez79 said:Hello, everyone.
It’s hard to find much useful experience regarding Antiphospholipid Syndrome online. Following a dissection of my carotid and vertebral arteries, I was sent for bloodwork and ended up with a diagnosis of Antiphospholipid Syndrome, Vasculitis, and Hyperhomocysteinemia. I’ve been on Warfarin for about a year and a half now. My doctor mentioned a genetic mutation. I’ve had four successful pregnancies before this. Why did this happen? And when exactly did it start? I just don't know. Searching the internet only turns up info on this being discovered during pregnancy.
Does anyone have advice? Is anticoagulant therapy really a lifelong commitment? Is there any hope that my blood chemistry might actually normalize?
Thanks for the help.

Ma'am,

Based on what you've described, the criteria for Antiphospholipid Syndrome don't seem to be met. You haven't mentioned having a thrombosis (an artery dissection isn't a diagnostic criterion for APS) or a history of pathological pregnancies. Furthermore, while there is a certain genetic predisposition for Antiphospholipid Syndrome, there aren't "classic" genes where a single mutation triggers the disease. It seems odd that you were told a genetic mutation was the cause in your specific case. It sounds more likely that you are dealing with thrombophilia, which is not the same thing as Antiphospholipid Syndrome.

Something doesn't quite add up here.

Which type of Vasculitis are we talking about?

How to get a partial refund from HealthCare? in Feedback & Suggestions · Apr 26, 2021

Dear User,

After some discussion, we’ve decided to lift your partial ban from the Health forum. I'll have rustydrifter10 clear the restriction so you can get back to posting in the Health section.

Moving forward, please stick to the community guidelines. We'd prefer to avoid a repeat of the issues that led to this ban in the first place.

Best of luck.

Regards,
Nicholas Myers

Lab results - looking for opinions [PLEASE READ 1ST POST] in Health · Apr 23, 2021

Jacob Lopez51 said:All these results look solid. A Western Blot for Borrelia is a much more definitive and specific test. If you’re getting this done here in the States, I’d suggest using Labcorp; they send samples out to specialized labs, and you can usually get results within four days.

The issue is that you already know you were bitten by a tick and completed treatment. I find it unlikely that reactivated symptoms mimicking neuroborreliosis would just suddenly appear two years later. How did these symptoms actually start? Was it stress or something else?

If we were dealing with neuroborreliosis, there would be visible brain damage and poor imaging results, obviously...

Sir,

I am not entirely sure why you feel qualified to offer diagnostic advice to everyone else posting vague symptoms on this or any other forum based solely on your own experience, but since it hasn't technically violated the rules of this board yet, I will let it slide.

If you are already assuming neuroborreliosis is the culprit, then your advice is fundamentally flawed. You cannot diagnose neuroborreliosis through blood work, an MRI, or an EMG. The only way to confirm that diagnosis is via a lumbar puncture and a comparative analysis of the spinal fluid against the serum.

Furthermore, an MRI doesn't have to show pathology, especially in the early stages of neuroborreliosis. I don't know what gives you the authority to state, "If it were neuroborreliosis, there would be brain damage..."

Please, read some basic guidelines—like these—before you continue playing the role of the Lyme and autoimmune disease guru across this entire forum.

How to get a partial refund from HealthCare? in Feedback & Suggestions · Apr 18, 2021

Hello,

We’ve received your request. Once the Health sub moderators have had a chance to weigh in—which I expect should take just a few days—we will notify you of our final decision.

Best regards,
Nicholas Myers