Integrative Care Podcast

(se)® LAB
Integrative Care Podcast
31:49
 

One Stop Shop -- That is exactly what Structural Elements® is! CEO and Founder, Doug Bertram dives deep into how Structural Elements® applies our proprietary model to the human body and how that informs their multi-practitioner approach with a combination of modalities. 

This podcast provides a new appreciation for how important structural balance is to pain-free activity.

Listen and learn:

  • How exactly Structural Elements® applies to the workings of the human body and how that informs their multi-practitioner approach with a combination of modalities,
  • What are some examples of structural balance exercises and orthopedic conditions treated by physiotherapy, and
  • How an initial appointment would work regarding assessments and examples of therapies like deep tissue restoration. 

Listen more to Finding Genius Podcast


TRANSCRIPT

Intro: [00:00:18] Richard Jacobs has made it his life's mission to find them for you. He hunts down in interviews geniuses in every field sleep science, cancer, stem cells, ketogenic diet and more. [00:00:28][10.1]

Intro: [00:00:28] Here come the geniuses. This is the Finding Genius podcast that Richard Jacobs. [00:00:33][4.8]

Richard: [00:00:37] Hello, this is Richard Jacobs with the Financial Genius podcast. I have Doug Bertram is the CEO of Structural Elements. Website is also structuralelements.com. They are an orthopedic wellness clinic that strives to provide the highest standard of care through a contemporary business model in a proprietary treatment approach. So we'll get into that. Doug, thanks for coming. [00:00:59][21.4]

Doug: [00:00:59] Yeah, thanks for having me. [00:01:00][0.9]

RIchard: [00:01:01] Tell me in your own words, what structural elements about. [00:01:04][2.6]

Doug: [00:01:05] The structural elements originally started as an education company. And a lot of times when people first see our brand and your structural elements, they think of an engineering firm. And I kind of wear that like a badge, because that's very much the approach that we take to looking at the human body. And then I would say to people when we're trying to explain it is you don't want to wait until a car falls into the Pacific Ocean before you bring in an engineer to, you know, look at the mechanical stress and the capacity of the bridge. You want to make sure that that's done ahead of time. So the structure elements, we can take an engineering approach to the body of looking at quantified mechanical vulnerabilities so that we can try to stay ahead of joints from wearing out prematurely. And so we like to be on the front end. But we also don't catch a lot of our patients until they've already experienced pain or had some wear and tear. [00:01:59][54.8]

Richard: [00:02:00] So typically someone will come in and say they had low back pain for years. And, you know, it's hard for them to get in and out of bed or drive or things like that. What are some examples of what you get? [00:02:11][11.3]

Doug: [00:02:12] Sure. So we'd like to promote that. We treat an active population, but we use that term in a very relative sense. So we treat a lot of athletes. We treat runners, triathletes, Crossfit folks. We have a number of our therapists work with professional teams, both professional baseball and football. But we also consider somebody to be active if they just want to not hurt after spending time with their grandchildren. So we do try to establish an active goal with every patient, regardless of their chief complaint when they come in so low back pain, knee pain, elbow pain, shoulder pain, plantar fasciitis. These are the things that might bring somebody in initially. But very quickly, in the course of treatment, we want to establish an active goal. What would you do if the limitation of this pain wasn't there? How would you use your body differently? And we tried to focus on getting them to that goal instead of just mitigating the pain symptoms. I feel like I should go into a little more depth, into a little bit about how it doesn't matter what the license of the practitioner is. We have chiropractors, physical therapists, acupuncturists, massage therapists, and we use a combination of modalities. And so everybody practices Structural Elements in our locations regardless of their license. We even have a doctor who is doing injection therapy but is just looking at the body all through the same lens of kind of quantifying this mechanical stress and looking for where the breakdowns occur. [00:03:47][94.6]

Rochard: [00:03:47] You get guys do any pastoral work like the Gosu or Feldenkrais or Alexander technique or anything? [00:03:52][5.0]

