Harness Good Vibes To Manage Your Parkinson’s Biophysically

Jay Lombard, DO

Oh, thank you for having me. I’m looking forward to our conversation together.

Kenneth Sharlin, MD

Tell me a little bit about your background and becoming a neurologist and a little more about the work that you do.

Jay Lombard, DO

The idea that I wanted to become a neurologist came when I was like 19 years old. My dad suffered a massive stroke and ended up dying a year later, and I just could not understand then. Even through medical school and everything else, there was such a sense of nihilism about brain diseases. That thing is what propelled me to study neurology. Based on that experience and with an eye to understanding, these notions that the brain does not have regenerative capacity are not only wrong but they’ve been proven to be wrong. The question is: what are the biological mechanisms of neuroplasticity that allow us to think of Parkinson’s disease in a way that people don’t need to fear its progression? Once I understand that these technologies are currently available for them, regarding my research, I have a ton of research interests. My main area of research focus right now is the role that viruses play in the pathogenesis of ALS and Parkinson’s disease. I’m not only looking for the problem because there’s a saying: don’t look for problems; they’ll find you. However, the goal of looking for a problem is not to find the problem but to look for a solutions by understanding what the problem is. I have a small practice. I am a part-time author. I’ve written several books, which is like my spare hobby, and I spend a lot of my time with the people that I accept into my practice, who have become like family to me because I understand living through such catastrophic events, like having a loved one like my father die from a stroke, and what it’s like to be on the receiving end of that type of experience, which is where I  operate from at this point in my life.

Kenneth Sharlin, MD

Here at Shoreline Health, in neurology, we have this approach we call our five-pillar approach, which begins with making sure that we understand what the diagnosis is. Sometimes people come in already diagnosed, but sometimes people come in with a spectrum of symptoms. Maybe we’re not even the first person that they’ve seen. Are you engaging folks on the diagnostic side or the primary side early once their diagnosis happens? Or you’re looking at things from a different perspective than maybe other neurologists.

Jay Lombard, DO

The answer is simultaneous. that they’re not their processes. The older I get, the more I’ve learned to listen to the patient as opposed to listening to a diagnosis. Because once you see a diagnosis, it automatically puts you in, oh, a patient who has Parkinson’s disease. I’m going to give sinemet. If not, I’m going to go through all the medications. What I found in all of my patients with neurological problems, whether it’s Alzheimer’s, ALS, or Parkinson’s, is that there’s such significant overlap in the symptoms that for us to call these conditions separate diseases is what we can’t call the categorical error. Meaning that these conditions are two-dimensional. People with Parkinson’s may have memory problems and lose muscle mass. Patients with ALS may develop dementia or tremors, so the fact that we can localize to one anatomical region means we don’t understand that. We have to look at the underlying pathogenesis. What they have in common is that they look for treatments based on that approach as opposed to a diagnostic approach.

Kenneth Sharlin, MD

We were talking a little earlier this afternoon with Dr. Dale Bredeson, and he just brought up the point that we were talking primarily about Lewy body dementia, which is what we would call alpha-synuclein apathy or synuclein apathy. However many people who have Alzheimer’s disease often have Lewy body pathology as well. Vice versa. Mixed pathology with Parkinson’s and Alzheimer’s. It may be somewhat of an artifact of our time. Hopefully, if it’s an artifact, maybe we’re moving past it to put people in these very separate boxes and say, “If you have Alzheimer’s, you get this treatment. If you have Parkinson’s, you get this treatment.” Because that’s that disease-centered approach that has some value but has a lot of shortcomings as well.

Jay Lombard, DO

When you mention Lewy body disease, which I agree with, you can find it in any of the neurological diseases. Lewy Body Syndrome points to the role of sleep dysfunction as an underlying cause of neurological problems, meaning that when we sleep, we have a certain percentage of non-REM sleep that the brain requires, like cooking chicken soup. You have to not have too much salt. You have to have whatever matzo balls you need in the soup. But we find in patients for whom we’ve done sleep studies that there’s significant fragmentation of their sleep, particularly their non-REM sleep, more than their REM sleep. Non-REM sleep is like the slow-wave sleep of the brain. It’s like when the brain finally gets to relax because, during REM, the mind is as active as it is during a wakeful state. There’s no rehabilitation or vacation that the brain has with REM sleep. 

