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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
That, hey, if we can decrease the use of this by x percent, I feel like we're moving in the right direction. Your decreased need for that is indicating and showing that you're making some biomechanical changes that are decreasing the activation of some of those muscles.
Dr JJ Thomas:That's great. Yeah.
Joe Dawson:So it's cool to use that as a measuring stick. Welcome to the doctor JJ Thomas podcast.
Dr JJ Thomas:Hey, everybody. Welcome to the doctor JJ Thomas podcast. I'm JJ Thomas. So happy to have you here again, on our show. I have a special special treat with you, very good friend and brilliant another brilliant mind.
Dr JJ Thomas:Before we get started with introducing my friend Joe, I just wanna say thanks to all of you for subscribing and listening, and being loyal listeners. I just realized recently that we've been doing this a year now, and I have to say it's been one of the most rewarding things in my entire career. Just the interaction with all of you, the feedback, hearing of your successes with your patients, with your businesses. It's it's it's truly been a pleasure. So thanks for thanks for believing in me, and thanks for continuing to listen.
Dr JJ Thomas:And, hit that subscribe button if you haven't already. So let's introduce my friend Joe. Joe Dawson. Joe and I go way back to when we worked in the insurance based world together. And Joe joined our crew at Primal Physical Therapy a little over a year ago.
Joe Dawson:Yep.
Dr JJ Thomas:And Joe, part of the reason we brought Joe on was not because not just because he's an intelligent mind. He's a wonderful heart and soul. He really cares about the patients. All the things we look for in all of our therapists. But in addition, he had a niche.
Dr JJ Thomas:And as you guys know, we talk all the time about if you wanna make it in the cash based world, it really does help to have a niche. And Joe's niche is the evaluation treatment and management of, TMJ. Temporomandibular joint dysfunction or TMD. So Joe, thanks for coming.
Joe Dawson:Thanks so much for having me, JJ.
Dr JJ Thomas:Let's start by just hearing a little bit about your journey into how you found your niche. I guess a little bit about background first on you and in physical therapy in general. Then if you could elaborate on that into how you found your niche in TMD.
Joe Dawson:Sure. So started off in PT a little over 20 years ago and worked in a couple of different settings and landed at a hospital, an outpatient clinic in a hospital, which is kind of a unique setting. And during that time, I was treating everything under the sun. I was a hungry therapist that wanted to learn and treat everything from amputees to post op ACLs and was treating an older physician within the hospital, the late doctor Ed Granite. And doctor Granite had done a very interesting procedure on a patient who had cancer in his mandible.
Joe Dawson:And while I was treating him for his arthritic hip, he said, Joe, I just removed the mandible and I need to have physical therapy done. He this man can't open his jaw.
Dr JJ Thomas:Wow.
Joe Dawson:Can you help him? And as a young hungry therapist, you say yes to a physician when they ask
Dr JJ Thomas:you to come back. Opens. This I tell this to my kids. The door opens, you walk through it.
Joe Dawson:You better believe it. Yeah. So that's what I did.
Dr JJ Thomas:Wow.
Joe Dawson:And I researched. It really provided a catalyst to me as a hungry therapist to learn more about this TMJ that we had gotten some background on in school, but I didn't really feel completely comfortable jumping into this patient that had a piece of their mandible removed.
Dr JJ Thomas:Right.
Joe Dawson:So I jumped in head head first and learned quite a bit about TMJ through a number of avenues, taking some courses, looking back at my old textbooks, and found this passion for helping this gentleman who couldn't speak, couldn't eat.
Dr JJ Thomas:Wow.
Joe Dawson:Was a Spanish speaking patient, so couldn't communicate with me which further complicated things. It was obviously an incredible learning experience for me, and it really started my journey into the world of t m TMJ and TMD and how do I help these patients that are lacking such fundamental life skills.
Dr JJ Thomas:Yeah. For patients listening, you're gonna hear us interchange TMJ, which stands for temporomandibular joint and TMD which stands for temporomandibular dysfunction. So as therapists, there are sometimes we're talking about the TMJ as a joint, and sometimes we'll say TMD in the sense of how the management of the TMJ through temporomandibular dysfunction just as a a side note. But, so framework questions all these questions just came to me. About when when was this?
Dr JJ Thomas:Like, how long ago was this?
