Movement Disorder Intervention Strategies with Karl Sterling

Di: 0:24

Hello and welcome to BodyHolic with Di, episode number 25. My name is Di Katz-Shachar and I am a public health promoter. I hold an MPH from Tel Aviv University on the research track and I'm a fitness trainer with well over 17 years of experience, and I hold specializations in corrective exercise, women's fitness and Pilates. I'm also the founder and trainer of BodyHolic, the global health and fitness platform and community, and I'm the author of the book Rip it Up For Good. This podcast is a part of my effort and mission as a public health professional, because I believe that real science based information and knowledge is power, and my job in this life is to empower you. I want you to have high and sustained energy throughout the day and I want you to feel better than you have ever felt before, during and after your workouts, in and out of your clothing, and not only physically, but mentally and emotionally as well. Today is the second time I have the awesome opportunity to host Karl Sterling. We discuss very specific intervention strategies for managing Parkinson's disease and additional movement disorders in today's episode and I just have to make a little bit of a side note we can all benefit from the strategies that Karl discusses.

Di: 1:47

Just to recap, Karl Sterling is a neuro rehabilitation specialist and NASM master trainer based in Syracuse, new York, and he's the creator of the Parkinson's regeneration training and neuro motor training education programs. Karl's extensive experience as a rehabilitation specialist includes working with a variety of populations. However, carl primarily specializes in working with clients who have movement disorders such as Parkinson's disease, multiple system atrophy, ms Charcot-Marie Tooth, Alzheimer's, epilepsy, autism and more. Carl is the leading educator in the movement disorder, human movement and personal growth arenas. He is the chief operating officer of Agile Human Performance and owner and CEO of Neuro Motor Training LLC, which currently offer courses worldwide. In addition, carl is the founder and president of the Parkinson's Global Project, a non-profit foundation dedicated to funding education and research and helping people with Parkinson's and other movement disorders all over the world.

Di: 3:01

Without further ado, let's dive right into an episode that we can all benefit from. But it is also very important that you share this episode, I believe, with anyone you know that has a connection to someone or may be suffering from any kind of movement disorders. Let's go right in. Hello Karl Sterling, I am so happy to have you back on the podcast. How are you?

Karl: 3:33

Doing really well, Di, and it's really good to see you again too. Thanks for having me back.

Di: 3:39

Likewise, today we're actually going to be focused on intervention strategies for managing Parkinson's disease, but I bet we're probably going to go beyond Parkinson's Sure, can you?

Karl: 3:54

maybe talk about all humans.

Di: 3:55

Yeah, exactly. Can we maybe start by talking about the different types of intervention strategies?

Karl: 4:06

Sure. So first, what I do is like in your initial meeting, let's say, with somebody, and of course the learning curve with each person keeps, continues over time to see how they react to different stimuli. But we learn the most. I learned the most up front, first, couple of times especially, and what I'm really looking at is the end result, like where do they want to be? Okay, so a person comes in where are you now? What do you struggle with?

Karl: 4:40

I have this whole questionnaire too, that it's my own version of a PARQ which is more like 60 questions and find out what are your top struggles, if you will. Let's say, it could be getting out of bed, it could be walking, freezing for somebody with Parkinson's perhaps, maybe they've been falling. So we just want to find out where they're at. But even more so, like where do they want to be? What is their number one? Set of goals and then try to work backwards from there. But typically what happens is it's usually something like well, I want to move better, I want to improve my gait, my posture, my arm swing, I want to gain strength. Maybe they want to gain muscle, lose weight.

Karl: 5:34

Everyone is different, right, but the bottom line is I put it all into like two really big categories, and especially if we're dealing with movement disorders, and then under these two categories are subcategories and lots of them. The first one I said I refer to it as bottom up training. Someone is top down training. So it's interesting because I didn't know this and I actually felt like I had my own idea, sort of. But it's not a new concept because if you look at the work of, or the writings of John Rady at Professor at Harvard Medical School, Andrew Huberman, stanford and all these other geniuses out there, they talk about bottom up and top down. If you want, I can describe this bottom up thing.

Di: 6:35

Yeah, I would love it.

Karl: 6:37

I like to start with bottom up and here's what it is Now. This really comes to me from my years teaching for a really amazing lady who used to be based in New York City. Now she's in Arizona the past few years with her family. Dr Emily Spickle I refer to and I think she refers to herself as a functional podiatrist. She can take care of your bunion with surgery and she can do surgery. But she would rather not do surgery, not get, rather not give you supportive arch, supportive orthotics and have you build your own arch but improve your own foot posture. I taught for her for years and I learned so much from her.