The only vacation it gets is during non-REM sleep. What we’ve learned is that non-REM sleep is the principal mechanism to enhance what’s called lymphatic removal so that, as we sleep, the brain’s task is enhanced. It’s almost like thinking of it as a cesspool analogy: the janitor could come in now because everyone’s using the bathroom during the workday. Meaning at night is when you clean the toilets. Metaphorically, it’s time that the brain doesn’t have to worry about any of the housekeeping processes other than flushing out these bad proteins associated with Alzheimer’s. ALS and Alzheimer’s disease: The link to sleep disorders is probably, in my opinion, the most common risk factor for the development and progression of ALS, Parkinson’s, and Alzheimer’s disease. Sleep dysfunction.

Kenneth Sharlin, MD

Oh, yes. It’s probably bidirectional. In other words, when we know, speaking truthfully, that things like sleep apnea or other reasons to have fragmented sleep are major risk factors for these disorders, then, as these disorders evolve, there are certain calling cards that are characteristic of the imbalances that have evolved as that disease process moves forward. The REM sleep behavioral disorder and other things

Jay Lombard, DO

That’s exactly right. To add to that, it’s very interesting because the lymphatic system was only recently discovered. If you talk to a lot of neurologists, simply say, “Hey, you can get your patient’s lymphatic function about, like, what’s lymphatic?” To explain to the listeners, the lymphatic is a lymphatic system. It’s the immune system in the brain that’s tasked with being the principal anti-inflammatory mechanism. Biologically, that’s why sleep is, in my opinion, the greatest anti-inflammatory. Right from your experience as well, you get worried if a person like, let’s say, a patient with epilepsy who doesn’t sleep for three nights, if you don’t address it the fourth night, can have a seizure. Think about a patient who has not had normal sleep for years. How much damage are we doing to our brains because of that? The other point I want to make about this is that the problem when we say sleep apnea to non-neurologists is that they don’t understand that sleep apnea is one or two things. It’s either obstructive apnea, in which people who are overweight have big tongues. However, the majority of patients with neurological problems have central apnea, which means that giving them a BiPAP device is not going to help. It’s an issue of stimulating the brain. It’s not an issue of forcing air into the brain. I tell people, Look, you have sleep apnea. I don’t have sleep apnea. I know you probably do, but you just don’t know it.

Kenneth Sharlin, MD

For the listeners, there are specialized devices for this type of apnea called central apnea. It’s been a little while since I’ve done a lot of sleep medicine as a diagnostician, but we call it auto-S.V. type devices and may have evolved a little bit since then, but as opposed to the BiPAP, which more or less is an air splint to hold your upper airway open, these auto-servo mechanism type devices initiate the breath when the diaphragm is not active.

Jay Lombard, DO

Now, I’m going to write this down.

Kenneth Sharlin, MD

Auto SB; was an auto-servo mechanism, servo ventilation, or something like that. There may be some newer technology. I used to take a lot more sleep medicine than I do now. But that said, it doesn’t mean that we’re saying we ignore sleep. For every patient who comes in to see me, we take a history that includes what your sleep looks like, and at the very least, while this is by no means a tool to diagnose sleep apnea, at the very least, we’re getting overnight pulse oximetry. If they’re dropping their oxygen saturation, then they’re getting a sleep study.

Jay Lombard, DO

Exactly. Yes.

Kenneth Sharlin, MD

We’re definitely on that. People need to know. That’s something that I’m so glad Dr. Lombard is bringing up—that they need to talk to their doctor and make sure that somebody has at least screened them.

Jay Lombard, DO

Correct. 100% agree.

Kenneth Sharlin, MD

You used the word neuroplasticity while we were talking before the formal interview started. I wondered if you defined that. It’s an important concept because it’s central to everything that we’re talking about at the Parkinson’s Solutions Summit.

Jay Lombard, DO

The first neurologist who was Freud’s teacher was Charcot. Charcot was a very famous neurologist during his time in Europe. He would have had people take the train in to see him; they didn’t have airplanes in those days. He would greet them at the train station and notice that the majority of his patients had neurological problems. He saw everything. Their diseases named after him are, for God’s sake, Charcot-Marie-Tooth disease. He noticed that when people got off the train, their symptoms were better, and they would stay better until the time that they went to their hotel. They were back to feeling miserable again. Being a good historian, he figured out that there was something mechanically going on and that the vibration of the train helped them feel better. He didn’t know what the mechanisms were, but he observed them, and what he created was what was called the Charcot helmet. The Charcot helmet is probably in some museum somewhere. I’d love to find out and pay a visit to that museum ourselves. He developed these helmets right back in the early 1900s when my wife was going to dinner with her friends, seeing Barbie, and then, like, going for it, kid! I’m glad when the women take over the world; trust me, the men are doing a horrible job. It’s time for the women to take over. But where was I in this conversation?