Joe Dawson:So this patient, we're we're talking we're going back 19 years.
Dr JJ Thomas:That's awesome. Yeah. Yeah. And it just it just ignited a fire in you. Like, wow.
Dr JJ Thomas:This is really cool. And tell me about that. Like, it sounded to me as you were talking about that, that there you know, everything we do in as physical therapists, most PTs, I think we do this because we enjoy the reward of helping people do things that they can't do otherwise. Like, we say on our website, like, we we are proud to be part of your journey to help you do the things you love faster. Right?
Dr JJ Thomas:So what is about treat, treating this gentleman in particular that was so special?
Joe Dawson:He, like so many other TMD sufferers, didn't have a lot of places to turn. Yeah. So your post op ACL athlete loved them, but people are thirsty to treat those patients. There's a there's a huge desire to treat that those that clientele. And what I found pretty quickly, doctor Granite was asking me because I was a PT in front of him and I think he had already experienced the lack of care and outlets for these patients.
Joe Dawson:So it's, first off incredibly rewarding to treat an underserved population of people, which really helped me find my niche. I have all of these people all of a sudden starting to come to me because they had heard this person was effectively treated for their dysfunction.
Dr JJ Thomas:Right.
Joe Dawson:But also just fundamentally these patients lack, like I was mentioning, the ability to open their mouth or close their mouth. So they are having a hard time talking at work, talking with family Yeah. Trying to sleep, trying to eat some of the most basic life functions. Yeah. And when you can restore something like that on that level Yeah.
Joe Dawson:That person has an appreciation for your profession and the skills and the treatment that you provide unparalleled with almost anything else. Yeah.
Dr JJ Thomas:And it's so rewarding. Right? Like, that's it's that's so good.
Joe Dawson:It's why we wake up and do what we do. Right? To help somebody get back to whatever function that is, whether it's playing tennis or walking down the stairs or eating your lunch.
Dr JJ Thomas:Yeah. And it's funny because that just reminded me of another thing that I often When therapists are asking me like how they can choose a niche. I'm like, oftentimes the niche chooses you. Like you think you're too That happened to me with dry needling. Like truthfully, I sought out dry needling because I had a patient that I that had seen, I thought everybody else and wasn't getting better, and I was looking for a way to help him.
Dr JJ Thomas:And that's how I found her kneeling, but it it really still chose me just as it sounds like t m TMD chose chose you.
Joe Dawson:Yeah. Absolutely. I mean, and and the relationship that I developed with doctor Granite after that and the other physicians that he ended up introducing me to and how that kind of played out the next 7, 8 years of my career was really incredibly formative and still is now. I mean, with the way I interact with dentists now and the way I can interact with TMJ patients, you know, it it was just incredibly formative for me.
Dr JJ Thomas:So tell me what that looks like. So because I'm I'm putting myself in the new therapist shoes that's listening to this podcast, and they're trying to figure out, you know, how they're gonna know when their niece chooses them. So you found this passion, and then what were the next steps? You like, what did you do from there to cultivate or or curate this, this skill of yours, the skill set?
Joe Dawson:Yeah. So first was just having a fundamental understanding of the anatomy. Yeah. Like anything else, having a really good making sure you have the fundamentals, the basics of the joint. Mhmm.
Joe Dawson:And then working off of that and doing some osteopathic type education was what I was really into early on in my career. So taking some course work through the Institute of Physical Art, but basically exhausting my options from an educational standpoint with these patients. Right.
Dr JJ Thomas:Like, seeking out any right. That's what I imagined. Like, seeking out all the sources of continuing education you can to support the foundational anatomy that you that you knew on your own.
Joe Dawson:And and additionally, the Singing Institute of Clinical Excellence. I thought they were an incredible outlet, for some extra foundational background information. And then learning through your patients is a powerful tool.
Dr JJ Thomas:Yeah.
Joe Dawson:Being able to see, oh, I worked on this joint in this way and this was the response I got that test retest and really diving into getting a sense for what worked and what didn't. Sometimes not as efficiently I would have liked to early on. Yeah. But now now it's much more of a well oiled machine as far as that
Dr JJ Thomas:goes. So I'm glad you brought that up because I know in in the years time that I've been working with you, I've seen your clinical success rates accelerate even like astronomically. I mean skyrocket.
