Weight Loss

Nick:
Hello and welcome to the Ascend Health Show. I’m your host, Nick Angelis. I’m a nurse anesthetist and the owner of Ascend Health Center. And today I have not one but two guests. I’m very excited about this. Originally, I think we’re just going to talk about beards. But since you’re here to Crystal, we’ll change it up a little bit and yeah, so I’ll let you guys introduce yourselves and what you do, starting with Crystal.
Crystal:
Okay. So as you said, my name is Crystal Harper. I’m a board certified family nurse practitioner. I own my wellness in Ravenna and I also work at Access Point Community Health Centers.
Nick:
That’s great. And what about you, Doctor?
Mike:
Dr. Mike Scarpato? I work at Integrity Chiropractic Clinic. I’m a chiropractor just looking to get people healthy every day. Naturally. Primarily through the spine.
Nick:
Sounds great. So my first question and this isn’t something we discussed at all, but on my way here I was like, Well, it’s getting warmer now, so I should get outside and start doing things. But for those of us who are in Ohio, there’s a huge difference. Like we basically have two wardrobes like this the wardrobe of winter where I might watch TV, go to a play, just stay at home. And in the summer when I try to do everything because I know it’s so limited and because winter is always coming. So how do we get back into the flow of being healthier and being outside and doing things without having to visit you all the time because I messed up my back?
Mike:
Yeah, that’s a great question. So obviously one of the best things you can do is just mindfully each day making sure you’re doing the things you heard for years, make sure you’re drinking plenty of water, make sure you’re getting plenty of rest. Make sure that you are doing stretches. If you’re giving stretches or have an exercise routine that’s going to help to keep blood flow going, that’s going to keep your mind awake and alert and that But motion is life. So the more that you move, the better you tend to feel.
Nick:
I’m doing this totally wrong because I eat a healthy diet, right? Let’s play basketball for three hours and then nothing for another week.
Crystal:
Ease into it, you know? Right? Start with one day a week, two days a week, you know, because one 20 minutes.
Nick:
At a time. That makes sense too, because one of your specialties is weight loss. So you have similar advice or how do you now that people are more willing to be active? Because I’m sure in the winter you can get on a treadmill 20 minutes a day, but not all of us have that discipline, but not all of us. I mean, I don’t have that discipline, right?
Crystal:
Yeah. So I mean, I tell them, you know, similar information, you want to just start with what you’re able to tolerate and then don’t overdo it. You know, I find that if people overdo it and they jump all in, they kind of tend to to pull back because it’s just too much for them. So I say just, you know, start with one day a week this week and then, you know, two days a week and then three days a week. And as you can tolerate it, you increase it and just low and slow.
Mike:
You know, it’s very good advice.
Nick:
Makes sense. I think my challenge is often when I tell someone like, okay, well let’s start real small, then they start real small. So it’s like imperceptible changes that. So how do you politely say like, okay, let’s start small but not like look, I walked to the living room. I don’t know what else you want from me.
Crystal:
I mean, you know, take a 20 minute walk today, okay? Walk your dog, you know, then maybe, you know, walk your dog a little bit longer of a walk tomorrow, you know? And if you’re feeling good with that and you’re going for walks every day, you know, maybe increase the pace and then slowly as you’re comfortable, start to incorporate some other exercises.
Nick:
Is that with you too, with stretches and such? Sure.
Mike:
You know, you definitely want to start off, you know, kind of kind of on the slower side, you know, do it maybe once a day, a couple sets. Hold the stretch for 20, maybe 30s just to see how it feels. Make sure you’re not over stretching. It should be a nice, gentle, easy stretch. And then just like Crystal said here, increase it a little bit more, you know, each day or even each week, get yourself into a routine. The routine is really going to be key because if you don’t make the plan for it, if you’ll make time for it, it becomes easy to fall off and life is busy. You know, we all live very busier lives than ever before. And so just making sure that you make that commitment because that’s really what it is. It’s a commitment to better health. You want to make sure that you stay with it. It just becomes easier to fit it in over time. Absolutely.
Crystal:
And they see what 30 days it takes to make a solid routine.
Mike:
Yeah, between 21 and 30 days. Okay.
Nick:
Yeah. Because at my clinic we talk about neuroplasticity and changing the way your brain works. And I think all of us being in this type of business, we’re used to seeing all sorts of competitor hype of like, Well, we can do this. You can take this magic supplement or this magic stretch, but you’re saying like, just do something for a while and then you’ll be more used to it.
