Beyond MRI: Dr. Bagnell's Approach to Unseen Brain Imbalances

Beyond MRI: Dr. Bagnell's Approach to Unseen Brain Imbalances

Host Mike Roth opens Season 8 of Villages Vitality: Senior Life Unscripted with Dr. Michael K. Bagnell of Bagnell Brain Center, who treats patients with dizziness, concussion symptoms, brain fog, dysautonomia, and cognitive changes despite “normal” MRI/CT results. Bagnell explains dysautonomia as age-related weakening of autonomic brainstem control affecting heart rate, blood pressure, swallowing, and other functions, and emphasizes that brain function can be strengthened to improve balance, cognition, and quality of life. He describes noninvasive diagnostics focused on function, including precise eye-movement tracking with specialized goggles, vestibular testing using a rotary chair, and EEG brain mapping to assess brainwave power and connectivity. He outlines individualized, largely nonpharmaceutical neurorehabilitation (including targeted exercises and stimulation options), discusses typical program length, self-pay costs, and highlights sleep as foundational for brain health. He shares how to learn more via the Bagnell Brain Center website and social channels.

00:00 Season 8 Welcome

00:43 Meet Dr Bagnell

01:33 What Is Dysautonomia

03:16 Strengthening The Brain

04:27 When Scans Look Normal

06:14 Eye Tracking And Vestibular

09:18 Brain Mapping EEG

11:26 Vertigo Success Stories

13:31 Alzheimers Diet Tip

14:32 Slow Medicine Approach

17:52 Neuro Rehab Treatments

19:33 Costs And Coverage

20:07 Chiropractic And Brain Links

22:25 Two Week Intensive Program

25:35 Sleep As Foundation

27:21 Contact And Closing

Villages Vitality Listeners, I've got some good news for you. In season 8 most new episodes will released as both audio & video versions. Videos on Apple Podcasts, Busssprout.com and YouTube. If you're listening via our Buzzsprout feed, you can ask questions via the Fan Mail button or leave me comments as a text or in our new feature, you can send it as a voicemail. If you'd like a response, make sure you leave your name, email address and cell phone number.

Transcript

Copy Transcript Copied

SPEAKER_00 0:14

Welcome to season eight of Villages Vitality Life, Seniors Life Unscripted. In this new season, we talk to leaders of clubs and interesting folks who live in and around the villages. We also talk to people who have information vital to seniors. You will get perspectives of what is happening in and around the village's Florida. In addition, we will add more information for all seniors.

SPEAKER_02 0:38

This is Mike Raw on Villages Vitality, Senior Life Unscripted. I'm here today with Dr. Michael K. Bagnell, a doctor of chiropractic medicine, a diplomat of the American Chiropractic Neurological Board, a Fellow of the American Board of Brain Injury and Rehabilitation, and board certified in neurofeedback. Thanks for joining me, Michael. I'm looking forward to this. Michael helps patients who've been told everything looks normal, yet who still struggle with dizziness, concussion symptoms, brain fog, dysautonomia, or cognitive changes. At Magnell Brain Center, he combines advanced neurological diagnostics, innovative technology, and personalized neurorehabilitation to uncover what others may have missed. Michael, thanks for joining us. Start by telling our listeners what some of these words might mean.

SPEAKER_04 1:41

There's a part of our brain that runs automatic signals. Swallowing. It's automatic. Moving my eyes around. Heart rate changes. Blood pressure. It's changing as I lay down or I get up. Autonomia is a condition that the automatic system of the brain is not operating properly. So we become dysfunctional. Common as we age, 60 and above, this automatic system becomes weaker. Everything becomes weaker as we age, right? My body becomes weaker, my eyes become weaker, thereby the glasses, my hearing becomes weaker. And so also parts of the brain become a little bit weaker. So we can strengthen them. But when they become weaker, we may have problems with dysautonomia, meaning changes of position, which affects our heart rate and blood flow. So we can feel, I feel a little dizzy when I stand up, or my heart starts to race and I have to sit down. The system of the brain controls organ functions, male and female aspects of our function, gastrointestinal, cardiovascular, salivation. My eyes may be dry, swallowing. I may have more trouble swallowing as I get older. I may cough or choke a little bit. I never used to do that when I was younger. So it's the autonomic in my model, right here in our brainstem. But the brainstem, this area of automatic control and function, gets weaker as we age and can create health problems. People seek out different specialists, but yet it comes back to its neurology inside the brain.