Doug: [00:03:53] Yeah, again, we would say that we use Structural Elements technique, but one of our absolute pillars is big picture posture, because if I may take a liberty here of jumping into possibly a secondary topic, but it neatly ties in to how I would explain this. We're a cash practice and that's something I like to bring up early in the conversation, because one of the reasons why we're a cash practice is we look at the body as a complete system. We don't look at people as a series of parts. And so we are very much concerned with the importance of posture. And because of that, we find it very difficult to limit our intervention in our treatment to a specific body part. Even though somebody might come in for foot pain, the solution might be in reducing head forward posture and opening up the internal rotation of their shoulders to change their center of mass and how they're loading the foot. So in the insurance world or the conventional kind of treatment strategy around insurance reimbursement, you're really dealing with what procedures are reimbursable given a diagnosis code. And we just refuse to limit our care to our patients based on chasing what is understood in terms of reimbursement from the insurance companies. [00:05:11][77.9]

Richard: [00:05:12] So I don't blame you. Yeah, I don't blame you one bit. I've had knee pain and back pain. I've had all these modalities, literally every single one you mentioned. And right, if I was on insurance, forget it. They just shoot you up and say, "heres a pain pill". You've got to have all that stuff. So I'm totally with you that I understand. [00:05:30][18.5]

Doug: [00:05:32] Yeah. Or in the physical therapy world, you come in with a diagnosis for foot pain, you tell them that that day you're back hurting. Well, that's a separate code. You have to go back to your doc and get a script for that as well. And we'll treat that on a separate visit. And it's just our belief that that's not the way that the body works. [00:05:47][14.4]

Richard: [00:05:48] Yeah, it's ridiculous. And then you're right, sometimes you don't know the arch of my foot would hurt. And it turns out my you know, my leg muscle or my knee muscles pulling this way or my hip is out and they would never even begin to find that at a clinic that you're talking about. So you have to have this holistic approach. And I'm sure your clients are surprised. I was surprised at the fact that it's weird and I was constantly reminded by therapists it's all works together. [00:06:14][26.4]

Doug: [00:06:15] Absolutely, so somebody comes in with the diagnosis of a chief complaining of headaches or again, of plantar fasciitis. And we say we are of the pelvis school of thought that the pelvis has to be balanced for everything above and below to function properly. It doesn't always start in the pelvis, but once it's in the pelvis, it's everywhere. And so we do a lot of assessment of looking at the rotations of the pelvis. We look for functional movement through the pelvis. We look at the hind foot and how it moves lower leg mechanics. And a lot of people when they're coming in with with heahaches or jaw pain, like why in the world are you looking at my hips? You know, didn't you read my intake form? You know, I'm here for my head and my jaw. But as soon as you start talking to patients and educating them about the interconnectedness of how the body works and functions as a system, all of a sudden people are like, wow, that is that makes so much sense. And that's so cool like this really is helpful to understand how it all fits together instead of just feeling like, oh, I'm getting older, I'm falling apart from this long list of complaints. And we're like, no, you're not. You just are out of balance. And it's showing up in multiple areas of your body. [00:07:26][71.8]

Richard: [00:07:27] So athletes, I can understand you, they're putting their body through the paces. You do a lot with just normal folks, you know, 30s, 40s, 50s. And what do you see if so? [00:07:37][9.8]

Doug: [00:07:37] So, yeah, I mean, let's go back to your posture question. We all sit too much, right? We're all on devices more than we should be. We're all in front of screens, especially these days, you know, zoom calls and everything. And the body just has some chronic patterns that show up when we are in a sitting position too long and the hip flexor shortens the posterior chain of the glutes, they tend to get overstretched and weak. We tend to get internally rotated our shoulders and our head tends to move forward. And when you have that common postural collapse, it is going to have a whole cascade of effects on the body. And certainly our primary method of treatment is to balance the structures of the body. But one of the big benefits that is helping regulate the autonomic nervous system. And most people don't realize that our stress response is controlled by two branches, the sympathetic and parasympathetic. And when we sit for prolonged periods of time, the sympathetic nervous system, which is regulated by something called the dorsal ganglia of our thoracic spine. Right? Our mid back. If you get too much tension in your mid back, you get a whole cascade of stress responses that show up. You know, it affects your digestion and affects how you sleep. It affects your blood flow to the rest of your body. Your pupils get dilated. It changes heart rate, it changes respiratory volume. So even though we really focus on preserving the joints to keep people active and mobile, there's a huge part that goes into just regulating your stress response and all of the endocrine systems and all of the hormone changes that happen when those systems overlap. So everybody, everybody, everybody is affected by that. And it's just societal. But it's also, you know, it's just a common postural collapse. It's physics. So we treat everything from, you know, young kids, which I love to work with kids while they're growing. We work with a lot of high school athletes and really try to help them through growth spurts as well as manage when they start to get sports specific, because that has a lot of challenges for a young athlete. And then just the average Joe just hurts and doesn't want to hurt and wants to feel better and be more active, you know, so nobody's off the list unless they have a situation that is acute and needs to to receive more advanced immediate medical care, assuming that they're safe to treat we work all walks of life. [00:10:12][154.5]