Karl: 7:21

This whole bottom up concept really starts with the skin on the bottom of the feet. The planter skin is statistically the most highly populated skin, I should say the most densely populated skin on the body, with small nerve, sensory and mechanical receptors, and these nerves are directly connected through our nervous systems to our brain. So if we look at, let's say, over the years we're using over the decades, we're maybe wearing shoes and socks all the time. Some people never go barefoot, for whatever reason. Sometimes they just don't like it or they don't think it's good for them or that forbid. Maybe somebody who they feel is an authority figure, like maybe even a podiatrist, said don't ever go barefoot and I'm no doctor, but I can tell you most of the time that's fake news. You probably want to go barefoot.

Di: 8:22

I'm not sure what they would say so there are doctors that would say that.

Karl: 8:28

Oh yeah, my daughter's podiatrist who is no longer her podiatrist said don't ever go barefoot.

Karl: 8:34

How interesting, wow, how surprising. Yeah, totally ridiculous, and I think, in those cases, to be fair to them a little bit is that I don't mean to diss the community at all. We need our doctors and our experts, but they're looking more at the let's see the anatomical function or the biomechanics, not so much sensory input, because a lot of people just bypass the whole sensory input factor of any kind of touch. So palms are the second, statistically second, most popular with small nerve, mechano and sensory receptors. We use our hands every day, but do we get on our bare feet every day on our planter skin? Not usually. So what happens, though, is these nerves? They tend to go to sleep. They're not dead, they're dormant, though. So that's because we've had some kind of cushion between the skin and the surface underneath us for so long.

Karl: 9:35

The sole of the shoe. You know that will just steal information, vibration forces that your body would benefit from receiving, but a portion of that goes away into the sole of the shoe. The thicker the sole, the more it sucks out, sucks information. You get less input, less accurate input as to what's underneath you exactly. So I mean, I could go down that road for two days and talk, but I'll spare you. Bottom line, though, is if you take somebody who's having some trouble with, let's say well, let's just say stride symmetry, so their, their gait is not very symmetrical. They maybe they have a shuffly step, or something like that.

Karl: 10:25

If you do something as simple as get their shoes and socks off, have them walk around on whatever surface you know, assuming that it's safe, you'll probably hear feedback from them that they feel more, they feel more sensation, and you'll probably observe different movement. Most of the time it's going to be improved. What we do here is we'll do that, or usually we just have them get on this giant power plate we have. We have the very blessed and lucky to have the top end power plate. It's the most incredible, best whole body vibration device, non-demand kind, and so we put them on that, and, you know, not only do we wake up their skin on the bottom of the feet, but the nervous systems, their brain, yeah, a lot of times, if they have neuropathy of any type or to any degree, that diminishes or, oftentimes, just goes away, and sometimes it's a permanent thing where it's just gone away, and sometimes it's just a temporary fix.

Karl: 11:27

But we can do so much in regards to stimulating input, because if you think about it like this, we kind of take this first thing here of the planter skin, that's like our first go-to but stimulate your brain so you get more input, because when you get more input it will immediately send out a stronger, faster, better signal with output to help you stabilize better. And the thing that we find more than anything else with a barefoot stimulation portion of a session is that people feel more secure and more stable in their movement. And if they weren't feeling that secure or stable or they're really they have a fear of falling, because maybe they fall, their fall risk is high, for whatever reason. This can be a really simple game changer. It's like just so basic, right. So that's the first of the bottom-up category, if you will, but we're also working on the top. We are working simulating the brain through the feet.

Karl: 12:37

I mean, I'm pretty cool From there. It depends upon the person, but we always want to be working on things that we need to be thinking about over the lifespan, or I'll say the health span. That seems to be the word I like these days, because we can have a long lifespan without great health, or maybe a portion of life, Maybe it's towards the end of years, like, sadly, my dad many years was very sick before he passed, but so his health span lasted a certain number of years. Then there's about six years of bad health, right? Well, if we can, let's say, make our health span improve or increase our health span so we live longer, we live healthier during the years that we have, all this stuff that we work on is going to be geared towards that. I mean basic things like strength. So many people come in, and I'm actually no exception. I'm 62. So I'm not as strong as I used to be, although I'm stronger than I've been in probably 30 years. But you know when I was 30,.

