Latest / The Driven Athlete / From Neck To Nerve: Understanding Carpal Tunnel And Its Many Hidden Triggers | Ep 110

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From Neck To Nerve: Understanding Carpal Tunnel And Its Many Hidden Triggers | Ep 110 · The Driven Athlete

• 0:00
  SPEAKER_00: If you're a driven, active person who wants to reach and pursue a higher quality life, wisdom, and ambition, then guess what?
• 0:06
  SPEAKER_00: This podcast is for you.
• 0:08
  SPEAKER_00: This is the Driven Athlete Podcast.
• 0:12
  SPEAKER_00: All right, y'all.
• 0:13
  SPEAKER_00: Welcome back to the Driven Athlete Podcast.
• 0:16
  SPEAKER_00: Um, I uh with a lot of golf, tennis, pickleball, paddle, and uh racquetball, and just exercise, all right.
• 0:28
  SPEAKER_00: Um wrist issues are common.
• 0:31
  SPEAKER_00: Okay.
• 0:32
  SPEAKER_00: And uh when we investigate why somebody's having some wrist pain, um we always need to investigate like a couple things.
• 0:41
  SPEAKER_00: One, um, what reproduces the symptoms?
• 0:45
  SPEAKER_00: When did it start?
• 0:46
  SPEAKER_00: Like what caused it?
• 0:48
  SPEAKER_00: Um what definitely makes it like what what activities seem to consent consistently make it worse?
• 0:54
  SPEAKER_00: What is it like when you sleep?
• 0:56
  SPEAKER_00: Like in the morning when you wake up or in the middle of the night, does it hurt or cause symptoms?
• 1:00
  SPEAKER_00: Prolonged sitting, and then also ruling out is there contributions of neural referred pain from the neck, okay?
• 1:08
  SPEAKER_00: Um, or up the chain proximally, proximally being like closer to midline, like up in your shoulder, through the elbow, on the neck.
• 1:15
  SPEAKER_00: But for the sake of this conversation, um, carpal carpal tunnel issues is uh is not an uncommon thing.
• 1:23
  SPEAKER_00: Death workers, especially too, you know, people that work with their hands a lot.
• 1:26
  SPEAKER_00: Um, but if somebody's having wrist uh carpal tunnel type symptoms, it's usually referred pain into the palm of the thumb and the first three fingers.
• 1:38
  SPEAKER_00: And the reason is because the median nerve passes through the carpal tunnel.
• 1:43
  SPEAKER_00: Okay.
• 1:43
  SPEAKER_00: Imagine like it's my watch.
• 1:45
  SPEAKER_00: Um, the the roof of the carpal tunnel is the flexor retinaculum.
• 1:51
  SPEAKER_00: It's a thick fibrous band, like a thick ligament that spans over the top um of the wrist bones, okay, the carpal bones.
• 2:01
  SPEAKER_00: All right.
• 2:02
  SPEAKER_00: And that flexor retinaculum retinaculum serves as like the roof if you were to look at it from this angle, like this.
• 2:07
  SPEAKER_00: Like my wrist is up, and the band of my watch is on top of my wrist, um, like that.
• 2:12
  SPEAKER_00: Okay.
• 2:12
  SPEAKER_00: And then imagine if a pen was the median nerve, it goes underneath the flexor retinaculum, so it would look like that.
• 2:19
  SPEAKER_00: Okay.
• 2:20
  SPEAKER_00: So um that's a crude way to check it out.
• 2:23
  SPEAKER_00: And it's actually deep and uh buried within, protected between nine tendons.
• 2:32
  SPEAKER_00: So there's nine tendons that go through the carpal tunnel as well.
• 2:36
  SPEAKER_00: Okay.
• 2:36
  SPEAKER_00: And uh the carpal, the the bottom of the floor of the carpal tunnel will be the carpal bones, and then the roof is the uh the flexor retinaculum, okay?
• 2:46
  SPEAKER_00: And you have nine tendons and one nerve that pass through that tunnel.
• 2:50
  SPEAKER_00: And the nerve is buried in between the nine tendons, all right, like it's one band within the nine bands.
• 2:58
  SPEAKER_00: So it kind of looks like like imagine like that, like if my fingers were a bunch of tendons and the pen was a nerve, it'd be like that.
• 3:04
  SPEAKER_00: Okay, so it spans through like that.
• 3:07
  SPEAKER_00: So it's very vulnerable to a lot of compression and irritation and moving components, all right, and force.
