Episode Transcript
[00:00:00] Speaker A: Foreign.
Welcome to the Comeback with Boomerang Healthcare, your podcast for relief, recovery and restoration.
I'm Dr. Peter Abachi.
[00:00:23] Speaker B: And I'm Dr. Sarah Guzet. As doctors, we know healing isn't just about treatment. It's about having the right tools, mindset, and support to move forward.
[00:00:34] Speaker A: You can have pain, you might be injured or even hurting on the inside with all you got going on, you can still have a really great life. And that's what we're here for. This is the Comeback. Let's get started. So today we really wanted to dive in on the subject of MRIs.
I think this is a topic that, that a lot of people we work with, a lot of our patients often concerned or stressed about the, the findings or what does it say, how does it explain, you know, what they're feeling and what they're dealing with? And how can we help people better understand what, what they're saying, what it all means, what's the science behind it? And to do that, of course, we're bringing in a really awesome expert to break it all down. Right, Sarah?
[00:01:23] Speaker B: Absolutely. We're excited to have Dr. Kim with us today and to dive a little deeper into the importance of MRIs. Oftentimes when we're treating our patients, they take a look at their impressions or their reports and there's so many questions that can often lead to an increase in anxiety and fear of movement, and it's so important that they understand what's happening.
[00:01:46] Speaker A: So. Dr. Jinsep Kim is an ABMR board certified in physical medicine and rehabilitation. He graduated from Southwestern Adventist University with honors in biology, followed by graduating with a Master of Arts in Biology at Texas Christian University.
Dr. Kim completed his medical training at Loma Linda University School of Medicine and followed a one year internship at the University of Virginia Healthcare and Science Center. Dr. Kim is a Texan, and it.
[00:02:19] Speaker B: Sounds like he also completed his residency and physical medicine rehabilitation at Loma Linda University here in California, where he was distinguished with the Pride in Service award. Following residency, he completed a one year fellowship in interventional pain management.
Dr. Kim's interests include neuropathic pain, back pain, neck joint pain, headaches, fibromyalgia pain, abdominal pain, non surgical management, and the rehabilitation of orthopedic issues including industrial injuries. He's an expert in interventional pain techniques such as radiofrication frequency ablation, epidural steroid injections, selective nerve blocks, Botox, neuromodulation, and joint injection. So lots of good stuff. We're so excited to have you here, Dr. Kim. Thank you for joining us.
[00:03:07] Speaker C: Good morning.
[00:03:09] Speaker A: Holy moly. Dr. Kim, you know a lot of stuff and that is why we're so excited to chat with you. And we've had the sort of luxury of hearing you talk about this subject before educating people within our organization and our patients. And you do such a great job. So we're going to take advantage of your skill set. For everyone who's listening, let's kind of start off with just the basics of what exactly is an mri?
[00:03:40] Speaker C: MRI is a wonderful tool that we have and practicing medicine, we rely on imaging as a big part of our diagnostic workup. And an MRI is a non invasive modality that allows us to gain images of soft tissues. It's a strong magnetic field. And this magnetic field causes water molecules to change their orientation in your body. And then as the magnetic field is turned off, the water molecules change their orientation and gives off a tiny bit of energy. And the MRI scanner can detect that energy change. And then the computers associated with the MRI then creates an image that we can then see what's happening within the body. It's a wonderful tool. The nice thing is that it uses magnets so we're not exposed to any radiation. And it's a very safe modality to use. As long as you don't have any implanted medical parts, then we have to be a little bit concerned. But otherwise it's a very safe modality to gain insight as to what's happening within your body.
[00:04:46] Speaker B: That's a fantastic way of really explaining it. And I think one of the important components too is understanding what, when is it needed, when is it indicated, and are repeat ones also needed, and if so, how often?
[00:04:59] Speaker C: Well, that's a great question, Sarah. I think when it's needed is when a patient has persistent conditions or if there's a sudden change to their health. So if you have a person who's been doing well, usual customary activities, and all of a sudden they have a significant change in their health, that's when we should be looking at diagnostic testing, including an mri.
Also, even with individuals that may have a chronic condition and they've been living with a painful condition or a disabling condition for quite some time, if there's any sudden changes to the condition, an MRI might be called for. Otherwise, if you've had an MRI before, then when should you get another one? I think if an MRI is done within the past two years, we can use that information.