Richard: [00:10:12] So what's a typical session look like? Is it, you know, here, go do these exercises and call us when you're done or you know what happens? [00:10:20][7.6]

Doug: [00:10:21] We're very hands down. We're very manual based. And we offer a couple of core treatments. One, we call the Structural Elements treatment, the (se) treatment or the other is called DTR, which is Deep Tissue Restoration. The (se) treatment starts with the standing postural assessment, we again quantify all the mechanical stress, triangulate off bony landmarks, look for where your body is out of alignment, and then we get you on the table and we hunt around for something very specific that we would call focal adhesions. Focal adhesions are changes that occur in the connective tissue, primarily along the intramuscular SEPTA, which is the connective tissue that separates one functional muscle from its neighbor. So this is our primary exploration is looking for where our patients' bodies have formed these compensatory changes in the connective tissue as a response to being out of alignment. And then for the most part, most treatments and the (se) treatment we use needles. It depends a little bit on the scope of practice of the provider as well as where they're practicing. Some states are different with the practice acts, but for most of our providers, we use needles. And that's another segment I like to get into is the difference between how we needle and dry needling and acupuncture. If we can sidebar that one a second. [00:11:39][78.5]

Richard: [00:11:40] Well, one second for the common public. When you say needles, they are probably thinking of injections but you're talking about acupuncture, right? Yeah, exactly. [00:11:48][8.1]

[00:11:49] We're talking acupuncture needles. But since we took a pause, there's a lot of confusion. When we use needles, we're talking about solid filiform needles. We're not injecting anything for the most part. We do have MDs that do injections. But that's a very specific intervention. For the most part. We're using a solid filiform needle, which is a dry needle. Right. The differentiator there is a dry needle is a term that was used when you were looking at the double blind controlled based studies for the effectiveness of injection therapy. Right. So you need a control group. And the control group is you put a needle in, but you don't inject anything. And the term dry needle comes from that. Once people realized that there was a lot of benefit to the dry needle, they started using a safer, dry needle, which is a solid needle versus the hollow hypodermic needle. And it's thinner than the hypodermic needle for the most part. And that is an acupuncture needle. So the tool of an acupuncture needle and the tool of a dry needle are identical. The “why” you needle is what's different. And a lot of people make the mistake of using acupuncture synonymously with the practice of Chinese medicine and the ideals of Chinese medicine. But there's as many reasons to perform acupuncture as there are, you know, acupuncturists, right? I mean, there's absolutely orthopedic acupuncture. There's absolutely sports acupuncture. There's absolutely acupuncture that focuses on tight taught bands as well as there's acupuncture points that focus on these focal adhesions. It's the exact same tool that is used in dry needling. Typically when you hear the term dry needling its therapists that are trying to elicit a twitch response and a tight muscle band to get it to relax, that's a little different than how we use it. Again, we retain needles, we wind collagen fibers around the shaft of the needle to get a connective tissue cellular response. It's called the fibroblast and it releases a chemical reaction when it is under mechanical stress. And and so we're using that to relax and lubricate the connective tissue where it is bound to neighboring structures. And then once we have loosened up those vocal adhesions, we then organize and integrate, which is usually with a manual therapy technique of pin and strip where we hold that focal adhesion where we take a patient through an active range of motion to reorganize the fibers and then we'll do manipulations when necessary to realign the pelvis or to mobilize the spine or the small joints and then strengthening lengthening exercises to help them hold the alignment. [00:14:26][157.3]

Richard: [00:14:27] So when people come in how much are they familiar with and how much is new to them? I'm sure some of the modalities that I've never experienced before and some of them may have. So they will have the kind of sophistication you get them first timers? [00:14:39][11.7]