• 3:13
  SPEAKER_00: It's because tendons slide and glide when they contract and move, all right.
• 3:18
  SPEAKER_00: And um anyway, the thought is if somebody's having referred pain in their hand, and maybe even muscle wasting of the thin Reminence, the thin R eminence is the pad of your thumb, you have uh three muscles in there that are pretty significant for thumb movement and strength, like opposition and flexion and abeduction, uh, sorry, adduction.
• 3:42
  SPEAKER_00: Um and those muscles are innervated by the median nerve.
• 3:46
  SPEAKER_00: And the three fingers, your thumb, index finger, and middle finger are the sensory, like the sensation feelings, uh, is also distributed from the knee median nerve.
• 3:57
  SPEAKER_00: That distribution is is supplied by the median nerve.
• 4:01
  SPEAKER_00: All right.
• 4:01
  SPEAKER_00: So if somebody has pain in those three fingers, their thumb, index finger, middle finger, and wasting the thin are eminence muscles, the pad of your thumb, then that would mean that the median nerve is involved.
• 4:11
  SPEAKER_00: All right, that's what I want to say.
• 4:13
  SPEAKER_00: Probably compressed.
• 4:14
  SPEAKER_00: That's a good way, that's also an interesting way to say it.
• 4:16
  SPEAKER_00: But that lead the word compression, in my opinion, like nerve compression, leads somebody to think, well, I need to uncompress it.
• 4:24
  SPEAKER_00: And the best way to do that is surgical intervention, which I don't hate surgery.
• 4:27
  SPEAKER_00: Surgery is important for sure.
• 4:29
  SPEAKER_00: And I have high respect for surgeons.
• 4:31
  SPEAKER_00: It's just not always the route to go.
• 4:33
  SPEAKER_00: There might be another option that yields results that you're looking for, and then can avoid surgery, which is just time, money, and there's there is some risk involved.
• 4:43
  SPEAKER_00: Like there's a bottom line, there's always risk involved.
• 4:45
  SPEAKER_00: And it just causes it can anyway, it's just it's a it's a decision that's personal for everybody, okay?
• 4:51
  SPEAKER_00: Um, but the that those symptoms with numbness, tingling, and then wasting of that muscle belly um would indicate the median nerve is involved.
• 5:02
  SPEAKER_00: Okay, there's involvement of the median nerve, there's a neurological involvement.
• 5:05
  SPEAKER_00: The question is uh how?
• 5:08
  SPEAKER_00: Um, why did it start in the first place?
• 5:11
  SPEAKER_00: And then where?
• 5:12
  SPEAKER_00: Like, where is the neural involvement irritation occurring?
• 5:17
  SPEAKER_00: Because it could be in multiple locations.
• 5:19
  SPEAKER_00: A person could have irritated uh neural sensitive neural irritation and neural uh issue uh um involvement.
• 5:28
  SPEAKER_00: Okay, that's where I'm gonna use involvement, stemming from the cervical vertebrae in the neck, the neck vertebrae.
• 5:34
  SPEAKER_00: All right, so discs, of course, can contribute um the foramina, the the facet joints and uh of the neck vertebrae um allow for little tunnels through the vertebrae called foramina, that the nerve roots from the spinal cord exit the spinal column and then they exit out the neck, down the through underneath the collarbone, underneath your shoulder girdle, and like in the axillary region, which is like the armpit region of your arm, and then it goes all the way down and extends to the hand.
• 6:03
  SPEAKER_00: That's the neural pathways from your spinal cord from the neck.
• 6:08
  SPEAKER_00: All the way down to the bottom where somebody has symptoms in their hands, like in like a median nerve distribution pattern.
• 6:15
  SPEAKER_00: Um, well, it could be mid to lower cervical um nerve root irritation or involvement.
• 6:21
  SPEAKER_00: I'm not gonna say nerve compression again, because that just leads to people being like, well, then why don't we just shave out the bone or shave the tent the disc out?
• 6:28
  SPEAKER_00: Well, the reason why I don't immediately jump to that solution is because plenty of people have herniated discs with no pain.
• 6:36
  SPEAKER_00: And plenty of people have facet arthropathy or like inflate uh inflammation, bone spurs, um, breakdown of the facet joints and inflammation in the neck joints that cause foramenal narrowing or foramenal space choking of the nerve, and they have no pain.