Karl: 13:53

I could have done a lot more and I did do a lot more. In certain ways I've been building it back up, but I have to maintain that. So I have to keep on working on my strength. It's the foundation for my movement, our movement, our balance. We need to keep enough muscle mass so we can be in control of our movement. Also, our bone density is another thing that can change over the years. We do a lot with a really cool machine here, made by pretty much a partner of the same owners actually as power plates called bio density.

Di: 14:34

I saw that you got super excited about that and that got me all excited.

Karl: 14:40

We have people come in every day man, the doctor and I upstairs. We went in on this and we have so much osteoporosis, osteopenia, osteoarthritis, for a number of reasons. A lot of times it seems to be more so postmenopausal women, just real simple there. A lot of times just has to do with the hormonal changes. You would take somebody like my wife, for example, who had cancer 19 years ago and she's 60 now with the chemo pills and all those things, if somebody's had anybody, male, female, if they've had cancers, or there's certain medications especially related to cancers, chemotherapy and this and that that can really wreak havoc with your bones.

Karl: 15:29

Yes, we have this machine and it's very, very cool because you can load to the max safely. Maybe you do 300 pounds on a leg press but you're doing 1200 on our bio density effectively. Well, great, you're building strength, building a little bit of muscle and you're triggering the body's own ability to build that soft bone tissue and increase, improve your T scores, z scores and build bone density. But along with that, we don't want to replace full range of motion, resistance training, our body weight things. We want the full range of motion. Our muscles need that. That's where, if you don't have access to bio density or something like that.

Karl: 16:16

Well, circling a way back now to bottom up, we talked about planter, skin and stimulation, just bottom up, we walk on our legs, not our hands usually. So we want to make sure we have a nice strong foundation, and so strength will help us to maintain bone density. In other words, you know how it is, build muscle and your bones can benefit and they will benefit. So balance, coordination, rotations, just anything that the person will be doing during their day activities, a daily living. We want to work towards having the sensory input from beneath us to have us not have a better, let's say, awareness, proprioceptive and kinesthetic maybe, of where we are in space and then take it from there to be working on the strength which is foundation for movement, balance and things like that. I could go on and on about that. I won't because the other thing we're doing is, let's say, top down training. If you want, I can just share a little bit about what I, how I view that, if you will.

Karl: 17:36

Yeah of course. So none of this comes from me. I'm not strong enough to make up any of this stuff, but you know I love Dr Lisa Moratory. Let me talk about her for a minute. Lisa Moratory is, as far as I know, she's still at Stony Brook University on Long Island and it's got to be 10, 11 years ago.

Karl: 17:58

We met up through a friend of mine in New York City really great NASM, rick Richie, so one who introduced me to her, dr Richie. So we, we met up and she was talking about domains not all of them, but some domains of cognition and memory. She says, you know, in Alzheimer's, dementia and cognitive decline, and just always want to make sure that we can build and maintain our ability to stay sharp, to have good reaction time, to think quickly, to remember things, and if we practice it we'll get better. But we also want to make sure that we can do a lot of this while we're moving, because every time you think you don't want to have to stop walking if you have to have a thought. I mean, it sounds ridiculous, right, right no, it's amazing.

Karl: 18:57

So now we'll go into different types of movements. It could be just walking. It could be walking off an infinity pattern which I learned from Perry Nicholston. I don't know if you know, dr Perry no but we got to have him on my show.

Di: 19:15

Oh really.

Karl: 19:17

He wrote the forward for my first book. Thank you, dr Perry. Call Parkinson's Regeneration Training, which really could be just training for all humans, because you know that whole thing about being able to multitask. Well, you know, there are studies, and in fact Lisa Mortory, she did a couple of these studies at Stony Brook where what does it look like when somebody's texting and walking? What are the statistics of falls and injuries? Well, definitely I tripped over a bench on top of the university when I was texting and I'm walking and I didn't see the bench. I went right over, you know.

Di: 20:02

Right, right. We're all guilty of that.

Karl: 20:06

We are all guilty of that.

Karl: 20:10

So just think about multitasking, and when you're looking at, let's say, a person or a population who's dealing with a neurodegeneration in the brain or the nervous systems At some point, especially with Parkinson's, msa and certain other conditions or diagnosis, there's a significant problem many times with being able to perform one task while doing the other. It could be as simple as they're walking across the room, their phone rings, it's on the other side of the room and that distraction actually causes a freezing. I got to get my phone and then they freeze up and they're trying to turn to go get it, but, let's say, their center of mass doesn't stop moving up here, the upper body of that keeps on moving and their feet are frozen.