Doug: [00:14:39] Yeah. You know, nowadays it's rare that we have had anybody that hasn't either had most of the modalities that we used or hasn't known somebody that has or, you know, I mean, the very few people you have to start from ground zero to educate them about what we're doing. Most people have had some experience, but the most common feedback that we get is that we're a one stop shop. [00:15:06][26.9]

Brief Announcement: [00:15:07] If you like this podcast, please click the link in the description to subscribe and review us on iTunes. [00:15:12][5.1]

Doug: [00:15:13] You know, people are like, man, I have to go to my massage therapist for this and my physical therapy therapist for the exercise, my chiropractor to get adjusted. And here you guys blend everything into one treatment. That's awesome. You know, and that's the biggest response that we get. The I would say the most common outlier of what people haven't necessarily experienced is the dry needling or acupuncture, and people have again, because of injection therapy, you're having blood draws, a lot of people aren't huge fans of needles, and that sometimes is a deterrent for them to try the therapy. But what we find is most people kind of fear the needles, but look forward to the manual therapy and most people relax and fall asleep and drool on our floor while the needles are in and we're peeling them off the ceiling when we're doing the manual therapy. So the little counterintuitive, but the needles are actually very relaxing and totally painless. [00:16:08][55.1]

Richard: [00:16:10] Yeah I've had acupuncture and it's totally different from being injected. It has nothing to do with each other. So what order do you do things in, like what orders have you found work and which ones don't? What's an example? [00:16:22][11.9]

Doug: [00:16:23] An example is freeing up the tissue prior to re-aligning the body. If you don't and sometimes we call it a bang trim. Right. If somebody goes in for a haircut and they need just a little trim between full haircuts, they can come in and they'll get a bang trim. So sometimes we have patients that they were recently in and they were like, man, I was just in. And I took my dog for a walk and saw a squirrel and he yanked me out. I feel like my hips kind of came out again a little bit. We'll say, no problem, come in. We won't do a full treatment. We'll just do a bang trim. And what we do then is we just do kind of a quick assessment and a fairly quick adjustment. But without the needles, without all the manual therapy and without all the connective tissue focus and even then people have been in recently, it is just so important to release and address any sort of change or restriction in the soft tissue prior to trying to correct the alignment of the joints because they just get pulled right back out of alignment if the connective tissue is still compensated and in a compromised position. So that is really important and I feel like that's one of the things that we differentiate ourselves. And then the strengthening and lengthening exercises, in my opinion, you really can't strengthen around a joint that is compromised in terms of its position. Right? Because you're just trying to strengthen a muscle that's already overstretched into weakness and it just isn't effective. So we believe you have to quantify and then do a good analysis, you have to free up the connective tissue, then you can realign the body, then you can strengthen. And we're been doing this for twenty seven years now, and I'm pretty adamant that it is the right sequence. [00:18:07][104.1]

Richard: [00:18:08] I'm sure you have cases where the joint is so pissed off or inflamed that you can only do limited stuff to try to, you know, get it out of it's chronic or acute condition. Sorry, it's acute state first before you could really work on it, right? [00:18:20][11.8]

Doug: [00:18:21] Absolutely. And again, lots of times, you know, people it takes a little bit of education to take the example of somebody who has osteoarthritis and we've got some inflammation in their left knee and they come in. I might not touch their knee for a couple of visits because I'm first focused on balancing the pelvis and getting the necessary mobility in the ankle and in the hind foot so that they can have proper gait mechanics without torquing the knee. And until we fix that, any benefits that I can get to the knee are going to be extremely short lived and potentially run the risk of irritating it further if I'm just going to subject it back to the same forces following the treatment. So I'm pretty adamant in making sure that we have a fairly neutral foundation before we go after really trying to remodel the affected joint. [00:19:12][51.1]

Richard: [00:19:12] I've heard this from a lot of chiropractors that say, like some people, a lot of people will be resistant if they don't do it right. You know, typical models, they'll come in, someone will get adjusted. They're like, oh, I recommend you come back twice a week for the first month and then once a week after that then it's just once a month. And the person may feel, I guess if it's not adequately explained, why do I have to come so much? Why can't I just come once I'm fixed? How do you deal with that mentality, how to identify it and how do you, you know, make sure that the person doesn't think that so they ghost you later on and don't do the right treatments? [00:19:46][33.8]