Crystal:
Yeah, absolutely. I agree.
Nick:
That is a lot easier than the magic stretch, right? Unless you have a magic stretch you’d like to share with us.
Mike:
When I find it, I’ll be sure to let you know.
Nick:
Yeah. For seven low payments of 999, magic tricks can be yours.
Crystal:
The machine will stretch you, right?
Nick:
Yeah.
Crystal:
I mean, it’s like basic health principles. You know, everybody wants, like, fancy quick fixes and it just comes back to the basics, you know?
Nick:
Okay. And I think part of what you’re saying, too, is if you can start with these basics and. You start to feel better and you can sustain and then maybe we can talk about like the advanced stuff, so to speak. But until we can get in the habit of doing something, anything for our health, it probably isn’t anything that we can really tell A patient is going to really help them until they start that step. I agree. Although I guess the challenge too is and this is a slightly different topic, but how do we help people who often can’t make that first step? Like in the case of my clinic, it’s often the Ketamine infusions where it’ll change your brain and then hopefully the patient then gets the motivation or they like before they might not exercise. And it’s it’s not like the Ketamine is a magical substance that all of a sudden they’re like, I’m going to exercise. It’s just that when they do it they tend to regret it less and they get more out of it. And then the hope is that after that experience, like, Well, maybe I’ll just start doing this on my own. So is there any way to sort of jumpstart that? Like I know you do a lot of weight loss.
Crystal:
Yeah. So there are a couple of things that we offer because like you said, it’s hard to just get those first steps going and get that motivation and get their energy up and feeling good. So we do have a couple of adjuncts as we’re working on lifestyle changes and you know, the behavioral therapy and everything. We do have a couple of things that we kind of add in or start in the beginning. So those are more natural products like different lipotropic that we use. We also use vitamin B12. We also want to make sure that we’re increasing and keeping up with everybody’s vitamin D, You know, that does a lot physically and mentally. And then we also offer semaglutide. And so, you know, that’s approved, as you guys know, for short term weight loss and long term maintenance. And so that looks different for everybody. So as we’re using these couple of things to kind of help get them going in the beginning, you know, we’re working on lifestyle changes with them getting into a good exercise routine, eating a nice, healthy, balanced diet, not so much dieting because we want this to be sustainable, but working on just changing those core lifestyle routines that way everything is sustainable. You know, when they’ve reached their goal and you know, they leave us at a better place.
Nick:
So you’re saying you’re trying to take like the shame and guilt out of it where it’s not, Oh, I did this wrong or I’ve got this many points left. It’s just let me start making some gradual changes.
Crystal:
Yeah, yeah. Basic stuff. You know, we work on eating better, you know, better content, like you said, different nutritional values and, you know, checking where they’re at with everything, doing blood work and just making sure that their body is in sync. Right. Like the body is always striving to be in sync. So working on good routines and kind of getting them to that point where they’re happier and they’re feeling better because then they’ll want to do more for themselves. Okay.
Nick:
And here I’ll nerd out for just a minute. Just bear with me here. Use phentermine at all. Or is it just more of the drugs that sort of make your stomach stop digesting quite as quickly to lose the weight?
Crystal:
So I have not had to use the Ketamine at all. We’ve had a lot of success in our clinic with the more natural or using the Semaglutide as an adjunct. So with the more natural treatments I’m talking about the tropics like a mic or a LIPPOMANO those have the B vitamins and methionine I sold alkaline, that type of stuff and then we use the SEMAGLUTIDE when we have used those or we need that extra boost in the beginning. So basically the SEMAGLUTIDE is working on the pancreas, you know, letting the body know, hey, you’re hungry, you know, or you’re not hungry. Excuse me, you’ve had enough to eat right now, you know, let’s just let our body digest that. And then it also delays that gastric emptying so that they feel fuller for a longer period of time. So they’re not eating as often and they’re not eating as much. So we’re getting down to those healthy portions in really eating those three meals a day and not just kind of snacking all the time. You know, we’ve kind of gotten used to that in our society.
Nick:
That’s true. I think it’s more of our unconscious snacking or unconscious activities that are a lot of the reasons that people have to come see any of the three of us. Yeah.