However, there are certain individuals that may have a progressive disorder like a tumor or cancer that might be Growing that we should be checking on regularly. With serial MRIs, then I usually recommend it be done within a year, sometimes even earlier. With a rapidly progressive disease or in conditions where they have an aneurysm, a blood vessel that's expanding abnormally, we need to make sure that it's not growing and changing. So serial MRIs can be very helpful in those type of conditions, too.
[00:06:22] Speaker A: What kind of tissue injuries or problems are best seen with an MRI versus maybe other options like an X ray or CT scan or something different?
[00:06:35] Speaker C: That's a great question. I think the reason that we rely on MRIs is because it's so much better at looking at soft tissues.
So we think about all the organs in our body. We certainly have bone structures, but our soft tissues include our brain, our nervous system, our lungs, all the insides of our guts, our liver, pancreas. All those structures are not well visualized on traditional imaging like X ray or even with ct.
An MRI is able to give us much better pictures and images of those type of soft tissues. And so when we're looking at even, for example, like a spine. Spine. Our spine is a complicated piece of machinery. It has the bony elements, but it also has a lot of soft tissue elements. And the MRI is great at looking at the soft tissue elements, while an X ray and CT scan is much better at looking at the bony elements. Sometimes we need both, Sometimes we need just one. So the doctors can help choose which one to use. Maybe one, maybe two, or maybe all three.
[00:07:43] Speaker B: Fantastic. And I think something else that comes up a lot of times is when a patient is reporting pain.
What happens with the MRI imaging, as far as always, you know, capturing it? Is it, you know, the only factor that's taken into account?
And what happens if an MRI doesn't pick up something but the patient continues to report pain?
Curious how you describe that.
[00:08:13] Speaker C: There are, unfortunately, lots of mysteries that occur in medicine, and that's one of the mysteries that we deal with all the time. I think it's very important that we focus on what the patient is sharing with us and what they're experiencing. The MRI is just one piece of the puzzle. It's a great tool, but it's not something that's all revealing. We still call it practicing medicine because we don't have all the answers. There are many times when we see patients and we do end up getting an mri, and the MRI doesn't give us the answer as to why that patient has that pain. Then we need to look at other possible diagnostic tests or other potential entities that might be the source of that pain that might not be revealed on that mri. The other thing that I always tell patients is that if this is continuing, it may not be apparent right now, but later on it may become apparent.
So just because we don't have an MRI doesn't mean that I can. We can dismiss or ignore this pain. We do still need to treat it. But an MRI also gives us a lot of information when we do have positive findings to help direct future treatment.
[00:09:25] Speaker A: You know, I often tell patients, you know, we treat patients, we don't treat MRIs.
You know, this is one piece of information that we use to help you. And sometimes it doesn't really explain the experience that the person is going through, you know, who's walking in their shoes. Sometimes it does. It gives maybe a lot, sometimes maybe very little. But you want to explain it in a way so that you, you know, you don't invalidate the experience or the severity of what somebody might be going through or feeling, but you want to, at the same time, understand what it really says.
How do you navigate explaining medical information like MRI results in the context of how the person, you know, the individual person. How do you connect the dots when maybe it doesn't really show exaggerated or horrible anatomic findings?
How do you help people understand the difference between pain and anatomic findings?
[00:10:33] Speaker C: I think we see this a lot where we have patients, for one example, come in with a lot of low back pain, and we move forward with the diagnostic workup and getting an mri, and it shows minimal or limited findings. That conversation with that patient is here. We know that there is no significant pathology like real large disc herniations or spinal stenosis. There's nothing horrible going on in your spine as far as what the MRI shows. But we also know that you're experiencing the pain that you have. There may be conditions that. There are conditions that may cause pain that are not seen on mri, in particular, like muscle cramps and spasms. If you ever had a charley horse in your calf, you know how awful that can feel. Imagine that happening in your neck or in your lower back.
That soft tissue irritability and spasms can be very disabling, but it will not show up on an mri. I personally have had experience like this where I went through about a week where I could barely walk. I could barely climb out of bed and make it to the bathroom. And I had an MRI later on that didn't show anything. So I was really scratching my head about that too. But there are conditions where there may Be pain actually causes me to think, is that, what else could be there? So it makes me broaden the scope instead of looking at just the spine. If we get a spine mri, could there be something else, like some growth in the abdomen or an aneurysm or maybe other conditions that maybe can be contributing to their pain? Could there be underlying disorders, such as rheumatological disorder or autoimmune disorder, that may be contributing to their pain, that might not show up on their mri? So there's lots of causes and lots of conditions that may cause pain that just are not identified on an MRI. So I think, Dr. Hibachi, you're absolutely correct. We treat the patient, we don't treat the mri.