Doug: [00:19:47] Yeah, well, one of the things that we like to use as an analogy is you tell people you never go to a personal trainer and do one session and expect to maintain fitness. It's a process. And the more good habits you have that offset or outweigh the bad, the more you're going to preserve and maintain proper function and proper health of the body. And so it's a process and you're never done, you know, because I also like to say, you know, we're all going north and southbound on the train. We can slow that train down. Right. And the more that we have proper alignment, we can then have better function of our whole system. Right. And a lot of times when people are out of alignment, they're using their big muscles, their prime movers, as postural stabilizers, and that's a lot of muscle to feed. And you don't use a muscle as a stabilizer and expect effective and efficient movement out of that same muscle. So as people age, ah man, I've gotten really stiff. I've lost range of motion. I just don't move like I used to. And a lot of it is because they're relying on the wrong muscle groups for stabilization and they're tying up their mover's to just maintain brightness. Some balance starts to go by the wayside. You know, it causes metabolic issues because they're feeding large muscle groups instead of small intrinsic muscles. Again, change the stress response. People just find themselves in a pickle. And so we try to, you know, really kind of unwind that web and get them back to finding the efficiencies in their structure. [00:21:30][103.2]

Richard: [00:21:32] Again, In terms of managing attitude. Do you find that people are coming to you at a point where they've tried everything else? Like what's the typical set of stories that you get when people come in? Where are they coming from mentally and what have they tried? [00:21:43][11.2]

Doug: [00:21:45] It's pretty all over the map. I mean, we get a lot of people who come in and they're kind of at wit's end because they've been everywhere else. They've tried everything else and they maybe have had, you know, a round of injections that maybe brought them some short term relief. But the problem came back or they've been to physical therapy and they got a little better. But it's still not where they want it to be. They know they've been recommended for a joint replacement, but they want to put it off because they feel they're too young or it's not a good time. But then we get, you know, athletes who are super bought into, you know, preserving their body and staying competitive. We also get which surprises a lot of people. We also get a lot of, you know, hairstylists and restaurant servers and construction workers and people that make a living with their body and have realized that if I don't take care of my body, I could be out of work. And that's a demographic that is very responsive to paying out of pocket to get results because they are dependent on their bodies to go to work that day. And then what else surprises people is a lot of millennials have a really high value proposition around wellness and taking care of themselves and of not having the aches and pains and stuff that they've seen their parents go through. And they want to be proactive. You know, there's a big kind of value proposition around prevention with that demographic. [00:23:20][95.6]

Richard: [00:23:21] So what do you think is going to be the future of your clinic? What do you see changing or you just continuing on and serving more people or are their new things coming? [00:23:29][7.6]

Doug: [00:23:30] I mean, we are a franchise. We have three locations currently. Pre covid-19, we had some pretty aggressive expansion plans that we pumped the brakes on a little bit of a couple of clusters of company owned stores. But everybody that works in our clinics are micro franchisees. But what we've done in response to covid is we have opened up training as well as practice management in cash practice, marketing and everything else to non brick and mortar (se) therapists. So we call this network provider and they wouldn't do business as Structural Elements, but they have the ability to learn the modality and benefit from the infrastructure that we've created. We're really built to be two, three hundred clinics in the next few years and in part to pump in our brakes a little bit has allowed us the opportunity to go a little deeper with some of our services. And the main development that we're doing right now is the injection and adding the injection therapy with the docs, but not just joint specific, but a comprehensive injection solution to address a number of structures that are undernourished biologically. You know, blood supply to a lot of tendons and ligament is very poor and the ability to systemically control inflammation or again, to look at the pain generator versus the side of dysfunction. That's a big differentiator. So we're going a little deeper. Again, as I said, we have chiropractors, we have physical therapists, we have acupuncturists, massage therapists, and we are all working under the same (se) provider, (se) therapist label. [00:25:25][114.6]

Richard: [00:25:26] In addition to your therapy outside of the clinic, how much do you encourage people to do? What do you encourage them to do? Do you encourage them to do certain stretches at home or to just simply exercise and do people do it? What's that, the whole plan for the person looks like when they're not in the clinic? [00:25:42][16.8]