Joe Dawson:Yeah.
Dr JJ Thomas:And I mean, you were always an excellent clinician, but I definitely have seen a a sharp uptick in your, ability to get get patients better faster. And so, you know, tell me about that. Like tell is that I tend to think that partly has to do with the the model. Like switching from the insurance based world to the to the cash based practice model where you I mean, where you now have time to test, retest, and really develop your own clinical patterning. But, I'd love to hear your perspective on on if you think that was an influencer or were there other influencers?
Joe Dawson:That's a huge influence. The move in environment, and certainly my former position, I was a manager and had a lot of hats to wear. But just the the business model that we had, was fast paced and tended to, you know, you you got something in your target and you went after it, versus the environment that we treat in and that I treat in now and get a chance to really evaluate the body as a system. Look at the person from head to toe. Get a chance to explain to them why I'm treat looking at their back.
Joe Dawson:Yeah. Additionally, these patients are coming in as TMJ patients. They didn't even know that physical therapy was an option for them.
Dr JJ Thomas:Right.
Joe Dawson:So explaining why they're even there. Why why did your dentist or your doctor even think to send you to me? Yeah. This isn't your knees. This isn't your shoulders.
Joe Dawson:This is your jaw. Mhmm. We're gonna be putting our hands in your mouth possibly. Yeah. This is a different experience.
Joe Dawson:And so, I just find that that was, you know, also something that was super interesting and something that I kinda had to wrap my head around
Dr JJ Thomas:Mhmm.
Joe Dawson:As I started to work with this clientele.
Dr JJ Thomas:Mhmm. That, so how do as you bring up a good point. Like, the TM to me, the TMJ is the temporomandibular joint is is just another joint. Right?
Joe Dawson:Absolutely.
Dr JJ Thomas:Like, it is and it isn't. I mean, sure. You're gonna be sticking your fingers in their mouth and but but I would love if you could talk to me about your perspective on the similar, like, sort of similarities and differences between treating, say, a TMJ and treating maybe a knee.
Joe Dawson:Sure. So a lot of similarities as you alluded to. We're still dealing with muscles, joints, nerves, blood supply Mhmm. And a brain. Mhmm.
Joe Dawson:So, you know, this person is apt to stresses and all the other things that come along with it. So lots of similarities. I'm still looking at the body as a whole. The the, a lot of times I analogize or it's an analogy of the foot to the TMJ where the, kinetic chain has such a profound effect on it. So the foot, right, what happens at the hip and the knee and the low back has a big time effect on what happens at foot.
Joe Dawson:Well, it's the same thing for the jaw. All of the things that happen on this chain up to that jaw have a profound effect. Mhmm. So that is very similar in that we need to look at the body as a whole. But differentially, we're dealing with breathing.
Joe Dawson:We're dealing with possibly sticking our fingers in somebody's mouth and working through the inside of their cheek, which as a PT is an incredible feeling being able to work on the muscle from the inside and the outside of the muscles. So many muscles when we're palpating, we can't get that type of a of a feel on the muscle. And and that's that's pretty incredible. And
Dr JJ Thomas:also an honor. I will say, like, there are certain things we do as PTs that I know none of us in our facility, and I'm sure many of you don't take lightly. So like for patients that are listening, you know, recognize that we are honored when you trust us. You entrust your body with us to, you know, to do something. It feel you know, it could be potentially construed as invasive to stick your fingers in someone's mouth.
Dr JJ Thomas:But it's a necessary it's a necessary intervention in order to get the results we want, but but we don't take that lightly.
Joe Dawson:Right.
Dr JJ Thomas:Yeah.
Joe Dawson:And I mean, that's, as you said, can feel intrusive at first, but I think if you're working and you have the experience of working with those patients, a, you see it as an honor that you would allow me to even approach you. And b, I think as a professional, I think you can explain the basis for why you're doing it. And if you're if you're receiving treatment for TMD and they're not going inside your mouth, you may wanna be concerned about the care that you're getting. So, yeah, I think it's a it's an incredibly important point and obviously a big difference when you're treating TMD. But otherwise, when you think about similarities and and things, you know, head position, thoracic, treatment, how they breathe Yeah.