Kenneth Sharlin, MD

Vibrational helmets.

Jay Lombard, DO

That led to the understanding that Parkinson’s disease is less of a neurochemical phenomenon. We think of what Parkinson’s is. Oh, it’s low dopamine. But is low dopamine the cause or consequence? Like everything else, cause or consequence? What happens during brain diseases like ALS or Parkinson’s is that the brain becomes in what’s called a pathological reentry circuit. Think of it like the Mac; when it goes into that crazy spiral and you have the computer off, that happens in the brain of patients with these neurological conditions; they’re called closed loops of signaling from the pathological areas of the brain. Right to the musculature. We’ve lost inhibition. you’re shaking. Instead of dealing with that area and making people not shake anymore, instead of, the idea is that you can interrupt those closed circuits through what are called afferent pathways, where you stimulate the periphery, like in a train when you’re vibrating because the train tracks, so that’s what my current research is on a clinical basis to understand what type of modalities we can use based upon Charcot’s principle of breaking these pathological loops through vibration to understand more about how to treat this condition. Non pharmacologically.

Kenneth Sharlin, MD

What have you discovered? Where are we with this endeavor?

Jay Lombard, DO

I can’t tell you. It’s top secret.

Kenneth Sharlin, MD

Well, it is. Let’s say it’s important.

Jay Lombard, DO

I’m joking. Please, I’m joking; you’ve got to get used to my sense of humor because I thought you could see that. So what it is: there are several different devices. One is available in Italy. It’s called the Equistaci; they have evidence-based utility using this in Parkinson’s patients. It’s very simple. It’s giving proprioception at the lower limb level. It’s at specific frequencies where the brain starts reading a different signal than it’s used to reading. It interrupts the pathological cycle by sending an exogenous external signal different from that. My other research in this area is something called synchronization. How do we synchronize this holistic medicine concept not biologically but through vibrational devices? I’ll tell you a quick story. Your group’s going to love this, to be honest. I treat Parkinson’s patients, as I’m sure you do. One of the things that is most difficult to address in Parkinson’s patients is their anxiety. It’s just that when I see a patient with Parkinson’s disease, I ask them, What’s the one thing you could get rid of that would make it easier to have Parkinson’s? Just take one thing. The hands-down answer is, Please help me with my anxiety. With the idea of producing healthy signals through exogenous methods, I came across a technology called HeartMath. I had to speak to them directly a couple of weeks ago because that’s a personal story. But what they figured out is that if you try to change the brain, the brain is the most stubborn organ in the body. 

You think about every other organ like you do. Oh, let’s take a beta blocker. Slow your heart down. No problem.  Try changing brain behavior. The reason that we have such a high rate of nocebo effects is because the brain doesn’t like change. Even if there is a good change, is it? If I exercise, I’m going to feel good, but I’m not going to exercise because I don’t want to feel good. These are the patterns that the brain has. Instead of trying to convince the brain that something is wrong, assess the variability of the heart rate. Because of the variability, the heart rate is a mirror of the flexibility of the brain. There’s this field called neurocardiology, which lumps together the understanding that these two organs are one and you can’t separate them. Oh, you have heart problems to go to. Cardiologist, neurological neurologist: “Hello, it’s the same person, same organ system.” The heart and the brain either cohere, which means that they’re synchronized. The Charcot theory of using vibration to synchronize. And you can resynchronize through heart methods that are then able to convince the brain to get back in line, for lack of a better word. I want to tell you that I work with a very lovely woman, and she’s a very famous retired musician and therapist with Parkinson’s disease. She comes to me, and I walk her off the cliff every day. Every day I said, I want you to download HeartMath and call me back, like, in a week, and let me know how you are doing with it. I said no. I said, Come back to my office so I can evaluate you because I just saw her a week earlier. She comes in, and she’s like, She puts her feet on my desk, and she goes,” You’re cool with this?” I go, “I’m cool with it.” “I’m cool that you’re so cool. Are you kidding me?” I said, “How much anxiety effect did it have on you?” She said, “Well if my anxiety was a 12 or 14 out of 10, which means it was beyond a ten in terms of tolerability, it went down to a two.”