SPEAKER_02 3:13

So breathing is automatic.

SPEAKER_04 3:15

Yeah, automatically used to. We can train them.

SPEAKER_02 3:20

That's the interesting thing.

SPEAKER_04 3:21

We can strengthen, right? We don't think about strengthening the brain too much unless someone has had a stroke. Then we say, Oh, I need to have some strengthening therapy because of my brain. But yet we can strengthen areas of the brain to help cognition, memory, balance, which is a common problem, right? Falling and risk of fall, balance and stability are two things that the brain is the major control of. Muscles are important and our ability to coordinate. But the brain is working all that system out. And we can strengthen things in the brain, functions in the brain that give us a better quality of life. And that's what we're hopeful for is can we keep the quality as high as possible? Autonomy, having our own agency to do what we need to do on our own and be self-sufficient, whether it's our vision, our movement, and not falling. The brain is really the master control system. This fascinated me years ago when I moved from chiropractic medicine into more neurologic medicine. I always felt there was something more going on when we do these adjustments on people's bodies and it helps them. Well, what's happening in the brain? That's always what fascinated me.

SPEAKER_02 4:27

Dr. Bagnell, you often see patients who've told you that their tests were normal, yet they still feel anything but normal. What are you looking for? What might not show up in a traditional MRI or CAT scan or a neurological exam?

SPEAKER_04 4:42

Yeah, that's got to be a frustrating thing to hear when you're having some symptom and you don't feel well. Everything seems normal. And I've heard that 36 years in healthcare practice. I hear that so many times every year. What we're looking for is some of the tests that we do now in healthcare, especially in neurology and especially in the work that I do, is going to non-invasively look at how the brain functions. So again, thinking about the model which I'm showing, when we look at a CAT scan or an MRI of the brain, we're looking at the physical structure. If the physical structure is within a normal range, then it looks good. We don't understand what the problem is. But we want to look at how it is functioning. I often use the analogy like a Tesla. If it looks beautiful from the outside, but if I don't know how to operate it, when I get into it, there's this computer, and I don't even know where you start this thing. My job is to use the technology that we have now to analyze your brain. I could say, Mike, you have your MRI and CAT scan, it looked normal now, which is good. Now, when we do this test and this test, which I'll explain as we go on, we can look at the right frontal lobe, or maybe it's your left temporal lobe that have lower activity, which may be the source of your problem. So let's do some further tests. We can now look at the function of the brain. And that is where we can be specific with people and dial in a therapy that would strengthen their brain.

SPEAKER_02 6:11

Makes sense. We needed a different way of looking at it. Now, tell our listeners about some of the technological advances that that you use to measure eye movement, balance, vestibular function, like in the ears, balance, how our brains respond to movements and what those kinds of measurements can reveal to you that other doctors miss.