• 6:53
  SPEAKER_00: So the presence of those things doesn't always indicate success or failure, or you need surgery or you don't need surgery, because there's plenty of people that have it and they have no pain.
• 7:00
  SPEAKER_00: So then if somebody does have it, the presence of disc herniations or foramenal stenotic changes, stenosis, bone spurs, and narrowing of the foramenal space doesn't dictate that you're gonna be in pain forever.
• 7:12
  SPEAKER_00: It's like unless that's fixed, you're in pain.
• 7:14
  SPEAKER_00: That's not true.
• 7:15
  SPEAKER_00: Um, plenty of people have the evidence and they feel better.
• 7:20
  SPEAKER_00: All right.
• 7:20
  SPEAKER_00: But anyway, so we have to rule out that the main contributions of symptoms isn't stemming from the neck.
• 7:27
  SPEAKER_00: Then we have to rule out the pathways of and of uh sensitive areas of compression and entrapment down the chain.
• 7:36
  SPEAKER_00: Okay.
• 7:37
  SPEAKER_00: And the next one out the neck is the scaling triangle.
• 7:40
  SPEAKER_00: All right, you have three scalene muscles on the lateral side of your neck that connect from the first and second rib to cervical vertebrae C2, three, and four.
• 7:51
  SPEAKER_00: All right.
• 7:51
  SPEAKER_00: And those scalene muscles create like a triangle type shape that the nerve bundles past the cervical plexus, passes through those scalene muscles and pierces right through them to continue down the pathway down the shoulder.
• 8:09
  SPEAKER_00: So that is an area for compression as well of like irritation and guarded tension that can elicit symptoms or exacerbate symptoms.
• 8:18
  SPEAKER_00: Okay.
• 8:19
  SPEAKER_00: Muscle guarding is usually tertiary.
• 8:21
  SPEAKER_00: It's not usually the problem.
• 8:22
  SPEAKER_00: Muscles are guarded because of a joint dysfunction.
• 8:25
  SPEAKER_00: So I would again investigate the neck.
• 8:27
  SPEAKER_00: The next area of compression and irritation is between the first rib and the clavicle.
• 8:32
  SPEAKER_00: The first rib is up at that connects to T1, which is right below C7.
• 8:37
  SPEAKER_00: So it's up in your up in the top part, the lower part of your neck, like where your upper trap is located.
• 8:42
  SPEAKER_00: And uh the clavicle, their collarbone.
• 8:44
  SPEAKER_00: So between the first rib and the collarbone, like in the front part of your upper trap, that's a space where that nerve bundle passes through again.
• 8:52
  SPEAKER_00: Okay.
• 8:52
  SPEAKER_00: So that nerve, that neurovascular, but there's also vascular structures here too, guys.
• 8:56
  SPEAKER_00: So like blood vessels, major blood vessels, pass through the area as well.
• 9:01
  SPEAKER_00: Um, the way we always learned it was like there's nerve, artery, vein, lymph.
• 9:04
  SPEAKER_00: So a nerve, arteries, veins, and lymphatic tissue vessels.
• 9:09
  SPEAKER_00: Um, those those structures, they all travel together as units and through the same pathways.
• 9:16
  SPEAKER_00: All right.
• 9:17
  SPEAKER_00: So um those neurovascular bundles are sensitive, all right.
• 9:21
  SPEAKER_00: Those vascular components too.
• 9:22
  SPEAKER_00: But anyway, so it passes through uh another area of potential in of compression or entrapment between the clavicle and the first rib.
• 9:30
  SPEAKER_00: All right, so if somebody has first rib dysfunction or elevated first rib, that can allow maybe more irritated contributions to that neuro neural structure, that would cause symptoms in the hand.
• 9:41
  SPEAKER_00: Um, or if somebody has shoulder dysfunction and the clavicle, like an AC sprain or AC joint dysfunction, the clavicle lack of uh rotation and mobility for shoulder movement, um, that can also create and contribute to neurological symptoms.
• 9:55
  SPEAKER_00: Okay, next place down the chain is the pec minor.
• 9:58
  SPEAKER_00: All right.
• 9:58
  SPEAKER_00: So underneath your pec major, which is the muscle for bench pressure and push-ups and stuff, that's pectoralis major.
• 10:04
  SPEAKER_00: Underneath that is pectoralis minor.
• 10:06
  SPEAKER_00: And underneath that is the neurovascular bundle.