Joe Dawson:Tongue function. Tongue function is probably a difference we'll say because I don't know how often we're looking at the tongue with any other joints
Dr JJ Thomas:in
Joe Dawson:the body. But but that's also a very interesting kind of aspect of treating TMD.
Dr JJ Thomas:Yeah. That's great. And what about, so you mentioned a lot of things that seem very postural to me.
Joe Dawson:Mhmm.
Dr JJ Thomas:And so could you give a guesstimate of how many patients you treat with TMD that you would say have a postural component?
Joe Dawson:I would say 80, 85 percent have a postural component.
Dr JJ Thomas:Yeah. I would have guessed.
Joe Dawson:And the other 15%, we just haven't noticed the postural component yet probably. But, yeah, I think I think that's a huge part of it. And so what I talk with a lot of my patients about when it comes to posture is, thinking having a clear understanding of how the TMJ changes based on my head position and the most important things we do is is talk and eat in these seated postures. Yeah. And so thinking about the open versus closed pack positioning of the jaw and making sure that the jaw is put in a position to win, just like the knee or any other joint, is critical.
Joe Dawson:So oftentimes, I'll joke with my patients that they're imagine you're eating dinner with the Queen of England, you know, and you have to really be hyper aware of your posture as you're eating for those irritable TMJ joints. That's oftentimes what I'll do is I'll kinda give them a thought to kind of have in their head. So as they go to eat or they go to talk on the phone at work that they're envisioning this posture that will help their jaw perform at its best.
Dr JJ Thomas:That's great.
Joe Dawson:Yeah. So posture is a huge component of that which then leads into breathing and any number of other topics.
Dr JJ Thomas:And that's again why we have to treat the body as a system. Right? Like that is for those of you, you know, Joe is, Joe's drank the Kool Aid for sure at primal at primal headquarters and prime through primal university. And, and Yeah. I mean, if if we're just treating the jaw itself, we're really just potentially treating the symptom and not really addressing the underlying causes.
Dr JJ Thomas:So, patients, clinicians listening, make sure that you're, you're you're working with someone that can address those things. What about on that same note, you and I have had conversations before about the use of of mouthguards. Mhmm. And I'd love to you to give the audience a little bit of your perspective on their on their on their use, and how you prefer they be utilized within a a plan of care. And I know it's gonna depend, but give me the best case.
Joe Dawson:Yeah. So there's I've learned over the years just by interacting with different specialists, there's a wide array of nightguards. I think first and foremost, when we talk about nightguards, we have to think about what kind of symptoms do the does the patient wake up with and what do they really need? Do we just need to protect the teeth? Are we trying to keep this clencher, this grinder from cracking their molars or do we need to actually do something more significant with that night guard?
Joe Dawson:Is there something we need to do for the arthritic joint that requires some decompression? There's some incredible things that some of these specialist dentists out there can do with these decompression braces to help with with bone marrow and helping the end of the mandible kind of regenerate bone to make it easier for the disc to be recaptured. Some really interesting studies out there. So, yes, there are nightguards, there are custom nightguards, there are great dentists out there. If you have a good relationship with the dentist, understanding how they approach that with their custom nightguards is important.
Joe Dawson:But also for those patients that just need their teeth protected, they may do better with just an over the counter. And that's really important to have those good relationships with your dentist and your referral sources so that everyone's on the same page as far as what's gonna be best for that patient. Is it an over the counter? Is it something that they need custom because of their bite and assist symptoms that they're dealing with? Or do they need something decompression wise?
Joe Dawson:And those decompression orthoses are interesting because oftentimes they wear it during the day as well. So that's a whole different ball of wax, but I think very interesting nonetheless.
Dr JJ Thomas:So I have 2 questions off of that. 1 is on the treatment side of that. Like, I know for myself when I have patients who, who wear foot orthotics for for instance. My goal oftentimes, my goals with those patients if possible is to eventually wean them out of those. And so how do you handle, a prescription of a mouth guard?
Dr JJ Thomas:Definitely as with a foot orthosis, there's there are times where it's absolutely necessary at that phase they're in, but if I can build and strengthen their arch and the rest of their body in a way that, gets that kinetic chain back in line and they can they can support their arch on their own, then that's gonna be my end goal. And so how does that work with with the treatment you do with your patients with TMJ and, TMD and, and mouthguards?