Crystal:
Well, and I think that, you know, especially with with COVID everybody or not everybody, but a lot of more people have been home. And so the fridge is right there. It’s easily accessible. They’re more sedentary. They’re not moving as much. They’re not getting up and getting dressed and going to the office every day. So it’s, you know, combating some of those that those learned behaviors that we’ve developed over the last couple of years.
Nick:
And how do you respond to people just being devil’s advocate here, of course, because that’s my favorite. How do you respond to people that say, no, all these drugs should be for diabetics. It’s not really for weight loss because you’ve already said a little bit that if you position it as, okay, here’s a little kick starter, it doesn’t become like it’s not the weight loss equivalent of a Suboxone clinic where it’s like, Hey, you’re going to be on this forever because now we’ve got you hooked and this is easy revenue. So how how do you combat those sort of complaints.
Crystal:
That so you know, I was just thinking about this on my way in this morning because, you know, you see this on the news everywhere, right? It’s it’s on social media feeds. It’s on the news, different groups. So, you know, my thought is that if I can treat your obesity and prevent you from developing diabetes, then we won’t have to go down that road. So like, yes, you know, obesity is a chronic disease just like diabetes is a chronic disease. And so will they both kill you? Absolutely. You know, so if we can. Ideally treat people when they’re over fat before they become obese and morbidly obese. We want to try to prevent the diabetes and heart disease and strokes and all of that. And when you look at the cost of obesity on society, it’s as bad as, you know, diabetes. I mean, we look at, you know, stroke prevention, heart attack prevention and all of that stuff.
Nick:
And the other thing is larger people are like the last unprotected class. Like we made a lot of work over the years of like, okay, you can’t make fun of people because of their race. You can’t make fun of people because of sexuality. Well, guess what? It’s still accepted in society to make fun of people because of their weight. And it is something that and again, it’s an awkward conversation. But you know, this show isn’t to just talk about things that may be true or to sort of skirt around generalities like this is a fact. And so what you’re saying is, well, we can wait five years and give you this drug for your diabetes or we can give it to you now for your obesity and then you won’t have the diabetes that we have to treat.
Crystal:
Yes, absolutely. Yeah, we want to be proactive with health, you know, I think in every aspect. So yeah.
Nick:
So and I have a similar approach where when I first started the clinic, I tell patients, Oh, we’re going to do some vitamins, we’re going to eat healthier, your mental health is going to get better. And then if we need to, we’ll go to transcranial magnetic stimulation or we’ll go to, you know, this medicine for your pain or and then I realized, well, no, no one comes to a new provider because what they have is working. They’ve already tried it on their own. What we need to do is get the ball rolling almost like a debt snowball where you pay off a credit card. You’re like, Oh wow, I can actually do something. So whether or not it’s always the best medical or nursing or chiropractic advice, it’s like, No, we need a win. And once we get a win, then we’ll be able to work together much better and we can get a lot more wins. But until we get that first one, the the barrier of trust, which is a good barrier because I mean, you can spend a lot of money going to a lot of providers all over northeast Ohio for a lot of problems and at the end you’re probably you may be the exact same just a lot poorer. So I don’t think trust is something that we should be offended if it’s really hard for us to earn.
Crystal:
Absolutely. I agree.
Nick:
And do you have any thoughts on this since?
Mike:
I think Crystal really kind of nailed all the big points. You know, it’s she’s still your fire man. Yeah, right. I’ve been sitting here nodding my head saying, Yeah, yeah, yeah. That’s definitely what I would have said too. But she pretty much hit the head. You know, it’s a process and it’s going to take time. You know, it’s good to remind the patients like, hey, this is going to it’s going to be a little hard at first, but be patient with yourself and just kind of, you know, do a little bit more each day and just keep up with the effort, you know, I mean, it’s a sustained effort that really gets you from where you are to where you want to be. So and having obviously the great guidance is going to help you get along there, whether you you know, sometimes you might feel caught up, maybe you feel like you’re not moving as quickly as you should be or could be. And it could just be how your body kind of processes and handles it all too.