Di: 21:09

Oh boy.

Karl: 21:10

Yeah, that's one of the things that happens to certain people. Anyways, all will happen because of a distraction which caused them to freeze. Maybe they wanted to rotate and they got stuck in the rotation and they go down. We really need to be working on I call it mindful movement, but I didn't make that one up either. That's from a book called the Brain that Changes Itself by Norman Doige out of Toronto. When he was talking about, john Pepper was diagnosed with Parkinson's in 1962. This is 61 years ago and he's doing amazingly well in South Africa, probably in his 80s or beyond. We connected on LinkedIn recently so I'd hoping to talk with him someday. But Pepper distinguished this mindful movement in his own life.

Karl: 22:10

We work on that here constantly with various things. Sometimes we'll put dots on the floor as a trigger, let's say a visual stimuli to get the foot to go towards it. If they have a kinesia, which is a temporary loss of voluntary movement, they know they want to go. They can't get that foot to step and then they might trick themselves into it by thinking of a rhythm or thinking of something and then boom, they go. Or visual stimuli I have people who have tape on their floors at home, built squares of tape because these are like traffic areas, where they oftentimes get caught up and then, when they're stuck, they just step on one of the dots and it gets them going.

Di: 23:00

Wow, the thing that I keep thinking about is how scary is it when you keep going but your legs don't? That really gets into my heart right there. So if you're saying that one thing that can help is actually putting tape on the floor, that's huge. I mean, people need to know that that's an option and it's very affordable. You can do it at home.

Karl: 23:35

Yeah, buy a roll of duct tape or painter's tape, just put it on your floor. A little dot here, a little dot there. Let's say, areas where you commonly get boggled up or you freeze. Have tape around so that you have a visual stimuli.

Karl: 23:59

The reason it's important is because it's pretty interesting how, when we look at Parkinson's and MSA and some other Parkinson's-like or, let's say, dopamine deficient type disorders, there's dopamine in our retinas. So a lot of times in Parkinson's and other types of diagnosis like that, that lack of dopamine causes depth perception issues and contrast challenges, if you will. So how that relates to getting stuck is I think it's not completely separated from it. It can be separated the distraction of a phone ringing, let's say, or a person saying, hey, d, come here. You're caught off guard and you want to turn and go. That's one distraction.

Karl: 24:51

But now you need to look in that direction of the person or the phone or wherever you want to go to, and maybe the lack of dopamine in your retinas is causing a problem with determining how far away the person or the phone is, or maybe there's an obstacle in the way we see it all the time where somebody's walking really, really well and then they get to a doorway or a change of the surface in the floor from hardwood to carpet or whatever, or there's an obstacle in the way and it throws them off because visually not exactly sure how big this opening of the door is or where that surface change is exactly, or is there a step up or a drop down and so that can cause freezing.

Karl: 25:40

So doorways, a good place to have pieces of tape, visible cues, because somehow that seems to trigger and bypass, sort of anyways, bypass that help to bypass the freezing. If you will Not all the time, it doesn't. Nothing works all the time for everybody. In fact, sometimes it works great for somebody. In certain days they're just having a bad day and it's just not working at all.

Di: 26:09

It's just like balance. People with great balance have off days. There are so many factors that go into it.

Karl: 26:17

Absolutely. When I talk about if we get really nerdy and into the science of this whole multitasking thing, what I'm really looking at D is taking a movement, things on top of the movement. So let's take something really, really simple, which doesn't necessarily mean easy. We have a really cool brand new treadmill here from Diaco Medical Rehab. It goes forwards, it goes backwards, uphill, downhill. We have a big synaptic sensory screen we can wheel around to the back of it. It's made to fit this treadmill. So we'll have people walking on the treadmill, maybe backwards, very slowly, and then they're actually playing games on this 60 inch screen. So they're doing two things at once. They were walking maybe uphill, backwards, even Right, right, or just on a level surface, forwards. We have all safety precautions in place. We're not going to let them get hurt or fall, but that's kind of an extreme thing, though.