Joe Dawson:My hope is always to decrease the use of any brace or orthoses over time. For the nightguards specifically, not so much the decompression but just specifically the nightguards. My hope is to bring them down off of that, whether that's with using exercises to kinda set them up to decrease but ultimately to move them away from it over time. And I I almost use that as a goal. Mhmm.
Joe Dawson:That, hey, if we can decrease the use of this by x
Dr JJ Thomas:percent, I
Joe Dawson:feel like we're moving in the right direction. Your decreased need for that is indicating and showing that you're making some biomechanical changes that are decreasing the activation of some of those muscles.
Dr JJ Thomas:That's great. Yeah.
Joe Dawson:So it's cool to use that as a measuring stick.
Dr JJ Thomas:Yeah. Because we're you and I are talking about this because we're very comfortable with it. But for patients listening, TMD is actually an overuse disorder. It's a it's you know, if you think of most like as I said, TMD and other dysfunctions in the body are have a lot of similarities. Right?
Dr JJ Thomas:And so TMD, a lot of times the the correct me if I'm wrong, but the jaw muscles get overused because you're clenching so much, right? It's a compensation pattern. And so I believe what Joe is saying is that when we can fix the alignment in the in the posture and in the structure all the way leading up to the to the TMJ, then those muscles will start to relax a little bit and not compensate as much.
Joe Dawson:Yeah. And even in the last couple of years, working with some of these specialists and looking at breathing Yeah. A lot of grinding and the genesis for some of their grinding is them actually trying to open their lower airway
Dr JJ Thomas:at night.
Joe Dawson:And so they're grinding their teeth back and forth trying to open their lower airway because we, as humans, tend to be poor utilizers of our upper airway, which is through the nose. And so if we're talking lower and upper airway, upper airway through the nose, lower through the mouth, when we breathe at night, we tend to be snoring and blocking our upper airway and breathing through our mouth, which just drives grinding even worse. Yeah. So there's been some pretty profound changes in how we address some of this stuff at night, to decrease some of that grinding just by helping with some of the airway stuff as well.
Dr JJ Thomas:That's great.
Joe Dawson:And so if you have a a practitioner that speaks your language, that wants to refer you a patient that's doing some of this stuff, watching how some of those things change by helping their breathing patterns can be pretty powerful.
Dr JJ Thomas:And that leads me to my next point that I was gonna make is that is that clinicians who are considering a specialty in the TMD. I think it's very beneficial. What I've seen you do in your own practice is is the relationships you've built with doctors that you trust what they're doing. Because for me, that's always been one of the scariest things with any, you know, referring a patient to any doctor is knowing that that they're going they're going to someone that is gonna support their goals in a way that we are in line with. Right?
Dr JJ Thomas:So I think it's great the community you've built of of trustworthy physicians, ortho I mean, they're all different types of physicians. Right? In order to support your patients. So you could actually help them direct who to go to.
Joe Dawson:Big time. And I I think that goes across a lot of different aspects of physical therapy and medicine in general that if I'm referring you to someone, that person becomes an extension of my own practice.
Dr JJ Thomas:That's right.
Joe Dawson:And vice versa. Mhmm. So if somebody's referring a patient to me, I take that on obviously as an honor, but it's also an extension of their practice. Yeah. You know, so we should be speaking the same language.
Joe Dawson:That patient should be hearing similar messages from those physicians and us. And I think that makes the the and I think that makes the the care collaborative Mhmm. In its in its very nature. And b, the patient gets way more out of it.
Dr JJ Thomas:Yes. And and the patients get the patient gets way more out of it because your goals are in line. Yeah. And as a profession as you're, you know, building your practice or continuing to build your practice. I'm speaking to Joe, but I'm really speaking to all of you.
Dr JJ Thomas:As you're building your practices, when As you're developing these professional relationships with doctors and physicians that you trust and you're in line with their same goals, you're you're feeding your own ability to serve your patients better which is gonna come back to everyone tenfold.
Joe Dawson:Absolutely.
Dr JJ Thomas:Yeah. That's awesome. Through the years, I wanna end we're gonna have to wrap up now. Getting we're getting to the end of our time, but but through the years as you've developed your practice and you developed your this niche, and this relationship with doctors and patients. Is there is there any particular case that stands out to you, that kinda supports Again, going back to I think most niches are formed because you have this burning passion inside, to do something helpful for other people.