• 10:09
  SPEAKER_00: Again, that's a large neurovascular bundle that passes underneath the pectoralis minor tendon.
• 10:14
  SPEAKER_00: Okay, so that's another area of potential guarded compression and and tightness and that can get bound down and limit mobility and create some irritation contributions that then can manifest as symptoms in the hand.
• 10:29
  SPEAKER_00: See where I'm going with this guy?
• 10:30
  SPEAKER_00: So there's a plenty of areas.
• 10:32
  SPEAKER_00: Okay, from there.
• 10:33
  SPEAKER_00: Um, oh, anyway, so with that though, we had to investigate shoulder dysfunction, okay.
• 10:38
  SPEAKER_00: Um, and maybe why the pec minor is bound down and guarded and tense, the creating some tension that might be leading to some compression of the neurovascular bundle in the first place.
• 10:50
  SPEAKER_00: That's just another component.
• 10:51
  SPEAKER_00: All right.
• 10:51
  SPEAKER_00: So something else we need to investigate.
• 10:53
  SPEAKER_00: Um, but the pec minor is uh it's a it's a player, you know, it's a key player that we have to investigate.
• 10:59
  SPEAKER_00: Um, below that is the antecubital region.
• 11:01
  SPEAKER_00: Okay, that's the anterior part of your elbow, the crease of your elbow joint on the inside.
• 11:06
  SPEAKER_00: Um, and there's uh, you know, a large neurovascular structures that pass through.
• 11:12
  SPEAKER_00: That's a sensitive, it's a vulnerable area of neural and vascular structures.
• 11:16
  SPEAKER_00: And um between there, okay, and your flexor pronator mass, muscle, your flexor pronator mass muscle group that connects to your forearm muscles.
• 11:27
  SPEAKER_00: All right, when you flex and curl your wrist, um, is your a muscle called your pronator teres.
• 11:32
  SPEAKER_00: And it actually has two heads, and the median nerve passes through the pronator teres like that, like scissors.
• 11:37
  SPEAKER_00: So if that area is guarded, the pronator teres is guarded, the anticubular, the front part of your elbow crease, the anticubular region is what it's called.
• 11:45
  SPEAKER_00: If that's uh involved as another area of inflammation, irritation, and sight uh compression or irritation for neural contributions for symptoms, that's another area that could be creating some symptoms.
• 11:57
  SPEAKER_00: Um, and then down the chain, finally at the very end, is the carpal tunnel.
• 12:02
  SPEAKER_00: All right.
• 12:03
  SPEAKER_00: And if there's compression of the media nerve as it passes through the carpal tunnel, my first thought is not that the carpal tunnel is tight, leading to a flexor retinaculum release surgery, which is carpal tunnel surgery.
• 12:18
  SPEAKER_00: But my question would be like first would be why is it getting inflamed in the first place?
• 12:24
  SPEAKER_00: Why is the nerve getting compressed?
• 12:26
  SPEAKER_00: Because the tendons that they pass that it passes through, those are inflamed and irritated and guarded and lit up.
• 12:32
  SPEAKER_00: All right.
• 12:33
  SPEAKER_00: Maybe the tendon sheet, like all the tendon sheaths, the tendon gliding is restricted.
• 12:37
  SPEAKER_00: Um, wrist range of motion plays a role, carpal, the carpal bone range of motion, the distal radial ulnar joint plays a role too.
• 12:44
  SPEAKER_00: That's the two forearm bones and they connect to your wrist.
• 12:46
  SPEAKER_00: So the distal radial ulnar joint, those things all contribute.
• 12:51
  SPEAKER_00: And that can lead to the tendons that pass through there to be inflamed.
• 12:55
  SPEAKER_00: And that then compresses the space that allow that for the nerve that passes through there, allowing less breathing room and less gliding availability or and ease of glide.
• 13:05
  SPEAKER_00: And that's gonna choke and compress the nerve.
• 13:08
  SPEAKER_00: Um, so in my opinion, I just don't think that a carpal tunnel surgery would be the first indicated thing in my head.
• 13:14
  SPEAKER_00: I'm gonna, I'm of course I'm biased because I'm a conservative therapy, you know, sports physio, but um, those are the things anyway, when somebody has neurological symptoms and maybe even muscle wasting and their thin are eminence, those are all things that I'm brainstorming.
• 13:30
  SPEAKER_00: All right.
• 13:30
  SPEAKER_00: And then investigating and diving into like this is a major contributing factor.