SPEAKER_04 6:34

So when we're going to evaluate someone's brain function, we're going to look at some of the tests you just mentioned. So if someone asked me, Doc, what is the number one way to get the most information about someone's brain functioning? I'd say eye movements. If you can measure and track very specifically how their eyes move side to side, up and down, quick eye movements back and forth, how their eyes respond to movement in the environment, we can gain tons of data about areas and regions of the brain and how they're working. In fact, this is what happens in the NFL. When someone has a head impact and they go into the tent and we don't see them, they're going through the concussion protocol, which is looking at eye movements. The eye movements tell us about different regions of the brain to know that side is working, this is not working. And then we can start to look at strategies to improve function in those areas. So eye tracking movements we do with goggles. The goggles that we use are the same goggles made by the same company out of Pittsburgh that they use in the International Space Station. So astronauts get space sickness, which is very debilitating. So they'll analyze their eyes to determine how their brain is functioning in relation to zero gravity or microgravity. So we use these goggles here to analyze eye movements. That's number one. Number two, we're going to look at how the vestibular system is functioning. Now, someone might say, Mine's fine. I said, How do you know? Because I don't feel dizzy. I said, that's very good. But when I can do different tests with the goggles on, we have a very specialized piece of technology, a chair, that we can precisely move with the goggles on. I can watch your eyes and how the vestibular is changing the way the eyes are functioning. With people who have dizziness, oftentimes there's a vestibular issue. But with the absence of dizziness, there can also be imbalances. There can be asymmetries where one side is stronger than the other, which we don't feel dizzy, but it can affect muscle tone in our body, in our back, and our neck. It can affect memory because they project upward. It can affect eye movements and stability. So we're always looking at the sensory inputs to the brain and measuring them precisely because it tells us about the brain. So the vestibular testing, and we can build protocols in our technology to rehabilitate that. Let's say we need to move left more than right, and we need to move at a certain speed. We can set all those parameters. And so the treatment becomes precise, effective. Because if I do that on my table, I might miss that. When you have the goggles, the data, we get very precise information about your brain and vestibular system, and we can then rehabilitate it. So those are two very unique ways to analyze the brain. And the third would be our brain map. We'll do an EEG, put a cap on. People may have had EEGs in the hospital or through a neurologist. And then the way we look at the data is a little different. It's like that MRI or the CAT scan. Okay, it looks normal. In the hospital, maybe they're looking for epilepsy, an epileptiform activity, some kind of spiking activity in your brainwaves. They're looking for tumors. So we look at that brainwave activity. If we want to rule out anything that's pathological, that's need additional care outside of us. But what we're looking for is how much power is going on in the brain? Do we have too much power, like the brain is overactive? Is it too low on power, like we're losing power in the brain? And this would also correlate to cognitive decline and dementia. Now, the beautiful thing here is that we can actually increase power, electrical conductance in the brain safely without subjecting someone to electrical stimulation. But we have to diagnose, know where and what's going on. So we look at power and signaling, we call it. With all this information, I could say, Mike, here's what we found. We found your left vestibular system is not signaling into your brain stem. This may also correlate with some swallowing issues with you, as an example. Or it may also affect some of the brainstem on the left, which would affect eye tracking in a particular direction. Now, when we looked at your eye tracking, it tells us that the left hemisphere is also having a problem because you're not tracking properly to the right. So see how we start building a case for weaknesses in absence of a diagnosis. We can look at where things are strong, weak, and then how do we strengthen those? And can we? This motivates me because I like to see people gain more of their life back. My father passed away from complications from dementia, from a car accident in the 70s that brought on an earlier dementia. So I lived with someone with a traumatic brain injury, early dementia, early cognitive decline, dementia, and then the subsequent things that took them out. I have a heart for that. And I want to see people go on and enjoy their life, play pickleball if they want to do that. I want to help them be able to do that.

SPEAKER_02 11:26

If someone comes to you complaining of vertigo, can you help them in your practice?

SPEAKER_04 11:31

Yeah, that's one of those key conditions, concussions, or in vertigo, but vertigo in particular, that vestibular system is going to be crucial for us. We're going to look at that carefully. I just had someone come in recently. They've been to the EENT. They told them, yes, you have vertigo, you have a nystagmus, and we're not sure what the source of it is. They did the positioning maneuver. He still had the problem. And within two weeks, we were solved. And he went away for the summer. Older gentleman went up to Maine to his vacation home, and he's completely fine. He came back last week, checked him in again. We evaluated him in the chair so we could get into that vestibular system and know what's going on. We analyze exactly where it is, what it is, and then we can build a protocol or a treatment approach to resolve that to the best of our ability. Some of them take longer than others because as we're older, the structures don't hold the stability, but they can hold the stability if we work with it over a period of time, depending on what it is.

SPEAKER_02 12:28

So you can take care of people who have stones in their ear canals?

SPEAKER_04 13:14

Yeah, that's a simple fix. The small little stones get loose and they're free-floating, and it's a positioning maneuver. But often as we age, they may have had that problem. So some people, if it's a simple fix one, two times, it's easy. And many people can do that. EENT can do that. A chiropractor can do that. I turn my head and have the world spins. But many of them go beyond that because they've had it over time. And the longer you have something, yes, you will compensate. Your brain will adapt to it, but it also limits people. No, I just don't do that anymore. When I bend over and I come back, I have to be very cautious with that. So as we start limiting and the brain compensates beautifully, your brain can only maintain compensation for so long. This is my personal experience. And when you get another stressor or you have an illness, it can cause that compensation you've been okay with to become less okay. And now you're back in that situation. So we really want to not compensate people, we want to strengthen, fix, and correct. And that's a better model.