[00:12:33] Speaker B: I think you make a great point. And actually, it brings to mind a case of a patient that I had that had two significant findings on their spine. They were involved in an injury, one in their low back, one in their cervical spine.
[00:12:46] Speaker C: Right.
[00:12:46] Speaker B: Their neck. And the patient was looking and reading the report and, you know, even brought it to me because of how anxious he was. And he's telling me he's seeing surgeons and they're advising that he needs surgery.
But he was very confused because his low back was where he reported the majority of his pain.
And he was reading it and he was telling me, but look. Look at the bulge. It's a lot, you know, bigger in my. In my back, but they want to do surgery in my neck, and I don't understand why.
And he was having neuropathy, right? Numbness, tingling down his arms. And then as I was treating him, he was reporting weakness. There was a lot of issues.
So, you know, getting him connected to the right doctor to explain to him his imaging and why they were advising not his neck. His neck and not his low back. And for his low back, they were recommending physical therapy. But it. It took some time for him to wrap his head around because he's reporting symptoms and he's looking at, you know, a disc bulge that's twice the size in the low back as opposed to the neck. And so curious if he of talk to that a little bit and kind of explain, you know, how frequent is that and does that happen a lot for, you know, our patients and how you talk about it?
[00:13:53] Speaker C: Absolutely, it does happen. And I think the easiest way for me to think and wrap my mind around it is if I were to take a recliner and put it in a very small room, it would take up a lot of space. But if I took it to a very large room, and placed the recliner there, then it might not take that up that much space.
So when you think about the cervical spine, the cervical spine structures are much smaller. They're about half the size, if not a third of the size of the structures that we see in the lumbar spine. So when we think about a 2 to 3 millimeter disc protrusion in the lumbar spine, we're like, wow, that's not that consequential. But in the cervical spine, that may be quite consequential. And so the room is a lot smaller. So spaces are smaller, structures are smaller.
So whatever insult might be there in the cervical spine, although if we look at it in reference to the lumbar spine, might look inconsequential, might be very challenging for the patient to deal with in the cervical spine. So we think about the cervical spinal canal and the lumbar spinal canal as the major openings, but the openings on the side where the actual nerve roots come out, those are much, much smaller. And so when you're talking about a patient with numbness and tingling weakness, could that be a result of nerve root impingement in the cervical spine? And could that lead to permanent neurological damage? While a disc protrusion that might be actually bigger in the lumbar spine, if it's central and not causing any nerve root damage, the surgeons might say, oh, we're not going to touch this one, but the cervical one, we need to treat and treat urgently.
[00:15:41] Speaker A: As we're talking about spine stuff, how do you approach, you have a patient, they have an MRI done, maybe the cervical spine, maybe the lumbar spine, maybe both. How do you approach, you know, looking at it, interpreting it, and then using that in your clinical practice?
[00:15:59] Speaker C: I think of this sort of like buying a used car. If I decide to go buy a used car, I prefer to go take a look at it. Go kick the tires, turn the steering wheel, start the motor up, go take a little test drive on it. If I'm relying on someone else's report about the shape and condition of that car, I might not end up getting what I really want.
So when I talk about MRIs, I greatly prefer to actually look at the MRIs myself. And it takes a little bit of learning and effort to get up to speed on looking at MRIs and interpreting them. But if you take the time and effort, it is a wonderful addition to your clinical practice.
Not only do I look at the MRIs myself, I like to review the MRI findings with the patient so I can show them what I See and explain to them. And although some patients might not find that very helpful, a lot of my patients do find that very helpful. I think wrapping your mind around the issue or problem and understanding it is of great value. And patients, oftentimes they're very anxious. They don't know what's going on. They, they are, they're challenged by doctors telling them, we should do this, we should do that. They don't have a good grasp of what is the problem and why the doctors are recommending these type of treatments. Once they see it, they're like, oh, I get it. This look at that big disc herniation, or look at that disc that has collapsed. Look at all the bone spurs that are there.