• 13:34
  SPEAKER_00: We need to attend to this.
• 13:36
  SPEAKER_00: And this also is a major contributing factor.
• 13:38
  SPEAKER_00: We need to attend to this.
• 13:40
  SPEAKER_00: And then we can do some manual uh manual therapy to intervene at the mobility to involve to improve the mobility of those structures, soft tissue restrictions and release, um, and then strengthening exercises and stability.
• 13:52
  SPEAKER_00: Some of those would be postural stability for the neck, postural endurance, next strengthening exercises for the anterior stabilizers of your cervical vertebrae, okay?
• 14:00
  SPEAKER_00: Followed by shoulder mobility, maybe pec to pec minor release, first rib mobs, mobile mobilizations, clavicle mobilizations, uh flexor proton mass of the proton or terries, soft tissue release, and then wrist mobilizations at the radius and ulna as they attach to the wrist, um, which should be the distal radial ulnar joint, um, or the axle carpal bones, and the uh wrist available mobility.
• 14:25
  SPEAKER_00: Those are all the manual therapy things we're gonna dive into.
• 14:28
  SPEAKER_00: Then we can then intervene with some exercises like nerve glides, postural strength exercises, shoulder and scapular upper rotation exercises to give the pec minor um to offset the compensations of the pec minor and offset the compensations of the of the clavicle, the collarbone that can cause shoulder dysfunction.
• 14:47
  SPEAKER_00: Um, but that's how that all kind of relates to symptoms down the hand.
• 14:50
  SPEAKER_00: This is it just, I mean, I'm just a nerd with this stuff.
• 14:54
  SPEAKER_00: I think it's just cool.
• 14:55
  SPEAKER_00: Okay, it's just interesting and it's intriguing.
• 14:56
  SPEAKER_00: And it's part of the fun component of my job is like, let's investigate and puzzle piece what the issue is, and then we can hone in and work our hypotheses to hone in on what's the actual dysfunction is, and that's the problem, and then that's what we're gonna work on versus um not working on any of that stuff or investigating any of that, and then just doing surgery.
• 15:18
  SPEAKER_00: Most likely, what's gonna happen down the road?
• 15:22
  SPEAKER_00: Oftentimes, people still have the same symptoms after they do the flexor retinaculum release for surgery of carpal tunnel.
• 15:28
  SPEAKER_00: I'm just saying, like it happens.
• 15:29
  SPEAKER_00: I've seen it before.
• 15:31
  SPEAKER_00: It's common, right?
• 15:32
  SPEAKER_00: It's not, it's not not uncommon.
• 15:34
  SPEAKER_00: Um, but so anyway, that's just a cool part of why I enjoy what we do, is because it's it's just interesting and we investigate that and then um and then it's like, all right, cool.
• 15:44
  SPEAKER_00: Now that we have a diagnosis and figured this stuff out, now what are we gonna do for it?
• 15:48
  SPEAKER_00: What's the course of action?
• 15:49
  SPEAKER_00: Another really strong component is postural awareness.
• 15:53
  SPEAKER_00: All right.
• 15:53
  SPEAKER_00: At some point we have, if nothing changes, nothing changes.
• 15:56
  SPEAKER_00: At some point, we have to intervene with postural and ergonomics.
• 16:00
  SPEAKER_00: And some of that sleeping posture is very influential.
• 16:03
  SPEAKER_00: Maybe not sleeping with your wrist curled and tucked, like fetal position, you know, um, all the time, or neck sidebent position if you're laying on your side, or neck being too extended in the on your pillow.
• 16:15
  SPEAKER_00: Like those things contribute and play a role because you're supposed to sleep for eight hours, and that's a long time in the same position that can cause some things to be irritated and then contribute to symptoms.
• 16:25
  SPEAKER_00: And then people ask, why is it not getting better?
• 16:27
  SPEAKER_00: I'm not even doing anything.
• 16:29
  SPEAKER_00: Um, we need to invent, we need to intervene with your sleep positioning.
• 16:32
  SPEAKER_00: All right, it can be done.
• 16:33
  SPEAKER_00: All right.
• 16:34
  SPEAKER_00: Don't resist it.
• 16:35
  SPEAKER_00: Just invite it and adapt.
• 16:37
  SPEAKER_00: Like that's we've got to intervene your sleep position.
• 16:39
  SPEAKER_00: And then also work posture.
• 16:41
  SPEAKER_00: Okay.