Karl: 27:31

Usually what we do is maybe have them sidestep through an agility ladder I have taped on the floor and maybe throw a ball, a ball with letters on it, for example, so you get the hand-eye coordination thing happening with the ball and we might pick a topic. The ball I have has the whole alphabet on it. Yesterday we did street names with a lady. She's going through the ladder, walking sideways, doing some cross foot patterns, doing a great job. You catch the ball. First letter you see. Name a street around here that begins with that letter. Throw it back to me. I do it. We do these things together a lot of times. It's good for me to do too.

Karl: 28:14

Oh yeah, we do sports, or flowers, or birds, or geography, or names women's names, men's names, whatever. We really try to get creative with adding something on top of or stacking something on top of our movement so that we can develop, if you will, those neural pathways that allow you and make it so that you can be good at doing these things. The more we do it, the better we're going to get at it, just like anything, If you don't mind a little shameful self-promotion. My book both books actually talk about neuroplasticity, but this one has a chapter about it Parkinson's Empowerment Training. It's very, very specific on how you can intentionally create new neural pathways. This is not rocket science. It's actually way simpler than I thought it was scientifically. Just that the work that it takes to do it well, it's work. But if you keep doing it for a few minutes a day, eventually you're going to be really good at throwing the ball, bouncing the ball back and forth. I mean, will I add more things?

Di: 29:37

No, matter what age, like you can see.

Karl: 29:41

Absolutely. Like John Radie from Harvard says till our dying day, as long as we're conscious, we can learn things.

Di: 29:48

Yeah.

Karl: 29:49

So the brain will change itself. It will adapt to what you need it to to some degree. And what doesn't mean we're ever going to get back to baseline where we were before diagnosis, but it's almost always. We will improve if we put in the work. Sometimes we do get past baseline where we were With a diagnosis or no diagnosis. I just started working with a 98 year old lady last month, right after our last conversation, and oh my gosh, she says I don't have a whole lot of years left. I don't think, but I really want to have a nice health span. She knows the word.

Di: 30:36

She got it.

Karl: 30:37

I want to be strong. So we're tossing things back and forth and she's doing sit to stands while we're doing it or whatever. It's really the big picture is this when people walk out the door here, I want the benefits of what we do here to travel outside with them. Fortunately, thanks to God and whoever is, whatever is this that this stuff really works beautifully, because people do come in and they said oh my gosh, you know I almost fell, but I didn't fall. Oh, I remembered this. I didn't used to remember that because they do a lot with cognition and memory and reaction time. We really want that. One of my favorite stories as a gentleman I've been working with for a couple of years. Two years ago he was falling down about once per week no injuries, parkinson's for many years. Well, by the end of two years ago it's hardly falling. Last year, no falls at all. So wow, carl, this stuff really works. Well, that's because you're working.

Di: 31:42

Well yeah, you know, all I'm doing is being your tour guide.

Karl: 31:46

Yeah, I show you what to do. You put in the work. You're like he's never missed a session. He comes in like clockwork, he's here so.

Di: 31:56

I love that.

Karl: 31:57

You know, we got a bottom up with a whole bunch of stuff and we got top down where we can really challenge the brain for a reaction time, cognition, memory, and we could do all that while we're moving, you know. So why not work on cognition and memory and reaction time while we're moving? Yeah, doesn't have to just be walking, it could be walking sideways backwards, could be jumping through an agility ladder on a single leg, if we're able to. We have people who couldn't do that. Just really try to overload them safely. Right, if you get hurt, we want them to feel fatigue, because that's actually a set of neurochemicals that comes about, made by the brain, when you're fatigued, that is, they're extremely healthy for the brain. They help with neuroplasticity, especially while you're sleeping. So, yeah, I mean, you know me, I could talk forever about it because I love it. I know those are my two biggest categories.

Di: 32:58

And I also know that you fit me in to your very, very busy schedule this morning, and I just want to say that you really challenged me right now because you know I talk about mindfulness a lot and I've got workshops on it and it's something that I'm very, very passionate about, and I very often will talk to people about how there is no such thing as multitasking, and I'm usually talking about the fact that you know you can't have your phone next to you and write an MBA paper, well, but on the other hand, you're also telling me about this stacking, and so I feel like now I'm going to change it where it's like there's no such thing as really multitasking when you do have to focus, because your brain is going to focus on, it's going to ping pong, but the stacking is kind of a form of it. It really is, and it's an amazing form and we should all be doing it.