SPEAKER_02 14:12

Let's take a short break and listen to an Alzheimer's tip from Dr. Craig Curtis. Dr. Curtis, can you give uh our patients a tip on keeping their brain healthy?

SPEAKER_03 14:27

Absolutely. My favorite tip is involves a change in eating patterns, but it's not a drastic change. It's simply increasing the amount of fresh fruits and vegetables, fish, other white meats, and lowering the amounts of red meat, sweets and sugars and also carbohydrates. It's essentially following a Mediterranean type diet plan.

SPEAKER_01 14:58

With over 20 years of experience studying brain health, Dr. Curtis's goal is to educate the village's community on how to live a longer, healthier life. To learn more, visit his website, Craig CurtisMD.com or call 352-500-5252 to attend a free seminar. I'm back with Dr. Michael Bagnell.

SPEAKER_02 15:16

Michael, explain to our listeners how you deal with people who come to see you who say they had dizziness, brain fog, headaches, anxiety, concentration problems. How do you determine whether those are related or different problems?

SPEAKER_04 15:31

When there's a constellation of symptoms like that, I just step back. I step back. And first thing I would say, Mike, is I tell myself, listen, listen. Why do I say that? Because as physicians, you may stop listening. Oh, yeah, I know what that is. No, no, stop. And my wife helps me with this. She's a very good communicator. And so I've learned a lot from her is listen carefully. Listen between what they're saying so that I can hear more. I prefer slow medicine. I don't do the fast food kind of medicine. Five minutes in and out the door. My initial exam is two hours with people. I want to take the time to understand and know as much as I can. A lot of it is testing. Anywhere from 20 to 30 minutes is just reviewing your history, asking you more in-depth questions about that. I've been with some wonderful older physicians over the years who tell me you can learn almost everything from the history that you need to know before you examine them. And I think that's very valuable information. So if your listeners will have doctors that don't listen, they might want to find new doctors. It's very important. When I hear all those symptoms, I start thinking, okay, let's start to evaluate the areas of the brain related to those symptoms. I go through a workflow in my mind or an algorithm. I'll look at blood profile, things in their blood. Even though I'm working with the brain, things in their metabolic function could be important to why they're having some of those symptoms. Hormonal inflammation, could it be immune issues or autoimmune issues they're dealing with? I look at labs prior to or during someone's work with me to evaluate the metabolic side of the profile. Is it contributing to some of these symptoms? Then I'm looking at the other tests, the eyes, the vestibular, the brain mat, to understand how the brain itself is functioning and I'll deduce where these symptoms may be coming from. We mentioned early in the show this long word, dysautonomia, which is very common as we age, especially in Alzheimer's, Parkinson's. So whether it's Parkinson's or a dementia type, we can have this problem develop because of the weakness that's developing in the brain. And so almost all of those symptoms could be related to someone dealing with dysautonomia. So the background of that situation would be let's strengthen their autonomic system first. And then as we're checking in with the client week by week, see what symptoms are being peeled away and improving. So I will often do those inventories with people weekly. Like, here's your short checklist, certain symptoms, like you're mentioning, and let's just check off where they are, zero to five, zero to five. And so I'm starting to see, oh, look, there's a progression of improvement. I can watch how someone is changing, even anxiety, depression, focus, attention, and concentration. We have indexes that are standardized, simple, and people fill them out. They're short. Some of them are on the computer. So we can keep measuring certain areas to determine what is the change. But all of those symptoms, we have to have a very good history and determine where different things might be emanating from.

SPEAKER_02 18:33

What kind of treatments do you have for these symptoms?

SPEAKER_04 18:37

So no pharmaceuticals are approaches based on clinical neuroscience models. Can we strengthen neurology, firing brain tissue together to build neuroplasticity in a region or a network of the brain? We use certain types of eye movement exercises precise to what a person might need to train an area. We use sometimes electrical stimulation, like something that's called a vagal stylator, which is very good for vagal nerve stimulation. Also, median nerve stimulation. I don't have the stimulator here, I'm just using my fingers, but it's a stillator, very small, that goes here on the median nerve. And people know the median nerve from carpal tunnel. But they have found in research studies that median nerve stimulation at 40 hertz improves cognitive measures, actually, in studies. So the way we will do some cognitive testing for people and see where they are, and we'll also do a pupillary test. So I have on my, I use my device, I have a pupillary measuring device here where I can take it up next to their eye. I shine the light in their eye quickly for like a flash, and then I measure their pupil response. And the pupil constriction and then recovery is a direct measurement of the brainstem function. Is it appropriate based on their history, their cognitive test, and this pupillary response today? Should I be doing my 40 hertz median nerve stimulation? I've been using that for a couple of years now in conjunction with other therapies, and I've seen very good subjective changes. And families say, I don't know what you started doing, but they had a jump in their ability to function. Some of my older patients, my older clients. That was very exciting and still is.