And you have to take the time to go through what's normal and what's not normal. But once you spend that time with a patient, they're aware of what's going on. I think they have a lot more comfort. They also are with you on your treatment plan. So we're all on the same team. Sometimes if you do not go through that kind of critical analysis with the patient, we're always in a contestuous, conflicted type of treatment plan.
And so it's wonderful when you can explain to the patient fully what's going on and they're on board with what you want to do or what you're recommending for them.
[00:18:09] Speaker B: I think that's so well put because so many of our patients really do struggle with. Right. Getting a copy of that impression report at home and not knowing what it means, or to your point, not understanding why providers are suggesting, you know, or advising for surgery or not to have surgery. And so I am curious, you know, any suggestions that you have for any of our listeners about how to process the information when it does sound scary and, or when it, you know, says everything is normal, but you feel far from normal.
[00:18:39] Speaker C: Sure. I think, first of all, look at MRI results as part of the information, part of the puzzle. It doesn't give all the answers. And so sometimes we as providers and patients that are looking at their own MRIs place too much weight. They give it too much consideration.
So sometimes it can be very helpful, sometimes it's not. And so in the right situation, it gives us a lot of useful information.
But in other situations, it may not be that helpful or may cloud the issues and make you think, oh, gosh, you know, this is, this is something that it's not. So use the MRI as a, as a tool, but don't over rely on it.
[00:19:24] Speaker A: Say you're you're kind of going over the information with the patient, and maybe you're looking at the report or maybe you're giving them your own report. And there's these names like stenosis and degenerative disc disease and spondylolisthesis and holy mackerel. Those names sound scary, right? And you're. You're saying these, these words out loud. How do you break it down?
You know, terms like that so that we can all understand them and appreciate what they mean for us and how we can use that information to better navigate our health plan?
[00:20:01] Speaker C: I think it's always putting in the terms that the patient can understand or what they're familiar with, these terms. They can look up the information on Google, because everybody has access to Dr. Google nowadays. But. But putting it in context is very important for them.
So I do think that putting it in the right phraseology, right terms, is dependent on what the patient's comfortable with. If they're comfortable, like they have a medical background, then you can use medical terms. If they don't have a medical background, then putting in terms that they're familiar with can be very, very helpful. Terms like stenosis is narrowing. If you have pinching around the nerve, it's going to cause problems for that nerve. Spondylosis is that degeneration around the disc and spondylolisthesis, things that are shifted out of position.
So going through the images and telling them, oh, this is out of alignment, this is shifted forward or backward or to the side, and then letting know that's what is being described by the term spondylolisthesis. This area is being pinched and narrowed, and you can see it in the axial images or on the transverse images, and you can show them. This is what's being described as stenosis. Once you show them and describe it in layman's terms and then use the medical terms, they're able to then link it together. And that's what I think helps.
[00:21:30] Speaker B: Fantastic. I think something that comes up a lot of times, too is sometimes I hear patients requesting more imaging saying, I want to have a better understanding of my pain or what's happening in my body. And they'll ask for an mri. But sometimes the doctor says, well, your condition, an MRI wouldn't pick that up. Right. And so I think it's helpful to also understand what are some of the common conditions or diagnoses that are better seen with an mri or what are some other tests that they might need instead.
[00:22:00] Speaker C: Sure.
So whenever we have neuropathic symptoms like numbness, tingling, Weakness. Those are typically soft tissue generated symptoms. So nerves being pinched, nerves being narrowed. Those type of conditions are oftentimes best identified with mri. If they have more mechanical symptoms where certain movements cause them pain, or where they're doing fine and all of a sudden they experience sudden pain and then it quickly goes away, that might be more easily identified by imaging that can detect shifts in position.
So MRI cannot do that. MRI is a static image. You're just laying there while the machine is going around making this loud thumping noise to getting images. A flexion extension of the neck or lower back might help identify segmental instability.
And a CT scan is far better at looking at bony structures. So if you've had previous fusions or surgery where they've tried to link bony elements together, MRI might not be able to identify that construct or that fusion coming apart while a CT can't. The other thing is that when we're using MRIs, certain things can cause distortions or abnormalities in the images. So if you have metal in the field, the metal will cause distortions and cause artifacts of the mri and you can't see what you're looking for in that area that has the metal. While a CT scan or X rays are able to look at it and identify structures even within the region of existing metal. When you have a condition, it's very helpful to know what the imaging parameters can identify and have your doctor guide you on what it is that you actually need.