Kenneth Sharlin, MD

It is important to understand that we do a lot. Every one of our functional medicine patients who engage us in our brain tumor program gets an inner balance device. My wife, Valerie, who is a certified HeartMath instructor, works with all of them.

Jay Lombard, DO

I have to introduce you to them directly after this call. But that’d be a great connection. Yep.

Kenneth Sharlin, MD

We interviewed Deborah Rosalyn for the Parkinson’s Solutions Summit, and she’s with HeartMath. She’s one of the chief officers of HeartMath. If you’re listening to this, I don’t know in what order the interviews will appear, but we’re introducing you to a little bit of HeartMath here. Either stay tuned and see the HeartMath interview or rewind a little bit and catch the HeartMath interview on our week of an opportunity to see any talks or interviews that you may have missed. It’s very important to watch. Very nice. Well, we do a lot of there’s a little digression, but we do some autologous mesenchymal stem cell work here, intrathecal injections. That’s why I don’t want to go there too much. But the point is that we use a little bit of conscious anesthesia for the procedure, which consists primarily of some diazepam, lorazepam, or whatever, sometimes triazolam. But the point is that the lingering effects of these sedating drugs carry over to the next day. Even though stem cells have regenerative effects, their anti-inflammatory effects certainly have not necessarily had an impact now. We can see a Parkinson’s patient who maybe couldn’t walk without a walker; he just walked right down the hallway with very little difficulty. Not that I recommend using these drugs for the treatment of Parkinson’s disease. It was, and these were anesthesia drugs. But the point is that the role that our biological stress response system plays in all of these diseases is quite profound.

Jay Lombard, DO

Well.

Kenneth Sharlin, MD

Neuroplasticity can be influenced by vibration. What is interesting to me as a neurologist is that when you go through traditional allopathic training, take a pill, or go to a surgeon, you can be influenced by a whole variety of things, including energy modalities. Vibration, I suppose, is a form of sound. We’d probably call it sound energy. There are other sound energy healing modalities, from binaural rhythms to some of the more Buddhist-oriented things that think of the sound bowl, the bowls that make sound, and they may not be in the clinic, but there are alternative healers who use those, and there’s probably some science behind that. We know that light plays a role. We know that electromagnetic fields have healing modalities. Have you explored some of these other energy modalities? Transcranial, alternating, or direct current stimulation can be very effective.

Jay Lombard, DO

I agree. I’m certainly a person who’s aware of the research on this. But as far as clinical intention, I have very little experience in those other areas. But just to broaden the conversation, the idea of neuroplasticity came from a Russian neurologist by the name of Alexander Luria. You are right. The credit belongs to him, meaning that he was not only able to recognize it in his personal life, but I’m not sure if he had a stroke or some other area in that regard. But he’s the godfather. We’re standing on the shoulders of giants at this point, acting like we’re so smart. These guys are the ones who led the research community to understand that the brain does have neuroplasticity. Neuroplasticity is something that I tell every patient, and you get the same question I get. People say, “Will I get better?” I say, “Then you have to change the conversation,” and they say, “What do you mean?” They’ll say, “I want to get back to my old self.” I hear that all the time. “Can you get me back to my old self?” I say, “Who’s your old self?” They go, “Someone optimistic and hopeful when other people are sick.” He’s a therapist. I’m talking to you about this. I said, “Let’s play a little game. You’re going to be your old self, and I’m going to be you at the current time.” They will go, “Okay.” And they will only be able to stay in that moment of their old self for a very brief period. What I realized is that there’s cognitive freezing as well as motor freezing in Parkinson’s patients. That is something that can be best addressed on a one-on-one experiential basis. During COVID, my practice went from being a busy practice to having almost no patients. The reason for that was: How can you treat patients remotely? I know we had to, but there’s so much other value as clinicians we can give to understand where the patient is coming from psychologically that we’re able to channel that back to them as a biofeedback method, as a therapeutic modality for them. Physical exercise, as you asked about something other than alternative therapies, is using different modalities other than vibration technologies, and you mentioned sound. There’s very strong research related to sound through very low-frequency ultrasound. Since you have a big background in ultrasound technology, who better than you to not only understand but also promote these technologies as they go forward? But people are looking at very tiny amounts of focused ultrasound. In my opinion, anatomy equals destiny because you can put these things anywhere you want. After all, we don’t know where in the scalp we should place them unless you’re doing actual, real ultrasound surgery. 