Nick:
So I think one thing that’s helped me too, because at a health center we’re moving a bit more toward functional psychiatry. I mean, you’re the third nurse practitioner I’ve had on the show and a lot of it’s similar content, which no one’s like, Oh wait, I’ve already seen this before, Let’s go watch cat videos. But it’s to have a very honest conversation with a patient. So now I tell them like, Look, we can get so much done, we can improve your mental health so much and some of this might not be worth the effort. So we need to decide together how much we want to work for, what kind of results, and we may decide to be like 90% better and that extra 10% isn’t worth it. And there’s no shame in that. Actually, that’s the way you want to be, like an accurate assessment of where I am and where I need to be because otherwise we’re back to American culture where you must be all the things all the time. And that’s such a stressful way to live that you can lose all the weight. You can get your back in perfect shape, but the stress of it, the cortisol being released will get you right back to where you were in a couple of years. So it’s like, no, that’s we’re not going for perfection. We’re going for the point where you’re like, This is good. I’m putting in a good amount of effort. I’m getting good results and let’s maintain this for a while.
Crystal:
Yeah, great. I feel well, I’m comfortable. I’m leading a healthy lifestyle.
Nick:
Because otherwise the appointments are super awkward where the patient feels like they have to be on the same page And yeah, I’m going to do all these things like, No, no, I’m going to be honest. Yeah, not going to tell them, but I’m going to eat cake. I’m getting a lot of cake. Have one bite of the cake.
Crystal:
You know, and you know, that’s a big part. You’re right. You know, like being honest and setting those expectations, like you said, with a patient’s like, you know, this isn’t some miracle thing. Like, you know, you have to put in the work and, you know, you still have to make those changes and it’s going to take time. And, you know, especially if they’re coming to you when their body is pretty depleted already. Like, you know, we’re looking at a longer period of time to kind of reach those therapeutic levels. And so I think just setting that expectation at that stage up front and then, you know, getting that trust and getting the patient to be honest with you about what they’re doing and what they’re not doing, you know, that’s a big barrier. But I think if you can have those. Those good relationships and rapport, the patients are more likely to be honest with you. And then at the end of the day it allows us to treat them better.
Mike:
I agree. You know, I mean, patients, they want to go to the gym three times and get six pack abs, right? Yes, they do. Being able to let them know, hey, this is going to be you know, you may notice you may notice a difference in a week. You’ll probably notice a difference in a month. But, you know, within a few months, looking back, you’re going to notice a big difference as long as you stick with it. So yeah. Yeah.
Nick:
And I think my problem often is that because I’m the sort of person that looks at a menu and decides like, Hmm, that looks like a tasty way to spend $9, but that isn’t worth $13. And most people aren’t like that. They’re like, This is what I want to eat. I’d like to have one. So I often go back to that like let’s make this a value proposition where you this is what you spend in both time and money and effort and this is what you get. But I realize that a lot of us make emotional decisions, so it works for some people. But most of the patients, when I talk to them that way, they’re like, Wait, what? What are you talking about? But I feel that health care is so opaque that and it’s not purposely so that all of us can get rich and drive fancy cars or something. But most especially if there’s any insurance involved, no one has any idea what’s going to happen six months from now. They might get a huge bill. I’m like, Oh, well, that wasn’t worth it at all. So how do you I guess the question is how do we tell them up front? Like, okay, here’s exactly how much effort I want from you or here’s the financial commitment or how do we keep it clear so they know what they’re getting into?
Crystal:
So that’s a good question. I think with a lot of different avenues tied into there. So on our very first consult with everybody, you know, I’m going over, you know, obviously doing an assessment of them and their personal health and where they’re at and like you said, where they want to be like what is the value in it for them? You know, where are they going to feel that comfort and health level? And then, you know, I tell them what I would recommend. We go over all the treatment options and then we go over all the costs of everything for them and kind of what that commitment looks like months, weeks. And of course, we don’t know how long it’s going to take somebody to to reach a certain goal, you know, But I like to let them know all of that up front. That way they can decide if this is something they want to commit to, you know? Right. Because it is it is very, you know, consuming in terms of cost and time and effort. But, you know, I feel like until the person is really ready to commit to that personal effort, you know, sometimes it doesn’t matter what we do for them, you know. Right. Right.