[00:23:58] Speaker A: How about, you know, we talked about the spine and a lot of people have spine issues. A lot of people get knee problems, shoulder problems. What are some common things that MRIs can help with? If your shoulder hurts or your knees feeling swollen or, you know, aching in the morning, how can we, how can that be helpful?
[00:24:19] Speaker C: Quite a bit. I, I think as far as joint structures, if you have a joint that has lots of ligaments and, and tendons and cartilage that are involved in making that joint work properly. And MRI is great at looking at those types of structures.
So ligaments are connections between bone, tendons are the connections between muscle and bone. But you also have lots of cartilage. The cartilage may be in the labrum or meniscus, and those type of cartilaginous structures cannot be seen on mri, on X ray or CT scans. Now, oftentimes X rays and CT scans also can be very helpful. In particular, I like to get, for knees, standing X rays because it will show you if one part of the knee is collapsing compared to the other part. So a knee structure, if you can look at my fist should be like this. But if one side is more narrowed, standing X ray can pick that up. And then MRIs are also good at identifying if there's tears or disruption or wearing of those structures and can identify sources of pain that X rays and CT scans may not.
[00:25:35] Speaker B: You were pointing out how there's so many different ways to do imaging.
And I was thinking about some of our patients and the way that they sometimes struggle with whether it be laying down or being in an enclosed space. I'll tell you, as a psychologist, I often get patients who are avoidant to go do an mri.
And eventually I'll ask, I'll be like, why haven't you done your appointment? And they'll share with me that they have a bit of claustrophobia. So I'm curious about, about that and how you handle those discussions.
[00:26:06] Speaker C: I tend to scold my patients a little bit, one day tell me that they cannot get an MRI because it's a very helpful tool and a lot of times we need the imaging to move forward.
So let's talk about different types of MRIs because there's open MRIs, there's the traditional MRI, and then now we have high field MRIs. The difference between all three as far as image quality goes, is that you have an open MRI which can be 0.3 to 0.9 Tesla MRI, a very low field magnet.
Traditional MRIs that have that tube is a 1.5. And then now we have high field MRIs that are 3.0.
So I think I tell my patients, if you want to get an open MRI because you can't tolerate that tube, you're going to be looking for something that you lost in your room with a, with a 15 watt light bulb.
If you go to a regular MRI, you're looking at something in your room that you've lost with a 75 watt light bulb. If you're looking at it with a 3.0, you got 120 watt light bulb. There is, there may be some differences between the 75 and 120 watt light bulb. But if you look at looking for something with a 15 watt light bulb, you're just may not see what you're looking for.
So the clarity of the images and the distortion of the images is also very important.
So I don't know if you remember when there used to be before we had cameras on our phones, there used to be digital cameras that you could buy at the convenience store. And they come in little paper box. You could take a couple of pictures and Send it off to be developed, and you get these grainy images that we're not anything close to what professional cameras can do. I think of open MRIs as getting images with that type of disposable camera. Yes, you can see images and shapes, but you cannot see detail because the images are very grainy and oftentimes out of focus. While the 1.5 and the 3.0 MRI gives much more clarity, much more like a regular camera or a professional photographer.
So that's the difference between an open MRI and traditional regular MRIs or high field MRIs. When a patient does have trouble, I often suggest, have you tried a little bit of sedation before your mri? If you have not, then I would recommend you get sedation. And if so, then I offer them a little bit of medication that they can use prior to the MRI to help them relax.
The other thing about MRIs, there are newer scanners that have a much shorter scan time. I would much prefer to sit in an MRI for.
For 30 to 40 minutes rather than an hour, hour and a half trying to get images. So if you do have a newer MRI in your area, you should ask, what is the scan time on that machine versus other machines in the area?
If you find a machine that has a very short scan time, I would choose that one over machines that have a long scan time. Because you have to stay still. You can't move. If you do move, it gives blurry images, so you have to stay still. And a little bit of medication can be very helpful.
[00:29:46] Speaker B: Those are great tips, and I love your metaphor.
This reminds me of a patient where we did indeed have a very blurry mri, and they were in our rehab program and the physical therapist was telling me his MRI isn't really that helpful. It was so blurry, and we wanted to make sure everything was okay. And so I went to go talk to him about, you know, how did he feel about getting it done again? And our thought was maybe he was in so much pain that he had a hard time staying still, because that's what they observed. And when I spoke to him, he was very stoic. And he shared with me that he actually struggles with panic attacks, but he didn't want to tell anybody. And so that's why he was fidgeting.