My idea is that we develop an ultrasound modality, particularly at the cranial-cervical junction. Why the cranial-cervical junction? Because, when you do an image of the necks of patients, they have a stiff neck. Oh, that’s your Parkinson’s. Maybe it’s not your Parkinson’s. Maybe it’s your cervical spine. I would do MRI scans on these patients, and they very commonly find abnormalities in what’s called the cranial cervical junction, which is the articular portion of the spine with the brain. My idea is that this is just happening in real time as we’re discussing this on whatever date we’re discussing it on to see if we can assess and validate that applying low-frequency ultrasound to create a cervical junction could have improvement in the lymphatic system as a way of shaking, almost like the Christmas glass tubes where you shake and the snowflakes come down. Think about that. An ultrasound shakes it up. You’re breaking up these protein aggregates, and you’re able to safely flush the toilet. Getting better sleep and flushing the toilet before you sleep means that you should use them. Open up the gates before they open. It would be a great sequence to see. We could even assess this with MRI studies to demonstrate that what we think we’re doing is doing what it’s doing.

Kenneth Sharlin, MD

I’m wondering if you’re familiar, there’s a German company called Storz Medical, they have a device approved in Europe by the equivalent of the European FDA for the treatment of Alzheimer’s disease, and it’s called a neurolith device. You can read about it on their website. They do say quite a bit about the science behind it. You may have to say when you go to the website that you’re in Germany or that you’re in England or France because if you say you’re in America or the US, they won’t show you the device. But other than that, you can go on there. It’s quite remarkable all of the different effects that this focused ultrasound has on the brain, including the neovascularization effect on brain tissue, which means bringing in new blood vessels, microvascular, all the way to the capillary level. Then that means delivering nutrients and oxygen. Removing things. That’s what the lymphatic system does.

Jay Lombard, DO

Exactly.

Kenneth Sharlin, MD

It does other things. Currently, it is not available for just somebody to walk into an office and have a treatment, but it can be purchased under a research license and used, including in the United States. I’ve been very interested in these. I just have to have a few more pennies in my piggy bank to buy one. But I know how to acquire one; there’s a distributor in the United States, and that’s what we are looking at.

Jay Lombard, DO

Can a guy tell you something and add this to your audience as well? I do hundreds of podcasts like I’m sure you do. This is the only podcast where I’ve learned more than I taught.

Kenneth Sharlin, MD

Well, thank you. I’ve learned a lot from you, and I appreciate it. By the way, I love these references, too, to Luria, and Charcot; I had the great honor. I don’t know that it was an honor. I don’t think he’s a little, as I’ll just say; that was a little rough around the edges with me. Maybe I deserved it. I was a resident, but I had the honor of training under Fritz Dreyfuss. I assume he may not be alive anymore, but Dreyfus gave his name to Emery Dreifuss muscular dystrophy. That’s about as close as I get to yours. Famously, you get a disease named after you, I guess.

Jay Lombard, DO

Well, I had a similar experience back in the day with Fred Plum. who left the legacy of writing books on Coma that we all had to read painfully because it was so complicated—those textbooks. I got to meet him towards the end of his life. Another person I had the honor of meeting before his death was Professor Damadian. He was the father of the MRI. He developed the MRI machine back in 1978 and won a patent battle against both GE and whoever else copied his MRIs. I got to meet him, and he was in his early eighties. You could tell he was slowing down. However, we discussed his new technology, which can assess lymphatic function through non-invasive CSF analysis. I just felt like giving a shout-out to him. Since we’re talking about legacy people who influence our careers, you, unbelievably, were influenced. at Emory. Alan Lade, does that ring a bell to you?

Kenneth Sharlin, MD

Yes. It’s been a long time.

Jay Lombard, DO

Yes. We got to have this podcast, and you guys can cut this out, I guess, by making your editors crazy. But we have to talk more about how connected we are.