Doug: [00:25:44] I try to encourage everybody to move their bodies, even if that just means, you know, an intentional, brisk walk a couple of times a day. If they can't do that, at least get up and move their bodies, try not to sit for prolonged periods of time. We try to encourage people to work on posture actively, both with something we call the traction exercise, which is just laying down in the floor, with bent knees and arms out to your side and doing some deep breathing for three minutes a day, as well as making sure that you're pulling yourself up from your sternum and setting your shoulders back and just kind of paying attention to your mechanics. But we also have, like, crazy athletes and we consider ourselves to be enablers. You know, if somebody's goal is to continue to run and qualify for the Olympic trials. Like we're going to manage that. Right. We're going to say alright. This is an important goal to you and we're not going to tell you not to do it. We're going to try to within reasonable limits of keeping you safe long term, we're going to try to support you through that goal. You know, a lot of what our Major League Baseball players or football players are doing, even a lot of ballet dancers, too. It's crazy what they subject their bodies to, but it's what they live for. So who are we to say anything different? You know, I mean, we try to help people achieve their goals and looking at short and long term consequences and being able to weigh those out. But we try to help people achieve their goals, not discourage them from, you know, from chasing them. [00:27:18][94.4]

Richard: [00:27:19] That's great. But do you think that you're the only integrated clinic that you know like this, or are there other places moving towards this model or is it just stuck in their own ignorant happiness of one thing at a time? [00:27:32][13.0]

Doug: [00:27:33] No, I think that there's a big movement towards integrative modalities. I think, you know, there's a big movement towards cash practice. And I draw those parallels because, again, with cash practice, there is a lot more freedom to look at the whole body. And once when you're looking at the whole body, I might do things a little differently than the next person. But when you're dealing with the same medium, there's going to be overlap. Right. Where I think you get a big divide is when you're looking at parts versus looking at people. And I think that there is a movement towards more integration. There is a lot more openness from the allopathic medical community. And we get a lot more referrals from docs then we used to. We used to get a lot of failed surgeries or people that were in chronic pain that they didn't know what to do with anymore. But now we get a lot more referrals for people that are not quite at the point of needing more invasive intervention. And they're sent for less invasive, more conservative therapies. So I do think it's a trend. And I don't think it's a fad. I think it's a trend that is here to stay and that people are prioritizing wellness. People are wanting to stay active and healthy later and longer in life as an expectation. And I think, you know, there's a huge fitness movement out there that people want to to be active. And in order to do that, they have to do the maintenance work for their bodies to be able to keep up. [00:29:12][98.9]

Richard: [00:29:13] Very good. So what's the best way for people to find out more about you and if they are local, where do they go? They're not local, do you have any services or resume or does it really need to be in person? [00:29:23][10.0]

Doug: [00:29:23] I mean, we do tele-wellness so sometimes and we've had a lot of, you know, runners or athletes that have heard us on podcasts or things that they just want some help troubleshooting or even helping understand what they might seek in terms of a local therapist. And so we do a lot of consultations over Zoom and tele-wellness. But we have two clinics in Maryland right now, one in northern Maryland in Hagerstown and another just south of Frederick, Maryland, in Urbana. And we also have a clinic in Milwaukee, Wisconsin, that is right on the east side of town there. And the URL just the structural elements.com, as you mentioned, is a great place, both for therapists that are looking for additional information on our business solutions or patients that are looking to find a provider that's the best place to go to. I'm also super transparent and very responsive to email, and I'm just [email protected] And I'm always excited to hear from people and answer any questions. If you go to our website, we also are on all the social media platforms and have a blog so you can sign up for our newsletter if you want to follow our progress. Going to our website is probably the one stop to link up everywhere else. [00:30:45][81.1]

Richard: [00:30:45] Very good. Doug, thanks for coming on the podcast. And it's really cool that you have this integrated model that's needed. Definitely. And I'm sure you help a lot of people. So thank you. [00:30:53][7.7]

Doug: [00:30:53] Absolutely. It's been my pleasure. And from everything that I looked at your site and you're doing great work and so I appreciate being a part of it and keep it up. [00:31:04][10.1]

[00:31:05] If you like this podcast, please click the link in the description to subscribe and review us on iTunes. [00:31:10][5.1]

[00:31:15] You've been listening to the finding his podcast with Richard Jacobs, if you like what you hear, be sure to review and subscribe to the Finding Genius podcast on iTunes or wherever you listen to podcasts and want to be smarter than everybody else, become a premium member and finding genius podcast dotcom. [00:31:33][18.5]

[00:31:34] This podcast is for information only. No advice of any kind is being given. [00:31:34][0.0]

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