Mike:
Like in my office, you know, the very first visit they come in, you know, we go over the history, you know, I do a very comprehensive exam on them. We actually take x rays. I have a digital x ray machine right in the office. And I actually go over the x rays with them just to show them, hey, here’s what you came in with. Here’s what we found in your exam and here’s what we found with the x rays too. And then we start treatment immediately that day and have them not come back until the next day or anything like that. It’s like they’re in my office right then and there. I want to take care of them, get them better immediately and we start that day. Typically I tell them I’d like to see them three times close together because that just helps me to monitor them very closely, see how they’re doing after their first adjustment, whether it’s with me or just first chiropractic adjustment period. And then by that third visit I have a really good idea of what we’re looking at in terms of time, in terms of cost and actually give them a few page megaset that explains more about what chiropractic is. You know, one of the biggest questions people have is what’s it going to take to get me better and how long? And I tell them, you know, the three phases that we go through, which is first, getting you out of pain as quickly and efficiently as we can. Second one is restoring the biomechanical function of the spine, making sure the nerves are impinged, making sure the spine and the rest of the body is moving properly. And then the third phase is the retainment phase, which is where after I’m done with their treatment plan, I see them periodically to keep them from coming back to what brought me there in the first place. So and then I laid down like, Hey, this is how many times I like to see you per week. You know, sometimes it’s as early as, you know, as many as three times a week for a short period just to kind of really keep that body and that pain. Inflammation levels under control and get things moving better right away, keeping those nerves un pinched and then explain to them, okay, then we’re going to decrease it to two times or decrease the one time we’re going to have a couple of exams to monitor your progress to make sure you’re moving along What I lay out for the patient.
Nick:
So what you’re saying is that a lot of the benefit is quality of life because when you you can’t do things because of your weight or because of your pain, then that’s a huge financial burden too. A lot of times there’s opportunities that you can’t take. There’s vacations you can’t take simply suffering. And probably what the x rays too, since apparently we’re talking about weight loss in this episode for our viewers, this is usually how it goes. We talk about something and about five minutes until we’re done, we’re like, oh, apparently this is what we’re talking about today. So this is about weight loss, right? You want to know what we’re discussing in this episode so you can see and say, okay, there’s some spinal compression or here’s a reason that we need to work on your weight. Here’s the benefit that losing a few pounds will do for you.
Mike:
Absolutely. You know, I mean, your spine is the. Protector of your nervous system is the master system. And when you have that extra weight, it will put extra pressure on the joints and the bones and even the discs which are like jelly donuts in between your the bones of your spine as a jelly inside and a thick crust and that extra weight on them will compress it and grind it down over time, not only because of it’s out of alignment because of the extra weight that is being put onto those onto those discs, which then makes a smaller hole where the nerve comes out of the spine and can pinch and irritate it more than that. But also if the knees and the pelvis and the hips are out of alignment too, you’re going to have that extra weight put on them. And that’s what a lot of hip and knee surgeries end up becoming for the replacements because of the degeneration that sets in over time.
Nick:
It makes sense too, because I don’t think any of us are first line providers, meaning usually I think for all three of us, somebody has tried a they’ve got their PCP or they’ve tried this or that before they get to us. And also a lot of times the things that we’re dealing with, it’s not showing up on x rays or MRI or CT scans or lab work. Sometimes it’s a general, okay, my body is out of whack. My nervous system isn’t quite functioning the way it needs to. And so sometimes that’s when we see the worst iatrogenic injuries or those caused by health care providers because we’re searching so hard for some symptom that we can treat with some medicine or some treatment. And I’ve seen the same thing with, okay, here’s our plan and we’re going to go gentle and conservative because it might just be we need to turn off the body’s auto immune system that’s completely out of whack, right?
Mike:
That’s exactly right. And I that one of the things I offer in my office, too, is something called biofeedback therapy. What it does, it measures the pitch of your voice. And they have found that when the voice is out of tune or out of alignment like your spine, that it can be traced back to past or even present stressful events. So if the mind isn’t right with it as well, you know, it could be it could help with motivation, it could help with the stress management and therefore it can get the mind more motivated and the person more motivated to actually make these gradual changes that we’ve talked about this whole show.
Nick:
Right. Because, you know, Ascend is a psychiatric clinic. And so of course, we’re giving antidepressants all the time. But when you look at risk benefit, there’s a lot of things you should try first before you try an antidepressant. And especially because of the way the mind and the body are linked, which it’s almost like we’ve gone backwards in time where 100 years ago, Crystal, if you had some issue like, Oh, it’s just female hysteria, it’s fine, sorry. But now we’re realizing more and more that no, there are a lot of these physical issues that you can diagnose as fibromyalgia as 17 other diseases, all that specific meds for them. But it comes back to like your mind hasn’t processed trauma correctly or you need to release some emotions or some very basic but still very difficult issues. And until we get to that mental part of it, we’re not going to find any relief. I agree. Although again, how do you say that to patients? Because you don’t want to say it’s all in your head because they’ve heard that before.