• 16:41
  SPEAKER_00: Um, the other things would be like what daily activity things that just maybe contribute to irritability again, exercise routines, workouts, um, job-related stuff.
• 16:51
  SPEAKER_00: We have to modify something.
• 16:53
  SPEAKER_00: Things need to be modified because if nothing changes, nothing changes.
• 16:56
  SPEAKER_00: Anyway, all of those things combined are all the golden BBs that all add up and tip the scale to create symptoms.
• 17:04
  SPEAKER_00: And then once we start tackling each one of those, then the scale retracts and then things start feeling better because the body is naturally very resilient.
• 17:12
  SPEAKER_00: Like it wants to heal itself.
• 17:14
  SPEAKER_00: It's trying constantly, it's just not being set up for success.
• 17:17
  SPEAKER_00: And that's where we come in.
• 17:18
  SPEAKER_00: Manual therapy to set the joints up for mobility and success and soft tissue restrictions, dry needling can be helpful too in leveraging the neurovascular, the neurological system to help improve symptoms and sensitivity, systemic inflammator inflammatory processes, and then corrective exercises to fix and solidify those changes with strength, stability, activation, um, and postural endurance, and then ergonomical interventions, work, sleep, and daily activities.
• 17:47
  SPEAKER_00: All those things kind of combined or all the golden BBs that add up to fix the problem.
• 17:53
  SPEAKER_00: And can you do that in one day?
• 17:55
  SPEAKER_00: Unfortunately, no.
• 17:56
  SPEAKER_00: It just takes some time.
• 17:57
  SPEAKER_00: But that's why you have somebody like us on your team.
• 17:58
  SPEAKER_00: We're on your team, we're in your corner, and uh we're gonna hold your hand, no pun intended, with a carpal issue, carpal tunnel issue along the whole way.
• 18:08
  SPEAKER_00: All right.
• 18:08
  SPEAKER_00: Um, but anyway, that's just those are that's where that's where our heads are at.
• 18:12
  SPEAKER_00: All right.
• 18:12
  SPEAKER_00: That's kind of in the uh what we're brainstorming and investigating.
• 18:17
  SPEAKER_00: All right.
• 18:17
  SPEAKER_00: So if you're battling anything like that, referred pain down the arm, that that that's not just for carpal, like for hand symptoms, but that same kind of thing goes along uh the same uh brain brainstorming process and uh evaluation and investigation, same kind of thing with referred neck pain or even shoulder pain.
• 18:35
  SPEAKER_00: If somebody comes in and they have tightness in their upper trap or their shoulder or tightness in their neck, we have to rule out all those same things, maybe not down the elbow in their hand, but the same thing for the neck, shoulder, clavicle, first rib, scapula.
• 18:48
  SPEAKER_00: Like, is it this a shoulder problem, a scapular issue, or a neck dysfunction, or maybe even a first rib upper thoracic problem?
• 18:54
  SPEAKER_00: Those are the hypotheses that we have to work through.
• 18:57
  SPEAKER_00: And then we figure that out with asking questions and then reproduction of symptoms, testing, intervention.
• 19:04
  SPEAKER_00: And then that process over many weeks is how we get the best results and all those five-star reviews you see and stuff.
• 19:09
  SPEAKER_00: But it just takes some time and the right lens of diagnosis that then dictates the trajectory of treatment.
• 19:16
  SPEAKER_00: But that's what we have to dive into.
• 19:18
  SPEAKER_00: Um, but anyway, if you have any questions, don't hesitate to reach out.
• 19:20
  SPEAKER_00: We're always here to help.
• 19:21
  SPEAKER_00: Um, comments, questions, concerns, or conflicting opinions.
• 19:24
  SPEAKER_00: We're always open to ideas and suggestions for the podcast or guests and stuff like that.
• 19:27
  SPEAKER_00: But please don't hesitate to reach out.
• 19:29
  SPEAKER_00: We'd love to talk, at least on the phone, about like what do you have going on and maybe point in the right direction.
• 19:33
  SPEAKER_00: Maybe give some insights.
• 19:34
  SPEAKER_00: There's no strings attached to that.
• 19:36
  SPEAKER_00: Like, we just want to help.
• 19:37
  SPEAKER_00: Um, but anyway, it yeah, we're always here to help.
• 19:40
  SPEAKER_00: Don't hesitate to reach out, and uh we'll we'll catch y'all next time.