Dr JJ Thomas:So is there any patient scenario that stands out that you could share with us that, comes to mind when you think of patients that you've been happy to help through the years?
Joe Dawson:So I'll say there's a couple. Yeah. The first one was the gentleman that I mentioned early on in our conversation. He was Spanish speaking. Unfortunately, had some cancer in the bone.
Joe Dawson:Helping that man and seeing the look in his eyes because he couldn't say very many words. But when you help somebody, you know, you double, triple the amount that they can open their mouth Yeah. The look in his eyes said everything
Dr JJ Thomas:It says it all.
Joe Dawson:I needed to see.
Dr JJ Thomas:Yeah. It's amazing.
Joe Dawson:But since then, such a variability in the patients that I've seen opera singers who were going to get their masters that couldn't open their jaw more than 20 millimeters. And to think about an opera singer whose livelihood was to sing Yeah. And to have that very specialized breathing technique helping her and being able to reestablish her mechanics with breathing and with singing was incredibly profoundly, enriching for me Yeah. And learning. Some more jujitsu guys that are working their way, you know, talk about opera singing versus jujitsu Yeah.
Joe Dawson:Trying to get out of a headlock. This is what he his biggest passion in his life, comes in with an emergently disrupted disc that was not, not relocating on its own and he was having a big time issue with opening and closing. So when I think about this, I think about how fundamental opening your mouth and closing your mouth and being able to talk and eat and avoid a headlock or Yeah. Or sing, how fundamental and how viscerally important these activities are to these people. And being able to affect that in some way, shape or form Mhmm.
Joe Dawson:Is is incredibly rewarding as a PT.
Dr JJ Thomas:It's very cool.
Joe Dawson:Yeah.
Dr JJ Thomas:That was cool. That case Joe just talked about just happened recently. Yeah. And and in our meetings, in our staff meetings, we always share, like, 1 press 1 personal, 1 professional win, and that was one Joe shared with us. I'm really glad he did because it's true that that energy is contagious.
Dr JJ Thomas:Like you could see on Joe's I didn't I wasn't there when he treated our jiu jitsu friend, but I could it translated into Joe's energy and face. Like Joe's excitement sharing the story, that was doc sent him over pretty emergently. Right? Oh, yeah. They the dentist couldn't act he got the dentist couldn't help him.
Dr JJ Thomas:So they called Joe, like, Joe, help us out. We don't know what to do.
Joe Dawson:Yeah. And And and in that vein, getting his cervical and thoracic spine to do what it needed to do Yeah. In comp without getting too technical was allow allowed him to be able to close, and really restore some centric rotation in his TMJ, which really was what he needed.
Dr JJ Thomas:Which also brings us back to the the point, like, the body is a system. Right. Right? And you can be and and even a TMJ specialist, a really good one is gonna still bring it back to the rest of the kinetic chain.
Joe Dawson:Absolutely.
Dr JJ Thomas:And so thank you, Joe.
Joe Dawson:Yeah.
Dr JJ Thomas:That's that's a perfect line to end on. That's reinforcement to, everybody listening that, like, truly, if you wanna be an expert in the field, find a niche, but also don't forget to treat the body treat and train the body like a system. We happen to have some great Con Ed courses. I'm not I can't help but plug it. We have some great con ed courses.
Dr JJ Thomas:We don't have TMJ and specific ones yet, but we have great courses to help you treat and train the body like a system. So check us out. Primal University. It's primalhq.com. And as I said in the beginning, if you haven't subscribed, already, hit that subscribe button because we have a whole slew of other great content coming up this year.
Dr JJ Thomas:This calendar is getting booked out, and for patients listening, if any of those symptoms rung a bell for you, make sure that you check out Joe Dawson. What is your Instagram again? Joeydpt. Joeydpt on Instagram, or we can help you find him any any anytime you need it.
Joe Dawson:Absolutely. John? Pleasure.
Dr JJ Thomas:You're the best.
Joe Dawson:Thank you.
Dr JJ Thomas:I'll see you in the office later today. And, for the rest of you, don't don't hesitate to leave a comment or reach out anytime you have questions. I look forward to next time.