Mike:
I have found that by just giving them informational pamphlets or even just, you know, touching upon it without going into it deeply, just, you know, kind of planting that seed and letting them know, hey, this is available. And it’s like I think that this is something that would benefit you. Here’s something I’d like for you to read and take this home, you know, and then we talk about it the next time follow up and be like, Hey, did you read that pamphlet? Did you read that paper? What did you think? You know, and let them know this is how tie it back to what brought them to you in the first place, whether it’s with weight loss, whether it’s with pain management, whether it’s just, you know, overall help help with their golf swing, you know, making sure that they can hit their their daily health goals, you know, or even just something as simple as being able to pick up their grandkids, just being able to tie it back to what brought them in there and saying reiterating the fact of, hey, this is something that can help you with this issue that means a lot to you. Right.
Nick:
And your office is in Fairlawn. So you’re you’re saying if you’re having these efficiencies that maybe it’s time for a consult, see if there’s something that you can do to help them? Yeah, absolutely. And how do they help? How do they reach you again with your website?
Mike:
So my website is integ. chiro.com. My email address is info at Antiwar.com and they can also call me phone number is (234) 334-7770 And we can set up a console right there, right then and there. I usually have plenty of available space throughout the week to make time for those that are really looking to get their self better.
Nick:
Which is important too, because sometimes the way health care works, it’s like, Oh yeah, we can totally get you in three months from now. You’ve got it. It’s going to be great.
Mike:
Yeah, no, I like to make sure I have plenty of time throughout the week set aside right to make sure that they’re not having to wait, like you said, three months, even, even a week. If I can get them in that day or within 24 hours. I mean, that’s that’s right. There is huge for them to be able to start getting on the road to better health. Right.
Nick:
And now, Crystal, your practice is the same where again, none of us have these large corporate conglomerates. It’s just us and some people helping us and whatnot. So obviously we’ve talked mostly about weight loss. I know you do a lot of IV nutrition and we’ll get more into that. But it’s the same thing where someone is finding some deficiencies in their health. You’re in the Kent Ravenna area and they can just contact your office then.
Crystal:
Yep. So they can call our office at (330) 839-8078. We are located on Prospect Street in Ravenna. If they have general questions, they can email me at my Wellness LLC at gmail.com. Our website is k my wellness.com and there is some general information on there. They’re always welcome to call or email or even stop in. Our clinic is open right now Tuesdays, Thursdays and Fridays. We’re always expanding hours. We also do home care as well. So if we have people who can’t get to us, we can come to them within a certain reasonable radius. But you know, we basically just want to get people to feel better, you know, and there’s a lot of different facets for that. So we have the infusions, we have our weight loss program. We treat a lot of different conditions. You know, endometriosis. I mean we have specialty blends that that was just one example. But we have a lot of blends, you know, that depending on what the symptoms are, we like to treat the person as a whole. So, you know, we’re not just treating one specific disease or one condition. You know, we’re looking at you as a whole and trying to just get you feeling better and aligned and leading a better quality of life.
Nick:
Absolutely. And Ascend Health Center is the same philosophy where we do psychiatry. We have therapists, a psychologist. I do a lot of pain management being a nurse anesthetist, but it’s the same idea that we don’t want to just take one sliver of your symptoms. We want to work with everyone on your health care team so that we can all find a solution together.
Crystal:
I agree. Get you feeling better. And I find, like you said, keeping those same day appointment slots available or even within the next day or so when people are ready and they’re calling you, it’s because they’re ready to come in and make a change. And you know, you want to capture that right now because they may not feel that way in a month or two months or, you know, later down the line. So, you know, when they’re ready, you have to capture them when they’re ready and meet them where they’re at.
Nick:
Good point.
Mike:
I agree. Yep. And I think we all have that same passion just making sure that we treat not just the symptom but the whole body because I’ve seen it time and time again where things are out of alignment in the neck, but it acts like an amplifier for things in the low back. So we want to make sure that we check over everything and nothing gets missed. Yeah.
Nick:
Well, thank you all for joining us today. And this has been the Ascend Health Show.