Karl: 34:14

Well, let me add on to that, because that's actually what you just said, Technically is exactly the same and is correct about not being able to multitask. We have to like, qualify and clarify what are we talking about? I have notes from Dr Moratory in our meetings that we've had over the years which he says just what you said your brain is going to ping pong because your brain does, it has to ping pong. So here's what we try to do. We'll try to get somebody let's just use one example they're stepping over these little five inch hurdles sideways, doing cross foot patterns. Okay, going through our facility Playing catch with the letter ball. We'll use that as the example. Maybe our topic is flowers, whatever, it doesn't matter.

Karl: 35:12

You'll see that when the person catches the ball and first of all that alone might make them stop, so they're not moving anymore Then when they come up with, let's say, a response, they throw the ball and they start moving. So what we're trying to do and we cue constantly is okay, you're doing a fantastic job, but try to keep moving, even while you're stuck thinking of an answer. So I don't know how to Claire, I don't know how to define this. Is this multitasking exactly? I think it is because you are moving and you are thinking, and maybe you're even throwing the ball back to me, but you're still toggling back and forth. Because that's how the break works and, like Lisa said, you can decide to do one thing at a time and toggle back and forth and it might be really fast, Like constantly.

Karl: 36:09

Okay, here, I only got to do this. Okay, I got to do that. Okay, now this and then back, and? But can you? How efficiently can you do all these three things at the same time with the least amount of toggling? I don't know if there's really an answer other than when I get my portable EEG in here and we start measuring brain activity during this. It probably won't give us an answer, but it's sure be real interesting to look at. So don't stray from what you're saying about mindfulness, because you are totally correct, man.

Karl: 36:44

No, I'm not Absolutely, I just finished writing a third book and I finished it in about a day.

Di: 36:51

Oh, did you finish?

Karl: 36:53

Yeah, did I tell you about that one.

Di: 36:55

You told me that you were ready.

Karl: 36:58

Now I'll send it to you in an email. What it is, and it's almost ready for the market.

Di: 37:05

I would love to.

Karl: 37:06

But yeah, I mean I had to have the phone away and all that stuff. I couldn't finish that book. I did it while I was really really good.

Di: 37:12

Cause our mind is like a movie. What a movie is? It looks like it's just a flow, but it's picture, picture, picture, picture, and it's very, very fast. So we really are unit taskers, we're not multi-taskers. But it's interesting, cause what you and Moratoria are saying is basically it's a matter of how fast you can move from one thing to another Physically in order to keep yourself safe. Also, so like can you react while you're walking and how fast can the ping pong be for you? I know you have to go.

Di: 37:51

I do so we are going to continue our journey together.

Karl: 37:58

I love that. I love talking with you. I love all the great work you're doing. It's such a great, great. Everything you do is just top shelf. You have great guests, you ask great questions. You're doing a lot to help people out there and I'll just I'll leave on this note you think about this whole idea of multi-tasking. You know, you're walking through the grocery store, you're looking for something. You're looking for a can of something, maybe I don't know. You're looking for an item and somebody bumps into you. You don't see them coming, you're still. You were looking for the item and you were moving, but you were moving, like subconsciously, because you're able to move we're not thinking about. If we had to think about every step we take every day, wouldn't it be like crazy or be horrible because it would be exhausting?

Karl: 38:55

We'd never be able to think, yeah, we'd be tired all the time because we're thinking about every step. So this should be happening on a subconscious level so that allows us to focus on the task at hand of looking for the item or where's the checkout lane. You know, I don't wanna have to stop and figure it out. I know I wanna move and figure it out, but then you get hit. That needs to be a subconscious, reactive thing within your brain that was built that causes you to react to a cross foot pattern. Do whatever it is you have to do so that you subconsciously, reactively, reflexive stability, let's say, that kicks in and you stay upright instead of falling down. It's so interesting, I could talk for hours about it, but-.

Di: 39:46

Yeah.

Karl: 39:47

But, yeah, it's a nice place. Yeah, so those are things that I like to think about and work on is just making everything as smooth as possible and try to make quality of life better, and for all people, because God only knows humanity needs that. Yeah, we need people like you. That's what we need.

Di: 40:07

Right back at Karl Sterling, . Thank you so so much. Your information and sharing it it is so valuable, and also what you're doing in this world is so, so valuable and thank you, thank you, thank you. Really, I'm so grateful.

Karl: 40:23

Well, bless you, my friend, safe travels and let's stay in touch, okay.

Di: 40:28

Absolutely absolutely.

Karl: 40:29

Thanks again for your time today. All right, take care.