SPEAKER_02 20:14

Are the therapies that you use and your services covered under Medicare and the advantage plans?

SPEAKER_04 20:20

Our work is on the cutting edge that all of our clients are under self-pay, whether it's credit or self-pay arrangements, because these are very novel types of things that come out of research and they're safe, they're non-invasive, but very novel. You can go to an EENT and they can see if you have the crystals loose, for instance, if you have dizziness and that will be covered. But when we get into the rotary chair and we do analyses and then we're do specific protocols, that's all on a self-pay basis.

SPEAKER_02 20:49

You started out in your career as a chiropractor. And chiropractors are known for working on people's backs. In your practice today, do you help people who have problems with their backs?

SPEAKER_04 21:01

We use physical medicine. So whether we're having to do things with their spinal system, it's less that we're doing things for the bones. We're using the vertebrae, or maybe I'm adjusting a shoulder or a wrist or an ankle or a knee. We can adjust the extremities or the spine or the neck. I use an instrument in the neck area. So it's safer. I feel like I have better control and people can relax more. We're trying to achieve a change in the neurology first as we make some adjustment, let's just say, change the neurology, change the joint motion, change the muscular aspect around that so people do move and feel better. Every single thing we do to the body, our brain has a recognition. So if my wrist is not moving, let's say I've broken my wrist and my wrist does not move more than this. I can't really move it. The area in my brain that recognizes my wrist, there's a little bit of a map area or real estate. There's real estate in the brain that recognizes this is my right wrist. When it doesn't do that, this part of the brain, the map will decrease. The real estate will decrease. And that causes brain reduction in function. And then maybe I go for PT and rehab and it starts to move again, and that area starts to increase again. When we make changes to the body with chiropractic medicine adjustments or muscular release with fascia, or they go to the PT. We have a physical therapist center next door, which I'll refer people to. They're going to be able to do some of that work even better than I am. But yes, I incorporate it into my work. And some people say, How is that changing the brain? I say, It's not the majority of the work, it's a percentage of the work, maybe 20% or 15%. I'm thinking of someone we're working with now, he's 80. And he actually is very healthy, but he's had two knee replacements, two hip replacements, and he's had a shoulder problem, but he hasn't had that replaced. We're trying to help him get ready because of his balance and some issues to go to Tuscany on a bicycle riding tour. Said, I think you're going to be able to do it because we've improved his balance in the chair, in his vestibular. We've improved that. So now he's. I told him the other day, I think you're going to be good with a bike trip.

SPEAKER_02 23:07

Asked about the average duration. How how many visits do you typically have with a new patient?

SPEAKER_04 23:12

Yeah, we have different types of patients, patients that live in town, people that come from around the country, sometimes from out of the country, and they stay with us for two weeks. And we work daily for two weeks. So five days, and then the next week, four days. They have the weekend off. And we're working multiple times a day because the brain can take that, right? The muscular system could not necessarily work out twice a day for most of us, especially not the same areas. But the brain can. And we also use hyperbaric oxygen. And I know you all have a wonderful hyperbaric oxygen center, I've heard, up in the villages. I'm not endorsing them, but I've heard good things beneficial for recovery, helpful for burns and wound recovery, diabetic wounds, traumatic brain injury. We have a low pressure chamber here. Someone will be here for two weeks. We work in 18 sessions. That's the model we've seen get the best results. We found that the sweet spot is 18 sessions over two weeks, and we're able to bring about substantial change. We can measure multiple times the first week and the second week and look for a trend moving in the right direction. People from time to time will want to come back for a maintenance follow-up. We're looking to make as much change as we can in that brain and get it strong, give people home recommendations that they can follow up with on their own. But once they're trained on those things, someone will often say, Tell me what I should do on my own. I say, we have to train you to be able to do it on your own and get your brain stronger because sometimes eye movements being very important for the brain. If we look at a target, like I'm holding my thumb up, and I tell them, I want you to move your head slowly at a frequency like this. And then I say, okay, show me how you do that. And they're moving their neck because their neck is stiff, and they're actually training it the way we don't want it. So we need to fix some things, train them, give them the activities or exercises, and then they can follow up and continue their trajectory of improvement.