And so when he knew that there was the option for, to your point, you know, a faster MRI and then potentially. Right. Some. Some medication to assist with him and realize how important that image was, he was. He was motivated and he was willing to go and give it another try. And sure enough, we got a much better image of the second appointment. So I think you, you touched upon so many important points there.
[00:30:45] Speaker A: Dr. Kim, you've given such great examples and analogies in breaking this down.
[00:30:53] Speaker B: You.
[00:30:53] Speaker A: Do you want to share a little bit about your personal, your. Your or your professional background? And how did you. How did you end up doing what you're doing and practicing this way? And how did you get here?
[00:31:06] Speaker C: I guess it all started sitting on my father's lap as he was a radiologist and during that time put up films for him, because at that time it was not computer generated images, it was films.
And so I would go in on weekends with him to the hospital where he would do his reads and I would put up the old X ray films and MRI and CT scan films for him to look at. And that's when I really gained interest in medical imaging. I'm very visually oriented, so I like to draw and actually wanted to go to art school at the art center in Pasadena, but I think my parents suggested I go into medicine instead.
When I went into medicine, I actually went into rehabilitation medicine thinking that I would enjoy working with people with chronic disabilities. And that's what I was drawn into and was going to be the director for a traumatic brain injury unit up in San Francisco.
But then I had a head injury, got into a boating accident, sustained a skull fracture, and so that set me back a little bit.
While I was recovering, I had a tremendous amount of personal experience with pain and realized how difficult it can be for patients to deal with pain and how difficult it is to. Even on the treatment side. Since I was already a physician at that time, the limitations that we had for treating chronic pain conditions. And so that's what got me interested. And instead of taking that job as director for a traumatic brain injury unit, I decided to go back to fellowship and get my training in interventional pain.
So that's how I ended up where I'm at. I very much enjoy treating and helping patients with chronic pain conditions, although I may not be able to cure or fix them completely. Certainly helping to gain quality of life and improving their quality of life is very rewarding to me. I enjoy that greatly.
[00:33:14] Speaker A: I can feel, I can feel your, your passion. I mean, your, your spirit for what you do runs deep. You know, from your personal experiences, your, your, your medical history, your family history, your. Your dad. It's very, it's very profound. It's a, it's a story that is very similar to, you know, a, a, a I think a lot of People, you know, this arena and healthcare and working with, you know, people with chronic disease, chronic pain, disabilities, it's, it's an, it's an amazing background that you have, Sarah. It seems like we're all, you know, working from our own injuries and pain experiences when we're, you know, we kind of bring that to the table.
[00:33:58] Speaker B: Absolutely. And I think it makes it relatable to our patients. We've often talked about how chronic pain can be isolating and letting our patients know that they're not alone and being there to not only advocate for their health, but also to support them on their journey. And that, that passion that you bring, Dr. Kim, is very apparent. And, you know, wanting to invest that time and really explain things to patients goes a long way.
So thank you so much for being here. Any closing words of wisdom to depart on us?
[00:34:30] Speaker C: Oh, I'm not sure if I'm the wisest person in the world. I do think that pursuing a healthy life is an investment that brings great rewards later on.
So I would tell everybody to invest in their health. Make healthy living choices, get good rest, eat right, put good fuel into your motor. Don't put bad fuel into your motor. And live as fully as you can.
[00:35:02] Speaker A: And tell us exactly where your practice for people who are looking for you.
[00:35:08] Speaker C: So we recently moved into a new location. It's in San Bernardino, California, and our offices welcomes patients from all walks of life. We focus primarily on injured workers. Is there a particular set of patients that need specialized attention?
But we also take all comers. So if you're interested in getting our approach on things, contact our office and I'm sure we'll share the contact information. And yeah, come see me. Let's see what we can do.
[00:35:46] Speaker A: I love it.
[00:35:48] Speaker B: Thank you so much for joining us today and appreciate everyone who's tuned in to the Comeback with Boomerang Healthcare. We're grateful to have you here. If you've enjoyed today's episode, be sure to subscribe so you never miss an update.
Also, follow us on social media for more tips, information, inspiration, and check out our website until next time. Keep moving forward. Your comeback is just getting started.