Kenneth Sharlin, MD

I want to say we just have a few minutes left, and this has been a nice, very warm, conversational interview. But I do want, since this is the Parkinson’s Solutions Summit, to make sure that folks who are watching and listening understand some of the profound things that Dr. Lombard has said. We’ve talked about the importance of sleep, and we’ve had a couple of other interviews that have brought up sleep. So we can’t emphasize this enough: get your sleep assessed, even if it’s just a simple overnight pulse oximeter on your finger that captures data about your oxygen. Folks, this either goes right through your insurance or you might get billed two dollars. This is not a big investment, but it could save your life. Find a neurologist who listens. Dr. Lombard talks about listening to their patients. There’s a statistic that says the greatest part of the diagnostic journey is listening. Someone once said that if you have an hour with the patient, spend 55 minutes on their history and 5 minutes on the exam and the tests. The tests are fun, interesting, and worthwhile. But I sometimes have to tell my patients nobody was ever healed on it by an MRI. We have to listen to our patients. Then he brought up neuroplasticity, the ability of the brain to change itself. This is so important for those who feel stuck because Parkinson’s folks are stuck from a motor perspective. It is often true that they’re stuck from a cognitive perspective. That was an observation we heard from another interviewer. Alex Burton is not a neurologist or a physician at all, but he does some wonderful work with movement and changing the way people think. We have to recognize where we are now and that everyone with Parkinson’s is different. In the listening and then in the investigation, we’re going to figure out what the factors are that brought you here. How did you get Parkinson’s disease? Then what Dr. Lombard is saying is that, from there, we can unravel the things that are keeping you on that trajectory and work on them. That’s where the difference is made. I hope I’ve summarized okay.

Jay Lombard, DO

For me, you’ve got me at the beginning. Where do we go from here?

Kenneth Sharlin, MD

Well, you still work with patients, and I am sure that folks can tell that you are such an empathic, caring, and extremely knowledgeable physician, neurologist, scientist, inventor, and author. If someone wants to work with you, how would they do that? How do they reach out to you?

Jay Lombard, DO

They would call my assistant, Michel, who’s like my older sister and thinks that I work for her. Her number is 8456341119. She’s the secret sauce to my practice because she makes sure I care about people if I forget to care. She knocked on my door and said, You need to wake up a patient who has a problem and get to it yesterday. Thank you. That’s just to be aware, though I don’t take a lot of patience because I probably spend most of my time—maybe 80% of my time—purely on research. In other words, if the person that you’re listening to feels like they have a connection with me, I’m happy to decide if I can take that journey. Because if I take a patient on, I take that case on for as long as the patient wants me to take it on. I like to keep my practice small, but we’ll see what happens. But the most important reason for this meeting was to meet someone who, as you said before this call, is a neurologist, and I won’t say anything that believes in the patient. That’s where both of us come from. We have to believe in our patients. If we don’t believe in our patients, they’re not going to believe in us.

Kenneth Sharlin, MD

It’s that you touched on something, too. I’m not sure that you necessarily meant it as a little pearl, but it’s so important that I want to bring it up as we wrap this up, because you’re right. As we went through COVID and there was a big emphasis on telemedicine, a lot of folks wanted to just work online with different providers. We hear about Sharlin Health. I’m sure with Dr. Lombard, we’ve adjusted to a degree to the reality that is Zoom and all that. However, there is a certain energy of presence, and I am a firm believer that if you truly are committed to getting better, whether you see Dr. Lombard, you see myself, or you see one of the other very talented people that we interview, please get in your car. Get in an airplane; get in a train. Come be present; be present at HeartMath Energy. It’s an energy that goes from our hearts to our brains; it’s an energy that comes from us. That is part of the healing as well. Please do work on this, folks. Think about it. Make that big commitment wherever you go. Getting help means being physically present.

Jay Lombard, DO

But I’ll leave you with this. I have meetings every Thursday with an autistic boy who’s a savant. One of the things he said to me was that he is a nonverbal kid. He writes on a letter board that life is a gift; be present.

Kenneth Sharlin, MD

Well, with that, Dr. Lombard, I want to thank you for being part of the Parkinson’s Solutions Summit. We found a close connection today, and perhaps afterward I’ll reach out and we can find some other times to continue our conversations.

Jay Lombard, DO

It’d be great. I look forward to that Ken. Thank you so much for hosting me tonight.

Kenneth Sharlin, MD

Bye-bye now.