SPEAKER_02 25:01

I've seen some traumatic improvements in people who've gone through the hobby uh clinic.

SPEAKER_04 25:07

It's good for us to have an ongoing type of brain support. Up until this point, what have we really done? What have we done for the brain? Really, not much. And even today, not too much. We're becoming more aware, yet it's not that prevalent. There's a doctor out at UCLA who wrote a book on Alzheimer's, Dr. Bredison, and he used the word cognoscopy. Maybe we should start having yearly cognoscopies along with the other types of testing that we do. Although that's funny, I like the thought because whether there are teenagers, 30 somethings, 60 somethings, or 80 somethings, it would do us good to know, oh, my brain's doing this because of the stress from last year. Maybe you can do this to stabilize that, because we just have a tremendous amount of decline in cognition. Our brains are heading into lower function as we age. So we want to do what we can to maintain brain health.

SPEAKER_02 26:01

How much does an average patient pay to go through the services with you, the diagnostics and then treatment? We do.

SPEAKER_04 26:08

The initial evaluation and then the care, depending on what we need to do.

SPEAKER_02 26:13

Michael, how important is sleep in improving brain function?

SPEAKER_04 26:18

Sleep is really the foundation because as our sleep deteriorates, even in our younger years, 30s and 40s, people will say, My sleep's not that good. It's not that deep or that regular, intermittent. I like the thought that maybe our sleep is really the one thing that we need to start working on. In fact, when I meet with people initially, I'm going to ask them questions about their sleep, right? No matter what they're presenting with, whether it's mental health issues, whether it's previous stroke, whether it's cognitive issues, balance, dizziness, what is your sleep like? Because when people say, I want to work on something on my own, I say we want to get you to work on your sleep. And then I will help them navigate that. Maybe it's getting a wearable device where we can get sleep architecture measurements. And they have the ring or aura ring and different devices. And so I look at the sleep architecture. Then I compare that to the brain map. And now I know based on brain waves and sleep cycles, are they fragmenting their sleep? But sleep, in and of itself, if we can get that into a healthier state for people, it can radically change brain health, their longevity, their improvement, because it's something that we have to do every day. And it's going to be a little bit of a detoxifier for the brain. The brain is cleaning up some things overnight metabolically. It's helping us process emotional stress through the day in our REM sleep. It's helping us physically recover our body's demands in our deep sleep. So it's probably the most important thing. And we have ways to measure and improve sleep and help guide people so that they can have better sleep quality. And this would support brain health for the rest of their time. So I think it's foundational.

SPEAKER_02 27:58

Dr. Bagnell, if someone wants to get a hold of you or learn more about your services, how do they do that?

SPEAKER_04 28:04

We are on the web at Bagno Brain Center. And some people are on social media connecting with grandchildren or younger people in their family on Facebook and Instagram. And Bagno Brain Center is our website, and that gives them videos and understanding of what we do and even our YouTube. It's all Bagnell Brain Center, so they're welcome to go there and communicate with us for any of their needs and support.

SPEAKER_02 28:26

Michael, thanks for joining us today.

SPEAKER_04 28:28

Look forward to helping. Good to meet you. Thank you, sir. Good meeting you.

SPEAKER_00 28:31

Remember, our next episode will be released next Friday at 9 a.m. Should you want to become a major supporter of the show or have questions, please contact us at Mike at Rothvoice.com. This is a shout out for supporters Tweet Coleman, Ed Williams, Dwayne Romick, Paul Sorgan, and Dr. Craig Curtis at K2 in the Villages. We will be hearing more from Dr. Curtis with short Alzheimer's tips each week. If you know someone who should be on the show, contact us at Mike at Rothvoice.com. The way our show grows is with your help. Text your friends about this show if you enjoyed listening. Use the fan mail button on our homepage, villagesvitality.life, to leave comments. Be sure to include your name, email, and phone number. We thank everyone for listening. The content of the show is copyrighted by Roth Voice twenty twenty six, all rights reserved.